NOTCH1 and leukemia: While thymic tissue preferentially expressed metabolites associated with lipid oxidation (e.g., carnitine) as well as purine and pyrimidine metabolism (PRPP), metabolites found elevated in NOTCH1-T tumors were linked to glycolysis (lactic acid) and TCA cycle replenishment (succinic, fumaric, and malic acids), indicating a significant metabolic shift with the development of leukemia (Figure 1E).