Classical markers for colorectal cancer diagnostics and beyond: emerging roles of CoA metabolism and protein CoAlation

Kulyaba, N. O.; Bdzhola, A. V.; Stasyshyn, A. R.; Filonenko, V. V.; Bidyuk, D. M.

doi:10.7124/bc.000B36

Biopolym. Cell. 2026; 42(2):79-89.

https://doi.org/10.7124/bc.000B36

Reviews

Classical markers for colorectal cancer diagnostics and beyond: emerging roles of CoA metabolism and protein CoAlation

1Kulyaba N. O., 2Bdzhola A. V., 1Stasyshyn A. R., 2Filonenko V. V., 1Bidyuk D. M.

University Hospital of Danylo Halytskyi Lviv National Medical University
69, Pekarska Str., Lviv, Ukraine, 79000
Institute of Molecular Biology and Genetics, NAS of Ukraine
150, Akademika Zabolotnoho Str., Kyiv, Ukraine, 03143

Abstract

Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide. Early diagnosis is essential for the effective treatment selection. Alongside standard clinical and instrumental methods, tumor markers are widely used in CRC diagnostics. The most common serum biomarkers are carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), although their limited sensitivity and specificity at early stages reduce their value for primary screening. Instead, they are mainly used for the disease monitoring. KRAS mutations are important genetic markers in CRC, while profiling of small non-coding RNAs in liquid biopsy is emerging as a promising non-invasive approach for diagnosis and patient stratification. However, most currently available biomarkers are more informative for prognosis and therapy selection than for early detection, emphasizing the need for additional molecular indicators. The recent evidence highlights oxidative stress and redox-dependent protein modifications as key contributors to CRC progression. Reactive oxygen species (ROS) promote genomic instability and regulate signaling pathways and posttranslational protein modifications, including recently characterized Coenzyme A-dependent protein modification (CoAlation). This review integrates classical CRC biomarkers with redox biology and discusses the potential of CoA metabolism and protein CoAlation as novel CRC biomarkers, with particular emphasis on CoA synthase (CoASY) as a possible determinant of therapy resistance.

Keywords: сolorectal cancer, carcinoembryonic antigen (CEA), CA19-9, oxidative stress, protein CoAlation

Full text: (PDF, in English)

References

[1] Patel SG, Karlitz JJ, Yen T, Lieu CH, Boland CR. The rising tide of early-onset colorectal cancer: a comprehensive review of epidemiology, clinical features, biology, risk factors, prevention, and early detection. Lancet Gastroenterol Hepatol. 2022; 7(3):262-74.

[2] Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024; 74(3):229-63.

[3] Biller LH, Schrag D. Diagnosis and Treatment of Metastatic Colorectal Cancer: A Review. JAMA. 2021; 325(7):669-85.

[4] Kanth P, Grimmett J, Champine M, Burt R, Samadder NJ. Hereditary Colorectal Polyposis and Cancer Syndromes: A Primer on Diagnosis and Management. Am J Gastroenterol. 2017; 112(10):1509-25.

[5] Cervantes A, Adam R, Roselló S, Arnold D, Normanno N, Taïeb J, Seligmann J, De Baere T, Osterlund P, Yoshino T, Martinelli E; ESMO Guidelines Committee. Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2023; 34(1):10-32.

[6] Ždralević M, Radović A, Raonić J, Popovic N, Klisic A, Vučković L. Advances in microRNAs as Emerging Biomarkers for Colorectal Cancer Early Detection and Diagnosis. Int J Mol Sci. 2024; 25(20):11060.

[7] Cancer in Ukraine, 2022-2023. Incidence, Mortality, Activities of Oncological Service. Kyiv; 2024.

