Fluorine-18-Labeled Thymidine Positron Emission Tomography (FLT-PET) as an Index of Cell Proliferation after Pharmacological Ascorbate-Based Therapy

Pharmacological ascorbate (AscH⁻) induces cytotoxicity and oxidative stress selectively in pancreatic cancer cells compared with normal cells. Positron emission tomography (PET) with the thymidine analog 3′-deoxy-3′-(¹⁸F) fluorothymidine (FLT) enables noninvasive imaging and quantification of the proliferation fraction of tumors. We hypothesized that the rate of tumor proliferation determined by FLT-PET imaging, would be inversely proportional to tumor susceptibility to pharmacological AscH⁻-based treatments. Indeed, there was decreased FLT uptake in human pancreatic cancer cells treated with AscH⁻ in vitro, and this effect was abrogated by co-treatment with catalase. In separate experiments, cells were treated with AscH⁻, ionizing radiation or a combination of both. These studies demonstrated that combined AscH⁻ and radiation treatment resulted in a significant decrease in FLT uptake that directly correlated with decreased clonogenic survival. MicroPET ¹⁸F-FLT scans of mice with pre-established tumors demonstrated that AscH⁻ treatment induced radiosensitization compared to radiation treatment alone. These data support testing of pharmacological ascorbate as a radiosensitizer in pancreatic cancer as well as the use of FLT-PET to monitor response to therapy.