Glucose restriction reprograms lipid metabolism and enhances immunotherapy through ZNRF3-Wnt-SCD signaling axis

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Abstract
Background: Glucose restriction is a hallmark of the tumor microenvironment (TME), yet how tumor cells adapt to this metabolic stress and the impact of metabolic reprogramming on the TME remains incompletely understood. Methods: A genome-wide CRISPR knockout positive screen was performed to identify key mediators of cellular adaptation to glucose restriction. Using biochemistry, molecular biology, metabolomics and confocal immunofluorescent microscopy to elucidate the underlying molecular mechanisms. Additionally, single-cell RNA sequencing and orthotopic tumor models were used to characterize TME remodeling and assess therapeutic efficacy. Results: We identified zinc and ring finger 3 (ZNRF3) as a key mediator of cellular adaptation to glucose restriction through genome-wide CRISPR/Cas9 screening. Multiple tumor cells adaptively survived in glucose-restricted conditions with downregulated ZNRF3. Mechanistically, low glucose suppresses ZNRF3 expression, leading to Wnt pathway activation and subsequent transcriptional repression of stearoyl-CoA desaturase (SCD). This metabolic rewiring enhances antitumor immunity by increasing T-cell infiltration and cytotoxicity. In multiple preclinical models, dietary glucose restriction synergizes with immune checkpoint blockade to suppress tumor growth. Conclusion: These findings establish the ZNRF3-Wnt-SCD axis as a metabolic checkpoint controlling tumor cell fate under glucose restriction and provide a rationale for combining dietary intervention with immunotherapy.
Funding Information
  • National Natural Science Foundation of China (82225033)
  • National Natural Science Foundation of China (82302943)
  • National Natural Science Foundation of China (U24A6012)
  • Shenzhen Medical Research Fund (C2401004)
  • Young Elite Scientists Sponsorship Program by CAST (2023QNRC001)
  • the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (2021-I2M-1-067)
  • the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (2023-I2M-2-004)
  • the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (2025-I2M-FGS-002)
  • the Special Research Fund for Central Universities, Peking Union Medical College (3332023030)
  • the Special Research Fund for Central Universities, Peking Union Medical College (3332024144)
  • CAMS Innovation Fund for Medical Sciences (2024-I2M-C&T-B-058)
  • Noncommunicable Chronic Diseases-National Science and Technology Major Project (2024ZD0533300)
  • China Postdoctoral Science Foundation (2023M730326)
  • China Postdoctoral Science Foundation (2024T170073)
  • Postdoctoral Fellowship Program of China Postdoctoral Science Foundation (GZB20230082)

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