1. Introduction
Metabolic reprogramming, which fuels tumour cell growth, is considered an emerging hallmark of cancer [
1]. Cancer cell metabolic remodelling is characterised by the aberrant metabolism of glucose, amino acids, and lipids [
2]. In addition to their dependency on aerobic glycolysis, cancer cells exhibit other metabolic adaptations, such as increased fatty acid synthesis and “glutamine addiction” [
3]. Glutamine metabolic reprogramming is mainly associated with several glutamine metabolic enzymes, such as glutaminase (GLS), glutamine synthetase (GLUL), and the glutamine transporter family (solute carrier (SLC) family). Among SLC family members, alanine-serine-cysteine transporter 2 (ASCT2, encoded by the
SLC1A5) is recognised as the principal glutamine transporter and is critical for glutamine uptake in tumour cells. Compared with its expression in healthy tissues, ASCT2 is overexpressed in many tumours, such as non-small cell lung cancer (NSCLC) [
4], breast cancer [
5], and hepatocellular carcinoma [
6]. Previous studies have mainly focused on the pro-proliferative effect of ASCT2 on tumours, such as breast cancer [
7], prostate cancer [
8], melanoma [
9], NSCLC, colon cancer, and endometrial cancer [
10]. A recent study revealed the critical role of ASCT2-mediated amino acid metabolism in promoting leukaemia development and progression [
11]. Thus, these studies indicate the importance of ASCT2 in tumour progression.
Since glutamine plays a critical role in cancer cell growth, new therapies targeting glutamine metabolism have attracted attention. One agent targeting GLS, CB-839, is currently being evaluated in phase II clinical trials. However, a limitation of targeting GLS is that these treatments may induce RAS-independent activation of MAPK signalling [
12]. In addition to agents targeting GLS, anti-ASCT2 agents have been developed as potential antitumour drugs and have shown promise. In addition to the drug GPNA [
13], H. Charles Manning and his team discovered a small-molecule inhibitor of ASCT2 (V-9302) [
14]. However, V-9302 may not be a specific inhibitor of ASCT2, as it also targets SNAT2 (sodium-coupled neutral amino acid transporter 2, SLC38A2) and LAT1 (large neutral amino acid transporter 1, SLC7A5) [
15]. In addition to small-molecule inhibitors, ASCT2 monoclonal antibodies are currently under investigation, but they do not appear to show selectivity between patients with low and high ASCT2 expression, which will limit their successful application [
16].
CAAs in the tumour microenvironment promote metabolic remodelling in breast cancer. However, our understanding of the interplay between breast cancer cells and adipocytes on glutamine metabolism is incomplete. Then, we focused on the effect of the adipocyte–breast cancer microenvironment on glutamine metabolism.
Therefore, we report the identification of a potential target of C118P, a new class 1 drug for which a clinical phase I trial has been approved. We aimed to identify biomarkers of C118P and recruit the appropriate patients to test the efficacy of C118P, and identified a potential target of C118P, ASCT2, via reverse docking. In this study, blockade of ASCT2 with C118P resulted in attenuated cancer cell growth and proliferation, increased cell apoptosis, and G2/M cell cycle arrest, which collectively contributed to the antitumour response of C118P in vitro and in vivo. In summary, investigating the effect and mechanism of C118P on inhibiting the proliferation of breast cancer cells is expected to provide guidance for the treatment of breast cancer in the clinic and promote the development of new drugs targeting metabolism.
2. Materials and Methods
2.1. The Chemicals and Reagents
C118P was supplied by Sanhome Pharmaceutical Co., Ltd. (Nanjing, China). Taxol was purchased from APExBio (Houston, TX, USA). An apoptosis detection kit (Annexin V-PI staining kit) was purchased from Vazyme Biotech Co., Ltd. (Nanjing, China). A cell cycle detection kit was obtained from Beyotime Biotechnology (Shanghai, China).
2.2. Cell Culture
Human breast cancer cells (MDA-MB-231, MDA-MB-468, BT-549, MCF-7, T47D, and BT-474 cells) were obtained from the Shanghai Institute of Life Science at the Chinese Academy of Sciences. All cell lines were authenticated by short tandem repeat (STR) analysis. Cells were cultured in DF12 medium (Gibco, Grand Island, NE, USA) containing 10% foetal bovine serum (FBS, PAN Biotech, Aidenbach, Germany) supplemented with 100 U/mL penicillin and 100 μg/mL streptomycin in a humidified atmosphere (BB15 incubator, Thermo, Dreieich, Germany) with 5% CO2 at 37 °C.