[8] REACCT Collaborative; Zaborowski AM, Abdile A, Adamina M, Aigner F, d'Allens L, Allmer C, Álvarez A, Anula R, Andric M, Atallah S, Bach S, Bala M, Barussaud M, Bausys A, Bebington B, Beggs A, Bellolio F, Bennett MR, Berdinskikh A, Bevan V, Biondo S, Bislenghi G, Bludau M, Boutall A, Brouwer N, Brown C, Bruns C, Buchanan DD, Buchwald P, Burger JWA, Burlov N, Campanelli M, Capdepont M, Carvello M, Chew HH, Christoforidis D, Clark D, Climent M, Cologne KG, Contreras T, Croner R, Daniels IR, Dapri G, Davies J, Delrio P, Denost Q, Deutsch M, Dias A, D'Hoore A, Drozdov E, Duek D, Dunlop M, Dziki A, Edmundson A, Efetov S, El-Hussuna A, Elliot B, Emile S, Espin E, Evans M, Faes S, Faiz O, Fleming F, Foppa C, Fowler G, Frasson M, Figueiredo N, Forgan T, Frizelle F, Gadaev S, Gellona J, Glyn T, Gong J, Goran B, Greenwood E, Guren MG, Guillon S, Gutlic I, Hahnloser D, Hampel H, Hanly A, Hasegawa H, Iversen LH, Hill A, Hill J, Hoch J, Hoffmeister M, Hompes R, Hurtado L, Iaquinandi F, Imbrasaite U, Islam R, Jafari MD, Kanemitsu Y, Karachun A, Karimuddin AA, Keller DS, Kelly J, Kennelly R, Khrykov G, Kocian P, Koh C, Kok N, Knight KA, Knol J, Kontovounisios C, Korner H, Krivokapic Z, Kronberger I, Kroon HM, Kryzauskas M, Kural S, Kusters M, Lakkis Z, Lankov T, Larson D, Lázár G, Lee KY, Lee SH, Lefèvre JH, Lepisto A, Lieu C, Loi L, Lynch C, Maillou-Martinaud H, Maroli A, Martin S, Martling A, Matzel KE, Mayol J, McDermott F, Meurette G, Millan M, Mitteregger M, Moiseenko A, Monson JRT, Morarasu S, Moritani K, Möslein G, Munini M, Nahas C, Nahas S, Negoi I, Novikova A, Ocares M, Okabayashi K, Olkina A, Oñate-Ocaña L, Otero J, Ozen C, Pace U, São Julião GP, Panaiotti L, Panis Y, Papamichael D, Park J, Patel S, Patrón Uriburu JC, Pera M, Perez RO, Petrov A, Pfeffer F, Phang PT, Poskus T, Pringle H, Proud D, Raguz I, Rama N, Rasheed S, Raval MJ, Rega D, Reissfelder C, Reyes Meneses JC, Ris F, Riss S, Rodriguez-Zentner H, Roxburgh CS, Saklani A, Salido AJ, Sammour T, Saraste D, Schneider M, Seishima R, Sekulic A, Seppala T, Sheahan K, Shine R, Shlomina A, Sica GS, Singnomklao T, Siragusa L, Smart N, Solis A, Spinelli A, Staiger RD, Stamos MJ, Steele S, Sunderland M, Tan KK, Tanis PJ, Tekkis P, Teklay B, Tengku S, Jiménez-Toscano M, Tsarkov P, Turina M, Ulrich A, Vailati BB, van Harten M, Verhoef C, Warrier S, Wexner S, de Wilt H, Weinberg BA, Wells C, Wolthuis A, Xynos E, You N, Zakharenko A, Zeballos J, Winter DC. Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review. JAMA Surg. 2021; 156(9):865-74.

[9] Ruers T, Bleichrodt RP. Treatment of liver metastases, an update on the possibilities and results. Eur J Cancer. 2002; 38(7):1023-33.

[10] Zhang L, Zhang L, Wang H, Chen L, Sui G. Diagnostic performance of contrast-enhanced ultrasound and magnetic resonance imaging for detecting colorectal liver metastases: A systematic review and meta-analysis. Dig Liver Dis. 2019; 51(9):1241-8.

[11] Gold P, Freedman SO. Specific carcinoembryonic antigens of the human digestive system. J Exp Med. 1965; 122(3):467-81.

[12] Hao C, Zhang G, Zhang L. Serum CEA levels in 49 different types of cancer and noncancer diseases. Prog Mol Biol Transl Sci. 2019; 162:213-27.

[13] Fletcher RH. Carcinoembryonic Antigen. Ann Intern Med. 1986; 104(1):66-73.

[14] Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer. Adopted on May 17, 1996 by the American Society of Clinical Oncology. J Clin Oncol. 1996; 14(10):2843-77.

[15] Ballesta AM, Molina R, Filella X, Jo J, Giménez N. Carcinoembryonic Antigen in Staging and Follow-Up of Patients with Solid Tumors. Tumour Biol. 1995; 16(1):32-41.

[16] Koprowski H, Steplewski Z, Mitchell K, Herlyn M, Herlyn D, Fuhrer P. Colorectal carcinoma antigens detected by hybridoma antibodies. Somatic Cell Genet. 1979; 5(6):957-71.

