Biological Research

ISSN 0716-9760 versión impresa

Biol. Res. v.35 n.1 Santiago 2002 Como citar

este artículo

Glucose transporters: expression, regulation and

cancer
RODOLFO A. MEDINA1 and GARETH I. OWEN2

1Laboratorio de Biologia Celular y Molecular, MIFAB, Universidad Nacional Andres Bello,

Avenida Republica 217, Piso 4, Santiago, Chile
2Departamento de Endocronologia, Pontificia Universidad Católica de Chile, Alameda 340,
Santiago, Chile

Corresponding author: Rodolfo A. Medina, Laboratorio de Biologia Celular y Molecular,

Universidad Nacional Andres Bello, Avenida Republica 217, Piso 4, Santiago, Chile. Phone: 56-2-
661 8419. Fax: 56-2-698 0414. e-mail: rmedina@abello.unab.cl

Received: February 01, 2002. Accepted: April 5, 2002

ABSTRACT

Mammalian cells depend on glucose as a major substrate for energy production. Glucose is
transported into the cell via facilitative glucose transporters (GLUT) present in all cell types. Many
GLUT isoforms have been described and their expression is cell-specific and subject to hormonal
and environmental control. The kinetic properties and substrate specificities of the different
isoforms are specifically suited to the energy requirements of the particular cell types. Due to the
ubiquitousness of these transporters, their differential expression is involved in various disease
states such as diabetes, ischemia and cancer.

The majority of cancers and isolated cancer cell lines over-express the GLUT family members
which are present in the respective tissue of origin under non-cancerous conditions. Moreover, due
to the requirement of energy to feed uncontrolled proliferation, cancer cells often express GLUTs
which under normal conditions would not be present in these tissues. This over-expression is
predominantly associated with the likelihood of metastasis and hence poor patient prognosis. This
article presents a review of the current literature on the regulation and expression of GLUT family
members and has compiled clinical and research data on GLUT expression in human cancers and
in isolated human cancer cell lines.

Key terms: GLUT, glucose transporters, expression, cancer, estrogen, progesterone, cell lines

INTRODUCTION
Most mammalian cells depend on a continuous supply of glucose not only as a
precursor of glycoproteins, triglycerides and glycogen but also as an important
source of energy by generating ATP through glycolysis. Glucose is a hydrophilic
compound; it cannot pass through the lipid bilayer by simple diffusion, and
therefore requires specific carrier proteins to mediate its specific transport into the
cytosol. There is an energy-dependent Na+/glucose co-transporter in the polarized
epithelial cells in the lumen of small intestine and in the proximal tubules of the
kidney. Exclusively in the aforementioned cells this protein uses the movement of
Na+ down its electro-chemical gradient to drive the uptake of glucose.

A ubiquitous glucose transport system also exists. All mammalian cells contain
one or more members of the facilitative glucose transporter gene family named
GLUT (Table 1). These transporters have a high degree of stereoselectivity,
providing for the bidirectional transport of substrate, with passive diffusion down
its concentration gradient. GLUTs function to regulate the movement of glucose
between the extracellular and intracellular compartments maintaining a constant
supply of glucose available for metabolism.

As any cell divides and grows the demand for energy increases, this is no less true
for cancer cells. Normal mammalian cells use oxygen to generate energy from
glucose, and other substrates, through oxidative phosphorylation. Although
tumors induce formation of new blood vessels to deliver nutrients and oxygen to
the growing tumor, angiogenesis does not keep pace with the growth of the
neoplastic cells. This results in large hypoxic areas throughout the tumor.

To form a three-dimensional multicellular mass, tumor cells must change their

metabolism in order to survive and grow under these ischemic conditions (Dang
& Semenza, 1999). Tumor cells in these areas are not killed by ionizing radiation,
which depends on oxygen, or by chemotherapeutic drugs, which do not reach
these regions. A characteristic feature of these ischemic conditions is the
production of large amounts of lactic acid from glycolysis in the presence of
reduced oxygen concentrations (Warburg, 1956). This is accompanied by an
increased rate of glucose transport (Pedersen, 1978: Birnbaum , 1987). We
have shown that lactate causes translocation of GLUT1 and GLUT4 to the plasma
membrane in isolated perfused hearts (Medina , 2002). It is possible that the
lactate acid build-up in tumors is involved in translocation of the transporters to
the plasma membrane which in turn causes an increase in glucose utilization by
these cells. This demand for energy is satisfied by an increased sugar intake which
is accomplished by an increase in glucose transporter expression and an increase
in the translocation of the transporter to the plasma membrane.

GLUT STRUCTURE AND FUNCTION

The GLUTs are intrinsic membrane proteins which differ in tissue-specific

expression and response to metabolic and hormonal regulation (James et al, 1994;
Mueckler, 1994; Stephens & Pilch, 1995). Many different isoforms of GLUT have
been identified (Table 1); all appear to share a common transmembrane topology,
having a large (50% of protein mass), highly conserved (97%), transmembrane
domain, with a less conserved, grossly asymmetric, non-membrane, cytoplasmic
and exoplasmic domains (Jung, 1998). The transmembrane domain is composed
of twelve membrane-spanning-helices, containing a water-filled pathway through
which the substrate moves (Lachaal et al, 1996; Zheng , 1996). The
cytoplasmic domain contains a short N-terminal segment, a large cytosolic loop
and a large C-terminal segment. The exoplasmic domain contains a large loop
bearing a single N-linked oligosaccharide moiety. The fact that isoform-specific
amino acid sequences are found at the cytoplasmic and exoplasmic domains
indicates that they are responsible for tissue-specific regulation of transporter
function. The fact that the transmembrane domain primary structure is largely
conserved suggests that the glucose channel is basically identical in structure
among the isoforms of this family.

