Theranostics 2021; 11(8):3595-3606. doi:10.7150/thno.51265

Research Paper

Vitamin C activates pyruvate dehydrogenase (PDH) targeting the mitochondrial tricarboxylic acid (TCA) cycle in hypoxic KRAS mutant colon cancer

Aiora Cenigaonandia-Campillo1, Roberto Serna-Blasco2, Laura Gómez-Ocabo1, Sonia Solanes-Casado1, Natalia Baños-Herraiz1, Laura Del Puerto-Nevado1, Jose Antonio Cañas3, María Jesús Aceñero4, Jesús García-Foncillas1✉, Óscar Aguilera1,5✉

1. Translational Oncology Division, Oncohealth Institute, IIS-Fundacion Jimenez Diaz-UAM (Madrid), Spain.
2. Hospital Puerta De Hierro Majadahonda, Majadahonda (Madrid), Spain.
3. Department of immunology, IIS-Fundacion Jimenez Diaz-UAM (Madrid), Spain.
4. Hospital General Universitario Gregorio Marañón. Universidad Complutense de Madrid. (Madrid), Spain.
5. Universidad Católica San Antonio (Murcia), Spain.

This is an open access article distributed under the terms of the Creative Commons Attribution License ( See for full terms and conditions.
Cenigaonandia-Campillo A, Serna-Blasco R, Gómez-Ocabo L, Solanes-Casado S, Baños-Herraiz N, Puerto-Nevado LD, Cañas JA, Aceñero MJ, García-Foncillas J, Aguilera Ó. Vitamin C activates pyruvate dehydrogenase (PDH) targeting the mitochondrial tricarboxylic acid (TCA) cycle in hypoxic KRAS mutant colon cancer. Theranostics 2021; 11(8):3595-3606. doi:10.7150/thno.51265. Available from

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Background: In hypoxic tumors, positive feedback between oncogenic KRAS and HIF-1α involves impressive metabolic changes correlating with drug resistance and poor prognosis in colorectal cancer. Up to date, designed KRAS-targeting molecules do not show clear benefits in patient overall survival (POS) so pharmacological modulation of aberrant tricarboxylic acid (TCA) cycle in hypoxic cancer has been proposed as a metabolic vulnerability of KRAS-driven tumors.

Methods: Annexin V-FITC and cell viability assays were carried out in order to verify vitamin C citotoxicity in KRAS mutant SW480 and DLD1 as well as in Immortalized Human Colonic Epithelial Cells (HCEC). HIF1a expression and activity were determined by western blot and functional analysis assays. HIF1a direct targets GLUT1 and PDK1 expression was checked using western blot and qRT-PCR. Inmunohistochemical assays were perfomed in tumors derived from murine xenografts in order to validate previous observations in vivo. Vitamin C dependent PDH expression and activity modulation were detected by western blot and colorimetric activity assays. Acetyl-Coa levels and citrate synthase activity were assessed using colorimetric/fluorometric activity assays. Mitochondrial membrane potential (Δψ) and cell ATP levels were assayed using fluorometric and luminescent test.

Results: PDK-1 in KRAS mutant CRC cells and murine xenografts was downregulated using pharmacological doses of vitamin C through the proline hydroxylation (Pro402) of the Hypoxia inducible factor-1(HIF-1)α, correlating with decreased expression of the glucose transporter 1 (GLUT-1) in both models. Vitamin C induced remarkable ATP depletion, rapid mitochondrial Δψ dissipation and diminished pyruvate dehydrogenase E1-α phosphorylation at Serine 293, then boosting PDH and citrate synthase activity.

Conclusion: We report a striking and previously non reported role of vitamin C in the regulation of the pyruvate dehydrogenase (PDH) activity, then modulating the TCA cycle and mitochondrial metabolism in KRAS mutant colon cancer. Potential impact of vitamin C in the clinical management of anti-EGFR chemoresistant colorectal neoplasias should be further considered.

Keywords: cancer, metabolism, PDK-1, vitamin C, KRAS, chemoresistance, hypoxia