ACSL4 as a context-dependent metabolic switch in hepatocellular carcinoma: implications for ferroptosis and immunotherapy

T cell-mediated oxidative killing. This apparent paradox can be reconciled by conceptualizing ACSL4 as a context-dependent metabolic switch. Its biological output is dynamically tuned by therapeutic modality, microenvironmental redox conditions, post-transcriptional regulation (e.g., miR-23a-3p and miR-145-5p), post-translational modification (e.g., SIAH2-mediated ubiquitination), and substrate flux partitioning. Through these multilayered regulatory mechanisms, ACSL4 integrates lipid remodeling with ferroptotic sensitivity and tumor-immune interactions within the tumor microenvironment. In this mini-review, we synthesize recent mechanistic and translational findings to propose a unifying framework for ACSL4 function in HCC. Understanding ACSL4 as a metabolic switch rather than a static oncogenic factor may enable rational design of ferroptosis-enhancing and immunometabolic therapeutic strategies and support biomarker-guided precision medicine in HCC.