TABLE 1
Tissue-specific expression of the GLUT family members.

Protein Alias Expression Function Reference

All tissues Basal uptake Mueckler , 1985

GLUT1 (abundant in brain
and erythrocytes)
GLUT2 Liver, pancreatic Glucose sensing Fukumoto , 1988
islet cells, Watanabe , 1999
retina
GLUT3 Brain Supplements Kayano , 1988
GLUT1 in
tissues in tissues
with
high energy
demand
Insulin
GLUT4 Muscle, fat, heart Fukumoto , 1988
responsive
GLUT5 Intestine, testis, Fructose
Kayano , 1990,
kidney, transport
Concha , 1997
erythrocytes
Spleen, leukocytes,
GLUT6 GLUT9 Doege , 2000
brain
GLUT7 Liver Joost&Thorens, 2001
GLUT8 GLUTX1 Testis, brain Doege , 2000a
GLUT9 GLUTX Liver, kidney Phay , 2000
GLUT10 Liver, pancreas McVie-Wylie , 2001
GLUT11 GLUT10 Heart, muscle Doege , 2001
GLUT12 GLUT8 Heart, prostate Rogers , 1998
pseudogene GLUT6 Kayano , 1990
The physiological function of GLUT transporters depend on their kinetic and
substrate specificities. Several studies have examined the kinetic properties of the
isoforms. However, the facts that glucose is rapidly metabolized and that transport
is not always rate-limiting, means that nonmetabolizable glucose analogues, such
as fluoro-deoxyglucose (FDG), 2-deoxyglucose (DG) and 3-O-methylglucose,
have to be used as glucose tracers. Results of transport assays, under equilibrium
exchange conditions, show an apparent Km for 3-O-methylglucose transport by
GLUT1 of 16.9-26.2 mM (Gould , 1991; Nishimura , 1993). Under the
same conditions GLUT4 has a Km of 1.8-4.8 mM (Keller , 1989, Nishimura
, 1993) and GLUT3 has a Km of 10.6 mM (Gould , 1991). This means
that GLUT3 and GLUT4 have a higher affinity for glucose than GLUT1, ensuring
that glucose transport will be maximal in tissues containing these isoforms even
when glucose concentrations are low. This is particularly important for the brain,
which expresses GLUT3, and relies on glucose as its only source of energy.

GLUT2 has a very low affinity for glucose with a Km for 3-O-methylglucose of 40
mM (Gould , 1991). Since normal circulating glucose concentration is 3.9-5.6
mM, the rate of transport will be directly proportional to glucose concentration.
Therefore, in the postprandial state, when circulating glucose levels are high, there
is a net flux of glucose into hepatocytes and pancreatic ß-cells. In contrast, when
circulating glucose levels are low, intracellular glucose concentration will increase
as a result of glycogenolysis and gluconeogenesis. When the intracellular glucose
concentration exceeds the plasma concentration GLUT transports glucose from
the liver into the circulation. GLUT2 also functions as a low-affinity fructose
transporter, which is consistent with the liver being the primary site for fructose
metabolism (Gould , 1991). GLUT2 is further involved in the anterior
transport of glucose supplied by choroidal circulation from the early stages of
retinal development (Watanabe , 1999).

The localization, expression and regulation of the GLUT family are tissue and
often cell-specific. New GLUT isoforms are continually being discovered and
characterized in various cell types. Their involvement in disease states is also
continually under review. In cancer cells, which have broken free from the
normally tight global regulation, aberrant expression of the GLUT family
members provides the energy source required for further uncontrolled
proliferation and metastasis. As every cell contains the genes for each GLUT
family member we observe in cancer cells the expression of certain GLUT
isoforms which, under normal conditions, would never have been expressed in
these tissues (Table 2 and 3). The review will place emphasis on the best
described models of GLUT expression and regulation. These are GLUT1 and
GLUT4 in adipose and muscle tissue. GLUT1 is thought to play a constitutive
role, and is responsible for basal glucose uptake. GLUT4 is the inducible
transporter and is classically referred to as the "insulin-responsive" transporter.
This nomenclature has arisen due to its translocation from the intracellular
membrane compartment to the plasma membrane, which was originally described
in response to insulin (Slot , 1991; Kraegen , 1993).

As well as transporting hexoses, the glucose transporters have also shown to be

involved in the transport of ascorbic acid. Although in specialized cells vitamin C
can be transported directly through a sodium ascorbate cotransporter, in the
majority of cells vitamin C entry is mediated by glucose transporters in the form
of dehydroascorbic acid (Vera , 1993; Agus , 1997).

