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Substrate-level phosphorylation

Substrate-level phosphorylation is a metabolic process in which a group is directly transferred from a molecule to or GDP, resulting in the formation of ATP or GTP without the involvement of a proton gradient or . This mechanism contrasts with , as it relies solely on the stored in the and can occur under both aerobic and conditions. In , the primary anaerobic pathway for glucose breakdown in the , substrate-level phosphorylation generates ATP at two key steps. First, catalyzes the transfer of a from 1,3-bisphosphoglycerate to , producing 3-phosphoglycerate and ATP, yielding two ATP molecules per glucose molecule. Second, facilitates the conversion of phosphoenolpyruvate to pyruvate, again transferring a to to form ATP, contributing another two ATP per glucose. Overall, these reactions net two ATP molecules in after accounting for the initial energy investment. Substrate-level phosphorylation also plays a role in the (Krebs cycle) within the under aerobic conditions. During the conversion of to succinate, succinyl-CoA synthetase (also known as succinate thiokinase) couples the cleavage of the high-energy bond to the of GDP to GTP using inorganic ; the GTP can then transfer its phosphate to to form ATP. This step produces one GTP (equivalent to one ATP) per cycle, or two per glucose molecule oxidized. Together, these instances highlight substrate-level phosphorylation's importance as a direct, oxygen-independent source of high-energy phosphates essential for cellular .

Overview

Definition and General Process

Substrate-level phosphorylation is a fundamental metabolic process in which a is directly transferred from a high-energy substrate to (ADP) or (GDP), forming (ATP) or (GTP), respectively. This reaction is catalyzed by specific enzymes, such as kinases or synthetases, and occurs without the involvement of an or membrane-bound complexes. The general mechanism involves a phosphorylated high-energy intermediate serving as the phosphate donor. In this process, the substrate's group undergoes nucleophilic attack by the (or GDP) molecule, facilitated by the enzyme's , leading to the release of the dephosphorylated substrate product. This direct enzymatic transfer ensures efficient coupling of the substrate's to phosphorylation, typically represented by the generalized equation: \text{Substrate-P} + \text{ADP} \rightarrow \text{Substrate} + \text{ATP} Similar reactions can produce GTP when GDP is the acceptor. The energy for this phosphorylation derives from the exergonic cleavage of high-energy bonds within the , providing approximately 30–50 kJ/mol to drive the thermodynamically unfavorable ATP (or GTP) synthesis under physiological conditions. This process operates independently of oxygen availability, enabling ATP production in both aerobic and environments, in contrast to , which relies on oxygen and a across membranes.

Historical Context and Discovery

Substrate-level phosphorylation was first identified in the context of anaerobic glycolysis during the 1930s and 1940s, primarily through the experimental work of Otto Meyerhof and his team at the Kaiser Wilhelm Institute for Biology in Berlin. Building on earlier observations of lactic acid formation in muscle, Meyerhof utilized cell-free extracts from frog skeletal muscle to demonstrate that the conversion of glycogen or glucose to lactate could directly produce ATP without requiring oxygen or mitochondrial respiration, highlighting a non-oxidative mechanism for energy conservation. This breakthrough was foundational, as it linked specific phosphorylated intermediates in the glycolytic pathway to ATP synthesis, distinguishing it from aerobic processes. Meyerhof's contributions earned him the 1922 Nobel Prize in Physiology or Medicine, shared with Archibald V. Hill, for elucidating the relationship between oxygen consumption, production, and heat generation in muscle—work that laid the groundwork for understanding ATP's role in . In the 1940s, as Meyerhof continued his research in exile , his group's use of cell-free systems provided early evidence of ATP regeneration during conditions, confirming the pathway's independence from electron transport chains. These experiments, involving sequential addition of glycolytic intermediates to extracts, revealed net ATP yield from substrate transformations, solidifying the concept's biochemical basis. The 1950s saw further elucidation through the purification and characterization of key enzymes catalyzing , such as those in and the . For instance, Hans Adolf Krebs had proposed the tricarboxylic acid (TCA) cycle in 1937, incorporating a substrate-level phosphorylation step at synthetase, which was later confirmed with enzyme isolations; this work earned Krebs the 1953 in or , shared with Lipmann for discoveries in coenzyme A-mediated . , during his tenure at the from 1947 to 1953, advanced understanding of ATP-related synthetases in nucleotide , purifying enzymes that highlighted direct phosphoryl transfers akin to those in central pathways. The distinction between substrate-level and was firmly established in 1961 with Peter Mitchell's chemiosmotic theory, which posited that oxidative ATP synthesis relies on a proton across membranes rather than direct substrate interactions, thereby emphasizing the unique, non-vectorial nature of substrate-level mechanisms observed in earlier studies. This theoretical framework, later validated and awarded the 1978 , integrated substrate-level phosphorylation as a complementary, respiration-independent process essential for cellular .

