Fasting improves therapeutic response in hepatocellular carcinoma through p53-dependent metabolic synergism

• DOI: 10.1126/sciadv.abh2635
• Publication Date: 2022-01-21T19:00:23Z
• Authors: Jelena Krstic; Isabel Reinisch; Katharina Schindl...; Markus Galhuber; Zina Riahi; Natascha Berger; Nadja Kupper; Elisabeth Moysche...; Martina Auer; Helene Michenthaler; Christoph Nössing; Maria R. Depaoli; Jeta Ramadani-Muja; Sinem Usluer; Sarah Stryeck; Martin Pichler; Beate Rinner; Alexander J. A. D...; Andreas Reinisch; Tobias Madl; Riccardo Zenezini...; Albert J. R. Heck; Meritxell Huch; Roland Malli; Andreas Prokesch
• Keywords: 0301 basic medicine; ddc:610; 03 medical and health sciences; SDG 3 - Good Health and Well-being; Biomedicine and Life Sciences; General; 3. Good health

Cancer cells voraciously consume nutrients to support their growth, exposing metabolic vulnerabilities that can be therapeutically exploited. Here, we show in hepatocellular carcinoma (HCC) cells, xenografts, and patient-derived organoids that fasting improves sorafenib efficacy and acts synergistically to sensitize sorafenib-resistant HCC. Mechanistically, sorafenib acts noncanonically as an inhibitor of mitochondrial respiration, causing resistant cells to depend on glycolysis for survival. Fasting, through reduction in glucose and impeded AKT/mTOR signaling, prevents this Warburg shift. Regulating glucose transporter and proapoptotic protein expression, p53 is necessary and sufficient for the sorafenib-sensitizing effect of fasting. p53 is also crucial for fasting-mediated improvement of sorafenib efficacy in an orthotopic HCC mouse model. Together, our data suggest fasting and sorafenib as rational combination therapy for HCC with intact p53 signaling. As HCC therapy is currently severely limited by resistance, these results should instigate clinical studies aimed at improving therapy response in advanced-stage HCC.