[17] Scarà S, Bottoni P, Scatena R. CA 19-9: Biochemical and Clinical Aspects. Adv Exp Med Biol. 2015; 867:247-60.

[18] Folseraas T, Boberg KM. Cancer Risk and Surveillance in Primary Sclerosing Cholangitis. Clin Liver Dis. 2016; 20(1):79-98.

[19] Li Z, Zhu H, Pang X, Mao Y, Yi X, Li C, Lei M, Cheng X, Liang L, Wu J, Ding Y, Yang J, Sun Y, Zhang T, You D, Liu Z. Preoperative serum CA19-9 should be routinely measured in the colorectal patients with preoperative normal serum CEA: a multicenter retrospective cohort study. BMC Cancer. 2022; 22(1):962.

[20] Benson AB, Venook AP, Al-Hawary MM, Arain MA, Chen YJ, Ciombor KK, Cohen S, Cooper HS, Deming D, Farkas L, Garrido-Laguna I, Grem JL, Gunn A, Hecht JR, Hoffe S, Hubbard J, Hunt S, Johung KL, Kirilcuk N, Krishnamurthi S, Messersmith WA, Meyerhardt J, Miller ED, Mulcahy MF, Nurkin S, Overman MJ, Parikh A, Patel H, Pedersen K, Saltz L, Schneider C, Shibata D, Skibber JM, Sofocleous CT, Stoffel EM, Stotsky-Himelfarb E, Willett CG, Gregory KM, Gurski LA. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021; 19(3):329-59.

[21] Zhou W, Yang F, Peng J, Wang F, Lin Y, Jiang W, Yang X, Li L, Lu Z, Wan D, Pan Z, Fan W. High pretreatment serum CA19-9 level predicts a poor prognosis for patients with stage III colon cancer after curative resection and adjuvant chemotherapy. J Cancer. 2019; 10(16):3810-8.

[22] Sefrioui D, Beaussire L, Gillibert A, Blanchard F, Toure E, Bazille C, Perdrix A, Ziegler F, Gangloff A, Hassine M, Elie C, Bignon AL, Parzy A, Gomez P, Thill C, Clatot F, Sabourin JC, Frebourg T, Benichou J, Bouhier-Leporrier K, Gallais MP, Sarafan-Vasseur N, Michel P, Di Fiore F. CEA, CA19-9, circulating DNA and circulating tumour cell kinetics in patients treated for metastatic colorectal cancer (mCRC). Br J Cancer. 2021; 125(5):725-33.

[23] Shin JK, Kim HC, Lee WY, Yun SH, Cho YB, Huh JW, Park YA, Chun HK. High preoperative serum CA 19-9 levels can predict poor oncologic outcomes in colorectal cancer patients on propensity score analysis. Ann Surg Treat Res. 2019; 96(3):107-15.

[24] Liu JM, Wang YY, Liu W, Xu D, Wang K, Xing BC. Preoperative CA19-9: a competitive predictor of recurrence in patients with colorectal cancer liver metastases after hepatectomy. Int J Colorectal Dis. 2021; 36(4):767-78.

[25] Yuan R, Chen Y, He X, Wu X, Ke J, Zou Y, Cai Z, Zeng Y, Wang L, Wang J, Fan X, Wu X, Lan P. CCL18 as an independent favorable prognostic biomarker in patients with colorectal cancer. J Surg Res. 2013; 183(1):163-9.

[26] Abe S, Kawai K, Ishihara S, Nozawa H, Hata K, Kiyomatsu T, Tanaka T, Watanabe T. Prognostic impact of carcinoembryonic antigen and carbohydrate antigen 19-9 in stage IV colorectal cancer patients after R0 resection. J Surg Res. 2016; 205(2):384-92.

[27] Shibutani M, Maeda K, Nagahara H, Ohtani H, Sakurai K, Toyokawa T, Kubo N, Tanaka H, Muguruma K, Ohira M, Hirakawa K. Significance of CEA and CA19-9 combination as a prognostic indicator and for recurrence monitoring in patients with stage II colorectal cancer. Anticancer Res. 2014; 34(7):3753-8.

[28] Stiksma J, Grootendorst DC, van der Linden PW. CA 19-9 As a Marker in Addition to CEA to Monitor Colorectal Cancer. Clin Colorectal Cancer. 2014; 13(4):239-44.

