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Catabolic efficiency of aerobic glycolysis: The Warburg effect revisited Abstract Background Cancer cells simultaneously exhibit glycolysis with lactate secretion and mitochondrial respiration even in the presence of oxygen, a phenomenon known as the Warburg effect. The maintenance of this mixed metabolic phenotype is seemingly counterintuitive given that aerobic glycolysis is far less efficient in terms of ATP yield per moles of glucose than mitochondrial respiration. Results Here, we resolve this apparent contradiction by expanding the notion of metabolic efficiency. We study a reduced flux balance model of ATP production that is constrained by the glucose uptake capacity and by the solvent capacity of the cell's cytoplasm, the latter quantifying the maximum amount of macromolecules that can occupy the intracellular space. At low glucose uptake rates we find that mitochondrial respiration is indeed the most efficient pathway for ATP generation. Above a threshold glucose uptake rate, however, a gradual activation of aerobic glycolysis and slight decrease of mitochondrial respiration results in the highest rate of ATP production. Conclusions Our analyses indicate that the Warburg effect is a favorable catabolic state for all rapidly proliferating mammalian cells with high glucose uptake capacity. It arises because while aerobic glycolysis is less efficient than mitochondrial respiration in terms of ATP yield per glucose uptake, it is more efficient in terms of the required solvent capacity. These results may have direct relevance to chemotherapeutic strategies attempting to target cancer metabolism. Background Since its original discovery by Warburg [1] it has been well established that most, if not all cancer cells are more dependent on aerobic glycolysis for ATP production than normal cells. The near uniform presence of this metabolic phenotype in tumor cells is counterintuitive, as glycolysis produces only 2 moles of ATP per mole of glucose, far less than the 36 generated by mitochondrial respiration (Figure 1). Several hypotheses have been proposed for the maintenance of this seemingly wasteful catabolic state. At the cell population level, mitochondrial respiration malfunction and enhancement of glycolysis are thought to be a metabolic advantage under the intermittent hypoxia conditions experienced by pre-malignant and malignant tumor cells [2,3]. However, aerobic glycolysis is not found exclusively in cancer cells, but is also observed in rapidly dividing normal cells even under conditions of normoxia [4]. It is also widely believed that the glycolysis rate increases in order to match the increased anabolic needs of the rapidly proliferating cells for precursor metabolites [5]. Yet, a focus on the cell's anabolic needs alone neglects two important facts; First, in addition to precursor metabolites, growing cells need ATP to meet the energy demands of biosynthetic pathways. Second, in its original definition the Warburg effect refers to the increase in the glycolysis rate ending in the excretion of lactate, which does not contribute to the production of precursor metabolites. Figure 1 Reduced model of cell metabolism. Schematic representation of ATP generation pathways via aerobic glycolysis (glycolysis + pyruvate reduction to lactate) and oxidative phosphorylation (glycolysis + mitochondrial respiration). The variable fG, denotes the glucose uptake rate, fL and fM, the components of the glucose uptake routed towards lactate excretion and respiration, respectively, and fATP the ATP production rate. Intermediate substrates of glucose catabolism are also used in a third process accounting for the production of precursor metabolites needed in anabolic processes (fP). The pathways considered in our model are shown in the gray-shaded area, while fP is treated as constant. The actual molecular mechanisms that lead to the enhanced aerobic glycolysis are increasingly well understood. Under physiological condition, for example, PI3K/Akt signaling pathways play a critical role in promoting aerobic glycolysis in activated T cells in response to growth factors or cytokines stimulation [6]. In the pathophysiological condition of tumorigenesis, malfunction of mitochondrial respiration due to mitochondrial DNA mutations/deletions is an important contributing factor [7-10]. Also, p53, one of the most frequently mutated genes in cancers, is both a positive regulator of mitochondrial respiration [11] and a negative regulator of glycolysis [12]. These, together with the activation of hypoxia-inducible factor (HIF), a transcription factor that is activated by hypoxic stress but also by oncogenic, metabolic, and oxidative stress, often lead to the overexpression of the glucose transporters and various glycolysis pathway enzymes or isozyme subtypes explaining the increased glucose uptake and altered utilization [13,14]. The evidence accumulated so far thus indicates that the presence of aerobic glycolysis is a common characteristics of rapidly proliferating cells, and that it may offer a growth advantage to rapidly proliferating normal cells, e.g., during development and tissue regeneration, and to cancer cells in tumor formation. Yet, a system-level interpretation of the origin of this growth advantage has not yet been formally provided. To start addressing this issue, here we introduce a reduced flux balance model of ATP generation that incorporates a glucose uptake capacity constraint and the limited solvent capacity of the cell cytoplasm. The model allows us to uncover the existence of two different energetically favorable metabolic regimes within proliferating cells, a finding that is congruent with experimental results. Results Reduced flux balance model of cell metabolism Figure 1 depicts a schematic model of glycolysis and mitochondrial respiration, the main pathways for ATP generation in cells. The glucose uptake flux (fG) is partitioned into the flux of aerobic glycolysis (fL), and to oxidative phosphorylation (fM). Aerobic glycolysis represents glycolysis, converting glucose into