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Aim: K-ras proteins have been found mutated in about 35% of human tumors and appear to be an important factor for tumorigenesis. Its expression correlates with metabolic alterations such as increased glycolysis and glutamine consumption. This ability of cancer cells to decouple glucose and glutamine uptake reprogramming their metabolism leads to a more efficient use of nutrients in order to support cell proliferation and represents an interesting target for cancer therapy. Aim of this study is to investigate the metabolic alterations occurring in k-ras transformed fibroblasts combining in vivo and in vitro studies. Materials and methods: nu/nu mice were subcutaneously implanted with 2.5 x 105 k-ras transformed murine NIH3T3 fibroblasts (oncogenic k-ras) or with 2.5 x 105 murine fibroblasts with the dominant negative mutation on GEF protein that attenuates k-ras activation reverting to the wild type phenotype (reverted). Lesions size was constantly monitored with calliper and volumes calculated as (L x l2)/2 mm3. Animals performed [18F]FDG- and [18F]FLTPET studies at several time points starting with a tumor dimension consistent with animal PET spatial resolution (approximately 2mm). Images were calibrated, corrected for isotope half-life and elaborated with PMOD software to calculate Standardized Uptake Value (SUVmax). Finally, animals were sacrificed and tumor collected for metabolomic analysis. Results: All animals injected with oncogenic k-ras fibroblasts develop in few days fast growing, aggressive and highly glycolytic tumors that appear homogeneous for both [18F]FDG and [18F]FLT SUV values. On the contrary, 40% of k-ras reverted animals develop heterogeneous tumors at later time. Among k-ras reverted animals, two distinct tumor phenotypes can be observed: small, slow growing and poor glycolitic tumors with low uptake of both tracers, and small, slow growing but highly glycolytic and proliferating tumors that present SUVmax values comparable to those of k-ras oncogenic tumors. A good correlation, even if not significant, between tumor volume and [18F]FLT SUVmax has been observed for oncogenic k-ras animals. Conclusions:PET imaging is an accurate in vivo technique able to visualize and monitor tumor development in the k-Ras fibroblasts mouse model. K-Ras transformed fibroblasts give rise to aggressive and fast-growing tumors that represent a good model to study the efficacy of cell metabolism based therapy. Finally, K-Ras reverted tumors need further investigations to understand the interaction among tumor microenvironment, metabolic alterations and genetic component that may trigger tumor development.

Abstract Background Rewiring of metabolism induced by oncogenic K-Ras in cancer cells involves both glucose and glutamine utilization sustaining enhanced, unrestricted growth. The development of effective anti-cancer treatments targeting metabolism may be facilitated by the identification and rational combinatorial targeting of metabolic pathways. Methods We performed mass spectrometric metabolomics analysis in vitro and in vivo experiments to evaluate the efficacy of drugs and identify metabolic connectivity. Results We show that K-Ras-mutant lung and colon cancer cells exhibit a distinct metabolic rewiring, the latter being more dependent on respiration. Combined treatment with the glutaminase inhibitor CB-839 and the PI3K/aldolase inhibitor NVP-BKM120 more consistently reduces cell growth of tumor xenografts. Maximal growth inhibition correlates with the disruption of redox homeostasis, involving loss of reduced glutathione regeneration, redox cofactors, and a decreased connectivity among metabolites primarily involved in nucleic acid metabolism. Conclusions Our findings open the way to develop metabolic connectivity profiling as a tool for a selective strategy of combined drug repositioning in precision oncology.

