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ARTICLE

SDHA Deficiency in Hepatocellular Carcinoma Promotes Tumor Progression through Succinate-Induced M2 Macrophage Polarization

Xinyang Li1,2,3,#, Luyuan Ma1,2,3,#, Chuan Shen1,2,3, Ruolan Gu1,2,3, Shilong Dong1,2,3, Mingjie Liu1,2,3, Ying Xiao1,2,3, Wenpeng Liu1,2,3, Yuexia Liu1,2,3, Caiyan Zhao1,2,3,*
1 Department of Infectious Diseases, Hebei Medical University Third Hospital, Shijiazhuang, 050000, China
2 Clinical Research Center for Infectious Disease of Hebei Province, Shijiazhuang, 050000, China
3 Hebei Key Laboratory for Diagnosis, Treatment, Emergency Prevention and Control of Critical Infectious Diseases, Shijiazhuang, 050000, China
* Corresponding Author: Caiyan Zhao. Email: email
# These authors contributed equally to this work
(This article belongs to the Special Issue: Targeting the Tumor Microenvironment: Emerging Insights into Cancer Progression and Therapeutics)

Oncology Research https://doi.org/10.32604/or.2025.073179

Received 12 September 2025; Accepted 12 November 2025; Published online 08 December 2025

Abstract

Background: Hepatocellular carcinoma (HCC) is an aggressive and lethal malignancy. Metabolic reprogramming dynamically remodels the tumor microenvironment (TME) and drives HCC progression. This study investigated the mechanism through which metabolic reprogramming remodels the TME in HCC. Methods: HCC patient transcriptome data were subjected to bioinformatics analysis to identify differentially expressed genes and immune infiltration status. Immunohistochemical analysis was performed to determine the correlation between succinate dehydrogenase complex subunit A (SDHA) expression and M2 macrophage infiltration. SDHA-knockdown or SDHA-overexpressing HCC cells were used for in vitro experiments, including co-culturing, flow cytometry, and enzyme-linked immunosorbent assay. Western blotting assay, functional assays, and subcutaneous tumor model mice were used to elucidate the molecular mechanisms underlying succinate-mediated HCC cell-macrophage interactions in the TME. Results: Higher infiltration of M2 macrophages correlated with worse prognosis in HCC patients. SDHA was downregulated in HCC tumor tissues and showed a negative correlation with M2 macrophage infiltration. SDHA knockdown promoted M2 macrophage polarization, whereas SDHA overexpression reversed this effect. Mechanistically, SDHA deficiency in HCC cells induced succinate accumulation, which promoted M2 macrophage polarization by activating the G protein-coupled receptor 91 (GPR91)/signal transducer and activator of transcription 3 (STAT3) pathway. Concurrently, succinate stimulation enhanced mitochondrial oxidative phosphorylation in M2 macrophages, thereby promoting HCC progression. Serum succinate levels were elevated in HCC patients. The receiver operating characteristic curve analysis indicated that serum succinate is a promising diagnostic marker for HCC (area under the curve = 0.815). Conclusion: SDHA deficiency leads to succinate accumulation, which promotes M2 macrophage polarization through the GPR91/STAT3 pathway, thereby facilitating HCC progression. Based on these findings, serum succinate could be a promising diagnostic biomarker for HCC.

Keywords

Hepatocellular carcinoma; metabolic reprogramming; tumor microenvironment; succinate; M2 macrophage; succinate dehydrogenase complex subunit A (SDHA); G protein-coupled receptor 91 (GPR91)

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