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BACKGROUND & AIMS: Cancer cell metabolism is considered to be an effective target of antitumor therapy. In cancer cells, inactivation of AMP-activated protein kinase (AMPK), an intracellular energy sensor, facilitates aerobic glycolysis and de novo lipogenesis, promoting tumor progression and malignant transformation. Therefore, activation of AMPK is a potential strategy to control tumor cell growth by regulating tumor cell metabolism. Recently, we found that retinoic acids, vitamin A derivatives, activate AMPK in hepatocellular carcinoma (HCC) cells. In this study, we examined the enhancing effect of retinoids on anti-cancer drugs and its effect to the metabolic pathway in HCC cells. METHODS: Cytotoxic effect of five anti-cancer drugs (adriamycin, cisplatin, mitomycin, sorafenib, 5-FU) was examined by WST assay in HepG2 cells treated with anti-cancer drugs alone or in combination with natural and synthetic …