BPGM (bisphosphoglycerate mutase) is a key metabolic enzyme that regulates oxygen delivery and cellular energy metabolism through multiple mechanisms. Its primary function involves controlling levels of 2,3-bisphosphoglycerate (2,3-BPG), a critical allosteric effector that modulates hemoglobin oxygen affinity and oxygen release capacity 1 2. BPGM operates through the Rapoport-Luebering shunt pathway, where it channels glucose metabolism toward glycolysis and promotes 2,3-BPG production 2 3. The enzyme is activated by AMPK signaling and sphingosine 1-phosphate (S1P), which triggers metabolic reprogramming in erythrocytes 2 1. Beyond erythrocytes, BPGM functions in various cell types including astrocytes, where it suppresses glycolysis under hypoxic conditions via HIF-1α and TET2 regulation 4, and oocytes, where it influences glucose metabolism during maturation 5. Clinically, BPGM expression serves as a biomarker for sepsis outcomes 6 and cancer prognosis, with altered expression patterns associated with cervical cancer progression 7 and hepatocellular carcinoma 8. BPGM deficiency impairs oxygen delivery capacity and contributes to tissue hypoxia in chr7 kidney disease 2 3.