This compound is then reduced intracellularly to ascorbic acid. Many human

tumors have been demonstrated to contain high concentrations of ascorbic acid
and thus the glucose transporters may play a role in the intracellular availability of
ascorbic acid in cancer cells (Agus , 1999)

TABLE 2

The Expression of GLUT1 in Human Cancer

Association refers to an association between Glut1 with metastasis and or poor
prognosis of the cancer. NR refers to
data Not Reported by the authors. Expression refers to the level Glut1 in relation
to relevant non-cancerous tissue.

Cancer Type Expression Association Source

Bladder Over-expressed Associated Chang , 2000

Bladder Over-expressed Associated Younes , 2001
Brain Over-expressed Associated Boado , 1994
Brain Reduced Not Associated Nagamatsu , 1993
Brain (Choroid
Reduced Not associated Kurosaki , 1995
Plexus)
Breast Over-expressed Associated Alo , 2001
Breast Over-expressed Associated Zimmerman , 2001
Breast Over-expressed Associated Younes , 1995
Breast Over-expressed Associated Brown , 1993
Breast Over-expressed NR Binder , 1997
Cervical Over-expressed Associated Airley , 2001
Colorectal Over-expressed Associated Sakashita , 2001
Colorectal Over-expressed Associated Younes , 1996
Colorectal Over-expressed Associated Haber , 1998
Cutaneous Basal Cell No Change NR Baer , 1997
Cutaneous Squamous
Over-expressed NR Baer , 1997
Cell
Embrionic Over-expressed NR Loda , 2000
Esophageal Over-expressed NR Younes , 2000a
Esophageal Over-expressed Not Associated Younes , 2000b
Gastric Over-expressed Associated Kawamura , 2001
Gastric Over-expressed Associated Noguchi , 1999
Head and Neck Over-expressed NR Reisser , 1999
Head and Neck Over-expressed Not associated Mellanen , 1994
Head and Neck Over-expressed Associated Reisser , 1999
Leiomyosarcomas Over-expressed Associated Rao , 1999
Lung Reduced Not associated Nigashi , 2001
Lung Over-expressed Not associated Kurata , 1999
Lung Over-expressed Associated Younes , 1997
Lung Over-expressed Associated Ogawa , 1997
Lung Over-expressed Associated Brown , 1999
Lung Over-expressed NR Ito , 1998
Lung (Brain metastsis) Reduced NR Zhang , 1996
Ovarian Over-expressed Associated Cantuaria , 2001
Pancreatic Over-expressed NR Reske , 1997
Pancreatic (islet) Over-expressed NR Boden , 1994
Penile Over-expressed NR Moriyama , 1997
Thyroid Over-expressed Associated Lazar , 1999
Thyroid Over-expressed NR Haber , 1997
Uterus Over-expressed NR Wang , 2000
Vascular
Over-expressed NR North , 2001
(Hemangioma)

GLUT PHYSIOLOGY

One of the most important, and well established, models of GLUT regulation is
the stimulation of GLUT expression and translocation in adipose and muscle
tissue by insulin (Birnbaum, 1992; James & Piper, 1994; Slot , 1991). It is
this process that provides the regulation of whole-body glucose homeostasis and,
when dysfunctional, plays a vital role in diabetes mellitus. GLUT4 is almost
completely responsible for insulin-stimulated glucose transport. In rat adipocytes,
the most studied cell system for insulin action on glucose transport, more than
95% of GLUT4 and 30-40% of GLUT1 is associated with intracellular
membranes, and are thus non-functional. These GLUTs are translocated to the
plasma membrane in response to insulin, where they are able to facilitate the
transport of substrate (Suzuki & Kono, 1980). GLUT4 is constantly recycled
between the plasma membrane and intracellular storage pool with two discrete
first-order rate constants, one for internalization (kin) and one for externalization
(kex). Insulin causes transporter translocation by reducing kin and increasing kex
approximately 3-fold each (Jhun , 1992). Impaired GLUT activity is in part
responsible for insulin resistance in human diabetes and obesity (Ismail-Beigi,
1993).
The rate of glucose utilization in the rat heart is greater than in many tissues such
as skeletal muscle, adipose and lung (James , 1985). Cardiac muscle glucose
transport and utilization is vital for normal function, a fact illustrated in GLUT4
cardiac knockout mice which show cardiac hypertrophy and other major
morphologic heart changes (Katz , 1995). Moreover, a high rate of cardiac
glucose metabolism becomes crucial during ischemia when oxidative
phosphorylation is limited. Under basal conditions glucose transport is the rate
limiting step in glucose metabolism, however, the element of control shifts to
phosphorylation by hexokinase in the presence of insulin (Kashiwaya , 1994).

TABLE 3

The Expression of GLUT2-5 in Human Cancer

Association refers to an association between GLUT2-5 with metastasis and/or
poor prognosis of the cancer. NR refers to
data Not Reported. Expression refers to the level GLUT2-5 in relation to relevant
non-cancerous tissue.