Mechanisms in Glycolysis

Phosphoglycerate Kinase Reaction

The (PGK) reaction represents the first substrate-level phosphorylation event in , occurring as step 7 in the pathway. PGK is a that catalyzes the reversible transfer of a from 1,3-bisphosphoglycerate (1,3-BPG) to (), thereby conserving energy captured during the earlier oxidation step. This reaction follows the oxidation of glyceraldehyde-3-phosphate by glyceraldehyde-3-phosphate dehydrogenase, which produces the high-energy acyl phosphate intermediate 1,3-BPG. The balanced equation for the reaction is: $1,3\text{-BPG} + \text{[ADP](/page/ADP)} \rightleftharpoons 3\text{-PG} + \text{[ATP](/page/ATP)} with a standard free energy change (ΔG°') of approximately -18.5 kJ/mol under physiological conditions, rendering it highly favorable due to the of the high-energy acyl bond in 1,3-BPG. The mechanism involves a direct, inline transfer from the carboxyl- at the C1 position of 1,3-BPG to the β- of Mg²⁺-coordinated within the enzyme's , without formation of a phosphoenzyme intermediate or involvement of components. This process occurs in the of eukaryotic cells, where it contributes 2 ATP molecules per glucose molecule processed through (one ATP per ).

Pyruvate Kinase Reaction

The pyruvate kinase reaction represents the final step of , catalyzing the transfer of a from phosphoenolpyruvate (PEP) to , thereby generating ATP and pyruvate in a substrate-level phosphorylation event. This irreversible reaction commits glycolytic intermediates to pyruvate formation and is essential for net ATP production in conditions. Pyruvate kinase (PK) exists as tissue-specific isozymes in mammals, including PKM1 (predominant in differentiated tissues like muscle and brain) and (expressed in proliferating cells, embryonic tissues, and many tumors), both derived from the , as well as PKL and PKR from the PKLR gene in liver and red blood cells. These isozymes share the core function of catalyzing the 10th step of but differ in regulatory properties and oligomeric states, with PKM2 capable of forming less active dimers in addition to active tetramers. The reaction proceeds as follows: \text{PEP} + \text{[ADP](/page/ADP)} + \text{H}^+ \rightarrow \text{pyruvate} + \text{ATP} with a standard free energy change (ΔG°') of approximately -31.4 /, rendering it highly exergonic. This large negative ΔG°' arises primarily from the subsequent tautomerization of the form of pyruvate to its more stable form, which provides an energetic driving force beyond the initial transfer. Mechanistically, facilitates direct phosphoryl transfer from the high-energy group of PEP to the β-phosphate of , without forming a phosphorylated intermediate; the enzyme positions substrates via coordination with divalent cations like Mg²⁺ and K⁺. The irreversibility is reinforced by the rapid, spontaneous enol-to-keto tautomerization of pyruvate, which shifts the far toward product formation and prevents reversal under physiological conditions. This reaction occurs in the and contributes two ATP molecules per glucose molecule processed through , accounting for the gross ATP yield in this pathway. It follows the enolase-catalyzed of 2-phosphoglycerate to form PEP. Regulation of is primarily allosteric and varies by to fine-tune glycolytic flux based on cellular energy status and metabolic demands. Fructose-1,6-bisphosphate acts as a feed-forward activator, binding to promote the tetrameric form and enhancing activity, particularly in and PKL. High ATP levels inhibit the enzyme by competing with at the and stabilizing less active conformations, while serves as an allosteric inhibitor signaling availability. Tissue-specific isoforms reflect these needs: muscle PKM1 is constitutively active with minimal for sustained ATP production during contraction, whereas liver PKL exhibits stronger inhibition by ATP and , and reversible phosphorylation by to prevent futile cycling during .