[29] Lin PC, Lin JK, Lin CC, Wang HS, Yang SH, Jiang JK, Lan YT, Lin TC, Li AF, Chen WS, Chang SC. Carbohydrate antigen 19-9 is a valuable prognostic factor in colorectal cancer patients with normal levels of carcinoembryonic antigen and may help predict lung metastasis. Int J Colorectal Dis. 2012; 27(10):1333-8.

[30] Grotowski M. Antigens (CEA and CA 19-9) in diagnosis and prognosis colorectal cancer. Pol Merkur Lekarski. 2002; 12(67):77-80. Polish.

[31] Diagnosis And Treatment Guidelines For Colorectal Cancer Working Group CSOCOC. Chinese Society of Clinical Oncology (CSCO) diagnosis and treatment guidelines for colorectal cancer 2018 (English version). Chin J Cancer Res. 2019; 31(1):117-34.

[32] Argilés G, Tabernero J, Labianca R, Hochhauser D, Salazar R, Iveson T, Laurent-Puig P, Quirke P, Yoshino T, Taieb J, Martinelli E, Arnold D; ESMO Guidelines Committee. Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020; 31(10):1291-305.

[33] Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rödel C, Cervantes A, Arnold D; ESMO Guidelines Committee. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017; 28(suppl_4):iv22-iv40.

[34] Prior IA, Lewis PD, Mattos C. A Comprehensive Survey of Ras Mutations in Cancer. Cancer Res. 2012; 72(10):2457-67.

[35] Maleki M, Golchin A, Javadi S, Khelghati N, Morovat P, Asemi Z, Alemi F, Vaghari-Tabari M, Yousefi B, Majidinia M. Role of exosomal miRNA in chemotherapy resistance of Colorectal cancer: A systematic review. Chem Biol Drug Des. 2023; 101(5):1096-112.

[36] Girigoswami K, Girigoswami A. A Review on the Role of Nanosensors in Detecting Cellular miRNA Expression in Colorectal Cancer. Endocr Metab Immune Disord Drug Targets. 2021; 21(1):12-26.

[37] Takeda M, Yoshida S, Inoue T, Sekido Y, Hata T, Hamabe A, Ogino T, Miyoshi N, Uemura M, Yamamoto H, Doki Y, Eguchi H. The Role of KRAS Mutations in Colorectal Cancer: Biological Insights, Clinical Implications, and Future Therapeutic Perspectives. Cancers (Basel). 2025; 17(3):428.

[38] Navarro-Jiménez M, González B, Mulet N, Hierro C, Alonso S. KRAS-targeted therapies in colorectal cancer: a systematic analysis of mutations, inhibitors, and clinical trials. NPJ Precis Oncol. 2025; 9(1):380.

[39] Zhu G, Pei L, Xia H, Tang Q, Bi F. Role of oncogenic KRAS in the prognosis, diagnosis and treatment of colorectal cancer. Mol Cancer. 2021; 20(1):143.

[40] Meng M, Zhong K, Jiang T, Liu Z, Kwan HY, Su T. The current understanding on the impact of KRAS on colorectal cancer. Biomed Pharmacother. 2021; 140:111717.

[41] Emile SH, Wignakumar A, Syed A, Horesh N, Barsom SH, Garoufalia Z, Wexner SD. An umbrella review of systematic reviews on the diagnostic and prognostic utility of circulating tumor DNA and MicroRNA in colorectal cancer. Cancer Treat Rev. 2025; 141:103040.

[42] Okugawa Y, Grady WM, Goel A. Epigenetic Alterations in Colorectal Cancer: Emerging Biomarkers. Gastroenterology. 2015; 149(5):1204-1225.e12.

[43] Dong Y, Wu WK, Wu CW, Sung JJ, Yu J, Ng SS. MicroRNA dysregulation in colorectal cancer: a clinical perspective. Br J Cancer. 2011; 104(6):893-8.

[44] Wu CW, Ng SS, Dong YJ, Ng SC, Leung WW, Lee CW, Wong YN, Chan FK, Yu J, Sung JJ. Detection of miR-92a and miR-21 in stool samples as potential screening biomarkers for colorectal cancer and polyps. Gut. 2012; 61(5):739-45.

[45] Nagel R, le Sage C, Diosdado B, van der Waal M, Oude Vrielink JA, Bolijn A, Meijer GA, Agami R. Regulation of the adenomatous polyposis coli gene by the miR-135 family in colorectal cancer. Cancer Res. 2008; 68(14):5795-802.