2.3. Cell Viability Assay
The effects of C118P on breast cancer cells (MDA-MB-231, MDA-MB-468, BT-549, MCF-7, T47D, and BT-474 cells) were determined using the MTT assay. Cell suspensions were prepared, and 1800 cells of each type were seeded into a 96-well plate. After incubation for 24 h, the cells were treated with C118P for another 72 h. Subsequently, 20 μL of an MTT solution (0.5 mg/mL) was added and incubated for another 4 h, and the medium was replaced with 150 μL of DMSO to dissolve formazan precipitates. The absorbance at 570 nm was detected using a universal microplate reader (Infinite M100, Tecan, Stadt Crailsheim, Germany). Inhibition rates were calculated with the following formula: inhibition rate (%) = (1 − absorbance of the treated group/absorbance of the control group) × 100.
2.4. Real-Time Cellular Analysis (RTCA)
An xCELLigence system is a novel approach developed by Roche Applied Science (Penzberg, Germany) to investigate cell growth, adhesion, and morphology in real time in a label-independent manner. A change in impedance is recorded as the cell index, which indicates cell number, cellular attachment, and morphology. Cells were seeded at a density of 8000 cells (MDA-MB-231) or 10,000 cells (MDA-MB-468) per well, placed on a rotating plate and incubated for 30 min, and subsequently placed in the xCELLigence system, which was linked to a 37 °C incubator with a humidified atmosphere containing 5% CO
2 [
17]. After incubation for 24 h, cells were treated with C118P and observed for 144 h.
2.5. Colony Formation Assay
The effect of combination treatment on cell proliferation was detected with colony formation assays. A total of 2000 cells were seeded into a 6-well plate and incubated for 24 h. Subsequently, the cells were treated with 0.025, 0.05, and 0.1 μM C118P for 14 days. The cells were then fixed with 0.5% crystal violet and stained with 4% formaldehyde. Colonies were then counted macroscopically.
2.6. Apoptosis Detection and Cell Cycle Analysis
Cells were collected with EDTA-free trypsin and washed with ice-cold PBS. Subsequently, the cells were suspended in 500 μL of binding buffer and stained with 5 μL of PI and 5 μL of FITC-conjugated Annexin V for 15 min. Apoptotic cells were analysed with a FACSCalibur flow cytometer (BD Biosciences, San Jose, CA, USA).
The cell cycle distribution was detected by PI staining. Cells were collected and fixed in 75% ethanol overnight after drug treatment. Then, the cells were washed with ice-cold PBS once and stained with PI for 30 min at 37 °C. Cell cycle analysis was performed using a FACSCalibur flow cytometer (BD Biosciences).
2.7. Western Blotting
Western blotting was performed as described in a previous study [
18]. The following antibodies purchased from Cell Signaling Technology (Danvers, MA, USA) were used: anti-m-TOR (Cat#2983, RRID: AB_2105622), anti-p-m-TOR (Cat#5536, RRID: AB_10691552), anti-p70S6K (Cat#9202, RRID: AB_331676), anti-p-p70S6K (Cat#9234, RRID: AB_2269803), anti-Bcl-2 (Cat#2872, RRID: AB_10693462), anti-MCL-1 (Cat#4572, RRID: AB_2281980), anti-Bcl-xl (Cat#2762, RRID: AB_10694844), anti-Cyclin B1 (Cat#4138, RRID: AB_2072132), anti-CDK1 (Cat#77055, RRID: 77055), anti-p-CDK1 (Tyr15) (Cat#4539, RRID: AB_331676), anti-LAMP-1 (Cat#9091, RRID: AB_2687579), anti-LC3I/II (Cat#4108, RRID: AB_2137703), anti-Beclin1 (Cat#3495, RRID: AB_1903911), anti-p62 (Cat#23214, RRID: AB_2798858), anti-GLS1 (Cat#88964, RRID: AB_2800133), anti-gp130 (Cat#3732, RRID: AB_2125953), anti-STAT3 (Cat#9139, RRID: AB_331757), anti-p-STAT3 (Cat#9145, RRID: AB_2491009), anti-ERK1/2 (Cat#4695, RRID: AB_390779), and anti-p-ERK1/2 (Cat#4370, RRID: AB_2315112) antibodies. Anti-ASCT2 (Cat#ab237704) antibodies were purchased from Abcam (Cambridge, UK). Anti-GLUL (Cat#A5437, RRID: AB_2863503), anti-GDH (Cat#A5176, RRID: AB_2863476), anti-β-actin (Cat#AC004, RRID: AB_2737399), and anti-GAPDH (Cat#AC002, RRID: AB_2736879) antibodies were purchased from ABclonal Technology (Wuhan, China). Anti-rabbit IgG conjugated to HRP (Cat#7074, RRID: AB_2099233) and anti-mouse IgG conjugated to HRP (Cat#7076, RRID: AB_330924) (Cell Signaling Technology) were used as secondary antibodies, and enhanced chemiluminescence reagent (Millipore) was used for detection after exposure in a Gel Doc 2000 image analyser (Bio-Rad, Hercules, CA, USA).
