UCSF

Non-invasive techniques to assess metabolic reprogramming during cancer progression can be used to improve therapeutic selection and provide an early assessment of therapeutic response or resistance in individual patients. Prior studies have shown that metabolic reprogramming plays a key role in the development of prostate cancer and renal cell carcinoma (RCC). This dissertation further elucidates the metabolic alterations that occur in treatment-resistant prostate cancer and in patient-derived models of RCC using high-resolution nuclear magnetic resonance (NMR) spectroscopy and hyperpolarized (HP) 13C magnetic resonance imaging (MRI), with the goal of identifying new non-invasive diagnostic imaging tools. Glycolysis, metabolism of pyruvate and glutamate via the tricarboxylic acid (TCA) cycle, glutaminolysis, and glutathione synthesis are upregulated in castration-resistant prostate cancer (CRPC) compared to their androgen-dependent counterparts, using human cell lines as well a treatment-driven transgenic murine model. These metabolic alterations were reversed in castration-resistant murine tumors by treatment with a secondary androgen pathway inhibitor, apalutamide, suggesting that early metabolic responses to treatment can be monitored using non-invasive imaging techniques. Furthermore, treatment-emergent small cell neuroendocrine prostate cancer, a consequence of protracted treatment with primary androgen deprivation therapy and secondary androgen pathway inhibitors, exhibits significantly upregulated glycolysis, TCA cycle metabolism of pyruvate and glutamate, and glutaminolysis, as well as significantly altered redox capacity compared to castration-resistant prostate adenocarcinoma using patient-derived xenograft models. Finally, the metabolic differences associated with the tumor microenvironment were compared between various patient-derived models of RCC, finding that RCC patient-derived xenografts (PDXs) displayed higher redox capacity and were more proliferative than cells and tissue slices derived from the PDXs and maintained ex vivo. The work presented in this dissertation suggests that a combination of HP [1-13C]pyruvate, [2-13C]pyruvate, [5-13C]glutamine, and [1-13C]dehydroascorbate can be used to distinguish advanced prostate cancer and RCC subtypes in future HP 13C MRI of patients for improved treatment selection and monitoring.