[46] Wiik EN, Pettersen HS, Skogseth H, Halgunset J, Wibe A. miR-143 and miR-145 in Colorectal Cancer: A Digital Pathology Approach on Expressions and Protein Correlations. APMIS. 2025; 133(7):e70051.

[47] Yen YT, Hsu CI, Chen YC, Tsai SC. Integrative Analysis of miR-21, PTEN, and Immune Signatures in Colorectal Cancer. Int J Mol Sci. 2025; 26(24):12118.

[48] Hu HY, Yu CH, Zhang HH, Zhang SZ, Yu WY, Yang Y, Chen Q. Exosomal miR-1229 derived from colorectal cancer cells promotes angiogenesis by targeting HIPK2. Int J Biol Macromol. 2019; 132:470-7.

[49] Han L, Shi WJ, Xie YB, Zhang ZG. Diagnostic value of four serum exosome microRNAs panel for the detection of colorectal cancer. World J Gastrointest Oncol. 2021; 13(8):970-9.

[50] Jelic MD, Mandic AD, Maricic SM, Srdjenovic BU. Oxidative stress and its role in cancer. J Cancer Res Ther. 2021; 17(1):22-8.

[51] Sharma A, Rajappa M, Saxena A, Sharma M. Antioxidant status in advanced cervical cancer patients undergoing neoadjuvant chemoradiation. Br J Biomed Sci. 2007; 64(1):23-7.

[52] Pisoschi AM, Pop A. The role of antioxidants in the chemistry of oxidative stress: A review. Eur J Med Chem. 2015; 97:55-74.

[53] Chang D, Wang F, Zhao YS, Pan HZ. Evaluation of oxidative stress in colorectal cancer patients. Biomed Environ Sci. 2008; 21(4):286-9.

[54] Kondo S, Toyokuni S, Iwasa Y, Tanaka T, Onodera H, Hiai H, Imamura M. Persistent oxidative stress in human colorectal carcinoma, but not in adenoma. Free Radic Biol Med. 1999; 27(3-4):401-10.

[55] Catalano T, Selvaggi F, Cotellese R, Aceto GM. The Role of Reactive Oxygen Species in Colorectal Cancer Initiation and Progression: Perspectives on Theranostic Approaches. Cancers (Basel). 2025; 17(5):752.

[56] Slipsager A, Henrichsen SN, Falkmer UG, Dybkær K, Belting M, Poulsen LØ. Predictive biomarkers in radioresistant rectal cancer: A systematic review. Crit Rev Oncol Hematol. 2023; 186:103991.

[57] Nakamura H, Takada K. Reactive oxygen species in cancer: Current findings and future directions. Cancer Sci. 2021; 112(10):3945-52.

[58] Tsuchiya Y, Peak-Chew SY, Newell C, Miller-Aidoo S, Mangal S, Zhyvoloup A, Bakovic J, Malanchuk O, Pereira GC, Kotiadis V, Szabadkai G, Duchen MR, Campbell M, Cuenca SR, Vidal-Puig A, James AM, Murphy MP, Filonenko V, Skehel M, Gout I. Protein CoAlation: a redox-regulated protein modification by coenzyme A in mammalian cells. Biochem J. 2017; 474(14):2489-508.

[59] Tsuchiya Y, Zhyvoloup A, Baković J, Thomas N, Yu BYK, Das S, Orengo C, Newell C, Ward J, Saladino G, Comitani F, Gervasio FL, Malanchuk OM, Khoruzhenko AI, Filonenko V, Peak-Chew SY, Skehel M, Gout I. Protein CoAlation and antioxidant function of coenzyme A in prokaryotic cells. Biochem J. 2018; 475(11):1909-37.

[60] Filonenko V, Gout I. Discovery and functional characterisation of protein CoAlation and the antioxidant function of coenzyme A. BBA Adv. 2023; 3:100075.

[61] Tossounian MA, Baczynska M, Dalton W, Newell C, Ma Y, Das S, Semelak JA, Estrin DA, Filonenko V, Trujillo M, Peak-Chew SY, Skehel M, Fraternali F, Orengo C, Gout I. Profiling the Site of Protein CoAlation and Coenzyme A Stabilization Interactions. Antioxidants (Basel). 2022; 11(7):1362.

