Liver ketogenesis forms and releases (BHB) in the blood; it enters tumor cells through monocarboxylate transporters MCT1-4, and then a BHB dehydrogenase forms acetoacetate, one of the SCOT substrates, while the other SCOT substrate, succinyl-CoA, comes from alpha-ketoglutarate dehydrogenase and from glutamate dehydrogenase fed by elevated glutaminolysis. The gene discussed is SLC16A1; the disease is neoplasm.