P1841 - Clinical Representation of the Warburg Effect in Stage IV Hepatocellular Carcinoma

Omar Oudit, DO¹, Javed Jagroo, MBBS², Sravani Bhavanam, ³, Mohamed A. Sabra, MD⁴, Jamal Perry, MD¹, Kibwey Peterkin, MD⁴, Corey Knowles, MD⁴, Abdulrahman Atasi, MD⁴, Vinay Chandramouli Bellur, ⁵, Sharanya Nemakallu, MD⁴, Derrick Cheung, MD¹
1Brookdale University Hospital Medical Center, Brooklyn, NY; 2Brookdale University Hospital Medical Center, Ozone Park, NY; 3Brookdale University Hospital Medical Center, Bangalore, Karnataka, India; 4One Brooklyn Health-Brookdale University Hospital Medical Center, Brooklyn, NY; 5Ramaiah medical college, Bangalore, Karnataka, India

Introduction: The Warburg effect is a metabolic phenomenon observed in cancer cells. It is characterized by aerobic glycolysis instead of mitochondrial oxidative phosphorylation as the primary mechanism of cellular energy generation [1- 3]. The exact benefit of such a metabolic switch is poorly understood, as aerobic glycolysis is thermodynamically more inefficient than mitochondrial oxidative phosphorylation [2-5].

Case Description/

Methods: Here, we present a case of a 40-year-old male patient with advanced stage four hepatocellular carcinoma with chronically low glucose levels measured in the 20s to 40s and completely asymptomatic. Upon examination, findings of sympathetic hyperactivity in the setting of hypoglycemia were absent, and the mentation was completely intact. This occurred in the absence of any states or medications known to induce hypoglycemia; concurrently, the patient demonstrated hyperphagia, suggesting increased metabolic demand in the setting of an immense, overwhelming tumor burden. During these hypoglycemic intervals, the patient's coagulation profile, including PT and INR, remained within normal limits, suggesting sufficient residual hepatic parenchyma and glucogenic capacity. The patient's glucose remained extremely low, refractory to correction with multiple dextrose, D5, and D10 administrations. This suggests chronic systemic habituation to malignant cell consumption of serum glucose leading to adaptations to this hypoglycemia in highly metabolically active organs, such as the brain, heart, liver, and kidneys.

Discussion: This report highlights the clinical utility of recognizing this metabolic state in the setting of advanced-stage malignancy with significant tumor burden and how it affects hospital glucose management. Its early recognition will lead to an increased ability to meet the patient's metabolic demands by administering appropriate, supplemental nutrition to satiate their hunger, potentially augmenting the delivery of palliative measures. This metabolic state may function as a surrogate marker, in conjunction with serum markers and imaging studies, for clinical determination of treatment escalation.


Figure: T2 Weighted MRI Imaging of Extensive Hepatic Tumor Burden

Disclosures:
Omar Oudit indicated no relevant financial relationships.
Javed Jagroo indicated no relevant financial relationships.
Sravani Bhavanam indicated no relevant financial relationships.
Mohamed Sabra indicated no relevant financial relationships.
Jamal Perry indicated no relevant financial relationships.
Kibwey Peterkin indicated no relevant financial relationships.
Corey Knowles indicated no relevant financial relationships.
Abdulrahman Atasi indicated no relevant financial relationships.
Vinay Chandramouli Bellur indicated no relevant financial relationships.
Sharanya Nemakallu indicated no relevant financial relationships.
Derrick Cheung indicated no relevant financial relationships.

Omar Oudit, DO¹, Javed Jagroo, MBBS², Sravani Bhavanam, ³, Mohamed A. Sabra, MD⁴, Jamal Perry, MD¹, Kibwey Peterkin, MD⁴, Corey Knowles, MD⁴, Abdulrahman Atasi, MD⁴, Vinay Chandramouli Bellur, ⁵, Sharanya Nemakallu, MD⁴, Derrick Cheung, MD¹. P1841 - Clinical Representation of the Warburg Effect in Stage IV Hepatocellular Carcinoma, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.