Thursday, 8 March 2018

L-Carnitine, ketolytic enzymes and therapeutic ketogenic diets for cancer management.

L-Carnitine plays an absolutely vital role in the metabolism of fatty acids.

Mo Farah is recently, somewhat controversially been pruported to have had an injection of L-Carnitine before the 2014 London Marathon for performance gains. It is worth noting that Mo Farah is an endurance athlete, so fat is the predominant fuel source. Fat oxidation rate is high so if you can sustain this for a longer period of time you can improve limits of exhaustion.

Carnitine shuttle (1)
This IV administration by Mo Farah is now being seen by the media in this country as 'cheating within the rules' with increased scrutiny recently of 'marginal gains' in athletic performance and sport in general after the cycling 'scandal' with Team Sky riders making the most of Therapeutic Use Exemptions (TUEs) that are known to improve performance for endurance athletes.



What helps athletes often has great potential for cancer patients- ie. infusion of nutrients, certain drugs, nutritional supplements, hyperbaric chambers, cold induced thermogenesis, infrared saunas, etc.

It is interesting....

Like Mo Farah I also take L-Carnitine because it ensures efficient transfer of long-chain fatty acids to mitochondria for subsequent β-oxidation. The brain has an abundance of mitochondria and if you subscribe to the mitochondrial defect theory of cancer as I do its kind of a no brainer (pun intended) that you would want to make the most of everything you can do to do try and restore mitochondrial function here. This can potentially be very beneficial for ensuring that ketone bodies produced during fasting, or fats on the ketogenic diet actually get used so that we can attempt to attain more healthy mitochondria.

This is what I take
There is exhaustive evidence showing how supplementation with L-Carnitine could benefit cancer patients, mostly for reducing general fatigue during chemotherapy (2) but also for normalising lipid metabolism for more general health (3). Anti-dementia effects have been proposed and suggested when co-administering L-Carnitine with medium chain triglycerides (MCTs) and other agents (5, 6). A higher rate of absorption would result in rapid perfusion of the liver, and a potent ketogenic response.


Perhaps an important consideration: 

If you are thinking of taking this as a brain cancer patient however, it may be worth some exploration to see if your tumour has increased activity of ketolytic enzymes to see if it can use fats to proliferate. You can ask about this from histological findings. 

Ketone body ketolytic enzymes to assess expression of include (4): 

Succinyl CoA: 3 Oxoacid CoA Transferase (OXCT1)
3-hydroxybutyrate dehydrogenase 1 and 2 (BDH1 and BDH2) 
Acetyl-CoA acetyltransferase 1 (ACAT1) 


This can be the case in more aggressive tumours rather than typically lower grade, more solid tumours. I suspect this may be because the tumour is more diffuse, and as such the cell membrane may lack integrity and become more permeable. This is a theory I have based on research looking at alterations of membrane integrity and cellular constituents in neuroblastoma and glioma cells (8). 

I could be completely wrong with that theory, but either way there is often an overexpression of Fatty Acid Synthase (FASN) in high grade gliomas (7), a key lipogenic enzyme in glioma stem cells (GSCs), as well as other important metabolic enzymes, meaning aggressive tumours will try to use whatever they can to grow and thrive and are excellent at adapting to use alternative fuels when you restrict main substrates. These tumours will use glucose, amino acids, fats and nucleic acids for energy, and while the demand will be different for each, as the tumour becomes more aggressive the amounts will change and it becomes more and more resistant to even the most aggressive treatments. 







6. Odle, J., 1997. New insights into the utilization of medium-chain triglycerides by the neonate: observations from a piglet model. The Journal of nutrition127(6), pp.1061-1067.



Thursday, 1 March 2018

Telomere biology and cancer

When I was first diagnosed I asked my oncologist about my prognosis and was told... 'well the good news is that you are still quite young.' He then went on to tell me dates for both the best and worst case scenarios. 

With biological age being so important for survival I asked 'Well then what if I just try and keep my biological age as young as possible?'. He said, 'Interesting point, well you can certainly try.'....

Telomere biology- try to stay young by supplementing with a bioavailable form of magnesium, vital for over 300 enzyme reactions in the body. Most of us are deficient and supplementation can improve sleep, energy levels, reduce seizure activity for those of us with epilepsy and improve mood.

