Metabolic Characteristics of Brain Tumors Using Hyperpolarized Carbon-13 Magnetic Resonance Spectroscopic Imaging (MRSI)

Study Overview
=================
Brief Summary
-----------------
This is a non-randomized, purely observational, feasibility study to detect metabolic changes in patients with brain malignancy using a novel hyperpolarized [1-13C]pyruvate MRSI.

Detailed Description
-----------------
The aim of this pilot study is to test the hypothesis that patients with brain malignancy present altered [1-13C]lactate and 13C-bicarbonate production from infused hyperpolarized [1-13C]pyruvate in tumor as compared to in normal-appearing brain regions. To achieve this aim investigators will assess metabolic phenotype in cancer patients with brain tumors (n = 20). Total target enrollment will be set at 25 subjects to account for attrition and screening failures. During each imaging session, following localization of the tumor in brain, tissue characteristics and morphological changes will be evaluated with 1H MRI. Then, cerebral metabolism will be assessed utilizing 13C MRSI after an intravenous injection with hyperpolarized [1-13C]pyruvate. Finally, contrast-enhanced 1H MRI will be acquired. The study agent, hyperpolarized [1-13C]pyruvate, will be administered under a Food and Drug Administration (FDA) Investigational New Drug (IND), which was approved on 1/3/2017 (IND# 133229). Preliminary data in human are essential to secure larger scale funding required for clinical studies. The investigators believe the ability to measure such metabolic shifts in vivo could have major significance in assessing the efficacy of multiple anti-tumor therapies currently under development that target reversing the Warburg effect as a means of controlling tumor growth. Brain tumor applications at the Advanced Imaging Research Center, Harold C. Simmons Comprehensive Cancer Center and the Neuro-Oncology Program of the Development of Neurological Surgery at the UT Southwestern Medical Center offer today a unique opportunity to lead globally the translational scientific efforts in this field.

Official Title
-----------------
Investigating Metabolic Characteristics of Intracranial Malignancy In Vivo Using Hyperpolarized Carbon-13 Magnetic Resonance Spectroscopic Imaging (MRSI)

Conditions
-----------------
Brain Tumor Adult

Intervention / Treatment
-----------------
* Drug: Hyperpolarized 13C-Pyruvate
* Drug: Gadolinium


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Definitive diagnosis of brain tumors by imaging which demonstrates all kinds of brain malignancy, including glioma, meningioma, and brain metastases prior to any chemotherapy or radiation treatment. 18-70 years of age Ability to understand and the willingness to sign a written informed consent. All races and ethnicities will be included; subjects must be able to read and speak the English language. Once the protocol is established, Spanish-speaking participants will be included. Women of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Exclusion Criteria: Subjects who are receiving any other investigational agents. Previous or current treatment by radiation or chemotherapy. Concurrent illness including, but not limited to, ongoing or active infection, uncontrolled chronic diseases such as hypertension, lung disease, liver disease, kidney disease, diabetes, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmias, or psychiatric illness/social situations that would limit compliance with study requirements. Subjects who have a history of alcohol abuse or illicit drug use. Subjects must not be pregnant or nursing due to the potential for congenital abnormalities and the potential of this regimen to harm nursing infants Subjects who have contraindication to contrast enhanced MRI examination Contraindications to MRI examination include: Medically unstable Heart failure Severe LVOT outflow obstruction Unstable angina Child bearing Lactating Any contraindication per MRI Screening Form including Implants contraindicated at 3T, pacemakers Implantable Cardioverter Defibrillator (ICD) Claustrophobia Since each subject may be receiving a gadolinium-based contrast agent intravenously: eGFR ≤ 30 mL/min/1.73m2 Sickle cell disease Hemolytic anemia

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Brain Tumor Patients<br>Brain Tumor patients will receive a bolus of Hyperpolarized 13C-pyruvate during MRSI. | Drug: Hyperpolarized 13C-Pyruvate<br>* Hyperpolarized 13C-pyruvate IV bolus followed by brain MRSI.<br>* Other names: HP [1-13C]pyruvate;Drug: Gadolinium<br>* Brain MRI performed with and without gadolinium-based contrast.<br>* Other names: Gadavist;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 13C-pyruvate Metabolic Product Ratio | Measurement of the ratio of metabolic products, [1-13C]lactate and 13C-bicarbonate, from hyperpolarized [1-13C]pyruvate will be used as an index of metabolic balance between glycolytic pathway and mitochondrial oxidative phosphorylation. | Screening (Baseline) and 1 day of Study Visit |