2.8. SPR Analysis of Recombinant Proteins
SPR measurements were performed using a Biacore T200 instrument (GE Healthcare, Chicago, IL, USA). The ASCT2 protein (SL5-H5149) was purchased from ACRO Biosystems. C118P at different concentrations (0.15625 μM to 10 μM) was run over the SPR instrument with a CM5 chip (GE, Chicago, IL, USA) using running buffer containing 1.8 mM KH2PO4, 10 mM Na2HPO4, 137 mM NaCl, 2.7 mM KCl, and 0.005% Tween-20 (pH 7.8). The binding and dissociation rates were measured at a flow rate of 25 μL/min. Ligand injection was performed over 1.5 min, followed by flow with ligand-free buffer to analyse dissociation for 2.5 min. Curves were corrected for nonspecific ligand binding by subtracting the signal obtained for the negative control flow cell. The equilibrium KD was derived from a simple 1:1 interaction model using Reichert data evaluation software (version 1.7.1).
2.9. Microscale Thermophoresis (MST) Analysis of Recombinant Proteins
The Monolith Protein Labeling Kit RED-NHS (L001) was purchased from NanoTemper Technologies (Watertown, MA, USA). For NT.115 NanoTemper measurements, an infrared (IR) laser beam coupled to a light path (i.e., fluorescence excitation and emission) with a dichroic mirror is focused into the fluid sample through the same optical element used for fluorescence imaging. The IR laser is absorbed by the aqueous solution in the capillary and locally heats the sample with a 1/e2 diameter of 25 μm. Up to 24 mW of laser power was used to heat the sample without damaging the biomolecules. Thermophoresis of the protein in the presence of C118P at varying concentrations (0.15625 μM to 10 μM) was analysed for 30 s. Measurements were performed at room temperature, and the S.D. was calculated from three independent experiments. Data were normalised to either ΔFnorm [‰] (10*(Fnorm (bound)—Fnorm (unbound))) or the bound fraction (ΔFnorm [‰]/amplitude).
2.10. Detection of ATP, Glutamine, Glucose, and Lactate Levels
After transduction or treatment with C118P at various concentrations (0.025, 0.05, 0.1 μM) for 48 h, ATP was detected with an ATP assay kit (Beyotime Biotechnology). Glutamine was detected with a glutamine assay kit (Sigma, St. Louis, MO, USA), glucose was detected with a glucose assay kit (Whitman Biotech, Nanjing, China), and lactate production was detected with a lactate production kit (Sunshine Biotechnology Ltd., Thatoom, Thailand).
2.11. Glutamine Uptake Assay
After pretreatment with C118P (0.025, 0.05, 0.1 μM) for 48 h, cells (1 × 105 cells/well) were incubated with [3H]-L-glutamine (400 nM, PerkinElmer, Shelton, CT, USA) in MEM (Life) for 15 min at 37 °C in the presence or absence of inhibitor. The cells were collected, transferred to a 96-well plate harvester (PerkinElmer), and analysed using a liquid scintillation counter (PerkinElmer).
