Submit Manuscript | http://medcraveonline.com development and can be used by the pharmaceutical industry to generate novel drugs. This is validated by the approval of Agas and Celgene's enasidenib by the FDA. This drug modulates the metabolism and is used as a medication against acute myelogenous leukemia. Enasidenib is an inhibitor of the mutated isocitrate dehydrogenase (IDH2), one of the main enzymes of the citric acid cycle (also known as Krebs cycle), a central pathway which converts molecules coming from all 3 main catabolic pathways into intermediate metabolites that finally fuel the respiratory chain, the main energy providing process in cells. IDH enzymes usually metabolize isocitrate into α-ketoglutarate, a crucial step in the citric cycle. When mutated in some cancers, this enzyme starts producing 2-hydroxyglutarate, a metabolite that causes cell differentiation defects and impairs histone demethylation [3]. While this approval highlights the promising role of anticancer drugs modulating metabolism, researchers have struggled to find other therapeutically useful targets in metabolic pathways.
Tumor MetabolismCell metabolism as well as cancer development and growth is complex. The intermodulation between metabolic pathways and the plasticity of these routes, plus the capacity of tumor cells to adapt are factors that slow down the advances in their understanding. Factors such as poor oxygenation, acidity and deprivation of nutrients, which normally cause cell death, are rapidly converted into promoters by tumor cells [4,5].The reprogramming of the glucose metabolism is a good example for this flexibility. Tumor cells typically exhibit a high uptake of glucose and are mainly metabolizing anaerobically. For many years, the explanation for that was attributed to the lack of oxygen, once the proliferation rate of tumor exceeds the angiogenesis. However, Otto Warburg (1927) verified that even in the presence of oxygen, tumor cells prefer to metabolize glucose into lactic acid. This process is known as anaerobic glycolysis and has been extensively studied throughout the years, but is still poorly understood [6,7]. Recent studies demonstrated that tumor cells prefer the anaerobic metabolism because it more efficiently produces energy and basic metabolites for protein biosynthesis as compared to aerobic metabolism [8,9]. These findings were confirmed in a study showing that one of the main molecule that control glycolysis and the anaerobic metabolism, the glucosetransporter (GLUT), was up regulated in breast tumor cell lines [10].To corroborate the complexity of cancer metabolism, it has been shown recently that some tumors also use the mitochondrial oxidative phosphorylations [11,12]. Growing evidence of the importance of the glucose metabolism for tumor development and the need of new therapeutic targets, lead to the application of drugs inhibiting the glycolytic pathway as potential approach. Metformin for example, a drug already widely used in diabetes treatment, decreases glucose consumption and, conseque...