Sunday, 4 February 2018

World Cancer Day

I am in my 5th year since being diagnosed with incurable brain cancer. I should be happy right? Well, sometimes yes, sometimes no. Its complicated. 
There have been many occasions that I didn't think I would make it this far. I feel incredibly fortunate, but even now I am still picking up all the pieces and coping with a 'new normal'. You learn to cope better with time, but its like grieving for a life lost. There is a new me that I don't recognise and have had to get to know, even if the essence of who I am stays the same, if you look closely behind the eyes can tell a different story.
Sometimes people may just think I should leave it behind me and 'get on with it', but I can't, as, like it or not, its with me every day and I am scarred by it. The invisible disabilities,- the uncertainty,- and 'living in the moment' is how I live. day by day. I have to... and I have little choice. 
Every day I experience some type of brain dysfunction that keeps me on my toes despite my best efforts to control it all. Mind over grey matter you could say... though it doesn't always go to plan. 
Today I am thinking of all those who have lost their battle as well as all those still fighting. I don't like all these war like terms to describe such indescribable and personal thoughts, feelings, and experiences, but its all we have sometimes as its incredibly difficult to sum it all up with the appropriate words. 
How can you? Its all relative and its so personal. 
Behind the smiles, laughs and appearances on social media and in public I remain somewhat empty inside, part of me is still missing. I get incredibly frustrated at times when I feel my seizure threshold is low and I can't have the social life I used to have or be as active as I used to be. I am a very introspective person and I can beat myself up at times whenever I am left alone with my thoughts. At the same time I am a problem solver and a perfectionist, desperately trying to find solutions to every problem. What if sometimes there are no solutions? We can still try our best to 'manage' I suppose. 
Part of me feels bad about thinking this as I feel I should be happy to just be able to not have grand mal seizures and be able to walk and talk. My speech will get slurred on occasion and I get some worrying sensations, but I haven't completely lost the speech in a while now. Sometimes people misread my body language because parts of my face go numb, but I try to hide this. Inside this pains me and it is a constant reminder that I have limits now. 
I try my hardest to have a positive outlook on life, but I experience an empty feeling that I've had ever since my first seizure and then all I have had to deal with since my diagnosis. Then there is my age, the time in life where you typically start to feel about romantic love, a career, a family, etc. My experiences undoubtely make me think long and hard about this and what to do. A cancer diagnosis affects so many aspects of someone's life, and often those around them. 
I have experienced profound loss, losing good friends and losing parts of my life that I previously took for granted. 
Whenever I hear of someone who has 'lost their battle', a part of me dies a little too as I feel the pain that is left behind with loved ones having to somehow pick up the pieces. I could never appropriately sum up in words how I really feel. 
Every day I have a unique pain and internal suffering, yet I have moments of delirious happiness where I look at the simplest things in life with the wonderment they deserve while everyone else seems to just pass by and not see the beauty. Everyone has their struggles, I understand that, but there is light. Life is a series of moments and there is light and shade. Every good story has this, and your life is a story. How do you want it to be? People, places and experiences that make me smile. These are the good moments that I cherish, and I have had that this weekend as I reflect and enjoy the beauty of nature. I am grateful for these moments and I have been able to control my symptoms very well over the past couple of weeks with just a few wobbles. I am also grateful that I have been able to share this indirectly with friends. 
There will always be moments of pain and I don't want to hide this any more. I know my symptom triggers, but again, these are scars and it has taken me a good few years to come to terms with this. For me personally it is my brain, which is kind of important, but I still have empathy for others with other types of cancer because there are unique aspects of it that are difficult to understand unless you have been there. 
Its all relative and everyone has their struggles, even people without cancer, but there is the other side of it to... 
The other side is that it really opens your eyes. 
Depending on how you choose to deal with it, a cancer diagnosis can open your eyes to what you are truly capable of and it can allow you to see the world in a different way. You realise that many of the clichès are true and you have an appreciation of the fact that 'life is short' and we must make the most of it. Sometimes, admittedly, it takes time to realise this, even after a cancer diagnosis.
I am incredibly thankful for what I have and to still be here and I'm working hard to stay happy but I'm still working on it 5 years on. I still believe my cancer is incurable and will be back in future, I don't know when, and I don't think this is being negative, as it is what it is. It is an incurable form of cancer and regrettably I had some palliative treatment for it, which for this type of cancer ironically increases risk of recurrence the longer you live. That might sound strange to some, but they don't expect you to live long enough to experience that. Sometimes living longer than your life expectancy puts you under a strange kind of pressure to be happy, and I'm working out what happiness really means to me. This is something everyone probably thinks about from time to time, but I've had a massive kick up the bum and its been a pretty wild ride.
I also feel I have a duty to try my best to make things better for myself and others in future. I promise I will try my very best to do all I can and while I do that I will make efforts to be a better person and to live the life that I want to live. 
LIFE IS FOR LIVING! 
This is the greatest message of all and one that I feel we all need to remember. 
I wish for a world where we can at least say that cancer is a chronic condition we can live WITH than one that we die OF. I think this is possible and it is why I am hopeful I will be successful in an important interview I have coming up on the 22nd of this month. 
I wish for a better future for all cancer patients and their families and I'll try my very best to make some kind of impact, however small. 
Thank you for all your love and support along the way, it genuinely means so much to me and keeps me sane! 