Glioblastoma (GBM) is a highly aggressive tumor of the brain. Despite the efforts, response to current therapies is poor and 2-years survival rate ranging from 6-12%. Here, we evaluated the preclinical efficacy of Metformin (MET) as add-on therapy to Temozolomide (TMZ) and the ability of [18F]FLT (activity of thymidine kinase 1 related to cell proliferation) and [18F]VC701 (translocator protein, TSPO) Positron Emission Tomography (PET) radiotracers to predict tumor response to therapy. Indeed, TSPO is expressed on the outer mitochondrial membrane of activated microglia/macrophages, tumor cells, astrocytes and endothelial cells. TMZ-sensitive (Gli36ΔEGFR-1 and L0627) or -resistant (Gli36ΔEGFR-2) GBM cell lines representative of classical molecular subtype were tested in vitro and in vivo in orthotopic mouse models. Our results indicate that in vitro, MET increased the efficacy of TMZ on TMZ-sensitive and on TMZ-resistant cells by deregulating the balance between pro-survival (bcl2) and pro-apoptotic (bax/bad) Bcl-family members and promoting early apoptosis in both Gli36ΔEGFR-1 and Gli36ΔEGFR-2 cells. In vivo, MET add-on significantly extended the median survival of tumor-bearing mice compared to TMZ-treated ones and reduced the rate of recurrence in the TMZ-sensitive models. PET studies with the cell proliferation radiopharmaceutical [18F]FLT performed at early time during treatment were able to distinguish responder from non-responder to TMZ but not to predict the duration of the effect. On the contrary, [18F]VC701 uptake was reduced only in mice treated with MET plus TMZ and levels of uptake negatively correlated with animals’ survival. Overall, our data showed that MET addition improved TMZ efficacy in GBM preclinical models representative of classical molecular subtype increasing survival time and reducing tumor relapsing rate. Finally, results from PET imaging suggest that the reduction of cell proliferation represents a common mechanism of TMZ and combined treatment, whereas only the last was able to reduce TSPO. This reduction was associated with the duration of treatment response. TSPO-ligand may be used as a complementary molecular imaging marker to predict tumor microenvironment related treatment effects.

Glioblastoma multiforme (GBM) is the most aggressive primary brain tumor with poor survival. Cytoreduction in association with radiotherapy and temozolomide (TMZ) is the standard therapy, but response is heterogeneous and life expectancy is limited. The combined use of chemotherapeutic agents with drugs targeting cell metabolism is becoming an interesting therapeutic option for cancer treatment. Here, we found that metformin (MET) enhances TMZ effect on TMZ-sensitive cell line (U251) and overcomes TMZ-resistance in T98G GBM cell line. In particular, combined-treatment modulated apoptosis by increasing Bax/Bcl-2 ratio, and reduced Reactive Oxygen Species (ROS) production. We also observed that MET associated with TMZ was able to reduce the expression of glioma stem cells (GSC) marker CD90 particularly in T98G cells but not that of CD133. In vivo experiments showed that combined treatment with TMZ and MET significantly slowed down growth of TMZ-resistant tumors but did not affect overall survival of TMZ-sensitive tumor bearing mice. In conclusion, our results showed that metformin is able to enhance TMZ effect in TMZ-resistant cell line suggesting its potential use in TMZ refractory GBM patients. However, the lack of effect on a GBM malignancy marker like CD133 requires further evaluation since it might influence response duration.

Purpose: In tumour, the imbalance between oxygen supply and demand leads to hypoxia, which represents a negative prognostic factor associated with aggressive tumour phenotype and therapy resistance. This review provides an overview of the use of positron emitter-labelled radiopharmaceutical used to image hypoxia in preclinical models of cancer. Methods: A critical and comprehensive PubMed search was performed identifying articles related to PET imaging for hypoxia assessment in preclinical setting from January 2007 up to January 2017. Results: We have considered and described a total of 54 original articles, exploring tumour-associated hypoxia in preclinical models. Results underlined the potential application together with the advantages and pitfalls of the use of PET in preclinical research. Multi-target imaging allowed to better define the relationship between hypoxia and other biological hallmarks of tumour; imaging of hypoxia was proved as a useful tool for lesions stratification and response prediction to radiotherapy; however, cutoff indexes were identified in few studies. Hypoxia PET showed remarkable tracer delivery limitations in the study of vascular disrupting agents but suggested the potential use of PET as a marker of response or resistance to anti-angiogenics. Finally, the effect of anaesthesia on tracer kinetics and tumour oxygenation as well as perfusion dependency in tracer uptake should be carefully evaluated to avoid artefactual results. Conclusions: Preclinical studies highlight the advantages and the limitations of the available hypoxia-radiotracers and their potential usefulness for the evaluation of treatments outcome and radiotherapy planning.