Cancer Type Glut Expression Association Source

Glut Over-
Gastric Associated Noguchi , 1999
2 expressed
Pancreatic Glut Reduced Not Seino , 1993
2 Associated

Nagamatsu ,
Brain Glut3 No Change NR
1993
Glut Over-
Brain Associated Boado , 1994
3 expressed
Glut Over-
Breast NR Binder , 1997
3 expressed
Glut Over-
Gastric NR Noguchi , 1999
3 expressed
Glut Over-
Gastric NR Younes , 1997b
3 expressed
Glut Over-
Head and Neck NR Reisser , 1999
3 expressed
Glut Over- Not Mellanen ,
Head and Neck
3 expressed Associated 1994
Glut Over-
Lung Associated Kurata , 1999
3 expressed
Glut Over-
Lung NR Ito , 1998
3 expressed
Glut Over-
Lung Associated Younes , 1997a
3 expressed
 Glut Over-
Lung NR Younes , 1997a
3 expressed
Glut Over-
Meningiomas NR Glick 1993
3 expressed
Ovarian Glut Over- NR Younes , 1997b
3 expressed

Glut Over-
Breast NR Binder , 1997
4 expressed
Glut Over-
Gastric NR Noguchi , 1999
4 expressed
Glut Over-
Lung NR Ito , 1998
4 expressed
Pancreatic Glut Reduced Not Reske , 1997
4 Associated

Glut Over-
Lung Associated Kurata , 1999
5 expressed

There are two main glucose transporters present in cardiac tissue. Under un-
stressed conditions approximately 60-70% of GLUT1 and 10-20% of GLUT4 is
localized in the plasma membrane (Zorzano ., 1997). In cardiomyocytes,
GLUT4 and GLUT1 account for approximately 60% and 40% respectively, of
total glucose carriers (Fischer , 1997). A number of different stimuli, such as
ischemia, insulin and lactate, have been shown to cause translocation of GLUT1
and GLUT4 to the plasma membrane (Brosius , 1997; Egert , 1999;
Montessuit , 1998, Fuller , 2001; Medina , 2002). These effects may
be crucial in the overall metabolism of glucose since, as mentioned above, under
many conditions; transmembrane transport is the limiting step in glucose
breakdown in the heart (Doenst & Taegtmeyer, 1998; Manchester , 1994;
Nguyen , 1990). In addition to increased translocation of GLUT4 in response
to acute myocardial ischemia, chronic ischemia increases GLUT1 protein content
by enhancing GLUT1 mRNA expression (Brosius , 1997).

Fasting and diabetes cause a repression of cardiac GLUT1 and GLUT4 protein
levels in the rat heart (Kraegen , 1993) and cardiac sarcolemmal vesicles from
diabetic rats show decreased glucose transport (Garvey , 1993). These results
suggest a decrease in glucose transporter number at the cell surface and indicate
that both fasting and diabetes alter the expression and distribution of glucose
transporters. Therefore, it is possible that GLUT depletion and diminished glucose
transport across the cell surface of cardiomyocytes in diabetes could limit glucose
availability and lead to myocardial dysfunction.

Many tissues types can utilize a variety of substrates, such as glucose, lactate and
fatty acids, as an energy source. In contrast, the adult central nervous system relies
on glucose as its sole source for ATP production. In order for glucose to reach
neurons within the brain it must first cross the endothelium of the blood brain
barrier into the interstitial space. From this compartment glucose must be
transported across the neuronal plasma membrane using the ubiquitous GLUT1
and GLUT3 isoforms. Brain GLUT1 is a multiple-molecular-weight species
ranging between 45-55 KDa (Olson & Pessin, 1996). The larger-molecular-weight
species are present in microvessels (Maher , 1994), the smaller species are
present in vessel-free preparation on brain membranes (Pardridge , 1990) and
an intermediate species is present in the choroid plexus (Kumagai , 1994).
The differences in molecular weight are due to differences in N-linked
glycosylation. The functional effect of the different glycosylation states is not
clear although there is evidence suggesting that they are involved in GLUT1
trafficking (McMahon , 2000) and substrate affinity (Onetti , 1997).
GLUT3 is highly expressed in the brain (Nagamatsu , 1992), specifically in
neurons (Maher , 1993). Its relatively low Km indicates that glucose transport
via GLUT3 is near maximal at normal plasma glucose concentrations (Gould
, 1991). GLUT1 and GLUT3 expression is regulated by developmental stage and
by metabolic state. Fetal and neonatal rat mainly express GLUT1 in all brain
related cell types, but neurons change to the expression of GLUT3 at about 10
days after birth (Nagamatsu , 1994). GLUT3 mRNA levels are up-regulated
by hypoglycemia in mouse brain in an apparent protective mechanism against
energy depletion (Nagamatsu , 1994a). In accordance with the neural tissue
having a preference for GLUT3 mediated glucose uptake, it is the detection of
immunoreactive GLUT3, but not GLUT1, in the high grade gliomas which
suggests that GLUT3 isoform may be the predominant glucose transporter in
highly malignant glial cells of human brain (Boado , 1994), (Table 2 and 3).
The same observation is apparent in the choroid plexus where GLUT1 is down-
regulated while GLUT3 levels remain unchanged (Kurosaki , 1995). As an
example that each cancer is different, Boado and colleagues (1994) observed that
GLUT1 was over-expressed in malignant glial cells. Although GLUT1 is the
consistently over-expressed isoform, the presence of GLUT3 tends to be a major
factor in tumour progression. GLUT3 over-expression in lung cancer cells confers
a higher probability of metastasis and thus worse prognosis than GLUT1 over-
expression alone (Younes , 1997a ,b). In accordance with this report, Zhang
and colleagues (1996) observed reduced GLUT1 expression in lung cancer cells
that metastasized to the brain (Table 2)

