Paragangliomas and pheochromocytomas (PPGLs) are chromaffin tumors associated with severe catecholamine-induced morbidities. Surgical removal is often curative. However, complete resection may not be an option for patients with succinate dehydrogenase subunit A-D (SDHx) mutations. SDHx mutations are associated with a high risk for multiple recurrent, and metastatic PPGLs. Treatment options in these cases are limited and prognosis is dismal once metastases are present. Identification of new therapeutic targets and candidate drugs is thus urgently needed. Previously, we showed elevated expression of succinate receptor 1 (SUCNR1) in SDHB PPGLs and SDHD head and neck paragangliomas. Its ligand succinate has been reported to accumulate due to SDHx mutations. We thus hypothesize that autocrine stimulation of SUCNR1 plays a role in the pathogenesis of SDHx mutation-derived PPGLs. We confirmed elevated SUCNR1 expression in SDHx PPGLs and after SDHB knockout in progenitor cells derived from a human pheochromocytoma (hPheo1). Succinate significantly increased viability of SUCNR1-transfected PC12 and ERK pathway signaling compared to control cells. Candidate SUCNR1 inhibitors successfully reversed proliferative effects of succinate. Our data reveal an unrecognized oncometabolic function of succinate in SDHx PPGLs, providing a growth advantage via SUCNR1.

Department of Biomedical Engineering Centre for Public Health Genomics University of Virginia Charlottesville VA United States

Department of Medicine Division of Endocrinology University of Florida and Malcom Randall VA Medical Center Gainesville FL United States

Division of Endocrinology 471 Department of Internal Medicine Radboud University Medical Center Nijmegen Netherlands

Hereditary Endocrine Cancer Group Human Cancer Genetics Program Spanish National Cancer Research Centre Madrid Spain

Institute for Cardiogenetics University of Lübeck Lübeck Germany

Institute for Experimental and Clinical Pharmacology and Toxicology University of Lübeck Lübeck Germany

Institute of Biotechnology Czech Academy of Sciences Prague West Czechia

Institute of Clinical Chemistry and Laboratory Medicine University Hospital Carl Gustav Carus Medical Faculty Carl Gustav Carus Technische Universität Dresden Dresden Germany

Institute of Interdisciplinary Integrative Medicine Research Shanghai University of Traditional Chinese Medicine Shanghai China

Laboratory of Surgical Pathology National Cancer Institute National Institutes of Health Bethesda MD United States

Neuroendocrine Oncology and Metabolism Medical Department 1 Center of Brain Behavior and Metabolism University Medical Center Schleswig Holstein Lübeck Lübeck Germany

Radboud University Nijmegen Netherlands

School of Medical Science Griffith University Southport QLD Australia

Section on Medical Neuroendocrinology Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda MD United States

Surgical Neurology Branch National Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda MD United States

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