Clinically Translatable Hyperpolarized (13)C Bicarbonate pH Imaging Method for Use in Prostate Cancer

[Image: see text] Solid tumors such as prostate cancer (PCa) commonly develop an acidic microenvironment with pH 6.5–7.2, owing to heterogeneous perfusion, high metabolic activity, and rapid cell proliferation. In preclinical prostate cancer models, disease progression is associated with a decrease in tumor extracellular pH, suggesting that pH imaging may reflect an imaging biomarker to detect aggressive and high-risk disease. Therefore, we developed a hyperpolarized carbon-13 MRI method to image the tumor extracellular pH (pH(e)) and prepared it for clinical translation for detection and risk stratification of PCa. This method relies on the rapid breakdown of hyperpolarized (HP) 1,2-glycerol carbonate (carbonyl-(13)C) via base-catalyzed hydrolysis to produce HP (13)CO(3)(2–), which is neutralized and converted to HP H(13)CO(3)(–). After injection, HP H(13)CO(3)(–) equilibrates with HP (13)CO(2)in vivo and enables the imaging of pH(e). Using insights gleaned from mechanistic studies performed in the hyperpolarized state, we solved issues of polarization loss during preparation in a clinical polarizer system. We successfully customized a reaction apparatus suitable for clinical application, developed clinical standard operating procedures, and validated the radiofrequency pulse sequence and imaging data acquisition with a wide range of animal models. The results demonstrated that we can routinely produce a highly polarized and safe HP H(13)CO(3)(–) contrast agent suitable for human injection. Preclinical imaging studies validated the reliability and accuracy of measuring acidification in healthy kidney and prostate tumor tissue. These methods were used to support an Investigational New Drug application to the U.S. Food and Drug Administration. This methodology is now ready to be implemented in human trials, with the ultimate goal of improving the management of PCa.