The Link Between Energy Production, Symbiosis, and Cancer Metabolism

by Joshua Emerson Kiddish, MBS 2019
Geisinger Commonwealth School of Medicine, Scranton, PA
Mentor: Michael Bordonaro, PhD



Cancer is a term that brings fear to many people. For the scientific community, it is a subject of active research. Many advances made in the last half-century have led to a better understanding of cancer and novel clinical treatment modalities.

The concept of a metabolic symbiosis in cancer was first proposed by scientist Otto Warburg in the 1950s. Symbiosis refers to an intimate relationship between two things, in which both benefit. So, how is that “cancer” and “benefit” are used in the same sentence? (By the way, this is not the same “benefit” that one wears a suit and tie to and eats at.) The “benefit” is exclusive to cancer: cancer cells in well-oxygenated state help the cells in oxygen-poor state to survive and thrive.

Usually, cancer grows rapidly and survives in relatively extreme physiological conditions. For example, cancer cells tend to prosper in microenvironments, which are typically much more acidic than neighboring healthy environments. Cancer also has the unique ability to “build” itself and spread. What does this mean? A cancerous tumor develops its own blood supply, becomes mobile, and invades other body parts.

The prevalent energy fuel source for cells is the simple sugar glucose. The symbiotic relationship theory in cancer cells proposes that cancer can produce energy by using fuel sources other than glucose. For instance, cancer cells can use lactate, which is considered a waste product of normal cellular metabolism. Why is this significant? Simply put, because in a normal and healthy cellular environment, this waste product would be nothing more than just that, waste! In cancerous tissues, however, the cells find a way to utilize the “waste” product and turn it into energy. This allows the cancer to grow and thrive in less than optimal conditions. Interestingly, research also suggests that the cellular power machinery, mitochondria, also undergo changes that allow them to better meet the energy demands of cancer cells.

It should also be noted that most symbiotic relationships evolve over time. This applies to cancer cells also. Cancers evolve over time in ways that increase their fitness and survivability. Cancers adapt over time and change their microenvironment conditions for optimal growth.

The knowledge of the symbiotic relationships in cancer has helped researchers develop more effective ways to treat cancer. It is possible, through chemotherapy, to attack specific pathways that allow cancer to survive. The discussed here relationship is another pathway that could be targeted. This could be a successful approach, because, if a cancer cell cannot produce the energy it needs, then it cannot survive.