Citrate inhibits proliferation via inhibition of the IGF-1R/PI3K/AKT axis, induces activation of the PTEN-eIF2a pathway in lung tumor cells [25], inhibits Mcl-1 [18], promotes apoptosis via the activation of Caspase 2 or 8 in pleural mesothelioma and gastric cells [21,22], and finally induces autophagy in ovarian cells [20,21], all findings indicating that citrate might affect different pathways according to the cell context. This evidence concerns the gene IGF1R and pleural mesothelioma.