PURPOSE: Lung cancer heterogeneity makes response to therapy extremely hard to predict. Patient-derived xenografts (PDXs) represent a reliable preclinical model that closely recapitulates the main characteristics of the primary tumor and could represent a useful asset to test new therapies. Here, using PET imaging, we verify how lung cancer PDXs reproduce the metabolic features of the corresponding primary tumors. METHODS: We performed longitudinal [18F]FDG-PET studies on nine different PDXs, obtained by implants of primary cancer fragments harvested from patients. Max [18F]FDG uptake values of the lesion for each group were calculated and compared to corresponding patient's uptake. RESULTS: Different PDXs showed variable tumor growth rate and [18F]FDG uptake confirming the preservation of individual characteristics. A good intra-group reproducibility of PET measurements was observed. Furthermore, the subgroup of PDXs originating from primary tumors with higher metabolic rate displayed a rank order of [18F]FDG uptake similar to that of patients' original SUV. CONCLUSION: PDXs reproduced the original glucose metabolism of primary lesions and represent therefore a promising preclinical model also for the early assessment of therapy efficacy.

Rationale Pathological response to neo-adjuvant chemotherapy (NAC) represents a commonly used predictor of survival in triple negative breast cancer (TNBC) and the need to identify markers that predict response to NAC is constantly increasing. Aim of this study was to evaluate the potential usefulness of PET imaging with [18F]FDG and [18F]FLT for the discrimination of TNBC responders to Paclitaxel (PTX) therapy compared to the response assessed by an adapted Response Evaluation Criteria In Solid Tumors (RECIST) criteria based on tumor volume (Tumor Volume Response). Methods Nu/nu mice bearing TNBC lesions of different size were evaluated with [18F]FDG and [18F]FLT PET before and after PTX treatment. SUVmax, Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG) and Proliferation (TLP) were assessed using a graph-based random walk algorithm. Results We found that in our TNBC model the variation of [18F]FDG and [18F]FLT SUVmax similarly defined tumor response to therapy and that SUVmax variation represented the most accurate parameter. Response evaluation using Tumor Volume Response (TVR) showed that the effectiveness of NAC with PTX was completely independent from lesions size at baseline. Conclusions Our study provided interesting results in terms of sensitivity and specificity of PET in TNBC, revealing the similar performances of [18F]FDG and [18F]FLT in the identification of responders to Paclitaxel.

Cancer aberrant N- and O-linked protein glycosylation, frequently resulting from an augmented flux through the Hexosamine Biosynthetic Pathway (HBP), play different roles in tumor progression. However, the low specificity and toxicity of the existing HBP inhibitors prevented their use for cancer treatment. Here we report the preclinical evaluation of FR054, a novel inhibitor of the HBP enzyme PGM3, with a remarkable anti-breast cancer effect. In fact, FR054 induces in different breast cancer cells a dramatic decrease in cell proliferation and survival. In particular, in a model of Triple Negative Breast Cancer (TNBC) cells, MDA-MB-231, we show that these effects are correlated to FR054-dependent reduction of both N- and O-glycosylation level that cause also a strong reduction of cancer cell adhesion and migration. Moreover we show that impaired survival of cancer cells upon FR054 treatment is associated with the activation of the Unfolded Protein Response (UPR) and accumulation of intracellular ROS. Finally, we show that FR054 suppresses cancer growth in MDA-MB-231 xenograft mice, supporting the advantage of targeting HBP for therapeutic purpose and encouraging further investigation about the use of this small molecule as a promising compound for breast cancer therapy.

