Pulse Brain · Growing Health Evidence Index
Tier 3 — Observational / field trialPeer-reviewedConventional

Dietary fructose promotes MASH/HCC progression through enhanced intestinal HIF-2α-dependent iron absorption

Mitchell, R. A.; Xu, M.; Hudson, E.; Teer, M. S.; Hill, B. G.; McClain, C. J.; Song, M.

bioRxiv · 2026

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Summary

This mechanistic study demonstrates that dietary fructose drives MASH and HCC progression through a previously uncharacterised KHK/PKM2/HIF-2α nutrient-sensing pathway that abnormally enhances intestinal iron absorption. Using genetic knockout models and selective inhibitors, the authors show that KHK-dependent metabolic reprogramming stabilises intestinal HIF-α via PKM2-mediated glutamine oxidation, subsequently increasing plasma iron and disease burden. The findings identify a therapeutically targetable pathway linking high-fructose consumption to iron-dependent liver disease progression.

Regional applicability

This is a mechanistic laboratory study conducted in a model system, with no defined geographic setting. The findings regarding fructose and iron metabolism may be relevant to United Kingdom dietary and clinical contexts where high-fructose consumption and metabolic liver disease are prevalent, though in vivo validation in human populations and application to UK dietary guidelines would be required.

Key measures

Intestinal HIF-α stability, plasma iron levels, KHK enzyme activity, PKM2-mediated signalling, iron absorption rates, MASH and HCC progression markers, systemic iron status and anemia phenotypes

Outcomes reported

The study identified a fructose-induced nutrient-sensing pathway (KHK/PKM2/HIF-2α) that enhances intestinal iron absorption and drives metabolic dysfunction-associated steatohepatitis (MASH) and hepatocellular carcinoma (HCC) progression. Mechanistic analysis revealed that fructose-induced metabolic reprogramming stabilises intestinal HIF-α, increasing plasma iron levels and promoting disease development in an iron-dependent manner.

Theme
Nutrition & health
Subject
Dietary fats & fatty acids
Study type
Research
Study design
Laboratory / in vivo model study
Source type
Peer-reviewed study
Status
Preprint
Geography
United Kingdom
System type
Laboratory / in vitro
DOI
10.64898/2026.06.07.729655
Catalogue ID
IR-ESmqhcvjv0-19203d

Topic tags

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