Although gliomas are relatively rare, they cause significant mortality and morbidity with a 5-year survival rate for glioblastoma, the most common glioma histology, of 5% [1]. The choice of appropriate tailored therapies is crucial for patients’ outcome, but requires precise identification of glioma subtype. The diagnostic and prognostic stratification of brain gliomas highly benefits from the identification of molecular markers such as mutations in isocitrate dehydrogenase 1 and 2 (IDH1 and 2) and codeletion of chromosome arms 1p and 19q (1p/19q codeletion), recently recognized as favorable predictive factors [2-4].
Magnetic resonance spectroscopy (MRS) has shown a great potential for the noninvasive identification of specific tumor sub-types and monitoring therapeutic response. Gliomas with an isocitrate dehydrogenase (IDH) mutation can be identified by the presence of the metabolite D-2-hydroxyglutarate (2HG), which is 1-2 orders of magnitude higher in IDH-mutated than in wild-type IDH glioma [5-8]. Recently, we reported the first in vivo detection of cystathionine and association between cystathionine accumulation and 1p/19q codeletion in IDH-mutated gliomas [9].
The in vivo quantification of cystathionine and 2HG opens up a possibility to investigate cancer-specific metabolic pathways noninvasively and to monitor cancer treatments in patients harboring these tumors. The possibility of simultaneous detection of 2HG and cystathionine in brain tumors will allow for a more specific characterization of glioma sub-types, with great benefit for patient care and treatment.