Friday, 12 January 2018

Blue light blocking glasses and cancer, epilepsy

These are the best blue light blocking glasses I have had and they don't look dorky. If you understand about the negative effects of artificial light at night you will understand how useful these can be to normalise natural melatonin secretion in the evenings. Endogenous melatonin produced by the pineal gland is one the most potent anti-cancer molecules known to man, as I have mentioned previously in this blog. The most noticeable benefit for me is improved seizure control after sunset. The effect of melatonin and sleep aids has been investigated for years as potential anti convulsive agents for good reason and the mechanisms of action go beyond improved sleep quality (although this is still HUGELY important for seizure control).

Blue light blocking glasses from BLUblox- https://www.blublox.com
Melatonin is a very powerful antioxidant with numerous physiological functions. The interplay between clock genes and light entering the retina is an intricate, delicate process that regulates normal cell division and associated regulatory processes. Clock genes can even influence the pharmacokinetics of chemotherapeutic agents so this is worth investigating and asking your oncologist if you are a patient reading this. You can then determine what time of day might be most effective for the type of chemotherapy you are taking. If you would like to learn more, the official name for this form of study is Chronopharmacology.


Known mechanisms of melatonin

The mechanisms underlying melatonin's ability to interfere with tumour metastases are numerous and involves several mechanisms involved with modulation of cell-cell and cell-matrix interaction (3).

General functions include:

a) Direct free radical scavenging, 

b) Ttimulation of antioxidative enzymes, 

c) Increasing the efficiency of mitochondrial oxidative phosphorylation and reducing electron leakage (thereby lowering free radical generation), and augmenting the efficiency of other antioxidants. 



Fig. 1- several mechanisms for the known effects of melatonin. (1)


'There may be other functions of melatonin, yet undiscovered, which enhance its ability to protect against molecular damage by oxygen and nitrogen-based toxic reactants. 

Numerous in vitro and in vivo studies have documented the ability of both physiological and pharmacological concentrations to melatonin to protect against free radical destruction.' (2



References:

1. Jung, B. and Ahmad, N., 2006. Melatonin in cancer management: progress and promise. Cancer Research66(20), pp.9789-9793.

2. Reiter, R.J., Tan, D.X., Mayo, J.C., Sainz, R.M., Leon, J. and Czarnocki, Z., 2003. Melatonin as an antioxidant: biochemical mechanisms and pathophysiological implications in humans. ACTA BIOCHIMICA POLONICA-ENGLISH EDITION-50(4), pp.1129-1146.

3. Su, S.C., Hsieh, M.J., Yang, W.E., Chung, W.H., Reiter, R.J. and Yang, S.F., 2017. Cancer metastasis: Mechanisms of inhibition by melatonin. Journal of pineal research62(1).





Saturday, 23 December 2017

Erenumab and other CGRP receptor antagonists- potential for action against brain tumours?

At the moment I'm keeping an eye on trial results and emerging research of this relatively new medication (Erenumab) for episodic migraine to understand how it could have anti-cancer activity against angiogenesis in malignant brain tumours.

Furness and Wookey, 2012

Erenumab is a human monoclonal antibody against the calcitonin gene-related peptide receptor (CGRP receptor) and its primary use is for the prevention of migraine.