The factors that determine whether disseminated transformed cells in vivo yield neoplastic lesions have only been partially identified. We established an ad hoc model of peritoneal carcinomatosis by injecting colon carcinoma cells in mice. Tumor cells recruit inflammatory leukocytes, mostly macrophages, and generate neoplastic peritoneal lesions. Phagocyte depletion via clodronate treatment reduces neoplastic growth. Colon carcinoma cells release a prototypic damage-associated molecular pattern (DAMP)/alarmin, High Mobility Group Box1 (HMGB1), which attracts leukocytes. Exogenous HMGB1 accelerates leukocyte recruitment, macrophage infiltration, tumor growth and vascularization. Lentiviral-based HMGB1 knockdown or pharmacological interference with its extracellular impair macrophage recruitment and tumor growth. Our findings provide a preclinical proof of principle that strategies based on preventing HMGB1-driven recruitment of leukocytes could be used for treating peritoneal carcinomatosis.

Le tecniche di imaging molecolare permettono di visualizzare e caratterizzare processi biologici e rivestono un ruolo fondamentale in oncologia, consentendo di identificare marcatori per la diagnosi e la risposta al trattamento. In questo lavoro di tesi è stato valutato il ruolo della PET come possibile marcatore di risposta al trattamento in a) un modello con k-ras oncogenico e b) un modello di glioma, focalizzando l’attenzione sulle alterazioni del metabolismo e l’ipossia. L’incremento della glicolisi e del consumo di glutammina sono associati a mutazioni dell’oncogene ras in diversi tumori. Il disaccoppiamento di tali processi determina una riprogrammazione del metabolismo per supportare l’aumentata proliferazione fornendo un interessante target terapeutico. Scopo dello studio è la valutazione in vivo delle alterazioni metaboliche e della risposta alla terapia nel modello ottenuto mediante inoculo di fibroblasti con k-ras oncogenico (NIH-RAS). A tale scopo gruppi di topi sono stati monitorati longitudinalmente mediante PET-[18F]FDG e [18F]FLT per la valutazione del metabolismo glucidico e della proliferazione cellulare. I tumori sono stati sottoposti ad analisi immunoistochimiche per confermare i dati ottenuti in vivo. Nello stesso modello è stato valutato l’effetto di un inibitore dell’autofagia (Clorochina) e della glutaminasi (BPTES) singolarmente e in combinazione mediante PET-[18F]FDG e [18F]FLT. Gli animali hanno sviluppato in breve tempo tumori glicolitici e caratterizzati da un’omogenea captazione di [18F]FDG e [18F]FLT. Le immagini PET hanno mostrato un aumento della captazione di [18F]FDG nel tempo e un andamento stabile della proliferazione come mostrato dalla costante captazione di [18F]FLT. Clorochina e BPTES in combinazione hanno determinato un rallentamento della crescita tumorale rispetto ai controlli, ma non sono state osservate variazioni nella captazione di [18F]FDG e [18F]FLT. La presenza di vie alternative per la produzione di glutammato e la necessità di dosi più elevate potrebbero spiegare l’assenza di efficacia di questi trattamenti. L’ipossia rappresenta un fenomeno sfavorevole per la progressione tumorale. L’espressione di HIF1α, principale regolatore dell’ipossia, è associata alla resistenza alla terapia in molti tumori, compreso il glioma. Per questo, una migliore comprensione della modulazione dell’attività di HIF1α nel processo di risposta alla terapia è di particolare interesse. Cellule di glioma U251-HRE-mCherry in grado di esprimere l’enzima luciferasi sotto il controllo di HRE (Hypoxia Responsive Element) e mCherry sotto controllo di un promotore costitutivo sono state utilizzate per valutare la modulazione di HIF1α in seguito a trattamento con Temozolomide (TMZ) in vitro e in vivo. La crescita tumorale è stata monitorata in vivo in animali sottoposti ad inoculo intracerebrale tramite bioluminescenza, fluorescenza, RM e PET con [18F]FAZA e [18F]FLT. In seguito, è stato valutato in vivo l’effetto di due diversi regimi di TMZ. Mediante bioluminescenza è stato possibile monitorare la crescita tumorale e identificare aree ipossiche. I dati ottenuti sono stati confermati dalle immagini di fluorescenza e PET-[18F]FAZA. Le analisi ex vivo per Ki67 hanno