Cyclocreatine suppresses creatine metabolism and impairs prostate cancer progression

Patel, Rachana and Ford, Catriona A. and Rodgers, Lisa and Rushworth, Linda K. and Fleming, Janis and Mui, Ernest and Zhang, Tong and Watson, David and Lynch, Victoria and Mackay, Gillian and Sumpton, David and Sansom, Owen J. and Vande Voorde, Johan and Leung, Hing Y. (2022) Cyclocreatine suppresses creatine metabolism and impairs prostate cancer progression. Cancer Research, 82 (14). pp. 2565-2575. ISSN 0008-5472 (

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Prostate cancer is the second most common cause of cancer mortality in men worldwide. Applying a novel genetically engineered mouse model (GEMM) of aggressive prostate cancer driven by deficiency of the tumor suppressors PTEN and Sprouty2 (SPRY2), we identified enhanced creatine metabolism as a central component of progressive disease. Creatine treatment was associated with enhanced cellular basal respiration in vitro and increased tumor cell proliferation in vivo. Stable isotope tracing revealed that intracellular levels of creatine in prostate cancer cells are predominantly dictated by exogenous availability rather than by de novo synthesis from arginine. Genetic silencing of creatine transporter SLC6A8 depleted intracellular creatine levels and reduced the colony-forming capacity of human prostate cancer cells. Accordingly, in vitro treatment of prostate cancer cells with cyclocreatine, a creatine analog, dramatically reduced intracellular levels of creatine and its derivatives phosphocreatine and creatinine and suppressed proliferation. Supplementation with cyclocreatine impaired cancer progression in the PTEN- and SPRY2-deficient prostate cancer GEMMs and in a xenograft liver metastasis model. Collectively, these results identify a metabolic vulnerability in prostate cancer and demonstrate a rational therapeutic strategy to exploit this vulnerability to impede tumor progression. Significance: Enhanced creatine uptake drives prostate cancer progression and confers a metabolic vulnerability to treatment with the creatine analog cyclocreatine.