Mechanisms in Aerobic Metabolism

Succinyl-CoA Synthetase in the Citric Acid Cycle

Succinyl-CoA synthetase (SCS), also known as succinate-CoA ligase, is the enzyme responsible for the sole instance of substrate-level phosphorylation in the (). In eukaryotic cells, SCS functions as an αβ heterodimer localized to the , where it couples the cleavage of the high-energy bond in to the phosphorylation of a diphosphate. This reaction occurs following the oxidative decarboxylation of isocitrate and α-ketoglutarate, integrating the energy released from substrate oxidation into direct triphosphate synthesis. The reaction catalyzed by SCS is reversible and proceeds as follows: \text{Succinyl-CoA} + \text{GDP} + \text{P}_\text{i} \rightleftharpoons \text{Succinate} + \text{CoA} + \text{GTP} with a standard free energy change (ΔG°') of approximately -3.3 kJ/mol, rendering it nearly thermodynamically neutral under physiological conditions. An ATP-specific isoform exists in some organisms and tissues, substituting ADP for GDP and ATP for GTP, with a similar ΔG°'. Per turn of the TCA cycle, this step generates one molecule of GTP (or ATP) for each acetyl-CoA oxidized, contributing directly to cellular energy homeostasis independent of the electron transport chain. The mechanism of SCS involves a two-step process harnessing the energy from the thioester bond of succinyl-CoA. In the first step, succinyl-CoA reacts with inorganic phosphate (P_i) to form enzyme-bound succinyl-phosphate and release coenzyme A (CoA). This intermediate then undergoes nucleophilic attack, transferring the phosphate to a conserved histidine residue on the α-subunit, yielding succinate and a phosphohistidine intermediate. In the second step, the phosphohistidine donates the phosphate group to GDP, forming GTP and regenerating the enzyme. This histidine phosphorylation ensures efficient energy transfer without dissipation as heat. Regulation of SCS is primarily achieved through product inhibition, particularly by succinate, which acts as a dead-end competitive with , thereby preventing excessive flux when downstream metabolites accumulate. Additionally, the enzyme's activity is indirectly linked to the preceding α-ketoglutarate dehydrogenase complex, as elevated levels from SCS inhibition can feedback to suppress this upstream step, maintaining TCA cycle balance.

Phosphoenolpyruvate Carboxykinase in Gluconeogenesis

(PEPCK) is a key in , catalyzing a substrate-level phosphorylation step that converts oxaloacetate (OAA) to phosphoenolpyruvate (PEP). In vertebrates, PEPCK exists in two isoforms: the mitochondrial form (PEPCK-M or PCK2) and the cytosolic form (PEPCK-C or PCK1), which are encoded by separate genes and localized to their respective cellular compartments. PEPCK-M predominates in tissues like the and , while PEPCK-C is highly expressed in the liver, where it plays a central role in hepatic glucose production during . This enzyme enables the bypass of the irreversible step in , facilitating the net synthesis of glucose from non-carbohydrate precursors such as and . The reaction catalyzed by PEPCK is: \text{OAA} + \text{GTP} \rightleftharpoons \text{PEP} + \text{CO}_2 + \text{GDP} with a standard change (ΔG°') of approximately -0.9 kJ/mol, rendering it near under physiological conditions. This and process is tightly coupled to the preceding step, where pyruvate is carboxylated to OAA by the biotin-dependent in the mitochondria, consuming ATP and resulting in a net ATP expenditure for the overall conversion of pyruvate to PEP. The mechanism begins with the binding of OAA to the enzyme's , coordinated by two divalent metal ions (typically Mn²⁺ or Mg²⁺) that facilitate , yielding a reactive intermediate. This intermediate is then directly phosphorylated by the γ-phosphate of GTP through nucleophilic attack, forming the high-energy phosphate of PEP without a free phospho- intermediate. PEPCK's activity is essential for hepatic , particularly from mitochondrial substrates like , where PEPCK-M generates PEP directly in the mitochondria for export or further . In the liver, both isoforms contribute, with PEPCK-C handling cytosolic OAA derived from mitochondrial export via the malate-aspartate . Regulation of PEPCK primarily occurs at the transcriptional level, induced by via the cAMP-protein kinase A pathway, which activates CREB to promote PCK1 during states. These regulatory mechanisms ensure PEPCK responds to hormonal and metabolic signals, maintaining blood glucose homeostasis.

