The role of endogenous thiols in intrinsic radioprotection

Observations are reviewed from experiments performed to study the role of endogenous thiols in the radiation response of cells using a glutathione-deficient and a related glutathione-proficient cell strain. The effect of glutathione in the initial radical reactions was considered and the yield of single-strand DNA breaks was the end-point of the response. The rejoining of breaks and clonogenic survival were chosen as end-points when, in addition, the role of glutathione in the subsequent biochemical processes was studied. The results were interpreted to indicate that glutathione plays a role in both the radical and the biochemical reactions which follow irradiation. In the former case, it functions as a damage-restituting reactant, in general agreement with the 'competition model'. Some biochemical repair processes, in particular those concerned with the rejoining of breaks induced by radiation in the presence of oxygen or misonidazole, appear also to be critically dependent on glutathione. Due, probably, to its particular spatial distribution, endogenous glutathione is specific in the radical processes, and exogenous thiols cannot be substituted for it. No such specificity was indicated in the biochemical processes related to strand break rejoining.

Bleomycin and misonidazole cytotoxicity

Chinese hamster ovary (CHO) cells were exposed in vitro to combinations of bleomycin and misonidazole under hypoxic conditions. Only one drug was present at any given time and cells were washed before being exposed to the second drug. Both drugs induced potentially lethal damage (PLD). This damage was repaired under hypoxic conditions very rapidly, and bleomycin-induced PLD was repaired more rapidly than misonidazole-induced PLD. If, after the combined treatment, cells are kept in hypoxia, much of the damage can be repaired.

Combined effect of misonidazole and glutathione depletion by buthionine sulphoximine on cellular radiation response

Chinese hamster cells (V79) and glutathione-proficient (GSH+/+) and glutathione-deficient (GSH-/-) human fibroblasts were treated with a glutathione (GSH)-depleting agent buthionine sulphoximine (BSO) and the hypoxic radiosensitizer misonidazole (MISO), separately or in combination. Subsequently, the cells were exposed to X-rays. Determination of the yield of single-strand DNA breaks (ssb) immediately after irradiation indicated no effect of BSO or MISO treatment when radiation exposure was made aerobically. Assuming that ssb determined immediately after irradiation reflects mainly the effect of radical processes, the results obtained with BSO and MISO, singly and in combination, agreed well with the predictions of a modified version of the 'competition model' using V79 and GSH+/+ cells. Some results obtained with GSH-/- cells could not be so explained.

[Radiosensitization research in cancer therapy]

Radiosensitization using Synkavit was first reported by Mitchell in 1953. Recently, renewed interest in radiosensitization has been shown by tumor radiobiologists since electron-affinitive hypoxic cell sensitizers were introduced Adams and his colleagues in 1973. Conferences on chemical modifiers i.e., radiosensitizers and radioprotectors, have been held every two years since 1977 in Britain or North America. At the last meeting in Banff, Canada in 1983 the results of randomized clinical trials of misonidazole were found to be rather disappointing and non-hypoxic cell sensitizers such as halogenated thymine analogues and PLD repair inhibitors were introduced. In parallel with these approaches, hyperthermia research combined with radiation was started in 1974. Very effective radiosensitization by heat-treatment, for example 43 degrees C for 40 min, has been shown in in vitro as well as in vivo experiments. Enhancement of the anti-tumor activity of some chemotherapy drugs using hypoxic cell sensitizers or PLD repair inhibitors was found to be a new approach for improving cancer chemotherapy in 1982. Hyperthermia was also shown to enhance the anti-tumor activity of some chemicals. Thus radiosensitization research may be extended to chemosensitization. i.e., from selective sensitization used in local radiotherapy to that used in systemic chemotherapy.

Influence of catalase on the radiation sensitizing effect of misonidazole

The radiation modifying action of misonidazole and catalase was investigated in Bacillus megaterium spores at various oxygen concentrations. Catalase (120 micrograms/ml) decreased the radiation sensitizing action of misonidazole. Misonidazole as an electron affinic radiation sensitizer enhanced the build up of H2O2, thus promoting the reaction with catalase. Protection by catalase was not enough to eliminate the total radiation sensitizing effect of misonidazole.

