NADPH production by the 10-formyl-THF pathway, and its use in the diagnosis and treatment of disease

1. A method of treating cancer in a cancer patient, wherein said method comprises administering to said cancer patient:

(A) an anti-folate anticancer agent; and

(B) one or more metabolic compound(s) selected from the group consisting of: formate, methyl formate, triethyl orthoformate, trimethyl orthoformate, glycine, 10-formyl-THF, and methylene-THF; with the proviso that said one or more metabolic compound(s) of said group is not ethyl formate; and

(C) a pharmaceutically acceptable excipient, carrier or diluent; wherein:

(i) said anti-folate anticancer agent is administered in an amount sufficient to inhibit an enzyme of folate metabolism; and

(ii) said metabolic compound(s) is administered in amount(s) sufficient to remediate the effect of the inhibition of folate metabolism on thymine synthesis, formate synthesis, glycine synthesis or purine synthesis in non-cancer cells caused by said anti-folate anticancer agent or to increase the therapeutic index of said anti-folate anticancer agent; and

(iii) said cancer is an adrenal gland tumor, an AIDS-associated cancer, an alveolar soft part sarcoma, an astrocytic tumor, a bladder cancer, a bone cancer, a brain and spinal cord cancer, a metastatic brain tumor, a breast cancer, a carotid body tumor, a cervical cancer, a chondrosarcoma, a chordoma, a chromophobe renal cell carcinoma, a clear cell carcinoma, a colon cancer, a colorectal cancer, a cutaneous benign fibrous histiocytoma, a desmoplastic small round cell tumor, an ependymoma, a Ewing's tumor, an extraskeletal myxoid chondrosarcoma, a fibrogenesis imperfecta ossium, a fibrous dysplasia of the bone, a gallbladder or bile duct cancer, a gastric cancer, a gestational trophoblastic disease, a germ cell tumor, a head and neck cancer, a hepatocellular carcinoma, an islet cell tumor, a Kaposi's sarcoma, a kidney cancer, a leukemia, a lipoma/benign lipomatous tumor, a liposarcoma/malignant lipomatous tumor, a liver cancer, a lymphoma, a lung cancer, a medulloblastoma, a melanoma, a meningioma, a multiple endocrine neoplasia, a multiple myeloma, a myelodysplastic syndrome, a neuroblastoma, a neuroendocrine tumors, an ovarian cancer, a pancreatic cancer, a papillary thyroid carcinoma, a parathyroid tumor, a pediatric cancer, a peripheral nerve sheath tumor, a phaeochromocytoma, a pituitary tumor, a prostate cancer, a posterior uveal melanoma, a renal metastatic cancer, a rhabdoid tumor, a rhabdomysarcoma, a sarcoma, a skin cancer, a soft-tissue sarcoma, a squamous cell cancer, a stomach cancer, a synovial sarcoma, a testicular cancer, a thymic carcinoma, a thymoma, a thyroid metastatic cancer, or a uterine cancer.

2. The method of claim 1 , wherein said anti-folate anticancer agent is an inhibitor of an enzyme of folate metabolism selected from the group consisting of: an inhibitor of dihydrofolate reductase (DHFR); an inhibitor of β-glycinamide ribonucleotide transformylase (GARFT); an inhibitor of 5′-amino-4′-imidazolecarboxamide ribonucleotide transformylase (AICARFT); an inhibitor of thymidylate synthetase (TYMS); an inhibitor of methylene tetrahydrofolate dehydrogenase 1 (MTHFD1); an inhibitor of methylene tetrahydrofolate dehydrogenase 2 (MTHFD2); an inhibitor of serine hydroxymethyltransferase 1 (SHMT1); an inhibitor of serine hydroxymethyltransferase 2 (SHMT2); an inhibitor of formyltetrahydrofolate dehydrogenase 1 (ALDH1L1) and an inhibitor of formyltetrahydrofolate dehydrogenase 2 (ALDH1L2).

3. The method of claim 2 , wherein said anti-folate anticancer agent is an inhibitor of serine hydroxymethyltransferase 1 (SHMT1).

4. The method of claim 3 , wherein said anti-folate anticancer agent that is an inhibitor of serine hydroxymethyltransferase 1 (SHMT1) is:

(1) (R)-6-amino-4-(3,5-bis(trifluoromethyl)phenyl)-4-isopropyl-3-methyl-1,4-dihydropyrano[2,3-c]pyrazole-5-carbonitrile; or

(2) (S)-6-amino-4-(3,5-bi s(trifluoromethyl)phenyl)-4-isopropyl-3-methyl-1,4-dihydropyrano[2,3-c]pyrazole-5-carbonitrile.

5. The method of claim 2 , wherein said anti-folate anticancer agent is a formate ester of said inhibitor.

6. The method of claim 1 , wherein said anti-folate anticancer agent is selected from the group consisting of: aminopterin; methotrexate; raltitrexed; pemetrexed; pralatrexate; 10′-deazaaminopterin; lometrexol; edatrexate; talotrexin; piritrexim and nolatrexed, and a formate ester thereof.

7. The method of claim 1 , wherein said one or more administered metabolic compounds includes methyl formate, triethyl orthoformate, or trimethyl orthoformate.

8. The method of claim 1 , wherein prior to said administering, said method comprises:

(1) administering deuterated serine to cancer cells of said cancer patient; and

(2) measuring the production of:

(a) deuterated NADPH from said deuterated compound; or

(b) a deuterated product of NADPH-driven reductive biosynthesis; by said cancer cells.

9. The method of claim 8 , wherein prior to said administering, said method comprises:

(1) administering said anti-folate anticancer agent and deuterated serine to cancer cells of said cancer patient; and

(2) measuring the production of:

(a) deuterated NADPH from said deuterated compound; or

(b) a deuterated product of NADPH-driven reductive biosynthesis; by said cancer cells.

10. The method of claim 8 , wherein said method comprises measuring said production of a deuterated product of NADPH-driven reductive biosynthesis, and said deuterated product is a fatty acid, pyrroline-5-carboxylate (P5C) or proline.

11. The method of claim 9 , wherein said method comprises measuring said production of a deuterated product of NADPH-driven reductive biosynthesis, and said deuterated product is a fatty acid, pyrroline-5-carboxylate (P5C) or proline.

12. The method of claim 1 , wherein said one or more metabolic compound(s) includes formate.

13. The method of claim 1 , wherein said one or more metabolic compound(s) includes said methyl formate, triethyl orthoformate, or trimethyl orthoformate.

14. The method of claim 1 , wherein said one or more metabolic compound(s) includes 10-formyl-THF or methylene-THF.

15. The method of claim 1 , wherein said one or more metabolic compound(s) includes glycine.