Commentary
ATP, Cancer and p53Ever since Otto Warburg reported his observations on the metabolism of cancer cells eighty years ago, 1,2 researchers have sought to exploit fundamental differences in the energy metabolism between normal and cancerous cells for diagnostic and therapeutic purposes. Warburg had observed that, despite the presence of oxygen, cancer cells generated the energy currency of cells, ATP, through glycolysis, instead of through the much more efficient process of aerobic glucose oxidation. The aerobic glycolysis of cancer cells is now known as the "Warburg effect". Many years later, our understanding of the metabolism of cancer cells has grown significantly. [3][4][5][6] As part of this expanded knowledge, it has been suggested that cancer cells are not inherently aerobically glycolytic, but rather glycolytic due to hypoxic conditions in the heterogeneous tumor mass. 7 Additional studies will define more precisely the links between metabolic pathways, genetic abnormalities in cancers and the microenvironment of cancers. Nevertheless, the current understanding has already led to new diagnostic and therapeutic approaches. For example, the FDG-PET imaging technique is becoming more and more important for the staging of solid tumors and is largely based on the assessment that cancers have an increased uptake of glucose. 7-9 Also, chemical compounds are being developed that result in depletion of ATP and preferential killing of cancer cells. [10][11][12] On the other hand, and in seeming contrast, ATP infusions have been investigated as an "energy boost" for cancer patients who suffer from cachexia. 13,14 It comes as no surprise that p53, one of the most intensively studied and central tumor suppressor genes, has been connected to the cell's energy metabolism in several ways. p53 consists of an amino-terminal transactivation domain, followed by a proline-rich region, the core domain that recognizes specific DNA sequences and the tetramerization domain. p53 is active as a homo-tetramer and, after activation through cellular stress signals, such as DNA damage and hypoxia, induces cell cycle arrest and/or apoptosis. p53 mainly functions as a transcription factor that activates and represses a number of genes, but it also uses non-transcriptional mechanisms to exert its biological effects. Its central role as a tumor suppressor protein is evidenced by the fact that close to 50% of human cancers carry p53 gene mutations. [15][16][17][18][19][20][21][22][23][24] One p53 mutant found in a hepatoma cell line has been demonstrated to directly activate the Type II hexokinase gene. Type II hexokinase is highly expressed in tumors and has been linked to increased glycolysis and the high metabolic rate of tumors. 25 This provides an intriguing potential connection between p53 mutations and alterations of cell metabolism, but needs to be expanded to additional and frequent p53 cancer mutants.The p53 protein itself has also been connected to the cell's energy metabolism, quite directly, through studies that chara...