Growth stimulation by misonidazole of lung carcinoma cells maintained in continuous organotypic and monolayer cultures

Inasmuch as misonidazole is a drug used in clinical trials for sensitizing radioresistant hypoxic cells in solid tumors, it seemed of interest to study its effects in human tumor cells maintained in tridimensional organotypic cultures. This type of culture involves: spatial organisation of the cells with fairly undisturbed differentiation patterns, minimal traumatizing culture conditions, and offers the possibility to follow post-treatment growth patterns over several months without disturbing the cultures. Misonidazole exhibited a radiosensitizing effect on irradiated nodules derived from a lung adenocarcinoma, and on cells of this tumor growing in monolayers. However, after a 4 hour contact with misonidazole at concentrations corresponding to the range of those found in the serum of treated patients, a significant stimulation of nodule growth was repeatedly observed, together with a strong increase in the frequency of sister chromatid exchanges. Similarly, after treatment of the same tumor cells in confluent monolayers, their colony forming ability was increased. These observations may account for some of the non- convincing therapeutic results obtained in clinical trials.

Changes in ultrastructure and function of hypoxic V79 fibroblast cells after treatment with misonidazole

Morphologic and enzymatic changes due to exposure to the radiosensitizing chemical, misonidazole, have been identified in V79 cells grown in a system in which oxygen tensions and culture density have been controlled. Misonidazole prevented the increase in mitochondrial size normally seen during exposure of these cells to conditions of moderate hypoxia (2 X 10(3) ppm O2). Mitochondrial size was also significantly decreased in cells from exponential cultures exposed to 1 mmol/l misonidazole. Morphologic changes to the mitochondria that varied from data reported elsewhere were also noted. Misonidazole caused a significant initial decrease in cytochrome oxidase activity after 4 hours of exposure of aerobic and moderately hypoxic cultures that did not return to normal in chronically hypoxic cells during continued exposure to the drug.

Effect of misonidazole on formation of thymine damage by gamma rays

The effect of the radiosensitizer misonidazole (Ro-07-0582) on the formation of thymine base damage of the 5,6-dihydroxydihydrothymine-type by gamma rays was measured under aerobic and hypoxic conditions. HeLa cells, prelabeled with [methyl-3H]thymidine, were suspended in phosphate-buffered saline in the presence and absence of misonidazole. Concentrations of misonidazole up to 15 mM were used. The cell suspensions were irradiated at ice temperature with 60Co gamma rays. Dose-response curves under aerobic and hypoxic conditions showed a much depressed base damage formation under hypoxia, which was created by blowing a stream of nitrogen across the cell suspensions for 30 min on ice. The presence of misonidazole had little or no detectable effect under hypoxia. It is concluded that an effect on the level of formation of thymine base damage is not primarily responsible for the radiosensitization by misonidazole under hypoxic conditions.

The effect of breathing 100% oxygen on lung response to radiation in mice

The response of the lung after single doses of radiation was measured in mice breathing air, or 100% oxygen, or in air-breathing mice given the hypoxic cell sensitizer misonidazole 30 min before irradiation. There was a clear enhancement of only the pneumonitis response in the mice breathing oxygen when breathing rate or lethality was used to assess injury. Less enhancement of the late fibrotic reaction was observed in these animals. No enhancement of either phase of lung response was observed in the misonidazole-treated mice. Dose reduction factors (DRF) were estimated from these data and used to calculate oxygen concentration in the lung, giving values ranging between 187 and 250 micron oxygen.

Scanning electron microscopy and transmission electron microscopy of the ciliated cells of the trachea of the rabbit treated with misonidazole alone and in combination with ionizing radiation

The trachea is often located in the treatment volume when irradiating malignant tumours in the thorax. In order to evaluate possible synergism between misonidazole and irradiation on this tissue, the following studies were made. Fifty rabbits were treated with daily injections of 100 mg misonidazole given i.p. on consecutive days from 1 to 10 days. Morphological investigations of the trachea were made with scanning electron microscopy (SEM), transmission electron microscopy (TEM) and light microscopy (LM). Physiological examinations were performed with recording of the ciliary beat frequency. The results were compared with those from a group of 100 rabbits given misonidazole in a similar manner and exposed to irradiation (2 Gy) 15-30 min after each injection. Ten rabbits were used as controls. The results are compared to the effect of fractionated irradiation alone with 2 Gy/day. Fractionated irradiation of the ciliary epithelium in the trachea of the rabbit has shown dose-dependent physiological and morphological effects. Misonidazole potentiates these effects of radiation with a more pronounced change of the ciliary beat frequency and an increased metabolic activity as could be visualized on TEM. The combination of drug and irradiation also induced a hyperplasia of the ciliary epithelium. Misonidazole itself had no effect on the ciliary beat frequency, but caused a hypoplasia of the ciliary epithelium.

