Inhibition of Glycolysis in Cancer Cells: A Novel Strategy to Overcome Drug Resistance Associated with Mitochondrial Respiratory Defect and Hypoxia

TLDR

Cancer cells rely on increased glycolysis (Warburg effect) due to mitochondrial dysfunction and hypoxia, a common feature of human cancers that contributes to therapeutic resistance and has broad clinical implications. Inhibition of glycolysis depletes ATP, triggers BAD dephosphorylation at Ser112, BAX mitochondrial relocalization, and massive cell death, especially in clones with mitochondrial respiration defects. Glycolytic inhibition kills colon and lymphoma cells under hypoxia, induces apoptosis in multidrug‑resistant cells, and offers a promising strategy to overcome drug resistance.

Abstract

Cancer cells generally exhibit increased glycolysis for ATP generation (the Warburg effect) due in part to mitochondrial respiration injury and hypoxia, which are frequently associated with resistance to therapeutic agents. Here, we report that inhibition of glycolysis severely depletes ATP in cancer cells, especially in clones of cancer cells with mitochondrial respiration defects, and leads to rapid dephosphorylation of the glycolysis-apoptosis integrating molecule BAD at Ser(112), relocalization of BAX to mitochondria, and massive cell death. Importantly, inhibition of glycolysis effectively kills colon cancer cells and lymphoma cells in a hypoxic environment in which the cancer cells exhibit high glycolytic activity and decreased sensitivity to common anticancer agents. Depletion of ATP by glycolytic inhibition also potently induced apoptosis in multidrug-resistant cells, suggesting that deprivation of cellular energy supply may be an effective way to overcome multidrug resistance. Our study shows a promising therapeutic strategy to effectively kill cancer cells and overcome drug resistance. Because the Warburg effect and hypoxia are frequently seen in human cancers, these findings may have broad clinical implications.