Is Dietary Nitrate Effective in Reducing Aerobic Glycolysis in Breast Cancer?
Is Dietary Nitrate Effective in Reducing Aerobic Glycolysis in Breast Cancer?
Breast cancer is the most prevalent cancer affecting women, with 1 in 8 women in the UK
 developing breast cancer in their life time. Chemotherapy drugs, currently used for locally
 advanced breast cancers, are associated with side effects while dietary supplements have
 complex effects with a relatively small effect size.

 Breast tumours have different metabolism compared to healthy tissue, including elevated
 lactate production by aerobic glycolysis (AG), an underpinning feature of metabolism in
 breast cancer cells. Dietary nitrate, contained in leafy green vegetables and beetroot, has
 been shown to improve energy efficiency in exercising skeletal muscle, positioning itself as
 a disruptor of AG.

 The purpose of this study is to examine if dietary nitrate can disrupt AG and as a result to
 halt or even reverse tumour progression and survival. This study will look at scans of breast
 tumours using magnetic resonance imaging (MRI). Changes to tumour related biochemical
 substances will be measured by advanced magnetic resonance spectroscopy and changes to tissue
 structure will be measured by advanced diffusion MRI techniques.

 In this study, 16 patients undergoing surgery will be recruited for two MRI scans following a
 5 day intervention programme.
In this longitudinal study, the investigators propose to examine the changes in lipid
 composition and microstructure in breast tumours at baseline and post dietary nitrate
 intervention through the applications of novel non-invasive magnetic resonance spectroscopy
 (MRS) methods and diffusion and lipid profiling MR imaging methods in patients. The
 investigators hypothesise that dietary nitrate disrupts tumour progression in breast cancer.

 1. Is there a significant difference in lipid composition in the tumour measured by MRS
 between baseline and post dietary nitrate intervention?

 2. Is there a significant difference in lipid composition in the whole breast tissue
 surrounding tumour measured by MRI between baseline and post dietary nitrate
 intervention?

 3. Is there a significant difference in tissue microstructure measured by MRI between
 baseline and post dietary nitrate intervention in the breast tissue?

 To assess the effect of dietary nitrate on tumour progression, paired t-tests will be
 performed on lipid composition measured from tumour between baseline and post intervention.
 To assess the effect of dietary nitrate on tumour progression, paired t-tests will be
 performed on lipid composition in the whole breast tissue surrounding tumour between baseline
 and post intervention. To assess the effect of dietary nitrate on tissue microstructure
 paired t-tests will be performed on water displacement measured from tumour between baseline
 and post intervention.
Inclusion Criteria:

 -  Patients with pathologically confirmed invasive ductal carcinoma (Grade 2 or 3)

 -  Undergoing wide local excision surgery or mastectomy

 Exclusion Criteria:

 -  Started hormone or chemotherapy treatment before recruitment.

 -  Undergoing treatment for concurrent cancer diagnosis.

 -  Taking antibiotics, proton pump or vegetable dietary supplement.