Mechanisms in Other Pathways

C1-Tetrahydrofolate Synthase in One-Carbon Metabolism

Substrate-level phosphorylation occurs in mitochondrial one-carbon metabolism through the action of monofunctional C1-tetrahydrofolate synthase (10-formyl-THF synthetase), encoded by the MTHFD1L gene, which catalyzes the reverse synthetase reaction. This enzyme plays a key role in assimilation, converting one-carbon units into for export to the , thereby supporting and synthesis in biosynthetic pathways. The reaction utilizes 10-formyl-tetrahydrofolate (10-formyl-THF) as the high-energy substrate, with and inorganic (Pi) as cosubstrates, yielding tetrahydrofolate (THF), , and ATP. The detailed net reaction is: \text{10-formyl-THF} + \text{ADP} + \text{P}_\text{i} \rightarrow \text{THF} + \text{formate} + \text{ATP} Here, the substrate-level phosphorylation specifically arises from the formyl group transfer to ATP. The mechanism involves hydrolysis of the formyl group from 10-formyl-THF, forming a phosphorylated formate intermediate (formyl phosphate) bound to the enzyme, which then transfers the phosphate to ADP to generate ATP. Located in the mitochondrial matrix, this pathway serves as a minor but critical ATP source under conditions where oxidative phosphorylation is limited, facilitating a formate shuttle to the cytosol for broader one-carbon metabolism. Regulation of MTHFD1L is responsive to cellular status, with activity modulated by availability such as serine levels, which influence the formate-to-CO₂ partitioning ratio. In metabolic disorders like cancer, MTHFD1L expression is often upregulated under the control of transcription factors such as NRF2, conferring proliferative advantages to tumor cells by enhancing one-carbon flux and ATP generation. Disruption of this impairs mitochondrial production, highlighting its specialized role in eukaryotic biosynthetic support distinct from energy-focused pathways.

Prokaryotic and Fermentation Examples

In prokaryotes, substrate-level phosphorylation plays a crucial role in during conditions, particularly through enzymes like acetate kinase, which catalyzes the transfer of a phosphate group from acetyl phosphate to , yielding ATP and . This reaction occurs in bacteria such as during mixed-acid , where glucose is metabolized to produce a mixture of organic acids, including , to regenerate NAD⁺ and generate ATP without oxygen. The acetate kinase reaction is given by: \text{Acetyl phosphate} + \text{ADP} \rightarrow \text{Acetate} + \text{ATP} \quad (\Delta G^{\circ\prime} \approx -15 \, \text{kJ/mol}) This process is exergonic under physiological conditions, driven by the high-energy phosphoanhydride bond in acetyl phosphate, and supports bacterial growth in oxygen-limited environments. Another example in anaerobic prokaryotes involves polyphosphate kinase, which facilitates substrate-level phosphorylation by transferring a terminal phosphate from polyphosphate to ADP, producing ATP and shortening the polyphosphate chain. This enzyme is prominent in stress responses among anaerobes, such as during nutrient limitation or oxidative stress, where polyphosphate serves as an energy reserve to rapidly generate ATP when oxidative phosphorylation is unavailable. The reaction is: \text{PolyP}_n + \text{ADP} \rightarrow \text{PolyP}_{n-1} + \text{ATP} In bacteria like Pseudomonas aeruginosa and other anaerobes, this mechanism enhances survival under harsh conditions by maintaining ATP levels independently of respiration. In bacterial propionate fermentation, substrate-level phosphorylation is coupled to the methylmalonyl-CoA:propionate CoA-transferase pathway, which operates similarly to succinyl-CoA synthetase but involves short-chain fatty acids. This transferase exchanges the CoA moiety between methylmalonyl-CoA and propionate, generating propionyl-CoA, which is then used to produce acetyl-CoA and ultimately ATP via acetate kinase in anaerobes like Propionibacterium freudenreichii. This pathway allows for efficient energy yield during the fermentation of lactate or sugars to propionate, with one ATP produced per propionate molecule via substrate-level mechanisms. A specific instance is seen in Clostridium acetobutylicum during butyrate fermentation, where butyrate kinase converts butyryl phosphate and ADP to butyrate and ATP, contributing to the solventogenic phase of acetone-butanol-ethanol production. The reaction proceeds as: \text{Butyryl phosphate} + \text{ADP} \rightarrow \text{Butyrate} + \text{ATP} This enzyme enables the bacterium to harvest energy from acyl phosphates formed in the acidogenic phase, supporting growth in anaerobic bioreactors. Substrate-level phosphorylation in these prokaryotic and fermentative contexts represents an ancient metabolic strategy, predating the evolution of , as it relies solely on chemical intermediates for ATP synthesis and is conserved across early life forms.

