Revisited Metabolic Control and Reprogramming Cancers by Means of the Warburg Effect in Tumor Cells

Int J Mol Sci. 2022 Sep 2;23(17):10037. doi: 10.3390/ijms231710037.


Aerobic glycolysis is an emerging hallmark of many human cancers, as cancer cells are defined as a "metabolically abnormal system". Carbohydrates are metabolically reprogrammed by its metabolizing and catabolizing enzymes in such abnormal cancer cells. Normal cells acquire their energy from oxidative phosphorylation, while cancer cells acquire their energy from oxidative glycolysis, known as the "Warburg effect". Energy-metabolic differences are easily found in the growth, invasion, immune escape and anti-tumor drug resistance of cancer cells. The glycolysis pathway is carried out in multiple enzymatic steps and yields two pyruvate molecules from one glucose (Glc) molecule by orchestral reaction of enzymes. Uncontrolled glycolysis or abnormally activated glycolysis is easily observed in the metabolism of cancer cells with enhanced levels of glycolytic proteins and enzymatic activities. In the "Warburg effect", tumor cells utilize energy supplied from lactic acid-based fermentative glycolysis operated by glycolysis-specific enzymes of hexokinase (HK), keto-HK-A, Glc-6-phosphate isomerase, 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase, phosphofructokinase (PFK), phosphor-Glc isomerase (PGI), fructose-bisphosphate aldolase, phosphoglycerate (PG) kinase (PGK)1, triose phosphate isomerase, PG mutase (PGAM), glyceraldehyde-3-phosphate dehydrogenase, enolase, pyruvate kinase isozyme type M2 (PKM2), pyruvate dehydrogenase (PDH), PDH kinase and lactate dehydrogenase. They are related to glycolytic flux. The key enzymes involved in glycolysis are directly linked to oncogenesis and drug resistance. Among the metabolic enzymes, PKM2, PGK1, HK, keto-HK-A and nucleoside diphosphate kinase also have protein kinase activities. Because glycolysis-generated energy is not enough, the cancer cell-favored glycolysis to produce low ATP level seems to be non-efficient for cancer growth and self-protection. Thus, the Warburg effect is still an attractive phenomenon to understand the metabolic glycolysis favored in cancer. If the basic properties of the Warburg effect, including genetic mutations and signaling shifts are considered, anti-cancer therapeutic targets can be raised. Specific therapeutics targeting metabolic enzymes in aerobic glycolysis and hypoxic microenvironments have been developed to kill tumor cells. The present review deals with the tumor-specific Warburg effect with the revisited viewpoint of recent progress.

Keywords: Metabolic enzyme; Warburg’s effect; aerobic glycolysis; apoptotic death; carbohydrate metabolic reprogramming; cytosolic to mitochondrial pathway determinant; glucose utilization; metabolic selectivity.

Publication types

  • Review

MeSH terms

  • Glycolysis*
  • Hexokinase / metabolism
  • Humans
  • Neoplasms* / metabolism
  • Phosphofructokinase-1 / metabolism
  • Phosphoglycerate Kinase / metabolism
  • Phosphoglycerate Mutase / metabolism
  • Pyruvates
  • Tumor Microenvironment


  • Pyruvates
  • Hexokinase
  • Phosphofructokinase-1
  • Phosphoglycerate Kinase
  • Phosphoglycerate Mutase

Grants and funding

This study has in part been supported by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Education, Korean government (the Jungjum yonguso Program, Autonomous key institute of Natural Sciences AKINS programfunded by the NRF-2019R1A6A1A10073079). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.