We have shown in preclinical studies that hyperpolarised [1,4-
13C2] fumarate magnetic resonance imaging can be used as an imaging biomarker to assess tumor necrosis as well as tubular necrosis in the kidney.
The hyperpolarised MRI agent [1,4- 13C2] fumarate is currently undergoing the required preclinical safety and toxicology studies, in preparation for a first-in-man clinical trial, led by Dr Ferdia Gallagher.
The clinical study will be conducted at 2 centres, the University of Cambridge and UCL, to evaluate hyperpolarised [1,4- 13C2] fumarate in renal cancer patients scheduled for nephrectomy. 13C magnetic resonance spectroscopic imaging ( 13C MRSI) measurements of tumour malate production as a marker of tumour cell death will be undertaken prior to surgery. Cell death will also be assessed using diffusion weighted MRI and histological examination and the results compared to those obtained using hyperpolarised [1,4- 13C2] fumarate MRI.
This study will provide the data required to apply for further funding to perform a multi-centre clinical evaluation study in renal cancer patients using hyperpolarised [1,4- 13C2] fumarate MRI.

Images from mice with subcutaneous-implanted lymphoma tumors who were either untreated (A) or treated with a chemotherapy medication Etoposide (B). The 1H image shows the anatomical location of the tumor, outlined in white. The adjacent images show increased colour intensity for 13C-malate in treated mice compared to untreated mice, indicating increased flux of fumarate to malate, which correlates to lower necrotic areas in the tumour of mice treated with Etoposide compared to the untreated tumour bearing mice.