The inhibitory effect of hepatic cancer energy metabolism on immune checkpoint therapy: perspectives from single-cell multi-omics analysis

Objective: To investigate metabolic reprogramming-especially pyruvate metabolism-in hepatocellular carcinoma (HCC) before and after immune checkpoint inhibitor (ICI) therapy, construct a metabolism-related prognostic model, and evaluate the therapeutic potential of targeting LDHA. Methods: xenograft experiments combining the LDHA inhibitor (R)-GNE-140 with a PD-1 antibody. Results: Post-ICI, HCC cells upregulated pyruvate metabolism genes (LDHA, LDHB, LDHD) but showed decreased glycolysis, lactate buildup, reduced acetylation, and suppressed TCA cycle with AMPK activation. Key transcription factors (MYC, SP5, HLF, SREBF1) were identified. CellChat revealed enhanced SPP1-CD44 and APOA1-ABCA1 signaling. Pseudotime analysis indicated terminal hepatocyte differentiation. The pyruvate metabolism-based signature predicted prognosis effectively. Combination therapy with (R)-GNE-140 and PD-1 blockade inhibited Huh7 proliferation, migration, and xenograft tumor growth without liver or renal toxicity. Conclusion: ICI therapy induces metabolic remodeling in HCC, marked by pyruvate metabolism dysregulation and lactate accumulation, contributing to resistance. Dual targeting of LDHA and PD-1 enhances antitumor efficacy, and the identified metabolic signature may serve as a prognostic biomarker and therapeutic target.