Selective enhancement of hypoxic cell killing by melphalan via thiol depletion: in vitro studies with hypoxic cell sensitizers and buthionine sulfoximine

The relationship between thiol depletion and its enhancement of melphalan (L-PAM) cytotoxicity was studied with the use of V-79-379A Chinese hamster cells in vitro. Selective killing of hypoxic cells by use of a specific and nonspecific reducer of endogenous cellular thiols was the approach used in combining drugs with disparate mechanisms of action. Noncytotoxic concentrations of agents were employed in those experiments designed to mimic a practical scheme for their implementation in vivo. Cells made hypoxic by gassing in suspension with 95% nitrogen and 5% CO2 were treated with buthionine S-R-sulfoximine (BSO), a specific inhibitor of glutathione synthesis and a hypoxic cell sensitizer (i.e., either misonidazole or SR-2508) before their exposure to the alkylating agent. Cellular loss of nonprotein thiols by treatment with BSO correlated with enhanced L-PAM toxicity; however, a far greater effect was achieved when this enzymatic inhibitor was used in combination with a hypoxic cell sensitizer. This chemopotentiation of hypoxic cell killing by L-PAM, along with little potentiation of toxic cell killing, indicated the practical and potential benefit of this sort of drug therapy in vivo.

[Effect of misonidazole (Ro 07-0582) and radiation on the monooxygenases of liver microsomes of the rat]

Three groups of male Wistar rats were compared: one group received injections of Misonidazole (MISO) (200 mg/kg, i.p.), another group was treated by whole-body irradiation, and the third population received both treatments. Irradiation induced an important decrease of monooxygenase (O-demethylase) activity of hepatic microsomes seven days after the treatment. Cyt. P-450 levels hardly decreased, whereas lipid peroxidation was two-fold three days after irradiation. These different parameters were not modified neither after misonidazole treatment nor after association of irradiation and MISO regimen. The presence of oxygen in liver may explain that a radiosensitizer such as MISO does not increase irradiation damage on liver microsomes enzymes, oxygen preventive activation of MISO by radiation: the nitro groupment of MISO was not reduced in nitroso and amine compounds.

Misonidazole protects mouse tumour and normal tissues from the toxicity of oral CCNU

Because the nitrosourea CCNU is given exclusively by the oral route in man, we have carried out studies in mice on the antitumour activity, acute toxicity and pharmacokinetics of oral CCNU, either alone or in combination with the chemosensitizer misonidazole. In both plasma and KHT tumour the peak concentration and "early" AUC for total nitrosoureas were about 1.4-1.5 fold greater for the oral compared to the i.p. route. These differences were reflected in the roughly twofold greater antitumour activity for the oral route. In contrast, acute toxicity tests showed that oral CCNU was 1.45 times less toxic to normal tissue, although the dose-limiting organ may be different for the two routes. Misonidazole reduced the antitumour activity of oral CCNU by dose modifying factors (DMF) of 0.58-0.71. Similarly, the acute toxicity was also diminished by a DMF of 0.74. Misonidazole has a complex effect on oral CCNU pharmacokinetics. The plasma and tumour total nitrosourea peak concentrations were reduced by 1.5 and 1.7 fold respectively. Misonidazole also reduced the "early" nitrosourea AUC, with the extent of the reduction depending on the minimum effective concentration (MEC) chosen. For example, the plasma nitrosourea AUC was reduced by factors of 1.05 and 9.6 for MEC values of 1 and 2 micrograms ml-1 respectively. We propose these pharmacokinetic changes to be the underlying mechanism for the reduction of oral CCNU cytotoxicity by misonidazole. Clinical trials of such combinations should be accompanied by detailed pharmacokinetic evaluation.

