Importance of Michaelis Constants for Cancer Cell Redox Balance and Lactate Secretion—Revisiting the Warburg Effect.

Simple Summary: In cancer cells, gross changes in gene expression help to enhance the uptake of glucose—the blood sugar—for the increased formation of building blocks for the cancer cells' unlimited growth. An issue related to the rewired cancer cell metabolism is that even under sufficient oxygen supply, cancer cells metabolize a large fraction of the glucose to lactic acid (or "lactate"). In non-cancerous cells, lactate would be formed only during oxygen deprivation in order to re-oxidize the cytosolic electron carrier NADH, which forms during the glycolytic glucose breakdown. This phenomenon of lactate secretion from cancer cells under aerobic conditions was named the "Warburg Effect", but the actual reasons for that are often regarded as not yet understood. However, when we acknowledge that the reprogramming of the different metabolic pathways of cancer cells is not neatly fine-tuned, it becomes plausible that lactate formation just serves to dispose of cytosolic electrons that exceed the capacity of the mitochondrial electron transport chain to accept cytosolic electrons. Interestingly, the kinetic properties of the enzymes that metabolize the glycolysis end product pyruvate are sufficient to explain the priorities for metabolite flux at the pyruvate junction in cancer cells: 1. mitochondrial oxidative phosphorylation for efficient ATP production, 2. cytosolic electrons that exceed oxidative phosphorylation capacity need to be disposed of and secreted as lactate, and 3. biosynthesis reactions for cancer cell growth. In other words, a number of cytosolic electrons just take the "emergency exit" from the cell by lactate secretion to maintain the cytosolic redox balance. Cancer cells metabolize a large fraction of glucose to lactate, even under a sufficient oxygen supply. This phenomenon—the "Warburg Effect"—is often regarded as not yet understood. Cancer cells change gene expression to increase the uptake and utilization of glucose for biosynthesis pathways and glycolysis, but they do not adequately up-regulate the tricarboxylic acid (TCA) cycle and oxidative phosphorylation (OXPHOS). Thereby, an increased glycolytic flux causes an increased production of cytosolic NADH. However, since the corresponding gene expression changes are not neatly fine-tuned in the cancer cells, cytosolic NAD+ must often be regenerated by loading excess electrons onto pyruvate and secreting the resulting lactate, even under sufficient oxygen supply. Interestingly, the Michaelis constants (KM values) of the enzymes at the pyruvate junction are sufficient to explain the priorities for pyruvate utilization in cancer cells: 1. mitochondrial OXPHOS for efficient ATP production, 2. electrons that exceed OXPHOS capacity need to be disposed of and secreted as lactate, and 3. biosynthesis reactions for cancer cell growth. In other words, a number of cytosolic electrons need to take the "emergency exit" from the cell by lactate secretion to maintain the cytosolic redox balance. [ABSTRACT FROM AUTHOR]