This simply means that it acts as an antagonist for the CGRP receptor. CGRP comprises of 37 amino acids and is produced in the peripheral and central neurons. The main function of this peptide is to transmit pain. Early studies in humans have shown that the drug could prevent migraines by up to 50% in phase 2 clinical trials (8) so wider spread use and future applications would be interesting to see. Long term safety requires further study as this is a relatively new drug.

Research into CGPR receptor antagonists have been in development over the last few years with limited success, but this new drug has been hailed as a significant breakthrough with greater potency shown in clinical trials.

Before the introduction of these newer drugs, the last time a promising drug came on to market specifically for migraine relief was in the early 1990s. This came in the form of a class of drugs called triptans, which act as selective serotonin receptor agonists to treat migraines and cluster headaches.

These drugs are typically administered by migraineurs at the onset of attack. The main difference with these drugs and CGPR receptor antagonists in terms of symptom relief is that triptans are not preventative, they are what is termed 'abortive treatment'. Its kind of like putting a plaster over a wound. Imagine if we could stop the wound forming in the first place or at least reduce the swelling and pain before it becomes a major problem.

The Role of CGRP and its Antagonists in Migraine (14)

I noticed that similar promising drugs targeting this receptor had some limitations. For example, Oicegepant has to be administered intravenously which isn't very practical, and further development of Telcegepant was suspended following phase III clinical trials after some studies indicated there was some liver toxicity after 3 months of use (12). Despite having had to be discontinued for a number of reasons, these drugs are generally tolerable with well established safety profiles. One very favourable aspect of Erenumab so far is that toxicity is low and as such it is more tolerable at therapeutic doses over time. Longer term safety has not yet been completely quantified but early signs are promising due to its increased potency at lower doses.

You would take Erenumab as an injection only once a month. Access to the drug would likely be difficult to get hold of for other purposes, but we can use all of this information to ask ourselves about other drugs or natural agents we may use that have similar mechanisms of action. There is also some possibility of using biofeedback to control these processes.


Mechanisms of Erenumab and other CGPR receptor agonists against brain cancer:

Erenumab's potential role in halting brain cancer cell replication and growth sparked my interest, as well as the ability to potentially monitor its effectiveness by assessing production and/or activity of calcitonin receptor in brain cells. Brain tumours could therefore be treated more effectively or even prevented at an earlier stage of development by administering an effective amount of the compound that binds to the calcitonin receptor to inhibit the growth of, or kill, brain tumour cells in the patient.

Furness and Wookey, 2012

What is CGPR and why is it an important drug target?

CGPR is one of several neuropeptides found in the human trigeminal sensory neurons and is a potent dilator of cerebral and dural vessels. It is also involved in meningeal dural vasodilation.

Image src: http://www.neurologyadvisor.com/reconsidering-the-vascular-hypothesis-of-migraine-pathophysiology/slideshow/3738/

Erenumab is unique because previous medications for migraine, apart from triptans, are usually indicated for other conditions eg. anticonvulsants and more general anti-inflammatory agents such as the NSAIDS paracetamol, aspirin, ibuprofen, naproxen. Typically these drugs are only partially effective at best for such severe headaches (1) and their effects don't last long enough for episodic migraines.


Links between aetiology of episodic migraines and pathogenesis of brain cancer:

Episodic migraines can be described as one of many forms of epilepsy, and brain cancer patients can suffer migraines, as well as general neuropathy for several reasons. This can even take the form of neuroinflammation as a result of the standard of care for brain cancer, so even from a quality of life perspective this drug is worth investigating in my opinion.

The headlines have been rather sensational with the drug being described as a 'miracle', a 'breakthrough' and 'groundbreaking' but sadly this is common when many new drugs come on to the market and they rarely live up to this promise in reality. With that being said, I do believe this drug is unique and has an interesting target for a number of conditions, which also includes breast cancer.

IMG src: https://www.theguardian.com/science/2017/nov/30/migraine-drug-erenumab-could-halve-the-length-of-attacks-study-shows

So often, most of the hype behind these new drugs tends to fizzle out until the next week's 'breakthrough drug'. There is always hope however, and this drug does indeed look very useful and efficacious for a number of reasons, which is why I have decided to do more research to understand the mechanisms of action, potential side effects short and long term, and its potential anti-cancer mechanisms specifically for brain cancer (the obvious application). This drug target is definitely on my list of back up plans in case I ever have a recurrence of my tumour.

