The "Warburg effect" describes a peculiar metabolic feature of many solid
tumors, namely their increased
glucose uptake and high glycolytic rates, which allow
cancer cells to accumulate building blocks for the biosynthesis of macromolecules. During aerobic glycolysis,
pyruvate is preferentially metabolized to
lactate by the
enzyme lactate dehydrogenase-A (
LDH-A), suggesting a possible vulnerability at this target for small-molecule inhibition in
cancer cells. In this study, we used FX11, a small-molecule inhibitor of
LDH-A, to investigate this possible vulnerability in a panel of 15 patient-derived mouse xenograft (PDX) models of
pancreatic cancer. Unexpectedly, the p53 status of the PDX
tumor determined the response to FX11.
Tumors harboring wild-type (WT) TP53 were resistant to FX11. In contrast,
tumors harboring mutant TP53 exhibited increased apoptosis, reduced proliferation indices, and attenuated
tumor growth when exposed to FX11. [18F]-FDG PET-CT scans revealed a relative increase in
glucose uptake in mutant TP53 versus WT TP53
tumors, with FX11 administration downregulating metabolic activity only in mutant TP53
tumors. Through a noninvasive quantitative assessment of
lactate production, as determined by 13C magnetic resonance spectroscopy (MRS) of hyperpolarized
pyruvate, we confirmed that FX11 administration inhibited
pyruvate-to-
lactate conversion only in mutant TP53
tumors, a feature associated with reduced expression of the TP53 target gene TIGAR, which is known to regulate glycolysis. Taken together, our findings highlight p53 status in
pancreatic cancer as a
biomarker to predict sensitivity to
LDH-A inhibition, with regard to both real-time noninvasive imaging by 13C MRS as well as therapeutic response.