Abstract
Tumorigenesis is caused by a series of defects that occur within the cancer cell and its microenvironment. These abnormalities allow the tumor cell to develop its own strategies for growth, proliferation, differentiation and metabolism. In the last, cancer cells favor lactic fermentation instead of oxidative phosphorylation OXPHOS (respiration). This metabolic adaptation is called the Warburg effect.We proposed an innovative therapeutic concept based on the induction of metabolic changes by the use of dichloroacetate (DCA) and this is associated with immunotherapy using activated NK cells. DCA, a pyruvate dehydrogenase kinase (PDK) inhibitor, induces the activation of pyruvate dehydrogenase (PDH), responsible for the catalysis of pyruvate to acetylcoenzyme A (Ac-CoA), promoting the oxidation of glucose/pyruvate in the mitochondria. DCA has been used for a long time as a cholesterol-lowering and anti-lactic acidosis therapy. My team has previously shown that the metabolic change allows tumor cells to escape the immune response. I have observed that DCA treatment induced a high upregulation of mRNA and protein expression of the stress ligands MICA, MICB and ULBP1. These are recognized by the NK cell activating receptor NKG2D, inducing a NK cell-mediated cytotoxic response against tumor cells. DCA-induced expression of these stress ligands depends on wtp53 expression on the tumor cell.On the other hand, we evaluated the effect of DCA on the expression of ABC carriers, which intervene in the efflux of anticancer agents used in chemotherapy. The expression of ABC carriers is strongly related to drug resistance phenotypes. We observed that DCA causes a decrease in the expression of ABCB1, ABCC1, ABCC5 and ABCG2 in wtp53 cells while it induces an increase in mutantp53 or nullp53 cells. Conversely, DCA-induced accumulation of antitumor drugs, i.e. daunorubicin, and favors chemotherapy-induced tumor death only in wtp53-expressing cancer cells. The promoters of these ABC transporters and the stress proteins presented above contain several binding sites specific to the transcription factor MEF2, which is the target of ERK5. We have found that in addition to the ability to change tumor metabolism, DCA modifies the expression ABCB1, ABCC1, ABCC5 and ABCG2 by activation of the ERK5 / MEF2 pathway. These results are confirmed in various cell lines, in cells derived from patients and in an in vivo model