GLUT2 is primarily expressed in hepatocytes and pancreatic-cells with lower

levels expressed in kidney and intestines. GLUT2 is a low-affinity receptor with a
high turnover rate (Gould , 1991). These kinetic properties allow GLUT2 to
function in the liver where glucose transport must not be rate limiting for influx or
efflux. When circulating glucose levels are high there needs to be net hepatic
uptake as the intracellular glucose is metabolized or converted into glycogen.
Conversely, when glucose levels are low, the liver needs to export glucose to the
plasma. This is achieved by GLUT2 coupled with the regulated phosphorylating
activity of hexokinase IV. Thus, during periods of glycogen synthesis hexokinase
IV is up-regulated and increases the formation of glucose-6-phosphate (Magnuson
, 1989). This provides the precursor for glycogen synthesis and glycolysis and
maintains intracellular glucose concentration low, which in turn drives the influx
of glucose. In contrast, during glycogenolysis and gluconeogenesis, hexokinase
IV is down-regulated, intracellular glucose concentration becomes greater than in
the plasma and there is a net efflux of glucose.

In order to regulate insulin secretion, pancreatic-cells need to be highly sensitive

to changes in plasma glucose concentrations. Therefore, a low-affinity transporter,
such as GLUT2 will not be saturated at physiological levels and glucose flux will
be proportional to plasma glucose concentration. As in the liver, hexokinase
regulates the entry of glucose into the glycolytic pathway and, along with GLUT2,
plays a role in glucose sensing by ß-cells (Hughes , 1992; German, 1993;
Heimberg , 1993).

Interestingly in pancreatic cancer cells it is GLUT1 (Boden , 1994) which is

over-expressed while GLUT2 (Seino ,1993) and GLUT4 (Reske , 1997)
expression are reduced, suggesting GLUT1 is the predominant mechanism of
glucose transport in these cancers. Despite this, several pancreatic cell lines have
been isolated which express GLUT2 (see Table 4). To date, in liver derived
(hepatoma) cancer cell lines, only GLUT1 has been demonstrated to be present.

The small intestine and kidney express the isoforms GLUT1, GLUT2, GLUT3,
GLUT5 and the Na+-dependent glucose transporter. GLUT2 is the primary
isoform responsible for transport across the basolateral membrane of intestinal
epithelial cells (Thorens , 1990) while GLUT5 mediates fructose uptake from
the intestinal lumen and efflux from the intestinal epithelia (Blakemore ,
1995). GLUT2 can also transport fructose but with a six-fold lower affinity than
GLUT5 (Colville , 1993). Human digestive tract cancers (gastric and
colorectal) show a distribution of GLUT over-expression with GLUT1, GLUT 2
and GLUT4 over-expressed. As a means of studying GLUT signaling, numerous
gastric and colorectal cell lines have been established which express one or more
of the isoforms GLUT 1-GLUT5 (Table 4).

TABLE 4

GLUT Expression in Human Cancer Cell Lines.

The GLUT family members reported here refer only to the glucose transporters reported in the
corresponding papers
and thus do not necessarily suggest over-expression of these transporters in relation to non-
cancerous tissue of
origin or the absence of other family members in these cell lines.

