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Review
. 2023 Jan 27:12:1060495.
doi: 10.3389/fonc.2022.1060495. eCollection 2022.

Correlation between the Warburg effect and progression of triple-negative breast cancer

Affiliations
Review

Correlation between the Warburg effect and progression of triple-negative breast cancer

Shaojun Liu et al. Front Oncol. .

Abstract

Triple-negative breast cancer (TNBC) is ineligible for hormonal therapy and Her-2-targeted therapy due to the negative expression of the estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2. Although targeted therapy and immunotherapy have been shown to attenuate the aggressiveness of TNBC partially, few patients have benefited from them. The conventional treatment for TNBC remains chemotherapy. Chemoresistance, however, impedes therapeutic progress over time, and chemotherapy toxicity increases the burden of cancer on patients. Therefore, introducing more advantageous TNBC treatment options is a necessity. Metabolic reprogramming centered on glucose metabolism is considered a hallmark of tumors. It is described as tumor cells tend to convert glucose to lactate even under normoxic conditions, a phenomenon known as the Warburg effect. Similar to Darwinian evolution, its emergence is attributed to the selective pressures formed by the hypoxic microenvironment of pre-malignant lesions. Of note, the Warburg effect does not disappear with changes in the microenvironment after the formation of malignant tumor phenotypes. Instead, it forms a constitutive expression mediated by mutations or epigenetic modifications, providing a robust selective survival advantage for primary and metastatic lesions. Expanding evidence has demonstrated that the Warburg effect mediates multiple invasive behaviors in TNBC, including proliferation, metastasis, recurrence, immune escape, and multidrug resistance. Moreover, the Warburg effect-targeted therapy has been testified to be feasible in inhibiting TNBC progression. However, not all TNBCs are sensitive to glycolysis inhibitors because TNBC cells flexibly switch their metabolic patterns to cope with different survival pressures, namely metabolic plasticity. Between the Warburg effect-targeted medicines and the actual curative effect, metabolic plasticity creates a divide that must be continuously researched and bridged.

Keywords: Warburg effect; basal-like breast cancer; glycolysis; metabolic plasticity; triple-negative breast cancer.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Hypoxia selects the Warburg phenotype. Hypoxia-mediated angiogenesis is gradual in precancerous lesions, and the creation of persistent hypoxia induces the Warburg phenotype to become the predominant metabolic pathway in TNBC cells. Continuous mutations and epigenetic modifications throughout the growth of cancers lead glycolysis to exceed the oxygen concentration restriction, resulting in the constitutive expression of the Warburg phenotype. HIF, Hypoxia-induced factor; VEGF, Vascular endothelial growth factor; Glut, Glucose transporter; HK, Hexokinase; PKM2, pyruvate kinase isozyme typeM2; LDHA, Lactate dehydrogenase; MCT4, Monocarboxylate transporter 4; G-6-P, Glucose-6-phosphate; PEP, Phosphoenolpyruvate; Acetyl-CoA, Acetyl-coenzyme A.
Figure 2
Figure 2
Hypoxia promotes the ECM remodeling. Hypoxia causes ECM remodeling, which affects tumor progression further. ①Enhanced matrix cross-linking. ②Local compaction and distant stretching of matrix fibers derived from CAFs-mediated contractile forces. ③ECM remodeling promotes the Warburg effect. ④ECM stiffness prevents drug penetration. LOX, Lysyl oxidase; CAF, Cancer-associated fibroblast.
Figure 3
Figure 3
Metabolic characteristics of TNBC cells in different niches. When tumor cells leave the tumor bed and begin the metastasis process, they will traverse multiple niches with diverse microenvironments. Different microenvironments impose distinct survival restrictions, and tumor cells must change their metabolic pathways dynamically to resist these pressures. CTC, Circulating tumor cell; EMT, Epithelial-mesenchymal transition.
Figure 4
Figure 4
The Warburg effect enhances immune escape of TNBC. Glycolysis facilitates tumor immune evasion via multiple mechanisms. MDSC, Myeloid-derived suppressor cell.

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Grants and funding

This work was financially supported by the National Natural Science Foundation of China (82274423).