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  • Metabolic therapy has become trendy

    2018-10-24

    Metabolic therapy has become trendy in attenuating the side effects of glioma treatment (Schwartz et al., 2015; Zuccoli et al., 2010; Seyfried et al., 2015). This type of therapy is designed to disrupt tumor microenvironment, while enhancing the health and vitality of normal cells. It has been demonstrated that high-dose radiation creates a microenvironment rich in glucose and glutamine, which may contribute to tumor recurrence as they are required for rapid tumor growth (Seyfried et al., 2015; Szerlip et al., 2011; Derr et al., 2009; Abbadi et al., 2014). In this context, a restricted diet will help lowering glucose availability in the tumor microenvironment. A case series report in patients receiving chemotherapy suggested that fasting has the potential to ameliorate side effects caused by this mode of cancer treatment (Safdie et al., 2009). Studies indicate that fasting has the potential to maximize the differential toxicity of chemotherapy to normal and cancer cells in vitro (Raffaghello et al., 2008), while slows progression of a variety of tumors in vivo, allowing long-term cancer-free survival (Lee et al., 2012). Furthermore, calorie restricted ketogenic diet presented anti-angiogenic, anti-inflammatory, and pro-apoptotic effects in experimental mouse and human S63845 tumors (Seyfried et al., 2015; Zhou et al., 2007). Studies in rodents demonstrated that survivors of acute ionizing radiation damage ameliorated life shortening if they were fed a diet based on non-essential antioxidant and chemoprevention mixture (Epperly et al., 2011). The use of inhibitors of nitric oxide synthase, such as T1023, has also been related to the prevention of radiotherapy complications. T1023 was found to selectively protect the non-malignant tissue during radiation therapy in a sarcoma rat model (Filimonova et al., 2015). Therefore, metabolic therapy could be used as a tool to avoid radiation effects not only in the NSCs, but in all normal cells. Based on the SVZ microenvironment alterations that have been described after radiation, i.e., inflammation, revascularization, ECM modifications, and fibrosis among others, there are numerous potential targets in the tumor microenvironment that could be used to ameliorate the adverse effects associated with radiation (Barker et al., 2015). Many microenvironmental therapies are being developed to be given alone or in combination with radiotherapy, showing promising results preventing tumor progression and recurrence. For example, SD-208, an inhibitor of the transforming growth factor beta-receptor 1, reduces tumor growth and fibrosis (Medicherla et al., 2007; Uhl et al., 2004). Acriflavine is a drug used to inhibit the hypoxia-inducible factor 1-alpha (HIF1α), a factor that is upregulated during hypoxia, reducing tumor growth and vascularization (Lee et al., 2009). However, these microenvironmental therapies have so far not been tested for their ability to reduce radiotherapy-related adverse effects. The multi-directional efforts that are being made in order to alleviate the disadvantages of radiotherapy give optimism to patients suffering from brain tumor. Furthermore, lately, nonradiation-based therapies have significantly improved, such as anti-tumor immunotherapy (Mitchell et al., 2015; Everson et al., 2015), providing new alternatives for fighting this devastating disease.
    Concluding remarks and future directions
    Conflict of interest
    Acknowledgments This research was supported by the National Institutes of Health — RO1 NS070024 (AQH), the Instituto de Salud Carlos III — RD12/0019/0028 (VCG), and the Fundación Progreso y Salud of the Andalusian Regional Ministry of Health — PI01092014 (VCG).
    Introduction Induction of pluripotent stem cells from somatic cells by defined transcription factors represents a major breakthrough in cellular reprogramming (Takahashi and Yamanaka, 2006; Takahashi et al., 2007). Transdifferentiation from one differentiated cell type into another by expression of lineage-related transcription factors has extended this concept (Caiazzo et al., 2011; Yoo et al., 2011; Ieda et al., 2010; Szabo et al., 2010; Sheng et al., 2012a). Those directly reprogrammed somatic cells are useful tools for understanding disease processes and discovering new therapeutics; however, they may have limited utilities as those induced cells always have little or no proliferation potential. Direct conversion of somatic cells to lineage-committed stem cells such as neural stem cells would allow production of sufficient cells for downstream research and clinical applications, and this approach meanwhile reduces the risk of tumor formation.