2.12. Oxygen Consumption Rate (OCR) Measurements
The OCR was measured using an XF96 analyser (Seahorse Bioscience, North Billerica, MA, USA). Cells were seeded in 96-well XF96 cell culture plates at a density of 20,000 cells/well. After incubation for 48 h, the cells were treated with C118P (0.025, 0.05, 0.1 μM). The media were then removed, and the wells were washed in XF-modified DMEM (Seahorse Bioscience) at pH 7.4 supplemented with 1 mM glutamine (glycolysis and mitochondrial stress tests), 2.5 mM glucose, 1 mM sodium pyruvate, 0.5 mM carnitine, and 1 mM palmitate in complex with 0.2 mM BSA (mitochondrial stress tests) and incubated for 1 h at 37 °C without CO2. The OCR was measured in the basal state (1 mM palmitate in complex with 0.2 mM BSA) or after the injection of 5 μM oligomycin, 1 μM 2-[2-[4-(trifluoromethoxy) phenyl] hydrazinylidene]-propanedinitrile (FCCP), and rotenone with antimycin A (both at 0.5 μM). After the Seahorse Bioscience experiments, the proteins were quantified to normalise the results.
2.13. MDC Staining and LysoTracker Red Staining
Monodansylcadaverin (MDC, KeyGEN BioTECH, Nanjing, China) is an eosinophilic stain that is commonly used as a specific stain to detect autophagosome formation. LysoTracker Red (Beyotime Biotechnology, Shanghai, China) is commonly used as a specific stain to detect lysosomes. After pretreatment with C118P (0.025, 0.05, or 0.1 μM) for 48 h, cells were incubated with MDC for 30 min or with LysoTracker Red for 60 min. Anti-fluorescent quenching tablets were used to seal the cells, and cells were photographed under a fluorescent microscope.
2.14. Lentivirus Transfection and Overexpression Studies
Small hairpin RNAs (shRNAs) against human
SLC1A5 and a negative control shRNA with the following sequences were purchased from GenePharma (Suzhou, China): LV3-
SLC1A5#1: 5′-GCTTGGTAGTGTTTGCCATCG-3′; LV3-
SLC1A5#2: 5′-GGATGTGGGTTTACTCTTTGC-3′; and LV3-NC: 5′-TTCTCCGAACGTGTCACGT-3′. The ASCT2 expression plasmid pcDNA3.1-Flag-
SLC1A5 was purchased from the Public Protein/Plasmid Library (Nanjing, China). Small interfering RNAs (siRNAs) against human
SLC1A5 and a negative control with the following sequences were purchased from GenePharma: si
SLC1A5#1: sense 5′-GCCUUGGCAAGUACAUUCUTT-3′; antisense 5′-AGAAUGUACUUGCCAAGGCTT-3′; si
SLC1A5#2: sense 5′-GUCGACCAUAUCUCCUUGATT-3′; antisense 5′-UCAAGGAGAUAUGGUCGACTT-3′; negative control: sense 5′-UUCUUCCGAACGUGUCACGUTT-3′; antisense 5′-ACGUGACACGUUCGGAGAATT-3′. Transfection was performed as described previously [
19].
2.15. Adipose–Breast Cancer Cell Co-Culture Model
Breast cancer cells (2.0–3.0 × 105) were seeded in the upper well of the Corning Transwell co-culture chambers (Corning, NY, USA). When the cells adhered, the induced mature adipocytes were seeded in the lower chamber. The supernatant from the upper and lower chambers was replaced with DMEM/F12 containing 2% FBS. Subsequent experiments were performed after three days of co-culture.
2.16. Three-Dimensional Culture
Breast cancer cells were cultured in 3.8 mL of complete medium, 1 mL of methylcellulose solution, and 50 μL of the Matrigel gel (Corning) mixture. Obvious white dots were visualised at the bottom of the well after a 72 h incubation in the cell incubator. Next, 96-well plates were spread with 50 μL of Matrigel, and 200 mL of complete medium was added to each well. Single-cell spheres were seeded in 96-well plates. Observation and photos were recorded for 0 h and recorded for 7 consecutive days.
2.17. Detection of the Mouse Microarray
The sandwich antibody chip is a chip based on the Raybiotech sandwich (Peachtree Corners, GA, USA), which is a detection mode using two antibodies. The experiments were performed by drying, sealing, and incubating the samples, followed by an analysis of fluorescence.
