Tumor metabolism: the lessons of magnetic resonance spectroscopy.

For many years after Warburg's classic work, it was generally assumed that tumors produced large amounts of lactic acid and consequently had an acidic intracellular pHi. However, with the advent of Magnetic Resonance Spectroscopy (MRS), a non-invasive in vivo measure of tissue pH became available and demonstrated that in both human and animal tumors, pHi was higher (> 7.0) than pH epsilon (< 6.8), in contrast to normal tissues (e.g., liver) in which pHi (approximately 7.2) is lower than pH epsilon (approximately 7.4). This result has been confirmed in animal tumors using an MRS-visible extracellular marker, 3-aminopropyl phosphonate. The pH gradient across the tumor cell membrane is part of an interrelated system of ionic gradients and measurements made by both 31P MRS and by conventional analysis in Morris hepatoma 9618a and in livers demonstrated that the following ions also changed: compared with liver the Na+ content was 2-fold higher, K+ was 20% lower, total Ca2+ was 8-fold higher (7.4 mumol/g wet wt) and total Pi 2-fold higher (8.5 mumol/g wet wt), suggesting the presence of insoluble calcium phosphate, HCO3- was lower, total Mg2+ was similar in both tissues, but free [Mg2+] (calculated by two different methods) was approximately 5-fold lower in the hepatoma, as was [ATP]/[ADP][P(i)]. Because of an inadequate blood supply, tumors are often hypoxic with impaired Krebs cycle activity, low [ATP]/[ADP][P(i)] and rely mainly on glycolysis for energy. The rapid production and subsequent export of anionic lactate-from the tumor cell would be accompanied by H+. This would account for reversal of the proton gradient and activation of the Na+/H+ exchange. The elevated [Na+]i would decrease the Na+/Ca2+ exchange, which would in turn tend to cause the accumulation of Ca2+ (and P(i)). Such calcification is a very common feature of tumor pathology. The data indicate the change in gradient of one ion (H+) involves alterations in the linked equilibria of many ions and also of energy metabolites and offers new insights into properties of tumors important both diagnostically and therapeutically.