ACSS1 and neoplasm: Although glucose-derived acetyl-CoA is the primary fuel for the tricarboxylic acid (TCA) cycle, metformin-treated CAR-T cells upregulate acyl-coA synthetase short-chain family member 1 (ACSS1) to produce acetyl-CoA from acetate to fuel the TCA cycle 66, enhancing their proliferation and tumor-killing capability through effective OXPHOS and energy production 67.