Hypoxia occurs frequently in human cancers and induces adaptive changes in cell metabolism that include a switch from oxidative phosphorylation to glycolysis, increased glycogen synthesis, and a switch from glucose to glutamine as the major substrate for fatty acid synthesis. This broad metabolic reprogramming is coordinated at the transcriptional level by HIF-1, which functions as a master regulator to balance oxygen supply and demand. HIF-1 is also activated in cancer cells by tumor suppressor (e.g., VHL) loss of function and oncogene gain of function (leading to PI3K/AKT/mTOR activity) and mediates metabolic alterations that drive cancer progression and resistance to therapy. Inhibitors of HIF-1 or metabolic enzymes may impair the metabolic flexibility of cancer cells and make them more sensitive to anticancer drugs.
IntroductionAll human cells require a constant supply of O 2 to carry out oxidative phosphorylation in the mitochondria for ATP generation. Under hypoxic conditions when O 2 availability is reduced, cells generally respond in three ways: (a) cell proliferation is inhibited to prevent any further increase in the number of O 2 -consuming cells; (b) the rate of oxidative phosphorylation is decreased and the rate of glycolysis is increased in order to decrease O 2 consumption per cell; and (c) the production of angiogenic factors is increased in order to increase O 2 delivery. Mutations in cancer cells dysregulate cell growth and metabolism, but the mechanisms and consequences of this dysregulation vary widely from one cancer to another and even one from cancer cell to another. In some cancer cells, O 2 still regulates the rate of cell proliferation, whereas others continue to divide even under severely hypoxic conditions; some cancers are well vascularized and perfused, whereas most cancers contain steep O 2 gradients that reflect the distance to the nearest blood vessel, the number of intervening cells and their metabolic activity, and the rate at which blood is flowing through the vessel. The metabolism of individual cancer cells reflects the presence of particular genetic alterations, which may alter metabolism in an O 2 -independent manner, as well as the spatial and temporal heterogeneity of O 2 availability within the tumor microenvironment. This Review summarizes the role of HIF-1 in the regulation of cancer cell metabolism, focusing primarily on the use of glucose as a metabolic substrate.