2.18. Nude Mouse Xenograft Study
Female BALB/c athymic nude mice (5–6 weeks) with body weights from 18 to 22 g were purchased from the Model Animal Research Center of Nanjing University (Nanjing, China). A total of 2 × 106 MDA-MB-231 cells transfected with shControl or shSLC1A5#1 were injected into the subcutaneous tissue of the armpit. Tumours were grown until their volume reached 300 to 500 mm3, resected, and cut into small pieces. Subsequently, the tissue pieces were subcutaneously implanted into each of the nude mice. The mice were randomly divided into groups of six individuals each. C118P was administered by tail vein injection at a concentration of 50 mg/kg. The negative group was given an equal amount of normal saline. At 21 days after administration, the mice were euthanised, and the tumour tissues were then resected and assessed. Tumour volume (TV) was calculated by the following formula: TV (mm3) = A/2 × B2, where A represents the longest diameter of the tumour, and B represents the shortest diameter. Relative tumour volume (RTV) was calculated with the following formula: RTV = Vt/V0, where Vt represents the TV on day t, and V0 represents the TV on day 0. The animal care and surgical procedures were guided by the Animal Care and Control Committee of China Pharmaceutical University.
2.19. Targeted Metabolomics Analysis
Metabolomics studies of mouse tumour tissue samples from different experimental groups were performed using LC-MS as the analytical method. Experiments were conducted by collecting biological samples, detecting samples with the instrument, and analysing the data, as previously described [
20].
2.20. Plasmids and ASCT2 Expression and Purification
The SLC1A5 was cloned into the pET-28b (GenScript, Nanjing, China) expression plasmid to produce recombinant ASCT2 with a histidine tag. E. coli strain BL21 (DE3) obtained from Tiangen Biotech Co., Ltd. (Beijing, China) was transformed with the plasmid and cultured on a selective antibiotic LB agar plate. After 16 h, a single colony was picked and cultured in 10 mL of LB medium containing 50 μg/mL kanamycin with vigorous shaking at 37 °C for 10 h. Then, 10 mL cultures were added to 250 mL of medium and cultured for 2 h. Next, protein expression was induced by the addition of IPTG to a final concentration of 0.5 mM. The cells were left to grow overnight at 16 °C and then harvested by centrifugation. Protein extraction and purification were performed using a Ni-NTA Fast Start Kit (QIAGEN, Hilden, Germany) and an AKTA system, respectively. Then, the purified protein was concentrated by centrifugal filter devices (Millipore, Burlington, MA, USA), mixed with glycerol to a final concentration of 20%, and stored at −80 °C until use.
2.21. Gene Expression Analysis
The GEPIA2 (Gene expression profiling interactive analysis, version 2) web server (
http://gepia2.cancer-pku.cn/#analysis, accessed on 20 July 2022) was used to determine the difference in ASCT2 expression between the breast cancer tissues and the corresponding normal tissues from the TCGA database [
21]. Violin plots of ASCT2 expression in different pathological stages of breast cancer were constructed using GEPIA2. The Human Protein Atlas (
https://www.proteinatlas.org, accessed on 20 July 2022) was used to obtain the expression of ASCT2 protein in human tissues [
22]. GEPIA2 was used to determine the significance of the association of OS (overall survival) with ASCT2 expression in breast cancer.
2.22. Statistical Analyses
All data in this study are expressed as the mean ± S.D. and were analysed using Student’s t-test (* p < 0.05, ** p < 0.01, *** p < 0.001, and N.S. represents no significant change).
4. Discussion
Targeting metabolic abnormalities is a research direction that has attracted much attention in the field of novel antitumour drug development. Recently, glutamine metabolism has become a hotspot in tumour metabolism research. As a transporter for glutamine, ASCT2 is an attractive tumour metabolism target, based on its role and increased physical activity in cancer [
31]. The inhibitors targeting ASCT2 mainly consist of small molecules and antibodies, such as MEDI7247, GPNA, V9302, etc. Despite these ASCT2 inhibitors, so far, few patients have benefited from ASCT2 inhibitor treatment strategies. In our study, C118P bound to ASCT2 and decreased its expression. Therefore, ASCT2 is recognised as a target of C118P. Compared with other ASCT2 inhibitors, C118P has the advantages of high efficiency and low toxicity.
The ASCT2 inhibitor MEDI7247 is a novel pyrrolobenzodiazepine antibody-drug conjugate (ADC) monoclonal antibody. MEDI7247 showed potent activity in vitro and in vivo in a spectrum of haematological cancers and solid tumours. GPNA is widely used as a drug to inhibit ASCT2 in basic research (IC
50~1000 μM) [
13]. However, as an ASCT2 inhibitor, GPNA exhibits poor potency and selectivity in human cells. V-9302 was reported to be the first specific and potent small-molecule inhibitor of ASCT2. V-9302 was shown to significantly inhibit ASCT2-mediated glutamine uptake with an IC
50 of 9.6 μM [
14]. Suppression of ASCT2 by V-9302 resulted in attenuated proliferation of cancer cells and increased oxidative stress, which, collectively, contributed to antitumour responses in vitro and in vivo. Nevertheless, V-9302 has shortcomings, such as low selectivity and high toxicity. Research showed [
14] that the response to V-9302 did not correlate with the level of ASCT2 expression in tumours. This means that the results of studies in which patients with high expression of the target ASCT2 are enrolled will be unreliable.
