A Review on the Role of Pyruvate Kinase M2 in Cancer: From Metabolic Switch to Transcriptional Regulation

Pyruvate kinase M2 (PKM2) is a pivotal glycolytic enzyme that supports cancer progression through both metabolic and non-metabolic functions. PKM2 exists in dynamic equilibrium between dimeric and tetrameric forms, thereby modulating the balance between anabolic and catabolic pathways. The dimeric form promotes aerobic glycolysis, diverting intermediates toward biosynthetic processes and oxidative phosphorylation, which are essential for tumor growth. In contrast, the tetrameric form also regulates lipid and amino acid metabolism, facilitating the synthesis of fatty acids, cholesterol, and serine. Unique among pyruvate kinase isoforms, PKM2 activity is tightly controlled by post-translational modifications and environmental cues. This review focuses on the numerous roles of PKM2 in metabolic reprogramming and transcriptional regulation, emphasizing its contribution to glycolysis, angiogenesis, inflammation, immune evasion, mitochondrial dynamics, and autophagy. PKM2-mediated regulation of mitochondrial fusion–fission balance helps maintain organelle integrity under oxidative stress. Furthermore, we discuss categories of PKM2 modulators and their mechanisms of action, highlighting the therapeutic potential of targeting dual-functionality PKM2 to develop more effective and less toxic anti-cancer strategies. Furthermore, the clinical relevance of PKM2 in human cancers is increasingly recognized, as its altered expression and localization serve as potential diagnostic and prognostic biomarkers, as well as determinants of chemosensitivity and therapeutic resistance. A comprehensive understanding of the multifaceted role of PKM2 could be implicated in novel interventions in cancer and other metabolic disorders.