invece confermato i dati PET-[18F]FLT ed hanno mostrato un’elevata proliferazione cellulare. Entrambi i dosaggi di TMZ hanno determinato una diminuzione dell’attività di HIF1α a tempi precoci. Al contrario, il segnale di fluorescenza e la captazione di [18F]FLT hanno subìto una diminuzione solo a tempi più tardivi. L’attività di HIF1α può essere considerata un marcatore di risposta al TMZ e questo modello un utile strumento per la valutazione in vivo di farmaci per il trattamento del glioma. Molecular imaging allows the non-invasive visualization and characterization of biological processes. It can be used in oncology to identify biomarkers for the evaluation of tumor progression and response to therapy. In this thesis work, the animal PET was used as potential biomarker of tumor response to therapy focusing on altered metabolism and hypoxia in a) a model of oncogenic k-ras and b) in a model of glioma. Metabolic alterations, such as increased glycolysis and glutamine consumption, are associated with mutations in k-ras gene. The decoupling of glucose and glutamine uptake leads to a reprogramming of their metabolism to support cell proliferation representing a target for cancer therapy. The aim of this study is to investigate metabolic alterations in k-ras transformed fibroblasts (NIH-RAS) in in vivo studies and to assess response to therapy. Animals subcutaneously implanted with NIH-RAS performed [18F]FDG- and [18F]FLT-PET at several time points to evaluate glucose metabolism and cell proliferation, respectively. Tumors were collected and evaluated for different markers by immunohistochemistry (IHC) to confirm in vivo results. In the same model, the efficacy of chloroquine (autophagy blocker) and BPTES (glutaminase inhibitor) alone or in combination was monitored by [18F]FDG- and [18F]FLT-PET before and 48 hours after treatments. All animals developed fast growing and highly glycolytic tumors in few days that appear homogeneous for both [18F]FDG and [18F]FLT uptake. PET imaging showed a significant increase in [18F]FDG uptake while cell proliferation remained stable over time, as depicted by [18F]FLT uptake. IHC analyses confirmed the high aggressiveness of these cells. Chloroquine and BPTES combined treatment slowed down tumor growth only if compared to vehicle, without affecting glucose metabolism or cell proliferation. The presence of alternative pathways for glutamate production and the need of higher doses of treatments may provide explanations to the lack of treatments’ efficacy. Hypoxia is implicated in many aspects of tumor progression and it is involved in the intracellular stabilization of the hypoxia regulator gene HIF-1α. Since the expression of HIF-1α is associated with poor prognosis and therapy resistance in glioblastoma, a better comprehension of its involvement in tumor response to treatment can be of great interest for clinical translation. U251-HRE-mCherry cells expressing Luciferase under control of a Hypoxia Responsive Element (HRE) and mCherry under the control of a constitutive promoter have been used to assess HIF-1α modulation and cell survival after treatment, both in vitro and in vivo. In vivo analyses characterized the model obtained by stereotaxic injection of glioma U251-HRE cells in mice brain. Tumor progression was monitored comparing bioluminescence, fluorescence and PET with [18F]FAZA and [18F]FLT. Afterwards, two regimens of temozolomide (TMZ) were administered starting 21 days after cells injection. TMZ efficacy was monitored by optical and fluorescence imaging, [18F]FLT-PET and MRI. Bioluminescent signals provided information about tumor growth and hypoxia presence, confirmed by both fluorescence acquisition and [18F]FAZA PET. IHC for Ki67 confirmed data obtained by [18F]FLT-PET, showing a high rate of cell proliferation. Both TMZ regimens showed a decrease of HIF-1α-dependent Luciferase activity at early time after TMZ administration. On the contrary, mCherry fluorescence, such as [18F]FLT uptake, decreased only at the end of treatments. HIF-1α activity reduction can be considered a biomarker of tumour response to TMZ and the U251-HRE-mCherry cell model a feasible tool to evaluate HIF-1α activity and treatment effects in in vivo studies.

