Glucose metabolic reprogramming in systemic lupus erythematosus and lupus nephritis: theoretical foundations and therapeutic implications

Lupus nephritis (LN) represents the most severe and frequent complication of systemic lupus erythematosus (SLE), yet its treatment remains a significant unmet clinical need. Recent advances in immunometabolism have revealed that glucose metabolic reprogramming-including shifts in glycolysis, the pentose phosphate pathway (PPP), and the tricarboxylic acid (TCA) cycle-plays a central role in driving pathogenic immune cell activation in SLE. However, a critical gap persists in understanding how these metabolic alterations specifically operate within the renal microenvironment to promote immune cell infiltration and intrinsic kidney cell injury in LN. This review synthesizes current evidence on the molecular mechanisms linking glucose metabolism to immune dysfunction in innate immune cells including monocytes/macrophages, neutrophils and DCs and adaptive immune cells including T cells, B cells and renal resident cells. We further discuss therapeutic strategies targeting metabolic pathways, including repurposed drugs (metformin, hydroxychloroquine, rapamycin), preclinical small molecules (PKM2, PFKFB3, LDHA, GLUT1 inhibitors), and combination therapies with biologics. Safety considerations, particularly the sensitivity of regulatory T cells (Tregs) to glycolysis inhibition, underscore the need for dose optimization. Finally, we highlight future directions, including real-time metabolic imaging, personalized glycolysis scoring, and spatiotemporal metabolic epigenetic models, which hold promise for advancing precision medicine in LN.