Monitoring response to a clinically relevant IDH inhibitor in glioma—Hyperpolarized (13)C magnetic resonance spectroscopy approaches

BACKGROUND: Mutant isocitrate dehydrogenase (IDHmut) catalyzes 2-hydroxyglutarate (2HG) production and is considered a therapeutic target for IDHmut tumors. However, response is mostly associated with inhibition of tumor growth. Response assessment via anatomic imaging is therefore challenging. Our goal was to directly detect IDHmut inhibition using a new hyperpolarized (HP) (13)C magnetic resonance spectroscopy-based approach to noninvasively assess α-ketoglutarate (αKG) metabolism to 2HG and glutamate. METHODS: We studied IDHmut-expressing normal human astrocyte (NHAIDH1mut) cells and rats with BT257 tumors, and assessed response to the IDHmut inhibitor BAY-1436032 (n ≥ 4). We developed a new (13)C Echo Planar Spectroscopic Imaging sequence with an optimized RF pulse to monitor the fate of HP [1-(13)C]αKG and [5-(12)C,1-(13)C]αKG with a 2.5 × 2.5 × 8 mm(3) spatial resolution. RESULTS: Cell studies confirmed that BAY-1436032-treatment leads to a drop in HP 2HG and an increase in HP glutamate detectable with both HP substrates. Data using HP [5-(12)C,1-(13)C]αKG also demonstrated that its conversion to 2HG is detectable without the proximal 1.1% natural abundance [5-(13)C]αKG signal. In vivo studies showed that glutamate is produced in normal brains but no 2HG is detectable. In tumor-bearing rats, we detected the production of both 2HG and glutamate, and BAY-1436032-treatment led to a drop in 2HG and an increase in glutamate. Using HP [5-(12)C,1-(13)C]αKG we detected metabolism with an signal-to-noise ratio of 23 for 2HG and 17 for glutamate. CONCLUSIONS: Our findings point to the clinical potential of HP αKG, which recently received FDA investigational new drug approval for research, for noninvasive localized imaging of IDHmut status.