Methylglyoxal in cancer: Bidirectional regulatory networks and precision intervention—From metabolic reprogramming to cross-disease synergistic targeting

Methylglyoxal (MG), a core byproduct of glycolysis, exerts a dual role in cancer via a "dose-dependent hormesis effect". At low concentrations, it promotes tumor proliferation and metastasis by regulating polyamine metabolism, epigenetic modifications, and the immune microenvironment. In contrast, high concentrations of MG trigger tumor cell apoptosis through inducing DNA damage and protein glycation. Unlike traditional reviews that focus solely on "MG toxicity" or "GLO1 as a single target", this review takes "metabolic network-signal crosstalk-cross-disease association" as the core context. It systematically dissects the bidirectional regulatory mechanisms of MG in cancer, highlights emerging pathways such as non-coding RNA-mediated GLO1 regulation, MG-polyamine metabolism crosstalk, and immunometabolic reprogramming, and integrates the MG regulatory network in cross-disease scenarios including diabetes, HIV infection, and occupational exposure. Finally, a "stratified targeting + synergistic intervention" precision therapeutic strategy is proposed, providing a novel perspective for basic research and clinical translation of MG-related cancers.