group of patients, also subjected to the same fasting conditions, were subsequently injected with a dose of L-alanine. Post-infusion, the 60 hour fasted patients showed a marked increase in hepatic mitochondrial oxidation, confirming the relationship. The glucose-alanine cycle may also be of significant clinical relevance in oncological (cancer) pathogenesis. A 2020 study explored the role of the glucose-alanine cycle in the metabolic reprogramming of Hepatocellular Carcinoma (HCC). HCC is the most common form of liver cancer and the third most common cause of cancer-related deaths worldwide. The search for alternative treatment options remains a lucrative area of research as current available therapeutics (surgery, radiotherapy, chemotherapy) generally have severe side effects and/or low success rates with HCC. One common characteristic of many novel alternative and/or supplementary treatments is the targeting of cellular metabolism of cancer cells, due to their general hyper-metabolic state which favors rapid growth and proliferation. In conjunction with consuming glucose at a much more rapid rate than healthy cells, cancers cells heavily rely on amino acid metabolism to satisfy their avid nutritional needs. The researchers involved in this study speculated exogenous alanine, processed via the glucose-alanine cycle, to be one of the alternative energy sources for HCC cells in a nutrient deficient environment and that this dependency can be harnessed for targeted therapy. To demonstrate this experimentally, HCC cells were cultured in vitro in a nutrient poor media and then supplied with alanine. The alanine supplication was enough to promote HCC cell growth under those conditions- a phenomenon called metabolic reprogramming. Next, they performed a series of over expression and loss of function experiments and determined that specifically Glutamic Pyruvate Transaminase 1 (GPT1) is the GPT isomer primarily involved in alanine turnover in HCC cells, consistent with previous findings that GPT1 tends to be found in the liver. They proceeded by treating the metabolically reprogrammed HCC cells with Berberine, a naturally occurring inhibitor of GPT1; the observed affect was to curb ATP production and subsequently the growth of the alanine-supplied cancer cells. Their study demonstrated that components of the glucose-alanine cycle, particularly GPT1, may be a good choice as a target for alternative HCC therapies and that Berberine, as a plant- derived selective GPT1 inhibitor, has potential for use in one of these novel medicines. The concept of alanine as an alternative fuel for cancer cells was similarly demonstrated in other studies performed on pancreatic cancer cells. References