Increased use of glucose through glycolysis is characteristic for neoplasti
c growth while the significance of serum-free fatty acids for regulation of
energy metabolism in cancer is poorly understood. We studied whether serum
-free fatty acids (FFA) interfere with glycolytic metabolism of lymphoproli
ferative neoplasms as assessed with 2-F-18-fluoro-2-deoxy-D-glucose ([F-18]
FDG) and positron emission tomography (PET). Twelve patients with newly dia
gnosed non-Hodgkin's lymphoma (n = 9) or Hodgkin's disease (n = 3) particip
ated in this study before start of oncologic treatment. Each patient underw
ent two [F-18]FDG PET studies within 1 week after overnight fast: once duri
ng high fasting serum FFA concentrations and once after reduction of serum
FFA by administration of acipimox. Acipimox is a nicotinic acid derivative
that inhibits lipolysis in peripheral tissues and induces a striking reduct
ion in circulating FFA concentration. In all cases, dynamic PET imaging ove
r the tumour area was performed for 60 min after injection of [F-18]FDG. Bo
th graphical analysis (rMR(FDG)) and single scan approach (SUV) were used t
o compare tumour uptake of [F18]FDG under high fasting FFA concentrations a
nd after pharmacologically decreased FFA concentrations. Serum FFA concentr
ations were reduced significantly from 0.92 +/- 0.42 mmol l(-1) at baseline
to 0.26 +/- 0.31 mmol l(-1) after acipimox administration (P = 0.0003). Pl
asma glucose, serum insulin and lactate concentrations were similar during
both approaches. The retention of glucose analogue [F-18]FDG in tumour was
similar between baseline and acipimox studies. Median rMR(FDG) of a total o
f 12 involved lymph nodes in 12 patients was 21.9 mu mol 100 g(-1) min(-1)
(range 8.7-82.5) at baseline and 20.1 mu mol 100 g(-1) min(-1) (range 10.7-
81.7) after acipimox, The respective values for median SUV were 7.8 (range
3.6-18.6) and 6.0 (range 4.1-20.2). As expected, [F-18]FDG uptake in myocar
dium was clearly enhanced by acipimox due to reduction of circulating FFAs.
In conclusion, blood fatty acids appear to have minor significance for [F-
18]FDG uptake in lymphoma. This suggests that glucose utilization is uncoup
led of FFA metabolism and indicates that glucose-free fatty acid cycle does
not operate in lymphomatous tissue. Glucose appears to be the preferred su
bstrate for energy metabolism in tumours, in spite of the high supply of FF
As in the fasting state. Although acipimox and other anti-lipolytic drugs h
ave potential for treatment of catabolic state induced by cancer, they are
not likely to interfere with tumour energy metabolism which is fuelled by g
lucose.