title: Press-pulse: a novel therapeutic strategy for the metabolic management of cancer.
abstract: BACKGROUND
  A shift from respiration to fermentation is a common metabolic hallmark of cancer cells. As a result, glucose and glutamine become the prime fuels for driving the dysregulated growth of tumors. The simultaneous occurrence of "Press-Pulse" disturbances was considered the mechanism responsible for reduction of organic populations during prior evolutionary epochs. Press disturbances produce chronic stress, while pulse disturbances produce acute stress on populations. It was only when both disturbances coincide that population reduction occurred.
  
  
  METHODS
  This general concept can be applied to the management of cancer by creating chronic metabolic stresses on tumor cell energy metabolism (press disturbance) that are coupled to a series of acute metabolic stressors that restrict glucose and glutamine availability while also stimulating cancer-specific oxidative stress (pulse disturbances). The elevation of non-fermentable ketone bodies protect normal cells from energy stress while further enhancing energy stress in tumor cells that lack the metabolic flexibility to use ketones as an efficient energy source. Mitochondrial abnormalities and genetic mutations make tumor cells vulnerable metabolic stress.
  
  
  RESULTS
  The press-pulse therapeutic strategy for cancer management is illustrated with calorie restricted ketogenic diets (KD-R) used together with drugs and procedures that create both chronic and intermittent acute stress on tumor cell energy metabolism, while protecting and enhancing the energy metabolism of normal cells.
  
  
  CONCLUSIONS
  Optimization of dosing, timing, and scheduling of the press-pulse therapeutic strategy will facilitate the eradication of tumor cells with minimal patient toxicity. This therapeutic strategy can be used as a framework for the design of clinical trials for the non-toxic management of most cancers.
authors.affiliation: Biology Department, Boston College, Chestnut Hill, MA 02467 USA.
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Seyfried
authors.affiliation: George Washington University Medical Center Washington DC, and Aegis Medical & Research Associates Annapolis, Maryland, USA.
authors.forename: George
authors.initials: G
authors.lastname: Yu
authors.affiliation: Department of Neurosurgery, University of Pittsburgh Medical Center, Suite 5C, 200 Lothrop St, Pittsburgh, PA USA.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Maroon
authors.affiliation: Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida USA.
authors.forename: Dominic P
authors.initials: DP
authors.lastname: D'Agostino
keywords: Cancer metabolism; Diet; Glucose; Glutamine; Glutaminolysis; Hyperbaric oxygen; KETONE bodies; Mitochondria; Warburg effect