pyruvate, and then pyruvate reduction by lactate dehydrogenase (LDH) in the cytosol, resulting in the end product lactate that is then excreted to the extracellular millieau. ATP generation through oxidative phosphorylation is decomposed into the generation of pyruvate through glycolysis, followed by the oxidation of pyruvate in the TCA cycle and the respiratory chain, the latter two processes taking place in the cell's mitochondria. There is also a third component for glucose utilization accounting for the production of precursor metabolites needed in anabolic processes (fP) (e.g., intermediate metabolites of the pentose phosphate pathway and the TCA cycle [5]), which have to have an overall proportionality with the available energy currencies (phosphate donors, mainly ATP) to enable cell growth. Thus, in the absence of a full scale kinetic model, in our modeling we assume that the ATP production rate (fATP) is proportional with the rate of anabolic processes (fP), and use fATP as a surrogate for the overall cell metabolic rate (Figure 1). Aerobic glycolysis includes the glycolysis pathway producing pyruvate and the pyruvate reduction producing lactate. The overall reaction for aerobic glycolysis is(1) Aerobic glycolysis has a yield of 2 moles of ATP per mole of glucose, resulting from the conversion of glucose into lactate. On the other hand, oxidative phosphorylation includes the glycolysis pathway producing pyruvate, the oxidation of pyruvate in the TCA cycle, and the respiratory chain. The overall reaction of for oxidative phosphorylation is(2) Oxidative phosphorylation yields 38 moles of ATP per mole of glucose, two of which are produced in glycolysis and the other 36 during the oxidation of pyruvate in the TCA cycle coupled to respiratory chain activity. Summing up these differential contributions we obtain the rate of ATP production(3) where the second equality was obtained using fG = fL + fM. Our aim is to determine the optimal flux distribution (fL, fM) that provides maximum ATP production rate given the cell's metabolic constraints. Of these, the first metabolic constraint is associated with the maximum glucose uptake rate (or glucose uptake capacity)(4) where FG is the maximum glucose uptake rate. The second constraint, quantified below, reflects on the high concentration of macromolecules within the cell's cytoplasm [15,16], resulting in a limited solvent capacity for the allocation of metabolic enzymes. Enzyme molecules have a finite volume and the total sum of their volumes cannot exceed the cell volume. In our case, this constraint applies to the volume occupied by glycolytic enzymes, LDH and mitochondria. Enzymes associated with other pathways occupy a fraction of the intracellular volume as well. Nevertheless, this fraction simply restricts the amount of the cytoplasmic space available to glycolytic enzymes, LDH and mitochondria. More precisely, if VG, VL and VM are the cell volume occupied by glycolytic enzymes, LDH and mitochondria, respectively, then(5) where VATP is the total cell volume reserved for the allocation of components of the ATP producing pathways. The occupied volumes VG, VL and VM are proportional to the enzyme masses MG, ML and MM, with VG = vGMG, VL = vLML and VM = vMMM, where vG, vL and vM are the specific volumes of glycolytic enzymes, LDH and mitochondria, respectively. In turn, the glycolytic rate (fG), the lactate excretion rate (2fL) and the mitochondrial ATP production rate (36fM) are proportional to the mass of glycolytic enzymes, lactate dehydrogenase and mitochondria respectively, with fG = rGMG/V, 2fL = rLML/V and 36fM = rMMM/V, where rG is the glycolytsis rate per unit of glycolytic enzyme mass, rL is the rate of lactate production per mass of LDH, rM is the mitochondrial ATP production rate per unit of mitochondrial mass, and V is the cell volume. In these equations the product by the mass and the division by the cell volume takes into account that the rates r are commonly reported in the literature per unit of dry weight, while the pathway rates f are reported per unit of cell volume. Because of the interdependency of volume, mass and reaction rate, the volume constraint (5) can be translated to the metabolic constraint(6) where ϕ ATP = VATP/V is the total volume fraction of the cell cytoplasm occupied by glycolytic enzymes, LDH and mitochondria, and the crowding coefficients aG = vG/rG, aL = 2 vL/rL and aM = 36 vM/rM quantify the occupied volume fractions per unit of glycolytic, lactate excretion and mitochondrial respiration rate, respectively. Using empirical data reported in the literature we have estimated the crowding coefficients (see Methods). We obtain aG ≈ 0.0027 (min/mM), aL≈ 0.00023 (min/mM) and aM ≈ 0.10 (min/mM), indicating that the mitochondria contributes about 5 and 50 times more to molecular crowding than glycolytic enzymes and lactate dehydrogenase, respectively. The unexpected consequences derived from this fact will be uncovered below. In our modeling we assume that VATP, rG, rL and rM are constant parameters that can be obtained from experimental estimates. Note though, that this is an approximation, as there may be regulatory mechanisms that under certain environmental or developmental conditions are capable of altering the amount of intracellular space allocated to ATP producing pathways and the activity of glycolytic enzymes, LDH and mitochondria. Taken together the relevant metabolic optimization problem is as follows: maximize the ATP production rate (3) under the metabolic capacity constraints (4) and (6). Optimal solution In the following we discuss the model-predicted utilization of aerobic glycolysis and oxidative phosphorylation pathways in the context of the cell's glucose uptake rate. It becomes obvious that the glycolysis rate matches the maximum glucose uptake capacity (fG = FG) to maximize the ATP production rate. However, there are some differences in the flux distribution along aerobic glycolysis and oxidative phosphorylation depending on the glucose uptake rate. Specifically,(7) for fG

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