Priority Research Papers:

A ketogenic diet supplemented with medium-chain triglycerides enhances the anti-tumor and anti-angiogenic efficacy of chemotherapy on neuroblastoma xenografts in a CD1-nu mouse model

Sepideh Aminzadeh-Gohari, René Günther Feichtinger, Silvia Vidali, Felix Sternberg, Tricia Rutherford, Maura O’Donnel, Andrea Stöger-Kleiber, Johannes Adalbert Mayr, Wolfgang Sperl and Barbara Kofler _

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Oncotarget. 2017; 8:64728-64744. https://doi.org/10.18632/oncotarget.20041

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Sepideh Aminzadeh-Gohari1, René Günther Feichtinger1, Silvia Vidali1, Felix Sternberg1, Tricia Rutherford2, Maura O’Donnel2, Andrea Stöger-Kleiber2, Johannes Adalbert Mayr3, Wolfgang Sperl3 and Barbara Kofler1

1 Department of Pediatrics, Laura Bassi Centre of Expertise-THERAPEP, Research Program for Receptor Biochemistry and Tumor Metabolism, Paracelsus Medical University, Salzburg, Austria

2 Clinical Nutrition Vitaflo International, Liverpool, United Kingdom

3 Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria

Correspondence to:

Barbara Kofler, email:

Keywords: neuroblastoma, ketogenic diet, medium-chain triglycerides, Warburg effect

Received: June 13, 2017 Accepted: July 31, 2017 Published: August 08, 2017


Neuroblastoma (NB) is a pediatric malignancy characterized by a marked reduction in aerobic energy metabolism. Recent preclinical data indicate that targeting this metabolic phenotype by a ketogenic diet (KD), especially in combination with calorie restriction, slows tumor growth and enhances metronomic cyclophosphamide (CP) therapy of NB xenografts. Because calorie restriction would be contraindicated in most cancer patients, the aim of the present study was to optimize the KD such that the tumors are sensitized to CP without the need of calorie restriction. In a NB xenograft model, metronomic CP was combined with KDs of different triglyceride compositions and fed to CD1-nu mice ad libitum. Metronomic CP in combination with a KD containing 8-carbon medium-chain triglycerides exerted a robust anti-tumor effect, suppressing growth and causing a significant reduction of tumor blood-vessel density and intratumoral hemorrhage, accompanied by activation of AMP-activated protein kinase in NB cells. Furthermore, the KDs caused a significant reduction in the serum levels of essential amino acids, but increased those of serine, glutamine and glycine. Our data suggest that targeting energy metabolism by a modified KD may be considered as part of a multimodal treatment regimen to improve the efficacy of classic anti-NB therapy.

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