Purpose: Hypoxia-inducible factor 1α (HIF-1α) activity is one of the major players in hypoxia-mediated glioma progression and resistance to therapies, and therefore the focus of this study was the evaluation of HIF-1α modulation in relation to tumour response with the purpose of identifying imaging biomarkers able to document tumour response to treatment in a murine glioma model. Methods: U251-HRE-mCherry cells expressing Luciferase under the control of a hypoxia responsive element (HRE) and mCherry under the control of a constitutive promoter were used to assess HIF-1α activity and cell survival after treatment, both in vitro and in vivo, by optical, MRI and positron emission tomography imaging. Results: This cell model can be used to monitor HIF-1α activity after treatment with different drugs modulating transduction pathways involved in its regulation. After temozolomide (TMZ) treatment, HIF-1α activity is early reduced, preceding cell cytotoxicity. Optical imaging allowed monitoring of this process in vivo, and carbonic anhydrase IX (CAIX) expression was identified as a translatable non-invasive biomarker with potential clinical significance. A preliminary in vitro evaluation showed that reduction of HIF-1α activity after TMZ treatment was comparable to the effect of an Hsp90 inhibitor, opening the way for further elucidation of its mechanism of action. Conclusion: The results of this study suggest that the U251-HRE-mCherry cell model can be used for the monitoring of HIF-1α activity through luciferase and CAIX expression. These cells can become a useful tool for the assessment and improvement of new targeted tracers for potential theranostic procedures.

PURPOSE: The aim of this study was to characterize a cell-based model for the molecular study of hypoxia-inducible factor (HIF)-1? activity, in the context of hypoxia, by means of different imaging techniques. PROCEDURES: Engineered U251-HRE glioma cells were used to analyze the molecular mechanisms underlying HIF-1? activity in vitro in relation to luciferase expression. The same cells were orthotopically implanted in mice to evaluate tumor progression and hypoxia induction by bioluminescence imaging, fluorescence imaging, positron emission tomography (PET), and magnetic resonance imaging (MRI). RESULTS: In vitro analyses highlighted the relationship between HIF-1? and luciferase activity in hypoxic conditions and after pharmacological treatments in U251-HRE cells. Through in vivo studies, it was possible to assess hypoxia establishment in relation to tumor growth by optical imaging, PET and MRI. CONCLUSIONS: The findings of this study indicate that the U251-HRE orthotopic murine model can be used to reliably evaluate processes modulating HIF-1? activity, using both molecular and preclinical non-invasive imaging techniques.

Introduction The prognosis of malignant gliomas remains largely unsatisfactory for the intrinsic characteristics of the pathology and for the delayed diagnosis. Multimodal imaging based on PET and MRI may assess the dynamics of disease onset and progression allowing the validation of preclinical models of glioblastoma multiforme (GBM). The aim of this study was the characterization of a syngeneic rat model of GBM using combined in vivo imaging and immunohistochemistry. Methods Four groups of Fischer rats were implanted in a subcortical region with increasing concentration of rat glioma F98 cells and weekly monitored with Gd-MR, [ 18 F]FDG- and [ 18 F]FAZA-PET starting one week after surgery. Different targets were evaluated on post mortem brain specimens using immunohistochemistry: VEGF, GFAP, HIF-1α, Ki-67 and nestin. Results Imaging results indicated that tumor onset but not progression was related to the number of F98 cells. Hypoxic regions identified with [ 18 F]FAZA and high-glucose metabolism regions recognized with [ 18 F]FDG were located respectively in the core and in external areas of the tumor, with partial overlap and remodeling during disease progression. Histological and immunohistochemical analysis confirmed PET/MRI results and revealed that our model resumes biological characteristics of human GBM. IHC and PET studies showed that necrotic regions, defined on the basis of [ 18 F]FDG uptake reduction, may include hypoxic clusters of vital tumor tissue identified with [ 18 F]FAZA. This last information is particularly relevant for the identification of the target volume during image- guided radiotherapy . Conclusions In conclusion, the combined use of PET and MRI allows in vivo monitoring of the biological modification of F98 lesions during tumor progression.