Abstract

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Patients with similar tumour types can have markedly different responses to the same treatment. The development of new treatments would benefit, therefore, from the introduction of imaging methods that allow an early assessment of treatment response in individual patients, allowing rapid selection of the most effective treatment.

Tumour cells have long been known to display high rates of glucose utilisation in the presence of normal levels of oxygen. In recent years it has become increasingly clear that this unusual glucose metabolism, and the other metabolic changes observed in tumour cells, are driven by oncogene activation and tumour suppressor loss. This altered metabolism has provided ways of detecting tumours and their responses to treatment using metabolic imaging.

We have been developing a new technique, termed nuclear spin hyperpolarization, which increases sensitivity in the magnetic resonance experiment by >10,000x. This has allowed us to image injected hyperpolarised 13C labelled cell substrates in vivo and, more importantly, their metabolic conversion into other metabolites. We have shown how, using various labelled substrates, this technique can be used to monitor early evidence of treatment response and subsequent cell death and to investigate various aspects of the tumour microenvironment, including the pH and redox state. This technique has recently translated to the clinic and we expect to image the first patients in Cambridge later this year.