Glut
Tissue Origin Denomination Source
Expression

Acetabulum HT-1080 Glut 1 Waki , 1998

 (presumed)
Glut 1
Bone HOS Waki , 1998
(presumed)
Glut 1
Brain Hs 683 Waki , 1998
(presumed)
Glut 1
Brain H4 Waki , 1998
(presumed)
Glut 1
Brain A-172 Waki , 1998
(presumed)
Breast MDA-MB-231 Glut 1, 3 Aloj , 1999
Grover-McKay ,
Breast MDA-MB-435 Glut 1, 2, 5
1998
Grover-McKay ,
Breast MDA-MD-231 Glut 1
1998
Breast 13762 Glut 4 Ara , 1998
Breast MDA-468 Glut 1, 2, 5 Zamora-leon , 1996
Breast T47D Glut 1 Aloj , 1999
Breast MCF-7 Glut 1, 3 Aloj , 1999
Gover-McKay ,
Breast MCF-7 Glut 1
1998
Breast MCF-7 Glut 1, 2, 5 Zamora-Leon , 1996
Rivenzon-Segal ,
Breast T47D Glut 1, 2, 3, 4
2000
Cervical HeLa Glut 1 Kitagawa , 1995
Choriocarcinoma BeWo Glut 1, 3 Ogura , 2000
Choriocarcinoma JEG-3 Glut 1, 3 Hahn , 1998
Choriocarcinoma JAr Glut 1, 3 Clarson , 1997
Choriocarcinoma BeWo Glut 1, 5 Shah , 1999
Colorectal CaCo-2 (PD7) Glut 5 Mesonero , 1995
Colorectal Caco-2 Glut 1, 3, 5 Aloj , 1999
Matosin-Matekalo ,
Colorectal Caco-2 Glut 5
1999
Colorectal LS180 Glut 1 Waki , 1998
Colorectal LS180 Glut1 Fujibayashi , 1997
Colorectal Caco-2 Glut 1, 3, 5 Harris , 1992
Colorectal Caco-2 Glut 2, 5 Brot-Laroche 1996
Colorectal Caco-2 (clones) Glut 1, 2, 3, 5 Mahraoui , 1994
Glut 1
Colorectal Caco2 Waki , 1998
(presumed)
Glut 1
Colorectal WiDr Waki , 1998
(presumed)
Glut 1
Colorectal LS 174T Waki , 1998
(presumed)
Epidermoid A431 Glut 1 Aloj , 1999
Gastric MKN45 Glut 1, 4 Noguchi , 1999
Gastric MKN 28 Glut 4 Noguchi , 1999
Gastric STKM1 Glut 4 Noguchi , 1999
Insulinoma CM Glut 1, 2 Baroni , 1999
 Leukemia K562 Glut 1 Ahmed , 1999
Leukemia U937 Glut 1 Ahmed , 1999
Leukemia U937 Glut 1, 5 Rivas , 1997
Leukemia HL60 Glut 1 Ahmed , 1999
Leukemia HL60 Glut 1 Chan , 1999
Vera , 1994, Rivas
Leukemia HL60 Glut 1, 5
, 1997
Leukemia K562 Glut 1 Cloherty , 1996
Leukemia Jurkat Glut 1 Berridge , 1996
Leukemia ACH2 Glut 1 Rivas , 1997
Leukemia 3BH9 Glut 1 Rivas , 1997
Leukemia U1 Glut 1, 5 Rivas , 1997
Leukemia CEM Glut 1 Rivas , 1997
Leukemia H9 Glut 1 Rivas , 1997
Liver Hep3B Glut 1 Iliopoulos , 1996
Liver HepG2 Glut 1 Younes , 2000
Liver HepG2 Glut 1 Aloj , 1999
Nasal septum RPMI 2650 Glut 1 (presumed) Waki , 1998
Oral OSCCs Glut 1, 2, 4 Fukuzumi , 2000
Ovarian HTB 771P3 Glut 1 Clavo , 1995
Ovarian A2780S Glut 1 Cantuaria , 2000
Ovarian A2780cP Glut 1 Cantuaria , 2000
Pancreatic beta-TC6-F7 Glut 2 Knaack , 1994
Papadopoulos ,
Pancreatic HP-62 Glut 2
1996
Renal 786-0 Glut 1 Iliopoulos , 1996
Retinoblastoma Y79 Glut 1, 4 Tsukamoto , 1997
Retinoblastoma WERI-Rb1 Glut 1, 3 Tsukamoto , 1997
Rhabdomyosarcoma RD (18) Glut 1, 3, 4 Ito 2000
Skin HTB 63 Glut 1 Clavo , 1995
Glut 1
Skin A-375 Waki , 1998
(presumed)

SIGNALING PATHWAYS IN GLUT TRANSLOCATION

Studies in adipose, heart and skeletal muscle have shown that insulin-induced
translocation of GLUT4 is mediated by phosphatidylinositol-3-kinase (PI3K), as
has been shown using wortmannin, a potent inhibitor of the enzyme (Lee ,
1995).

One possible mechanism for GLUT4 translocation is through the activation of

protein kinase Bb/Akt2, a downstream target of PI3K (Table 5). Intracellular
GLUT4-containing vesicles have a high basal level of PI4K activity. Insulin
stimulation targets PI3K to these vesicles leading to the accumulation of these
enzymes which act as docking sites for the recruitment and activation of Akt2.
Akt2 phosphorylates vesicular proteins, including GLUT4, which causes the
dissociation of the vesicles from an intracellular anchor and subsequent fusion
with the plasma membrane (Kupriyanova & Kandror, 1999). Although the
consensus is that PI3K is involved in insulin-stimulated GLUT4 translocation, it is
not clear whether other parallel pathways exist. There is evidence that the GTP-
binding protein Gq can couple to GLUT4 translocation in adipocytes. This
pathway is PI3K independent, requires tyrosine kinase activation and its inhibition
prevents insulin-stimulated GLUT4 translocation (Kanzaki , 2000) (Table 5).
This data suggests that insulin causes GLUT4 translocation though at least two
independent pathways in adipocytes.

Ischemia, hypoxia and contraction cause GLUT4 translocation through a PI3K

independent pathway (Lee , 1995; Yeh , 1995; Egert , 1997).
Moreover, we have shown that lactate also induces translocation of GLUT1 and
GLUT4 to the plasma membrane, in the rat heart, through a PI3K independent
pathway (Medina , 2002). This suggests that a common pathway based on
metabolic stress is shared between hypoxia-, ischemia- and contraction-stimulated
translocation of GLUT4. Since a common factor to all these conditions is the
production and accumulation of lactate, these findings support our hypothesis that
lactate may be involved in the cancer and metabolic stress-induced translocation
of the glucose transporters (Medina , 2002).

