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ResearchIn-Press PreviewMetabolismOncology Open Access | 10.1172/JCI165028

Circulating succinate-modifying metabolites accurately classify and reflect the status of fumarate hydratase-deficient renal cell carcinoma

Liang Zheng,1 Zi-Ran Zhu,1 Tal Sneh,2 Weituo Zhang,3 Zao-Yu Wang,4 Guang-Yu Wu,4 Wei He,4 Hong-Gang Qi,5 Hang Wang,6 Xiao-Yu Wu,1 Jonatan Fernández-García,2 Ifat Abramovich,2 Yun-Ze Xu,7 Jin Zhang,7 and Eyal Gottlieb8

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by Zheng, L. in: PubMed | Google Scholar |

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by Zhu, Z. in: PubMed | Google Scholar

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by Sneh, T. in: PubMed | Google Scholar

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by Zhang, W. in: PubMed | Google Scholar

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by Wang, Z. in: PubMed | Google Scholar

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by Wu, G. in: PubMed | Google Scholar

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by He, W. in: PubMed | Google Scholar

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by Qi, H. in: PubMed | Google Scholar

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by Wang, H. in: PubMed | Google Scholar

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by Wu, X. in: PubMed | Google Scholar

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by Fernández-García, J. in: PubMed | Google Scholar |

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by Abramovich, I. in: PubMed | Google Scholar

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by Xu, Y. in: PubMed | Google Scholar

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by Zhang, J. in: PubMed | Google Scholar

1Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

2Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

3Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University, Shanghai, China

4Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

5Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

6Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China

7Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

8Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, United States of America

Find articles by Gottlieb, E. in: PubMed | Google Scholar |

Published April 13, 2023 - More info

J Clin Invest. https://doi.org/10.1172/JCI165028.
Copyright © 2023, Zheng et al. This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Published April 13, 2023 - Version history
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Abstract

Germline or somatic loss-of-function mutations of fumarate hydratase (FH) predispose patients to an aggressive form of renal cell carcinoma (RCC). Since other than tumor resection, there is no effective therapy for metastatic FH-deficient RCC, an accurate method for early diagnosis is needed. Although MRI or CT scans are offered, they cannot differentiate FH-deficient tumors from other RCCs. Therefore, finding noninvasive plasma biomarkers suitable for rapid diagnosis, screening and surveillance would improve clinical outcomes. Taking advantage of the robust metabolic rewiring that occurs in FH-deficient cells, we performed plasma metabolomics analysis and identified two tumor-derived metabolites, succinyl-adenosine and succinic-cysteine, as outstanding plasma biomarkers for early diagnosis (receiver operating characteristic area under curve (ROCAUC) = 0.98). These two molecules reliably reflected the FH mutation status and tumor mass. We further identified the enzymatic cooperativity by which these biomarkers are produced within the tumor microenvironment. Longitudinal monitoring of patients demonstrated that these circulating biomarkers can be used for reporting on treatment efficacy and identifying recurrent or metastatic tumors.

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  • Version 1 (April 13, 2023): In-Press Preview
  • Version 2 (June 1, 2023): Electronic publication

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