Glioblastoma (GBM) metabolism has traditionally been characterized by a dependence on aerobic glycolysis, prompting use of the ketogenic diet as a potential therapy. We observed growth-promoting effects on U87 GBM of both ketone body and fatty acid (FA) supplementation under physiological glucose conditions. An in vivo assessment of the unrestricted ketogenic diet surprisingly resulted in increased tumor growth and decreased animal survival. These effects are abrogated by FAO inhibition using knockdown of carnitine palmitoyltransferase 1 (CPT1).Primary patient GBM cultures revealed significant utilization of FAO regardless of tumorigenic mutational status and decreased proliferation, increased apoptosis, and elevated mitochondrial ROS production with CPT1 inhibition. Metabolomic tracing with 13 C-labeled fatty acids showed significant FA utilization within the TCA cycle, indicating that FAO is used for both bioenergetics and production of key intermediates. These data demonstrate important roles for FA and ketone body metabolism that could serve to improve targeted therapies in GBM.traditionally characterized by its reliance on the Warburg effect. Under normal physiological conditions the healthy adult brain meets most of its energy demand by complete oxidation of glucose. This produces pyruvate which is then converted into acetyl-CoA for entrance into the TCA cycle to support the electron transport chain 1 . Thus, glycolysis and respiration remain tightly connected and result in more efficient ATP production with little lactic acid production. In contrast, the Warburg effect dramatically increases the rate of aerobic glycolysis and lactic acid production in the cytosol. While the benefits of this phenomenon are not completely understood, it has been posited that its main advantages are increased biomass production and facilitated invasion due to acidification of the microenvironment 2 .GBMs have been identified as highly reliant on aerobic glycolysis to the point that they are sometimes referred to as being "glucose addicted". Several common signaling pathways found to be altered in GBM, such as PI3K-Akt-mTOR and Myc pathways, promote this phenotype by increasing expression of genes that allow cells to take up large amounts of glucose for increased glycolysis and lactate production 1, 3, 4 . Alterations to these pathways are often associated with mutations common to GBM such as EGFR and PTEN. EGFR, an activator of PI3K, is amplified in ~40% of GBMs with approximately half of those tumors expressing the constitutively active EGFRviii variant 5 . The tumor suppressor protein PTEN, a potent PI3K antagonist, is also altered in 30-40% of GBMs 6 . Similar to EGFR amplification, loss of PTEN function by either mutation or deletion results in hyperactivation of the PI3K/Akt signaling network. Despite these findings, little progress has been made therapeutically in targeting enzymes reported to regulate glucose metabolism in GBM.The interconnection between oncogenic signaling networks and metabolic pathways is complex in...