A potential regulator of the pathway involved in metabolic stress-induced

translocation of GLUT4 is AMP-activated protein kinase (AMPK) (Table5).
Previous studies have shown that myocardial ischemia (Kudo, 1996) and skeletal
muscle contraction (Winder and Hardie, 1996) activate AMPK and that activation
of AMPK increases glucose uptake which is not inhibited by wortmannin. Finally,
it has been shown that AMPK activation causes the translocation of myocardial
GLUT4 and increases glucose uptake (Russell , 1999) (Table 5).

TABLE 5
Regulators and signaling pathways involved in glucose transport.

Regulator Pathway GLUT Isoform Cell type Reference

Czech&Corvera,
Insulin IR, PI3K GLUT4 Muscle, fat
1999
IGF-IR,
IGF-I GLUT4 Muscle, fat Jullien et al, 1995
PI3K
IGF-IR,
IGF-II GLUT4 Muscle, fat Burguera et al, 1994
PI3K
GLUT4,
Contraction AMPK Skeletal muscle Hayashi et al, 1998
GLUT1?
Ischemia AMPK GLUT4 Heart muscle Russell et al, 1999
Hypoxia AMPK? GLUT4 Skeletal muscle Zierath, 1998
Presumed
Nitric oxide cGMP Skeletal muscle Young et al, 1997
GLUT4
 Presumed
Phorbol ester PKC Skeletal muscle Hansen et al, 1997
GLUT4
a-Adrenergic
Gs protein GLUT4 Brown fat, muscle Shimizu et al, 1996
agonists
Presumed
b-Adrenergic agonist Gi protein Heart muscle Fischer et al, 1996
GLUT4
Bradykinin Gq protein GLUT3 Skeletal muscle Kishi et al, 1998
Thrombin Gi protein GLUT3 Platelets Heijnen et al, 1997
White and brown
Adenosine Gq protein GLUT4 Smith et al, 1984
fat

HORMONAL CONTROL OF GLUT EXPRESSION

Given the physiological importance of glucose uptake it is not surprising that

GLUT expression is regulated, to some degree, by almost all of the know
hormones. Insulin possesses long-term effects on GLUT content. Prolonged
exposure to insulin, as occurs in type II diabetes, causes an increase in GLUT1
protein levels (Ciaraldi , 1995). This is the result of enhanced GLUT1 mRNA
transcription (Garcia de Herreros & Birnbaum, 1989) and a rise in GLUT1 mRNA
half-life (Maher & Harrison, 1990). Nuclear hormone receptor ligands such as
testosterone, glucocorticoids, retinoic acid and thyroid hormones have been
shown to alter GLUT expression (Rincon , 1996; Sakoda ,2000;
Rivenzon-Segal et al, 2001; Matosin-Matekalo ,1999, respectively). Further
reports have demonstrated that prolactin (Haney 2001), follicle stimulating
hormone (FSH) (Kodaman and Behrman, 1999), noradrenaline and the
antidiuretic hormone, vasopressin (Vannucci , 1994) can also mediate
expression. Of particular interest to the authors is the role played by the female
sex steroid hormones estrogen and progesterone in GLUT expression and the
relation with endocrine cancers.

Sexual dimorphism exists in glucose metabolism. The role of sex hormones in this
metabolism is apparent in the fetal rat where males demonstrate delayed lung
maturation. This delay is speculated to be in part due to the predominantly female
sex hormone estrogen causing an increase in GLUT1, and consequently an
increase in glucose transport, in the female rat lung in comparison to the male
(Hart , 1998). Additional work in the rat model has demonstrated that glucose
uptake is impaired by the absence of estrogen or by the presence of progesterone.
This suggests that estrogen increases metabolic activity and this process is finely
regulated by the balance between estrogen and progesterone (Campbell and
Febbraio 2001). In the aforementioned study, progesterone decreased GLUT4 in
skeletal and adipose tissue, yet interestingly in another study of rat adipose tissue,
physiological doses of estrogen or progesterone did not alter GLUT4 expression,
while higher than physiological doses or the simultaneous co-addition of
physiological doses of both hormones reduced GLUT4 (Sugaya , 2000;
Sugaya , 1999). This indicates the complex interaction between signaling
pathways can produce differing responses to steroid hormones in the same tissue
or cell line. At any given time, the presence, absence or the activation level of
stimuli, such as insulin-like growth factor (IGF) and insulin, is different. Thus the
observed paradoxical results in response to sex steroid hormones may demonstrate
that cross-talk with other growth factors can differentially regulate the GLUT
family members.

In the Rhesus monkey brain, GLUT3 and GLUT4 expression is observed in the
corticol neurones and GLUT1 in the capillaries and glial cells. Estrogen
administration increased GLUT3 and GLUT4 expression and increased
paranchymal if not vascular GLUT1 expression (Cheng , 2001). In this same
study estrogen also increased the production of the IGF, suggesting that this
growth factor plays a co-regulatory role in glucose uptake. In support of this
argument, in mouse oocyte maturation the estrogen increase in GLUT1 expression
was significantly lower in the absence of IGF (Zhou , 2000). The breast
cancer drug Tamoxifen which possesses both estrogenic and anti-estrogen
activities depending on both the target gene and tissue, also increased GLUT3 and
GLUT4 in the Rhesus monkey brain, perhaps suggesting that the protective
estrogenic effect in the brain is connected to GLUT regulation, and that
Tamoxifen and other selective estrogen receptor modulators (SERMs) could
confer some of these protective effects on the human brain (Cheng , 2001). In
agreement with this hypothesis, estrogen was shown to increase GLUT1 and
protect against brain capillary endothelial cell loss in reduced glucose conditions
and anoxia (Shi , 1997) and reduce glucose transport inhibition in
synaptosomes from the rat cerebral hemisphere (Keller , 1997).