Physiological Roles

Importance in Anoxic and Hypoxic Conditions

Substrate-level phosphorylation plays a critical role in sustaining cellular energy production under anoxic conditions, where is halted due to the absence of oxygen, forcing cells to rely exclusively on for ATP generation. In , the net yield is 2 ATP molecules per glucose molecule through substrate-level phosphorylation reactions catalyzed by and , in stark contrast to the 30-32 ATP typically produced under aerobic conditions via combined and . This limited but immediate ATP supply prevents rapid energy collapse in oxygen-deprived tissues, such as during ischemia, by maintaining essential cytosolic and nuclear ATP levels that would otherwise deplete quickly without mitochondrial contribution. In hypoxic environments, cells adapt by upregulating glycolytic enzymes through hypoxia-inducible factor 1 (HIF-1)-mediated transcription, enhancing the flux through substrate-level phosphorylation to compensate for reduced oxidative capacity. HIF-1 binds to hypoxia-responsive elements in the promoters of genes encoding glucose transporters (e.g., ) and key glycolytic enzymes like hexokinase 2 and , thereby increasing glycolytic rates and production even in the presence of limited oxygen. Additionally, in the liver, (PEPCK) is upregulated via HIF-1 and ATF-2 , facilitating to support hepatic glucose output and maintenance under , though this process is energy-consuming. These adaptations are evident in during intense exercise, where oxygen demand exceeds supply, leading to accumulation as pyruvate is reduced to , sustaining high glycolytic rates for ATP via substrate-level phosphorylation while buffering in ischemic tissues. Despite these benefits, substrate-level phosphorylation in and has limitations, including lactate-induced acidosis that can impair cellular function and the inherent inefficiency prompting the , where rates accelerate dramatically to offset the low ATP yield per glucose. In normoxic conditions, substrate-level phosphorylation accounts for approximately 10% of total cellular ATP, primarily from and steps, but rises to 100% under as the sole energy source. Clinically, this is exemplified by the Warburg effect in cancer cells, where aerobic favors rapid substrate-level ATP production alongside biosynthetic intermediates, supporting proliferation even in oxygenated tumors despite the lower efficiency compared to oxidative metabolism.

Contribution to Total Cellular ATP Yield

In aerobic respiration, substrate-level phosphorylation contributes 4 ATP molecules per glucose molecule oxidized: a net of 2 ATP from glycolysis and 2 GTP (energetically equivalent to ATP) from the tricarboxylic acid (TCA) cycle. This direct yield represents approximately 12-13% of the total cellular ATP production, which ranges from 30 to 32 ATP per glucose when including oxidative phosphorylation. The remaining ATP arises from the oxidation of NADH and FADH₂ generated in these pathways, highlighting substrate-level phosphorylation's role as a foundational but minor direct contributor in oxygen-rich environments. Under anaerobic conditions, becomes the sole mechanism for ATP generation, yielding a net of 2 ATP per glucose via in most organisms, such as during or alcoholic . In certain employing extended pathways, such as homoacetogenic or , the yield can increase to approximately 2.4-3 ATP per glucose through additional substrate-level steps that optimize carbon flow and transfer. This represents 100% of the ATP produced anaerobically, underscoring its essential role in energy conservation without oxidative processes. The efficiency of substrate-level phosphorylation is inherently low compared to oxidative mechanisms, typically providing only ~2 ATP per glucose in standard , yet it enables rapid ATP synthesis to meet immediate cellular demands. In aerobic contexts, it supplements the higher-yield by delivering quick, direct energy while the associated pathways supply electrons for the . Variations occur across organisms; in plants and microbes, inorganic polyphosphate (polyP) stores can augment ATP yield through polyphosphate kinase-mediated substrate-level phosphorylation, converting polyP to ATP during stress or energy deficits. Conversely, in some obligate aerobes reliant on efficient oxidative systems, the proportional contribution from substrate-level phosphorylation remains negligible relative to total ATP output.

