Deuterium Metabolic Imaging Phenotypes Mouse Glioblastoma Heterogeneity Through Glucose Turnover Kinetics

Reviewer #1 (Public Review):

Summary:

This work introduces a new imaging tool for profiling tumor microenvironments through glucose conversion kinetics. Using GL261 and CT2A intracranial mouse models, the authors demonstrated that tumor lactate turnover mimicked the glioblastoma phenotype, and differences in peritumoral glutamate-glutamine recycling correlated with tumor invasion capacity, aligning with histopathological characterization. This paper presents a novel method to image and quantify glucose metabolites, reducing background noise and improving the predictability of multiple tumor features. It is, therefore, a valuable tool for studying glioblastoma in mouse models and enhances the understanding of the metabolic heterogeneity of glioblastoma.

Strengths:

By combining novel spectroscopic imaging modalities and recent advances in noise attenuation, Simões et al. improve upon their previously published Dynamic Glucose-Enhanced deuterium metabolic imaging (DGE-DMI) method to resolve spatiotemporal glucose flux rates in two commonly used syngeneic GBM mouse models, CT2A and GL261. This method can be standardized and further enhanced by using tensor PCA for spectral denoising, which improves kinetic modeling performance. It enables the glioblastoma mouse model to be assessed and quantified with higher accuracy using imaging methods.

The study also demonstrated the potential of DGE-DMI by providing spectroscopic imaging of glucose metabolic fluxes in both the tumor and tumor border regions. By comparing these results with histopathological characterization, the authors showed that DGE-DMI could be a powerful tool for analyzing multiple aspects of mouse glioblastoma, such as cell density and proliferation, peritumoral infiltration, and distant migration.

Weaknesses:

Although the paper provides clear evidence that DGE-DMI is a potentially powerful tool for the mouse glioblastoma model, it fails to use this new method to discover novel features of tumors. The data presented mainly confirm tumor features that have been previously reported. While this demonstrates that DGE-DMI is a reliable imaging tool in such circumstances, it also diminishes the novelty of the study.

When using DGE-DMI to quantitatively map glycolysis and mitochondrial oxidation fluxes, there is no comparison with other methods to directly identify the changes. This makes it difficult to assess how sensitive DGE-DMI is in detecting differences in glycolysis and mitochondrial oxidation fluxes, which undermines the claim of its potential for in vivo GBM phenotyping.

The study only used intracranial injections of two mouse glioblastoma cell lines, which limits the application of DGE-DMI in detecting and characterizing de novo glioblastomas. A de novo mouse model can show tumor growth progression and is more heterogeneous than a cell line injection model. Demonstrating that DGE-DMI performs well in a more clinically relevant model would better support its claimed potential usage in patients.

Reviewer #2 (Public Review):

Summary:

In this work, the authors attempt to noninvasively image metabolic aspects of the tumor microenvironment in vivo, in 2 mouse models of glioblastoma. The tumor lesion and its surrounding appearance are extensively characterized using histology to validate/support any observations made with the metabolic imaging approach. The metabolic imaging method builds on a previously used approach by the authors and others to measure the kinetics of deuterated glucose metabolism using dynamic 2H magnetic resonance spectroscopic imaging (MRSI), supported by de-noising methods.

Strengths:

Extensive histological evaluation and characterization.

Measurement of the time course of isotope labeling to estimate absolute flux rates of glucose metabolism.

Weaknesses:

The de-noising method appears essential to achieve the high spatial resolution of the in vivo imaging to be compatible with the dimensions of the tumor microenvironment, here defined as the immediately adjacent rim of the mouse brain tumors. There are a few challenges with this approach. Often denoising methods applied to MR spectroscopy data have merely a cosmetic effect but the actual quantification of the peaks in the spectra is not more accurate than when applied directly to original non-denoised data. It is not clear if this concern is applicable to the denoising technique applied here. However, even if this is not an issue, no denoising method can truly increase the original spatial resolution at which data were acquired. A quick calculation estimates that the spatial resolution of the 2H MRSI used here is 30-40 times too low to capture the much smaller tumor rim volume, and therefore there is concern that normal brain tissue and tumor tissue will be the dominant metabolic signal in so-called tumor rim voxels. This means that the conclusions on metabolic features of the (much larger) tumor are much more robust than the observations attributed to the (much smaller) tumor microenvironment/tumor rim.

To achieve their goal of high-level metabolic characterization the authors set out to measure the deuterium labeling kinetics following an intravenous bolus of deuterated glucose, instead of the easier measurement of steady-state after the labeling has leveled off. These dynamic data are then used as input for a mathematical model of glucose metabolism to derive fluxes in absolute units. While this is conceptually a well-accepted approach there are concerns about the validity of the included assumptions in the metabolic model, and some of the model's equations and/or defining of fluxes, that seem different than those used by others.

Reviewer #3 (Public Review):

Summary:

Simoes et al enhanced dynamic glucose-enhanced (DGE) deuterium spectroscopy with Deuterium Metabolic Imaging (DMI) to characterize the kinetics of glucose conversion in two murine models of glioblastoma (GBM). The authors combined spectroscopic imaging and noise attenuation with histological analysis and showcased the efficacy of metabolic markers determined from DGE DMI to correlate with histological features of the tumors. This approach is also potent to differentiate the two models from GL261 and CT2A.

Strengths:

The primary strength of this study is to highlight the significance of DGE DMI in interrogating the metabolic flux from glucose. The authors focused on glutamine/glutamate and lactate. They attempted to correlate the imaging findings with in-depth histological analysis to depict the link between metabolic features and pathological characteristics such as cell density, infiltration, and distant migration.

Weaknesses:

(1) A lack of genetic interrogation is a major weakness of this study. It was unclear what underlying genetic/epigenetic aberrations in GL261 and CT2A account for the metabolic difference observed with DGE DMI. A correlative metabolic confirmation using mass spectrometry of the two tumor specimens would give insight into the observed imaging findings.

(2) A better depiction of the imaging features and tumor heterogeneity would support the authors' multimodal attempt.

(3) Integration of the various cell types in the tumor microenvironment, as allowed with the resolution of DGE DMI, will explain the observed difference between GL261 and CT2A. Is there a higher percentage of infiltrative "other cells" observed in GL261 tumor?

(4)This underlying technology with DGE DMI is capable of identifying more heterogeneous GBM tumors. A validation cohort of additional in vivo models will offer additional support to the potential clinical impact of this study.