EPR imaging of oxygen consumption driven by NQO1-activated compounds in FH-deficient renal tumors

Patients with hereditary leiomyomatosis and renal cell carcinoma (HLRCC), characterized by mutations in the fumarate hydratase (FH) gene, are at risk for development of aggressive FH-deficient RCCs. FH-deficient tumor cells undergo a pronounced and irreversible metabolic shift to lactate fermentation due in part to loss and mutation of mitochondrial DNA. Fumarate accumulation in FH-deficient tumor cells leads to increased expression of NAD(P)H-quinone oxidoreductase 1 (NQO1) through activation of the NRF2 transcription factor. Although several therapeutic agents have shown promise in the treatment of FH-deficient RCC, clinical outcomes in patients remain unsatisfactory. In this study, we examined the mechanism and therapeutic efficacy of isobutyl-deoxynyboquinone (IB-DNQ), which undergoes futile redox cycling in the presence of NQO1 and oxygen, leading to sustained generation of the highly reactive and toxic superoxide anion. First, we found that patient-derived FH-deficient tumor cells exhibit minimal oxygen consumption in vitro, and EPR oxygen mapping of FH-deficient tumor xenografts in vivo revealed that tumor oxygen levels were elevated relative to other genetically defined in vivo models of RCC. Infusion of IB-DNQ in tumor-bearing animals resulted in rapid and robust non-mitochondrial oxygen consumption in FH-deficient tumor xenografts as measured by both EPR oxygen imaging and photoacoustic mapping of tumor hemoglobin saturation. Repeated doses of IB-DNQ resulted in reduced tumor growth rates. Metabolomic analyses revealed that IB-DNQ treatment strongly suppressed glycolysis and reduced cellular ATP levels by rapidly depleting NADH and NADPH in FH-deficient tumor cells. Finally, [1- 13 C]pyruvate hyperpolarized MR spectroscopy revealed decreased conversion of pyruvate to lactate in FH-deficient tumor xenografts following IB-DNQ treatment, providing a direct measurement of the impact of IB-DNQ on lactate fermentation in vivo. The combination of these in vivo imaging techniques and metabolite measurements demonstrate that NQO1-activated quinones can effectively target aerobic glycolysis in FH-deficient tumors which rely heavily on lactate fermentation for growth.