To further dissect the mechanism of estrogen action Welch and Gorski (1999)
demonstrated that in the rat uterus, estrogen increased glucose uptake in what
appears to be both a transciptionally-independent and dependent mechanism.
Estrogen causes an increase in glucose uptake in less than two hours and
continues beyond eight hours. This early timeframe appears to suggest
transcriptional independence, a theory that is confirmed by insensitivity to
cyclohexamide and the observation that estrogen does not increase GLUT1
mRNA levels or GLUT1 and GLUT4 protein levels until after four hours of
treatment. Presumably after eight hours, when levels of GLUT1 and GLU4 are
elevated in response to estrogen, these proteins translocate to the membrane and
augment glucose uptake. The possibility that at less than two hours estrogen
induced glucose uptake was via translocation to the membrane was ruled out by
the demonstration that both GLUT1 and GLUT4 localization was unchanged.
This suggests that a GLUT1 and GLUT4-independent pathway is responsible for
glucose uptake or that estrogen treatment causes a modification in the membrane
localized GLUT proteins, thus facilitating glucose uptake. A conclusion from
several publications is that hormone regulated glucose transport is not solely
mediated by glucose transporters. In breast cancer biopsies no positive
relationship was found between glucose uptake, determined by FDG, and
expression of GLUTs (Avril , 2001). In comparison of two cell lines Aloj
, (1999) reported that higher levels of glucose transporter protein do not
guarantee increased glucose uptake. Marom , (2001) demonstrated that
GLUT1 and GLUT3 transporter expression did not demonstrate a statistically
significant correlation with FDG uptake in potentially resectable lung cancer.
These results could be explained if it is the glucose phosphorylation, by
hexokinase, and not the glucose transport which is the rate-limiting step in
glucose uptake.

Collison , (2000) reported that in adipocytes estrogen treatment resulted in a

reduction in the ability of insulin to stimulate glucose transport, demonstrating
interaction between these two major signaling cascades, some of which have
already been mentioned (Table 5). Previous work has demonstrated that estrogen
and progesterone receptors can become transcriptionally active by the
phosphorylation cascades set in motion by membrane receptors such as IGF and
insulin (Klotz et al, 2002; Quesada and Etgen, 2001). Conversely, estrogen can
impinge on the calcium, cAMP and phosphorylation pathways and thus mediate
cell-specific responses (Flototto , 2001). To further elucidate these signaling
pathway interactions cells are transfected with luciferase reporter constructs under
the control of the GLUT promoters. In an example of this technique Montessuit
&Thorburn (1999) demonstrated that 12-O-tetradecanoylphorbol-13-acetate
(TPA) induced transcription from the GLUT1 promoter.

The breast and uterine endometrium are two of the classical target tissues for sex
steroid hormone action. GLUT1, which is expressed in mammary tissue under
normal conditions, is over-expressed in breast cancer tissue and has a high
association with metastasis. As breast cancers are predominantly estrogen-driven,
this suggests a correlation between GLUT expression and estrogen. Although
aforementioned work in the rat and monkey has demonstrated such a relationship,
Avril and colleagues (2001) reported that there was no correlation between
estrogen receptor status and GLUT expression. The role of estrogen in GLUT
over-expression remains elusive especially since it has been observed that in
many advanced breast cancers estrogen receptor expression is lost. Both breast
cancer biopsies and isolated cell lines have been shown to express GLUT5
(Zamora-Leon , 1996). GLUT5 is not expressed under normal conditions in
the breast and is only expressed by a few tissues in the body, thus suggesting that
breast cancers are utilizing fructose as an energy source in uncontrolled
proliferation.

SUMMARY

Glucose is an important substrate for ATP production in all mammalian cells.

However, because of its hydrophilic nature, it cannot enter the cell by simple
diffusion.

For this it requires specific facilitative transport proteins which are subject to
hormonal and environmental control.

The fact that glucose, and possibly fructose, is the only utilizable substrate
available for energy production to ischemic cancers suggests that GLUTs have
great therapeutic potential in combating this disease. This potential is not solely as
prognostic markers, through their association with metastasis and thus poor
patient prognosis, but also as direct targets of clinical intervention. Further
therapeutic potential may be derived from a better understanding of the
coordination between signaling pathways such as IGF, insulin and hormones, and
with this knowledge the design of drugs to exploit this interaction for patient gain.
To better understand this signaling pathway association, numerous cancer cell
lines exist which express the GLUT1 through GLUT 5 family members (and
potentially other members, Table 1). These cell lines (Table 4) will provide useful
experimental models in which interactions can be dissected, prognostic markers
characterized and potential drugs designed, before their transference to the clinic.

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