Comparison to Oxidative Phosphorylation

Mechanistic Differences

Substrate-level phosphorylation involves the direct transfer of a phosphate group from a high-energy to , catalyzed by soluble enzymes without the involvement of membranes or proton gradients. This process occurs primarily in the or , where enzymes such as facilitate the reaction by binding both the phosphorylated and , enabling the phosphate to be transferred in a single enzymatic step. For instance, in , the reaction catalyzed by is: \text{PEP} + \text{ADP} \rightarrow \text{pyruvate} + \text{ATP} This direct mechanism is independent of oxygen availability or the (ETC), allowing ATP production even under conditions. In contrast, relies on an indirect process driven by the ETC and chemiosmotic coupling across the . Electrons from NADH or FADH₂ are transferred through ETC complexes I–IV, which pump protons (H⁺) from the into the , establishing an known as the proton-motive force (Δp = Δψ + ΔpH). This gradient powers ATP synthesis via (complex V), also called F₀F₁-ATPase, where the flow of protons back into the matrix drives the rotation of the enzyme's rotor, inducing conformational changes in the catalytic F₁ subunit to form ATP from and inorganic (Pᵢ). The overall reaction can be represented as: \text{ADP} + \text{P}_\text{i} + n\text{H}^+_\text{(intermembrane)} \rightarrow \text{ATP} + n\text{H}^+_\text{(matrix)} Here, n typically ranges from 3 to 4 protons per ATP molecule synthesized. This process requires the oxidation of reduced cofactors (NAD(P)H or FADH₂) by the and is thus dependent on oxygen as the terminal . A fundamental mechanistic distinction lies in their spatial and energetic requirements: substrate-level phosphorylation operates through enzyme-bound, direct phosphoryl transfer in soluble metabolic pathways, bypassing any need for membrane-bound complexes or proton translocation, whereas is confined to the , harnessing the energy from reactions to generate and utilize a proton gradient. Consequently, substrate-level phosphorylation can proceed without , as seen in pathways, but cannot function without upstream substrate oxidation via the .

Regulatory and Evolutionary Aspects

Substrate-level phosphorylation is regulated through multiple mechanisms that ensure metabolic flexibility in response to cellular energy demands. plays a key role in pathways like , where enzymes such as phosphofructokinase-1 (PFK1) are inhibited by high ATP levels, preventing unnecessary ATP production when energy is abundant. Transcriptional control further modulates these processes, particularly under hypoxic conditions, where hypoxia-inducible factor-1 (HIF-1) upregulates to enhance substrate-level ATP generation as an adaptive response to low oxygen. Compartmentalization adds another layer of regulation, with cytosolic enzymes like responding primarily to substrate availability and glycolytic flux, while mitochondrial enzymes such as are influenced by tricarboxylic acid cycle intermediates and intramitochondrial conditions, thereby isolating these reactions from cytosolic states. In contrast to , which is tightly controlled by oxygen availability, the ADP/ATP ratio through respiratory control, and proton motive force across the , substrate-level phosphorylation is less dependent on oxygen and more responsive to immediate concentrations and allosteric effectors. This independence allows substrate-level processes to serve as a rapid, oxygen-insensitive energy source during transitions to anaerobiosis, whereas efficiency diminishes under low oxygen due to reduced activity. Additionally, substrate-level reactions in and the tricarboxylic acid cycle generate NADH, which feeds into the to support under aerobic conditions, illustrating their integrated role in overall energy homeostasis. Evolutionarily, substrate-level phosphorylation represents an ancient mechanism predating the rise of oxygen-dependent , likely present in the (LUCA) through pathways like and the pathway for ATP production via substrate-level means. This primordial system enabled energy conservation in anoxic environments, with emerging later, approximately 2.4 billion years ago, following the driven by cyanobacterial oxygenic . Its conservation across all domains of life—, , and eukaryotes—underscores its fundamental role, functioning as the primary ATP source in organisms and a vital backup in aerobes during . Contemporary research highlights the implications of dysregulation in substrate-level phosphorylation, such as mutations in leading to , a glycolytic defect causing due to impaired energy maintenance. Recent advances include the 2022 FDA approval of , an allosteric pyruvate kinase activator, as the first disease-modifying therapy for adults with PK deficiency, and the publication of the first international guidelines for its management in 2024.[](https://ashpublications.org/blood/article/144/Supplement 1/3696/534068/Clinical-Monitoring-Practices-Among-Adult-Patients) In , engineers leverage these pathways, particularly , to design cell-free systems for production, such as n-butanol from glucose, by enhancing substrate-level ATP regeneration to improve yields. Engineered acetogenic also utilize substrate-level phosphorylation in pathways producing biofuels like and from C1 feedstocks.

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