Fig. 9

Schematic diagram showing that hypoxia can upregulate a lipid metabolism-related gene ACSS2 in pNENs, and the upregulated ACSS2 gene in pNENs can enhance lipid metabolism reprogramming, which further regulated the expression of HMGCS1 to affect the PI3K/AKT/mTOR pathway to promote the progression of pNENs. In addition, we found that HMGCS1 can reverse the regulation of lipid metabolism exerted by ACSS2, as well as the pro-tumorigenic role of ACSS2 in pNENs, which has also been detected in vitro and in vivo