From:  Epigenetic and metabolic reprogramming in autoimmune rheumatology: toward immune tolerance reprogramming

 Metabolic pathways → chromatin effects → immune fate outcomes.

PathwayKey metaboliteChromatin effectImmune fate effectDisease contextReferences
GlycolysisLactate, pyruvateIncreased H3K27ac via acetyl-CoA availability; HIF-1α-driven enhancer activationPromotes Th17 differentiation, effector T-cell expansion, inflammatory macrophages, and invasive FLSRA synovium shows high glycolytic flux; Th17-FLS inflammatory loops[173175]
Oxidative phosphorylation (OXPHOS)NAD+, ATPSirtuin-dependent histone deacetylation; repression of effector loci; maintenance of FOXP3 enhancer integritySupports Tregs, Bregs, tolerogenic DCs, and M2 macrophagesNAD+ depletion in RA/SLE reduces Treg stability and mitochondrial fitness[176178]
Fatty-acid oxidation (FAO)Acetyl-CoA, NADHPromotes SIRT1/3 activity; enhances repressive chromatin landscapesStabilizes Treg phenotype; supports long-lived regulatory programsFAO impairment contributes to Treg instability in autoimmunity[56, 178, 179]
Glutaminolysisα-Ketoglutarate (αKG)αKG supports TET-mediated DNA/histone demethylation; maintains open chromatin at regulatory genesEnables Treg and Breg epigenetic stability; excessive glutaminolysis drives effector expansionHigh glutamine flux in RA FLS; αKG dysregulation affects Treg tolerance[60, 180, 181]
One-carbon metabolismSAM, SAHSAM availability regulates DNA/histone methylation; SAM depletion causes global hypomethylationControls FOXP3 methylation status; impacts lineage fidelitySAM: SAH imbalance seen in RA and SLE; influences T-cell differentiation[182, 183]
Redox/ROS regulationROS, NAD+/NADHROS oxidizes 5mC → 5hmC; alters methylation fidelity; NAD+ levels dictate sirtuin activityHigh ROS favors inflammatory programs; balanced redox supports regulatory phenotypesExcess ROS in RA/SLE fuels inflammatory memory in T cells and macrophages[184186]
TCA cycle dysfunctionSuccinate, fumarateSuccinate/fumarate inhibit αKG-dependent demethylases → hyperacetylated, pro-inflammatory chromatinEnhances IL-1β, TNF expression, and effector persistenceElevated succinate in RA macrophages drives pathologic cytokine output[43, 187]
Mitochondrial integrity & mitophagyNAD+Healthy mitochondria support epigenetic precision; dysfunctional mitochondria increase ROS & chromatin noiseSupports Treg stability and prevents exhaustion; dysfunction drives inflammatory cell fateMitochondrial fragmentation in FLS and T cells reinforces chronic inflammation[188190]

ATP: adenosine triphosphate; Breg: regulatory B cell; FLS: fibroblast-like synoviocytes; FOXP3: forkhead box P3; HIF-1α: hypoxia-inducible factor-1 alpha; IL-1β: interleukin-1 beta; PGC-1α: peroxisome proliferator-activated receptor gamma coactivator-1 alpha; RA: rheumatoid arthritis; ROS: reactive oxygen species; SAH: S-adenosylhomocysteine; SAM: S-adenosylmethionine; SIRT1/3: sirtuin 1/3; SLE: systemic lupus erythematosus; TCA: tricarboxylic acid; TET: ten-eleven translocation; TNF: tumor necrosis factor; Treg: regulatory T cell; 5mC: 5-methylcytosine; 5hmC: 5-hydroxymethylcytosine.