Development and First-in-Human Translation of Hyperpolarized [1-13C]Alpha-Ketoglutarate MR Spectroscopy in the Brain

Alpha-ketoglutarate (aKG) is a central intermediate of cerebral energy metabolism and a precursor for glutamate synthesis in the brain. Alterations in aKG metabolism occur in pathological contexts, including isocitrate dehydrogenase (IDH) mutant astrocytomas and oligodendrogliomas, in which mutant IDH converts aKG to the oncometabolite 2-hydroxyglutarate. Given its central role in brain metabolism, non-invasive interrogation of aKG-dependent metabolic flux is needed. Hyperpolarized (HP) 13C MR enables real-time visualization of metabolic conversion by transiently enhancing signal intensity by several orders of magnitude. Leveraging this approach, we report the first-in-human feasibility and safety study of HP [1-13C]aKG MR spectroscopy in the healthy brain (n = 3). A standard operating procedure (SOP) was developed for sterile [1-13C]aKG dose production, achieving reproducible polarization levels averaging 30.5 ± 2.2%. Following intravenous administration, time-resolved 13C spectra in healthy volunteers demonstrated the detection of HP aKG resonance and a measurable downstream glutamate signal, consistent across repeat acquisitions, with a delayed temporal profile relative to aKG observed in a representative dataset. Although performed in healthy volunteers, these results establish feasibility for HP [1-13C]aKG metabolic imaging to open a new window into normal and pathological brain cellular metabolism.