Well-differentiated/dedifferentiated liposarcoma (WD/DD LPS) is a common subtype of soft tissuesarcoma in adults. Our understanding of this disease is lacking and treatment options are limited. First, by investigating tumor metabolomics, we identify asparagine (Asn) as a fundamental purpose for mitochondrial respiration in WD/DD LPS. Asn promotes mTORC1 activity to support tumor growth. Depleting Asn by combining mitochondrial complex I inhibition with asparaginase holds therapeutic potential. Next, we characterize WD/DD LPS beyond histological classification by defining mechanisms of dysregulation in mitochondrial dynamics. WD LPS displays low MAPK signaling activity, elongated mitochondrial morphology, and high mitochondrial respiration. Whereas DD LPS displays high activation of MAPK signaling, which promotes activation of DRP1, fragmentation of mitochondria and a glycolytic phenotype. This shift in mitochondrial bioenergetics promotes tumor growth. Trametinib represents a novel therapeutic approach to target this adaptation. Moreover, Trametinib synergizes with chemotherapy, including agents Pazopanib and Palbociclib, further expanding its clinical potential. DRP1 expression may also serve as a prognostic biomarker, associating with worse survival. Altogether, these findings reveal several adaptations in mitochondrial bioenergetics that provide opportunities for targeted therapy in patients with WD/DD LPS.
The diagnostic definition of indeterminate lung nodules as malignant or benign poses a major challenge for clinicians. We discovered a potential marker, the sodium-dependent glucose transporter 2 (SGLT2), whose activity identified metabolically active lung premalignancy and early-stage lung adenocarcinoma (LADC). We found that SGLT2 is expressed early in lung tumorigenesis and is found specifically in premalignant lesions and well-differentiated adenocarcinomas. SGLT2 activity could be detected in vivo by positron emission tomography (PET) with the tracer methyl 4-deoxy-4-[18F] fluoro-alpha-d-glucopyranoside (Me4FDG), which specifically detects SGLT activity. Using a combination of immunohistochemistry and Me4FDG PET, we identified high expression and functional activity of SGLT2 in lung premalignancy and early-stage/low-grade LADC. Furthermore, selective targeting of SGLT2 with FDA-approved small-molecule inhibitors, the gliflozins, greatly reduced tumor growth and prolonged survival in autochthonous mouse models and patient-derived xenografts of LADC. Targeting SGLT2 in lung tumors may intercept lung cancer progression at early stages of development by pairing Me4FDG PET imaging with therapy using SGLT2 inhibitors.
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