Human lung tumors are metabolically distinct from adjacent lung tissue. It is unknown whether these reprogrammed activities predict clinical outcomes or represent meaningful therapeutic liabilities. The major bottleneck in understanding the clinical relevance of cancer metabolism has been a lack of data about human tumor metabolism in vivo. For the first time, we have overcome this limitation and used intra-operative infusions with 13C-glucose to define metabolic phenotypes in human non-small cell lung cancer (NSCLC). We reported that one NSCLC subset displays prominent import of lactate, while another subset produces lactate from glucose. Our observation that lactate uptake via monocarboxylate transport protein-1 (MCT1) correlates with rapid disease progression in lung adenocarcinoma is the first and to date only metabolic flux phenotype demonstrated to predict clinical outcomes in any human cancer. In this Project, we will expand the scope of metabolic analysis in human NSCLC, performing 13C infusions in more than 100 patients, assessing hundreds of metabolites in each tumor, and following clinical histories to identify new activities correlating with outcomes.
In Specific Aim 1, tumors infused with 13C will be analyzed by imaging, quantitative histopathology, RNA sequencing and whole exome sequencing to understand relationships between these features and cancer metabolism. We will focus on identifying metabolic features that correlate with reduced progression-free survival, under the rationale that such activities are attractive therapeutic targets to test in preclinical models. We will establish patient-derived xenografts (PDXs) from these tumors to test the importance of predictive metabolic activities for tumor growth and metastasis. While our open-ended metabolomics approach is designed to uncover novel therapeutic targets, based on our earlier work, we will specifically test whether inhibiting MCT1 reduces tumor growth and metastasis in mice.
In Specific Aim 2 we will follow up on our observation that lung squamous cell carcinomas require lactate export for maximal growth. We will test whether genetic or pharmacological inhibition of novel molecular components of MCT4-mediated lactate export suppresses tumor growth in mouse models and PDXs.
Specific Aim 3 will examine metabolic crosstalk among cancer cells and several important immune cell populations in the tumor microenvironment in mice and humans. We will test the hypothesis that lactate metabolism impacts these metabolic exchanges and that blocking lactate transport enhances the efficacy of immune checkpoint blockade therapy. Overall, these efforts will produce the most detailed and clinically- relevant view of NSCLC metabolism to date. The ability to combine our ongoing study assessing metabolic flux in human NSCLC with large legacy clinical datasets ideally positions us to understand the relationship between tumor metabolism and cancer progression, and to advance high-priority therapeutic targets into clinical trials. The immediate Human Endpoint of this project is the direct, detailed examination of tumor metabolism and tumor microenvironment patients with lung cancer following 13C-glucose infusions, while later Human Endpoints will involve therapeutic interventions targeting MCT1 and MCT4.

Public Health Relevance

The goal of SPORE Project #1 ?Targeting Metabolic Vulnerabilities in Lung Cancer? is to identify previously unknown acquired vulnerabilities related to tumor cell metabolism in lung cancer and in preclinical models test the effect of targeting these vulnerabilities alone and with clinically available therapies. This proposal will identify specific metabolic activities that predict disease progression in humans and will thoroughly study the effect of therapeutically inhibiting one such activity, lactate transport, on tumor growth and metastasis in preclinical models in mice. In addition, this project will provide some of the first data on how lung cancer metabolism affects its tumor microenvironment (and vice versa) particularly related to anti-tumor immune responses which will be of value to all of the other SPORE Projects.

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National Cancer Institute (NCI)
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University of Texas Sw Medical Center Dallas
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