Glutamine Ratio Is Key Indicator of Tumor Aggression in Ovarian Cancer, Study Finds


Key Points

  • A high glutamine ratio was directly correlated to tumor aggression and metastatic capability. Patients with this profile had the worst prognosis for survival.
  • The study uncovered a direct relationship between glutamine and STAT3, a key biomarker for ovarian cancer.
  • Ovarian cancer may be susceptible to multidrug cocktails tailored to match the metabolic profile of a patient’s tumor.

An analysis of the metabolic profiles of hundreds of ovarian tumors has revealed a new test to determine whether ovarian cancer cells have the potential to metastasize. The study, which was published in Molecular Systems Biology, also suggests how ovarian cancer treatments can be tailored based on the metabolic profile of a particular tumor. The research was conducted at the Texas Medical Center in Houston by researchers from Rice University, The University of Texas MD Anderson Cancer Center, and Baylor College of Medicine.

Role of Glutamine in Metabolic Profile of Ovarian Cancer

“We found a striking difference between the metabolic profiles of poorly aggressive and highly aggressive ovarian tumor cells, particularly with respect to their production and use of the amino acid glutamine,” said lead researcher Deepak Nagrath, PhD, who is Assistant Professor of Chemical and Biomolecular Engineering and of Bioengineering at Rice. “For example, we found that highly aggressive ovarian cancer cells are glutamine-dependent, and in our laboratory studies, we showed that depriving such cells of external sources of glutamine—as some experimental drugs do—was an effective way to kill late-stage cells.

“The story for poorly aggressive cells was quite different,” said Dr. Nagrath. “These cells use an internal metabolic pathway to produce a significant portion of the glutamine that they consume, so a different type of treatment—one aimed toward internal glutamine sources—will be needed to target cells of this type.”

It has long been known that cancer cells adjust their metabolism in subtle ways that allow them to proliferate faster and survive better. In 1924, Otto Warburg showed that cancer cells produced far more energy from glycolysis than did normal cells. The Nobel Prize–winning discovery became known as the “Warburg effect,” and researchers long believed that all cancers behaved in this way. However, intense research in recent decades has revealed a more nuanced picture.

“Each type of cancer appears to have its own metabolic signature,” Dr. Nagrath said. “For instance, kidney cancer does not rely on glutamine, and though breast cancer gets some of its energy from glutamine, it gets even more from glycolysis. For other cancers, including glioblastoma and pancreatic cancer, glutamine appears to be the primary energy source.”

New Biomarker for Prognosis

Dr. Nagrath said that the new metabolic analysis indicates that ovarian cancer may be susceptible to multidrug cocktails, particularly if the amounts of the drugs can be tailored to match the metabolic profile of a patient’s tumor.

The research also revealed a specific biochemical test that pathologists could use to guide such treatments. The test involves measuring the ratio between the amount of glutamine that a cell takes up from outside and the amount of glutamine it makes internally.

“This ratio proved to be a robust marker for prognosis,” said coauthor Anil Sood, MD, Professor of Gynecologic Oncology and Reproductive Medicine and Co-Director of the Center for RNA Interference and Non-Coding RNA at MD Anderson. “A high ratio was directly correlated to tumor aggression and metastatic capability. Patients with this profile had the worst prognosis for survival.”

The 3-year study included cell culture studies at Rice as well as a detailed analysis of gene-expression profiles of more than 500 patients from The Cancer Genome Atlas and protein-expression profiles from about 200 patients at MD Anderson.

“The enzyme glutaminase is key to glutamine uptake from outside the cell, and glutaminase is the primary target that everybody is thinking about right now in developing drugs,” Dr. Nagrath said. “We found that targeting only glutaminase will miss the less aggressive ovarian cancer cells because they are at a metabolic stage where they are not yet glutamine-dependent.”

Lifeng Yang, lead author of the study and a graduate student at Rice University, designed a preclinical experiment to test the feasibility of a multidrug approach. He used a drug to inhibit the early stage production of internal glutamine while also limiting the uptake of external glutamine. “That depleted all sources of glutamine for the cells, and we found that cell proliferation decreased significantly,” he said said.

Relationship Between Glutamine and STAT3

Dr. Nagrath said the study also revealed another key finding: a direct relationship between glutamine and an ovarian cancer biomarker called STAT3.

“The higher STAT3 is, the more aggressive the cancer,” Dr. Nagrath said. For the first time, we were able to show how glutamine regulates STAT3 expression through a well-known metabolic pathway called the TCA cycle.”

The study was supported by funding from the Collaborative Advances in Biomedical Computing Program at Rice’s Ken Kennedy Institute for Information Technology, Rice’s John and Ann Doerr Fund for Computational Biomedicine, the Odyssey Fellowship Program at MD Anderson Cancer Center, the estate of C.G. Johnson Jr, the National Institutes of Health, the Cancer Prevention and Research Institute of Texas, the Ovarian Cancer Research Fund, the Blanton-Davis Ovarian Cancer Research Program, the Gilder Foundation, and MD Anderson Cancer Center.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.