Retinoblastoma (Rb) is a pediatric eye cancer which if
diagnosed
at later stages can lead to Rb invasion into the choroid, optic nerve,
sclera, or beyond, with the potential of undergoing metastasis. Cancer
cells, including Rb cells, reprogram their metabolic circuits for
their own survival and progression, which provides a great opportunity
to monitor the extent of Rb progression based on metabolic differences.
Henceforth, the present study aims to map the metabolic variations
in patients with invasive (primarily enucleated eyes with high-risk
histopathological features) and noninvasive (eyes salvaged with treatment)
unilateral retinoblastoma (Rb) using nuclear magnetic resonance (NMR)
based serum metabolomics. Quantification of differential metabolites
in the serum obtained from 9 patients with invasive and 4 with noninvasive
unilateral Rb along with 6 controls (no retinal pathology) was carried
out using 1H NMR spectroscopy. A total of 71 metabolites,
such as organic acids, amino acids, carbohydrates, and others, were
identified in the serum obtained from 9 patients with invasive and
4 with noninvasive unilateral Rb. Partial least-squares discriminant
analysis (PLS-DA) models depicted distinct grouping of invasive and
noninvasive Rb patients and controls. Differential metabolic fingerprints
were observed for invasive and noninvasive Rb patients based on their
biostatistical analyses with respect to controls. Remarkable perturbation
was observed among various metabolites such as 4-aminobutyrate, 2-phosphoglycerate, O-phosphocholine, proline, Sn-glycero-3-phosphocholine (Sn-GPC),
and O-phosphoethanolamine in noninvasive and invasive
Rb patients with most of the effects being heightened in the latter
group. Metabolic changes unique to invasive and noninvasive Rb patients
were also observed. Multivariate receiver operating characteristics
(ROC) analysis unveiled the highest accuracy and potency of ROC models
2 and 5 to distinguish the noninvasive and invasive Rb from controls,
respectively. Metabolites identified in the serum of patients with
invasive and noninvasive Rb may aid in advancing our knowledge about
Rb tumor biology. Differential aberrant metabolic variations in patients
with invasive Rb compared to those with noninvasive Rb may guide the
decision of enucleation versus globe salvage.