Abstract

Rodent models of liver tumorigenesis have reproducibly shown that dietary sugar intake is a powerful driver of liver tumor initiation and growth. In contrast, dietary sugar restriction with ketogenic diets or calorie restriction generally prevents liver tumor formation. Ketogenic diet is viewed positively as a therapeutic adjuvant; however, most ketogenic diet studies described to date have been performed in prevention mode rather than treatment mode. Therefore, it remains unclear whether a ketogenic diet can be administered in late stages of disease to stall or reverse liver tumor growth. To model the clinically relevant treatment mode, we administered a ketogenic diet to mice after liver tumor initiation and monitored tumor growth by magnetic resonance imaging (MRI). Male C57BL/6 mice were injected with diethylnitrosamine (DEN) at 2 weeks of age and fed a chow diet until 39 weeks of age, when they underwent MRI imaging to detect liver tumors. Mice were then randomised into two groups and fed either a chow diet or switched to a ketogenic diet from 40–48 weeks of age. Serial MRIs were performed at 44 and 48 weeks of age. All mice had tumors at study completion and there were no differences in total tumor burden between diet groups. Although a ketogenic diet has marked protective effects against DEN-induced liver tumourigenesis in this mouse model, these data demonstrate that ketogenic diet cannot stop the progression of established liver tumors.

Highlights

  • Primary liver cancer, of which hepatocellular carcinoma (HCC) is the most common form, is the sixth most common cancer, the third leading cause of cancer-related deaths, and is a leading cause of death for patients with cirrhosis [1]

  • DEN is that a procarcinogen death and regeneration lead to we theused development ofliver hepatocellular progresses to HCC

  • These results demonstrate that a ketogenic diet administered after tumor initiation is not effective at decreasing or preventing DEN-induced liver tumor growth

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Summary

Introduction

Of which hepatocellular carcinoma (HCC) is the most common form, is the sixth most common cancer, the third leading cause of cancer-related deaths, and is a leading cause of death for patients with cirrhosis [1]. Chronic liver diseases, including hepatitis B and C, aflatoxin B1, and nonalcoholic fatty liver disease, promote cirrhosis and subsequently hepatocellular adenoma (HCA). Treatment options for liver cancer include transplantation, surgical resection, image-guided ablation, chemoembolization, and systemic therapies including antivirals and the VEGFR/multityrosine-kinase inhibitor sorafenib. Numerous clinical trials have compared the efficacy of similar agents, including lenvatinib and regorafenib, but sorafenib remains the only approved first-line treatment for HCC [2].

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