[62] Tsuchiya Y, Byrne DP, Burgess SG, Bormann J, Baković J, Huang Y, Zhyvoloup A, Yu BYK, Peak-Chew S, Tran T, Bellany F, Tabor AB, Chan AE, Guruprasad L, Garifulin O, Filonenko V, Vonderach M, Ferries S, Eyers CE, Carroll J, Skehel M, Bayliss R, Eyers PA, Gout I. Covalent Aurora A regulation by the metabolic integrator coenzyme A. Redox Biol. 2020; 28:101318.

[63] Malanchuk O, Bdzhola A, Palchevskyi S, Bdzhola V, Chai P, Pardo OE, Seckl MJ, Banerjee A, Peak-Chew SY, Skehel M, Guruprasad L, Zhyvoloup A, Gout I, Filonenko V. Investigating the Regulation of Ribosomal Protein S6 Kinase 1 by CoAlation. Int J Mol Sci. 2024; 25(16):8747.

[64] Yu BYK, Tossounian MA, Hristov SD, Lawrence R, Arora P, Tsuchiya Y, Peak-Chew SY, Filonenko V, Oxenford S, Angell R, Gouge J, Skehel M, Gout I. Regulation of metastasis suppressor NME1 by a key metabolic cofactor coenzyme A. Redox Biol. 2021; 44:101978.

[65] Lin CC, Lin YT, Chen SY, Setayeshpour Y, Chen Y, Dunn DE, Nguyen T, Mestre AA, Banerjee A, Guruprasad L, Soderblom EJ, Zhang GF, Lin CY, Filonenko V, Jeong SY, Floyd SR, Hayflick SJ, Gout I, Chi JT. Coenzyme A protects against ferroptosis via CoAlation of mitochondrial thioredoxin reductase. J Clin Invest. 2025; 135(19):e190215.

[66] Byrne DP, Shrestha S, Galler M, Cao M, Daly LA, Campbell AE, Eyers CE, Veal EA, Kannan N, Eyers PA. Aurora A regulation by reversible cysteine oxidation reveals evolutionarily conserved redox control of Ser/Thr protein kinase activity. Sci Signal. 2020; 13(639):eaax2713.

[67] Malanchuk O, Khoruzhenko A, Kosach V, Bdzhola A, Bidiuk D, Brett C, Gout I, Filonenko V. Immunofluorescent detection of protein CoAlation in mammalian cells under oxidative stress. Biol Open. 2024; 13(10):bio061685.

[68] Ferrandon S, DeVecchio J, Duraes L, Chouhan H, Karagkounis G, Davenport J, Orloff M, Liska D, Kalady MF. CoA Synthase (COASY) Mediates Radiation Resistance via PI3K Signaling in Rectal Cancer. Cancer Res. 2020; 80(2):334-46.

[69] Badgley MA, Kremer DM, Maurer HC, DelGiorno KE, Lee HJ, Purohit V, Sagalovskiy IR, Ma A, Kapilian J, Firl CEM, Decker AR, Sastra SA, Palermo CF, Andrade LR, Sajjakulnukit P, Zhang L, Tolstyka ZP, Hirschhorn T, Lamb C, Liu T, Gu W, Seeley ES, Stone E, Georgiou G, Manor U, Iuga A, Wahl GM, Stockwell BR, Lyssiotis CA, Olive KP. Cysteine depletion induces pancreatic tumor ferroptosis in mice. Science. 2020; 368(6486):85-9.

[70] Guertin DA, Wellen KE. Acetyl-CoA metabolism in cancer. Nat Rev Cancer. 2023; 23(3):156-72.

[71] Carrer A, Trefely S, Zhao S, Campbell SL, Norgard RJ, Schultz KC, Sidoli S, Parris JLD, Affronti HC, Sivanand S, Egolf S, Sela Y, Trizzino M, Gardini A, Garcia BA, Snyder NW, Stanger BZ, Wellen KE. Acetyl-CoA Metabolism Supports Multistep Pancreatic Tumorigenesis. Cancer Discov. 2019; 9(3):416-35.

[72] Sivanand S, Rhoades S, Jiang Q, Lee JV, Benci J, Zhang J, Yuan S, Viney I, Zhao S, Carrer A, Bennett MJ, Minn AJ, Weljie AM, Greenberg RA, Wellen KE. Nuclear Acetyl-CoA Production by ACLY Promotes Homologous Recombination. Mol Cell. 2017; 67(2):252-265.e6.