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. 2022 Sep 12;41:271. doi: 10.1186/s13046-022-02485-0

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© The Author(s) 2022

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 1 — Enhanced mitochondrial metabolism sensitizes cancer cells to elesclomol. Cancer cells highly dependent on mitochondrial metabolism are sensitive to elesclomol, including cancer stem cells, drug-resistant cancer cells, and glycolysis-inhibiting cancer cells. Both TICs in ovarian cancer and GSCs in glioblastoma are associated with cancer recurrence and are highly dependent on mitochondrial metabolism. Drug-resistant cancer cells, including bortezomib-resistant breast cancer cells, cisplatin-resistant melanocytes and lung cancer cells, and vemurafenib-resistant melanocytes, increase their dependence on mitochondrial metabolism in the development of drug resistance. PDK inhibitor DCA enhances mitochondrial metabolism in melanoma cells by shifting their metabolism from glycolysis to oxidative phosphorylation. In addition, hypoxia in solid tumors reduces the intensity of mitochondrial metabolism, and the degree of tumor hypoxia is positively correlated with the serum LDH levels of the patients. Patients with low serum LDH levels are sensitive to elesclomol. ATP: adenosine triphosphate; DCA: dichloroacetate; GSCs: glioblastoma stem cells; LDH: lactate dehydrogenase; PDH: pyruvate dehydrogenase; PDK: pyruvate dehydrogenase kinases; TICs: tumor-initiating cells