My first thought when reading more about this class of drugs is that it could be even more effective for meningioma brain tumours, at least for symptom control, as this type of tumour is more often associated with migrainous activity with or without an 'aura'.

Small meningiomas can be asymptomatic until they grow and spread, usually causing seizures and headaches. As with migraines, where up to 85% of sufferers can be female (9), the majority of patients with meningioma brain tumours are female (over 2.5x more frequency compared to males) (11). I am not sure why this is, it could possibly be a hormonal reason, but it is very interesting.

Image src: https://en.wikipedia.org/wiki/Meningioma

A meningioma is a type of brain tumour that forms from the meninges, layers of tissue that surround and protect the brain and spinal cord. These tissues are comprised of three layers known as the dura matter, arachnoid matter and pia matter. Even general observation can show you how migraines could be a serious concern as the tumour grows, and of possible surgical complications.

Image src: https://en.wikipedia.org/wiki/Meninges

Even if Erenumab could reduce the need for steroids to reduce brain swelling for these patients and/or associated symptoms, that would provide tremendous relief for these patients I'm sure. Let's not dismiss quality of life.


As part of a drug cocktail approach to manage cancer:

I am a huge fan of a drug cocktail approach using non toxic, repurposed drugs with key targets on signalling changes associated with malignant brain tumours. Perhaps most important, as an adjuvant treatment, I believe it is very vital to consider use of certain non-toxic agents whilst undergoing chemotherapy to aid drug delivery to the brain.

Chen, Y. and Liu, L., 2012


This is without a doubt the major hurdle of temozolomide and other chemotherapeutic agents for brain cancer. The main reason they don't work is because they cannot cross the blood brain barrier at appreciable doses to target cancer stem cells without significant toxicity to healthy brain cells. A few interesting agents that may aid drug delivery to the brain to enhance the effects of chemotherapy for brain cancer are detailed below.

There are many other proposed agents, but I think this is a nice brief summary of a few I have looked into most. The main action is to modulate the expression of efflux transporters. In a nutshell, efflux transporters play a vital role in drug absorption, ensuring it can be directly delivered to the intended site of action. One key target for high grade gliomas specifically, would be monocarboxylate transporters.

Why? Well, if you understand the Warburg Effect, you will understand that the high glycolytic nature of malignant gliomas describes their propensity to metabolise glucose to lactic acid at an elevated rate. This is a survival mechanism that has parallels with Darwinian evolution. Cancer is very clever and doesn't want to die so in order to survive, these neoplasms efflux lactic acid to the tumour microenvironment through transmembrane transporters- monocarboxylate transporters (MCTs). It has been suggested therefore that inhibition of MCT function could impair the glycolytic metabolism and effect both glioma invasiveness and survival (3)

Furness and Wookey, 2012


Anti-angiogenic benefits for malignant brain tumours:

The take home message here is that CGRP can become a major therapeutic target for brain cancer as we understand that endogenous CGRP facilitates tumour-associated angiogenesis and tumour growth (13). We have established that CGRP may be derived from neuronal systems, including primary sensory neurons and these neuronal systems exhibit numerous biological activities involved in brain cancer formation, survival and its ability to adapt and thrive.

I am currently investigating more natural ways to target this receptor by possibly using different frequencies of UV light. I understand, for example, that it is possible to use green light to combat neuroinflammation (10). I believe we could potentially use green light to not only to treat migraine photophobia, but also reduce neuroinflammation and silence peripheral nociceptors to alleviate both the inflammatory and neuropathic pain. It is noticeable that many who experience these types of migraines and pain exhibit a degree of photophobia. I don't think we can ignore this fact and how this all links together.

Rodrigo et al. 2017


References

1. Affaitati, G., et al., 2017. Use of Nonsteroidal Anti‐Inflammatory Drugs for Symptomatic Treatment of Episodic Headache. Pain Practice17(3), pp.392-401.

2. Chen, Y. and Liu, L., 2012. Modern methods for delivery of drugs across the blood–brain barrier. Advanced drug delivery reviews64(7), pp.640-665.

3. Colen, C.B., Shen, Y., Ghoddoussi, F., Yu, P., Francis, T.B., Koch, B.J., Monterey, M.D., Galloway, M.P., Sloan, A.E. and Mathupala, S.P., 2011. Metabolic targeting of lactate efflux by malignant glioma inhibits invasiveness and induces necrosis: an in vivo study. Neoplasia13(7), pp.620-632.

