Cited by 401Cancer, Hypoxia, and MetabolismImmune cells in cancerCancer Immunotherapy and Biomarkers

The DOI matches its Crossref record; 205 of the 205 references it cites were found in a registry or an index; 11 of the 300 sources its claims cite were checked for support.

Coupling Krebs cycle metabolites to signalling in immunity and cancer

Open access

Abstract

Metabolic reprogramming has become a key focus for both immunologists and cancer biologists, with exciting advances providing new insights into the mechanisms underlying disease. There is now extensive evidence that intermediates and derivatives of the mitochondrial Krebs cycle—metabolites traditionally associated with bioenergetics or biosynthesis—also possess ‘non-metabolic’ signalling functions. In this review, we summarize the non-metabolic signalling mechanisms of succinate, fumarate, itaconate, 2-hydroxyglutarate isomers (d-2-hydroxyglutarate and l-2-hydroxyglutarate) and acetyl-CoA, with a specific focus on how such signalling pathways alter immune cell and transformed cell function. We believe that the insights gained from immune and cancer cells that are summarized here will also be useful for understanding and treating a range of other diseases. Intermediate metabolites of the Krebs cycle serve bioenergetic and biosynthetic needs but have recently also been linked to signalling. The authors of this Review summarize such non-metabolic signalling functions of succinate, fumarate, itaconate, 2-hydroxyglutarate isomers and acetyl-CoA in both immune cells and cancer cells.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that Krebs cycle intermediates—succinate, itaconate, fumarate, 2-HG, and acetyl-CoA—act as signalling molecules in immune cells and cancer beyond bioenergetics. It synthesizes mechanisms by which these metabolites alter inflammation, epigenetics, and tumorigenesis, and discusses therapeutic implications.

Key findings

  • Succinate accumulates in LPS/IFN-γ-treated macrophages and promotes inflammation via SUCNR1, HIF-1α stabilization, mtROS/RET at complex I, succinylation, and epigenetic regulation; SDH inhibition by DMM/malonate reduces LPS-induced HIF-1α, IL-1β, and ROS and boosts IL-10/IL-1RA.
  • Itaconate, produced by IRG1/CAD from cis-aconitate, is anti-inflammatory: it inhibits SDH, induces Nrf2 via KEAP1 cysteine alkylation (e.g., C151), and can regulate the IκBζ–ATF3 axis; 4-OI was protective in LPS lethality. In peritoneal tumours, tumour-infiltrating macrophage-derived itaconate boosted OXPHOS/mtROS/MAPK and tumour growth.
  • Fumarate acts as an oncometabolite and immunomodulator: FH mutations cause HLRCC; fumarate succinates KEAP1, GAPDH, ACO2, and Fe-S proteins, inhibits α-KGDDs/TETs/JMJDs, drives pseudohypoxia and EMT; in β-glucan-trained monocytes fumarate accumulation is required for trained immunity and H3K4me3 at Tnf/Il6.
  • 2-HG enantiomers regulate immunity/cancer: D-2-HG from mutant IDH1/2 inhibits α-KGDDs (KDM IC50 24–106 μM; FIH 1.5 mM; PHD2 7.3 mM) and accumulates up to 35 mM in IDH-mutant glioma; L-2-HG rises up to 1.5 mM in TCR-triggered mouse CD8+ T cells and enhances anti-tumour capacity. Acetyl-CoA from citrate via ACLY supports histone acetylation and immune/tumour gene expression.

Methods

  • Narrative review; no primary experimental design, sample, or dataset is reported.
  • Synthesizes published literature on succinate, itaconate, fumarate, 2-HG, and acetyl-CoA in immunity and cancer; no systematic search strategy, inclusion criteria, or meta-analysis is described.
  • Main analysis is conceptual/mechanistic synthesis with figures and therapeutic discussion.

Limitations

  • Stated: limited human and in vivo data; rapid steady-state metabolism makes accurate in vivo snapshots challenging; human immune cell studies are limited.
  • Stated: many open questions remain about metabolite ratios/compartments, unidentified GPCRs/transporters, and whether metabolites are biomarkers or drivers; oncometabolite findings often come from rare cancer syndromes.
  • Evident: as a narrative review, it does not systematically assess evidence quality or quantify bias; many mechanistic claims rely on mouse/cell-line studies and cited primary papers.

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Integrity signals

Registry

Crossref · 10.1038/s42255-018-0014-7

Cites

205 of 205 references verified0 citation errors · 0 not checkable

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217 Not checked yet · 21 Own interpretation · 6 No basis given · 4 Couldn’t confirm · 2 Partly supported · accuracy not yet measured

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Metadata

Authors
Ryan, D. G., Murphy, M. P., Frezza, C., Prag, H. A., Chouchani, E. T., O’Neill, L. A., & Mills, E. L.
Affiliations
  • Trinity College Dublin (IE)
  • University of Cambridge (GB)
  • Harvard University (US)
Venue
Nature Metabolism
Published
2018-12-30
Volume
1
Issue
1
Pages
16-33
ISSN
2522-5812 (ISSN-L)
OpenAlex
W2907926991
Cited by
398
References
204
Citations by year
2026: 35 · 2025: 39 · 2024: 70 · 2023: 41 · 2022: 66 · 2021: 66 · 2020: 61 · 2019: 20
FWCI
3.82
Type
journal article
Language
en
Open access
Locations
  • Nature Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion)
  • Apollo (University of Cambridge) (submittedVersion)
  • Apollo
Funders
  • Wellcome Trust (110158/Z/15/Z, 205455, 110159/Z/ 15/Z, 109443/Z/15/Z)
  • Medical Research Council (MC_UU_00015/3, MC_UU_12022/6)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Hypoxia, and Metabolism
  • Life Sciences › Immunology and Microbiology › Immunology › Immune cells in cancer
  • Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
Keywords
Krebs cycle metabolites, metabolic reprogramming, succinic acid, fumarate, itaconate, 2-hydroxyglutarate, acetyl-CoA, immune cell function, cancer, carcinogenesis, tumor immunology, therapeutic target
MeSH terms
Citric Acid Cycle, Humans, Immunity, Innate, Macrophages, Neoplasms, Succinate Dehydrogenase, Succinates, Signal Transduction, Succinic Acid

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