To identify metabolic features that support the aggressive behavior of human neuroendocrine (NE) cancers, we examined metastatic prostate NE tumors and derived prostate NE cancer (PNEC) cell lines from a transgenic mouse model using a combination of magic angle spinning NMR spectroscopy, in silico predictions of biotransformations that observed metabolites may undergo, biochemical tests of these predictions, and electrophysiological͞cal-cium imaging studies. Malignant NE cells undergo excitation and increased proliferation when their GABA A, glutamate, and͞or glycine receptors are stimulated, use glutamate and GABA as substrates for NADH biosynthesis, and produce propylene glycol, a precursor of pyruvate derived from glycine that increases levels of circulating free fatty acids through extra-NE cell effects. Treatment of nude mice containing PNEC tumor xenografts with (i) amiloride, a diuretic that inhibits Abp1, an enzyme involved in NE cell GABA metabolism, (ii) carbidopa, an inhibitor of dopa decarboxylase which functions upstream of Abp1, plus (iii) flumazenil, a benzodiazepine antagonist that binds to GABA A receptors, leads to significant reductions in tumor growth. These findings may be generally applicable: GeneChip data sets from 471 human neoplasms revealed that components of GABA metabolic pathways, including ABP1, exhibit statistically significant increases in their expression in NE and non-NE cancers.metabolome-directed cancer therapy ͉ electrophysiology ͉ GABA signaling and shunt ͉ magic angle spinning-NMR ͉ metabolomics N euroendocrine (NE) cancers originate from either neuroectoderm or endoderm-derived epithelia and display a wide range of aggressiveness. On one end of the spectrum, neuroectodermal NE cancers originating from adrenal chromaffin cells (phenochromocytomas) are typically indolent with Յ10% undergoing metastatic spread (1). In contrast, small cell carcinoma, an endodermal NE tumor comprising up to 25% of lung cancers, is usually disseminated at the time of initial diagnosis (2). Adenocarcinomas originating in non-NE cell lineages in the lung, prostate, stomach, and colon, as well as other organs, can express NE cell-associated gene products. This ''neuroendocrine differentiation'' (NED) correlates with poor prognosis (3-8), although the underlying mechanisms remain obscure.To characterize the metabolic features of NE cancers and adenocarcinomas with NED that affect prognosis, we produced CR2-large T antigen (TAg) transgenic mice where transcriptional regulatory elements from the mouse cryptidin-2 gene (Defcr2) were used to direct expression of simian virus 40 TAg in a subset of prostate NE cells. Males from multiple pedigrees develop metastatic NE cell cancer with a very stereotyped pattern of progression. Transgene expression commences at 7 weeks of age. Within 1 week, foci of transformed NE cells appear that phenocopy human prostatic intraepithelial neoplasia, the postulated precursor of conventional adenocarcinoma of the prostate (9, 10). By 16 weeks of age, there is local invasio...