Here, we report the anti-breast cancer effects of C118P. C118P inhibited the proliferation of breast cancer cell lines with an IC
50 of 9.35 to 325 nM and exhibited an improvement in potency over GPNA and V-9302. Moreover, C118P exposure resulted in decreased mTOR activity, which is consistent with reduced amino acid transport and metabolism.
SLC1A5 silencing was reported to inhibit oesophageal cancer growth by inducing cell cycle arrest and apoptosis [
32]. C118P potentiated cell apoptosis and G2/M cell cycle arrest in breast cancer cells, and these effects might be mediated by ASCT2.
In this study, we identified ASCT2 as a target of C118P. Because of the structural complexity of membrane proteins, Jeff Holst [
33] constructed a homology model of ASCT2 for virtual screening [
34]. Benefitting from the resolution of the crystal structure of ASCT2 [
35], we obtained possible binding sites between the drug C118P and ASCT2 via virtual screening, which is worthy of further study in the future. Experimental validation of the specific binding sites of C118P with ASCT2, such as point mutation experiments and molecular dynamics simulations, may be necessary. C118P is currently being investigated in a phase I clinical trial in China. We hope our results guide the application of ASCT2 as a target of C118P in subsequent phase II clinical trials.
We found that the metabolic regulatory effect of C118P may not be closely related to the glutamine metabolic enzymes. Meanwhile, C118P may affect protein stability rather than protein synthesis after binding to ASCT2. Further research found that ASCT2 may be degraded through the autophagy–lysosomal pathway. Elevated autophagy is another notable characteristic of the observed C118P-mediated response. However, more research on this topic needs to be undertaken before the mechanism of ASCT2 downregulation can be more clearly understood. C118P probably exerts a dual effect on ASCT2. C118P binds directly to ASCT2, thus inhibiting the transport of amino acids, such as glutamine, and promoting ASCT2 degradation. Moreover, in the tumour microenvironment, C118P may indirectly affect ASCT2 expression through IL-6 and receptor gp130. Further experiments are still needed to verify this conclusion.
Despite these promising results, questions remain. Proteins were docked with C118P to identify the targets. Our results showed that the antitumour effect of C118P was partly caused by ASCT2-mediated metabolic alterations. However, other targets of C118P are not excluded. C118P showed antitumour effects against melanoma via BUB1B or against HCC via tumour vasculature [
36,
37]. In addition, our other studies have shown that C118P inhibited breast cancer metastasis through ASCT2. Whether C118P exerts antitumour effects through other targets in breast cancer still needs further investigation. Another significant issue is that specific antagonism of ASCT2 will also block the ASCT2-mediated transport of other neutral amino acids beyond glutamine. It cannot be excluded that the observed efficacy may be partly due to simultaneous blockade of multiple ASCT2 substrates.
In terms of experimental design, we used a cell-derived xenograft (CDX) model to evaluate the in vivo efficacy of C118P. However, because the CDX model cannot maintain the heterogeneity of tumour tissue, its biological characteristics and drug efficacy evaluation results are less similar to clinical characteristics. The patient-derived xenograft (PDX) model retains tumour heterogeneity, is more consistent with clinical tumour characteristics, and has better clinical predictability. We will continue to further evaluate the in vivo efficacy of C118P in the PDX model to provide a basis for clinical research. Moreover, expanding the sample size in future studies will allow us to more fully evaluate the efficacy and safety of C118P.
Targeting ASCT2 provides a new option for tumour therapy, but due to the existence of tumour metabolic heterogeneity, not all patients can benefit from ASCT2 inhibition, interference with glutamine metabolism treatment strategies. Finding sensitive indications for the clinical mediation of ASCT2 inhibitors is a common problem faced by targeted metabolism antitumour drugs, which has become an urgent issue to be solved. In the future, in view of the above problems, the metabolic heterogeneous characteristics of breast cancer and glutamine dependence will be analysed to find the difference in drug sensitivity and causes of ASCT2 inhibitors.