Telomerase reverse transcriptase (TERT) is essential for tumor proliferation and is an attractive therapeutic target. Non-invasive methods of imaging TERT can report on tumor proliferation and response to therapy. Here, we show that 2H-MRS following administration of [U-2H]pyruvate non-invasively monitors TERT expression in clinically relevant patient-derived glioma models. Importantly, imaging TERT using [U-2H]pyruvate provides a readout of response to targeted TERT inhibitors and standard of care chemotherapy in vivo, at early timepoints that precedes MRI-detectable anatomical alterations. Clinical translation of our results can enable non-invasive assessment of TERT expression in vivo and, thereby, aid in imaging response to anti-cancer therapies.
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