Figure 3.

Metabolic pathways in which succinate dehydrogenase (SDH) loss is involved, including glycolysis, tricarboxylic acid cycle and anaplerotic reactions. The first step in glycolysis is the phosphorylation of glucose to glucose‐6‐phosphate by hexokinase¹. Lactate dehydrogenase A (LDH‐A)² catalyzes the conversion of pyruvate and lactate with concomitant conversion of nicotinamide adenine dinucleotide (NADH) and NAD⁺. Pyruvate carboxylase³ catalyzes the conversion of pyruvate to oxaloacetate. Proposed metabolic changes in SDH loss are enhanced glycolysis, via activation of LDH‐A and hexokinase. Furthermore, pyruvate carboxylase may be upregulated in SDH loss and there may be an increased glutamine metabolism. A more detailed explanation is described in the text