title: Ketogenic diets enhance oxidative stress and radio-chemo-therapy responses in lung cancer xenografts.
abstract: OBJECTIVE
  Ketogenic diets are high in fat and low in carbohydrates as well as protein which forces cells to rely on lipid oxidation and mitochondrial respiration rather than glycolysis for energy metabolism. Cancer cells (relative to normal cells) are believed to exist in a state of chronic oxidative stress mediated by mitochondrial metabolism. The current study tests the hypothesis that ketogenic diets enhance radio-chemo-therapy responses in lung cancer xenografts by enhancing oxidative stress.
  
  
  METHODS
  Mice bearing NCI-H292 and A549 lung cancer xenografts were fed a ketogenic diet (KetoCal 4:1 fats: proteins+carbohydrates) and treated with either conventionally fractionated (1.8-2 Gy) or hypofractionated (6 Gy) radiation as well as conventionally fractionated radiation combined with carboplatin. Mice weights and tumor size were monitored. Tumors were assessed for immunoreactive 4-hydroxy-2-nonenal-(4HNE)-modified proteins as a marker of oxidative stress as well as proliferating cell nuclear antigen (PCNA) and γH2AX as indices of proliferation and DNA damage, respectively.
  
  
  RESULTS
  The ketogenic diets combined with radiation resulted in slower tumor growth in both NCI-H292 and A549 xenografts (P < 0.05), relative to radiation alone. The ketogenic diet also slowed tumor growth when combined with carboplatin and radiation, relative to control. Tumors from animals fed a ketogenic diet in combination with radiation showed increases in oxidative damage mediated by lipid peroxidation as determined by 4HNE-modified proteins as well as decreased proliferation as assessed by decreased immunoreactive PCNA.
  
  
  CONCLUSIONS
  These results show that a ketogenic diet enhances radio-chemo-therapy responses in lung cancer xenografts by a mechanism that may involve increased oxidative stress.
authors.affiliation: Free Radical and Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, Iowa 52242, USA.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Allen
authors.forename: Sudershan K
authors.initials: SK
authors.lastname: Bhatia
authors.forename: John M
authors.initials: JM
authors.lastname: Buatti
authors.forename: Kristin E
authors.initials: KE
authors.lastname: Brandt
authors.forename: Kaleigh E
authors.initials: KE
authors.lastname: Lindholm
authors.forename: Anna M
authors.initials: AM
authors.lastname: Button
authors.forename: Luke I
authors.initials: LI
authors.lastname: Szweda
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Smith
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Spitz
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Fath
mesh_terms: D000818:Animals; D002289:Carcinoma, Non-Small-Cell Lung / Q000378:metabolism / Q000628:therapy*; D045744:Cell Line, Tumor; D003131:Combined Modality Therapy; D055423:Diet, Ketogenic; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007659:Ketones / Q000378:metabolism; D015227:Lipid Peroxidation; D008175:Lung Neoplasms / Q000378:metabolism / Q000628:therapy*; D051379:Mice; D008819:Mice, Nude; D018384:Oxidative Stress; D018809:Proliferating Cell Nuclear Antigen / Q000378:metabolism; D011836:Radiation Tolerance; D023041:Xenograft Model Antitumor Assays
chemical_list: D007659:Ketones; D018809:Proliferating Cell Nuclear Antigen