The effects of P4HA overexpression in some BCs might be further enhanced by pyruvate, which is converted in BC cells into α-KG (through the alanine aminotransferase reaction which converts pyruvate and glutamate into α-KG and alanine), a cofactor of the collagen hydroxylation reaction by P4HA [178]. The gene discussed is P4HA1; the disease is breast cancer.