4. Dickerson, I.M, Brown E.B. Methods of treating cancer using an agent that modulates activity of the calcitonin-gene related peptide ("CGRP') receptor. In: University of Rochester. 2011. (ISBN No. US 20110189205 A1

5. Durham, P. L., & Vause, C. V. (2010). CGRP Receptor Antagonists in the Treatment of Migraine. CNS Drugs24(7), 539–548. http://doi.org/10.2165/11534920-000000000-00000

6. Furness S, Johns T, Wookey PJ. Diagnosis and treatment of brain tumors. In: Welcome Receptor Antibodies Pty Ltd; 2012. (ISBN No. WO2012000062 A1)

7. Evans, R.W., Timm, J.S. and Baskin, D.S., 2015. A left frontal secretory meningioma can mimic transformed migraine with and without aura. Headache: The Journal of Head and Face Pain55(6), pp.849-852.

8. Goadsby, P.J., Reuter, U., Hallström, Y., Broessner, G., Bonner, J.H., Zhang, F., Sapra, S., Picard, H., Mikol, D.D. and Lenz, R.A., 2017. A Controlled Trial of Erenumab for Episodic Migraine. New England Journal of Medicine377(22), pp.2123-2132.

9. Migraine Research Foundation. (2017) http://migraineresearchfoundation.org/about-migraine/migraine-in-women/ . Accessed online: 09 Dec. 2017

10. 7. Rodrigo N. et al. (2017). Green light alleviates migraine photophobia. Neurology. Apr 2017, 88 (16 Supplement) S47.005;

11. Schneider, J.R., Kulason, K.O., White, T., Pramanik, B., Chakraborty, S., Heier, L., Ray, A.E., Anderson, T.A., Chong, D.J. and Boockvar, J., 2017. Management of Tiny Meningiomas: To Resect or Not Resect. Cureus9(7).

12. Tepper SJ, Cleves C. Telcagepant, a calcitonin gene-related peptide antagonist for the treatment of migraine. Curr Opin Investig Drugs. 2009;10 (7):711–20.

13. Toda, M., Suzuki, T., Hosono, K., Hayashi, I., Hashiba, S., Onuma, Y., Amano, H., Kurihara, Y., Kurihara, H., Okamoto, H. and Hoka, S., 2008. Neuronal system-dependent facilitation of tumor angiogenesis and tumor growth by calcitonin gene-related peptide. Proceedings of the National Academy of Sciences105(36), pp.13550-13555.

14. Image credit: The Role of CGRP and its Antagonists in Migraine- Peripheral Actions of CGRP: Neurogenic Inflammation; Flipper.diff.org; Web December 2017; http://bit.ly/PsCR70



Sunday, 26 November 2017

WORTH REPEATING!- Drug cocktail approach against cancer stem cell-like cells

'Mitochondrial ROS and H2O2 production may be a trigger, for driving mitochondrial oxidative stress, ultimately leading to increased mitochondrial oxidative metabolism in CSCs. Pharmaceuticals, chemical inhibitors, or natural products that we have identified to target CSCs, which interfere with a specific metabolic process or function, are shown in BLUE.'

Sunday, 8 October 2017

Evidence for use of Stiripentol and other agents to effectively inhibit cancer stem-like cell activity.

A few months ago (in March, in a previous post in my blog), I theorised that stiripentol (the 'ketogenic diet pill') may be of use as an anti-cancer agent for brain cancer and perhaps others due to inhibition of Lactate Dehydrogenase activity. I think I have just found recent evidence that this theory may be valid.
Stiripentol

Stiripentol by Diatomit enhances beneficial effects of therapeutic ketosis for cancer management by inhibiting lactate dehydrogenase and offers neuroprotection and increased seizure threshold by enhancing central GABA neurotransmission.
Here is an extra from the paper with reference to stiripentol and complimentary agents that could possibly offer a safe, synergistic therapeutic benefit.
'We have now identified a variety of clinically-approved drugs (stiripentol), natural products (caffein acid phenyl ester (CAPE), ascorbic acid, silibinin) and experimental pharmaceuticals (actinonin, FK866, 2-DG), that can be used to effectively inhibit cancer stem-like cell activity.'
The study can be found here:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400535/