Enhancement of misonidazole radiosensitization by buthionine sulphoximine

The influence of glutathione (GSH) depletion on the radiation response and on the radiosensitizing efficiency of misonidazole (miso) has been studied in two types of mouse tumour and in mouse skin. Buthionine sulphoximine (BSO) has been administered in a variety of regimes, leading to a maximal depletion of GSH to 37% of control values in one tumour (CA MT) and 61% in the other (SA FA). Pretreatment with BSO did not alter the radiosensitivity of either tumour when treated with X-rays. It had a slight effect on the sensitizing efficiency of miso, corresponding to a factor less than three, which was detectable only at the highest X-ray doses used. No enhancement of miso efficiency was seen with 5 daily fractions. Prolonged administration of BSO resulted in a slight radiosensitization of mouse skin. When combined with miso the effect was very small and was only detectable at high X-ray doses. BSO however produced a marked enhancement of the acute toxicity of miso, as judged by lethality after large single doses.

Effect of misonidazole pretreatment on nitrogen mustard-induced DNA cross-linking in mouse tissues in vivo

In the present study we have used the alkaline elution technique to study the effect of misonidazole (MISO) on the initial amount of DNA cross-linking in various normal and neoplastic tissues of C3H mice treated with nitrogen mustard (HN2) in vivo. Tissue samples for analysis of the cross-links were prepared 1 h after injection with HN2 to minimize the effect of subsequent repair processes on the yield of lesions. For mice receiving HN2 alone, the greatest level of cross-linking was found in spleen and jejunum, with the liver showing the lowest level. In animals that had been pretreated with MISO (1 mg g-1, i.p.) for 0.5 h prior to injection with HN2, the amount of cross-linking in the spleen and jejunum was not affected by MISO; however, in all other tissues that were examined, cross-linking was enhanced by MISO to a varying extent depending on the specific tissue. The greatest enhancement was observed in the liver (X 6) and kidney (X 3.1), both of these tissues showing a greater enhancement than either of the two fibrosarcomas. The potentiation of HN2 cross-linking in a particular tissue correlated well with two cellular processes that are known to be nitroreduction-dependent in vitro, namely, the degree of MISO-induced GSH depletion and the binding of MISO to cellular macromolecules. Thus, the potentiation of cross-linking in normal tissues such as liver and kidney, and by inference in tumours, may be intimately related to the generation and/or accumulation of nitro-reduced MISO metabolites in those tissues.

The effect of misonidazole as a hypoxic radiosensitizer at low dose

Using an automated low dose survival assay, the radiosensitizing effectiveness of misonidazole at low radiation dose (0-6 Gy) was measured in cultured mammalian cells. Also measured was its effectiveness at high doses of radiation (0-35 Gy) using the conventional survival assay. In both cases, several concentrations of the drug from 0 to 5 mM were used. The data at low doses were analyzed by a two-parameter mathematical equation with linear and quadratic dose terms, S = e-alpha D-beta D2, which proved to be a good fit to the experimental data at all misonidazole concentrations. It is shown that whereas the coefficient of the quadratic dose term, beta, increases significantly with increasing misonidazole concentration, the drug does not significantly affect the coefficient of the linear term, alpha. The enhancement ratio (ER) of misonidazole is shown to be decreased at lower doses. The clinical implications of this result are discussed.

The effect of hypoxic radiosensitizer after mild hyperthermia in C3H mammary carcinoma

The radiosensitizing effect of misonidazole after hyperthermia was investigated in C3H mammary carcinoma. The tumors transplanted into the flanks of the mice were heated in a 42.3 degrees C water bath for 30 min. When misonidazole was administrated before heating, the subsequent radiation effect was prominently enhanced, whereas post-heating administration of misonidazole did not enhance the radiation effect significantly. The effect of varying the time between heating and radiation with or without misonidazole was as follows. Without misonidazole, the radiation effect was decreased at 6 hours after heating but increased at 12 hours, then it returned to the initial level at 24 hours and remained until 96 hours after heating. With misonidazole administered 30 min before irradiation, the radiosensitizing effect was observed at 24, 48 and 96 hours after heating. However, the total effects of this procedure were almost the same as the results in the combination without heating. Changes in the hypoxic fraction after hyperthermia are also discussed.

Effects of oxygen and misonidazole on cell transformation and cell killing in C3H 10T1/2 cells by X rays in vitro

The effects of oxygen (air) and misonidazole on the transformation and killing of 10T1/2 cells by X rays were examined. The oxygen effect for the cell transformation end point was very similar to that for cell killing. Misonidazole enhanced both cell killing and cell transformation to a similar extent. The enhancement of both end points by misonidazole occurred only in the absence of oxygen during irradiation and was of lesser magnitude than that observed for oxygen. These results demonstrate that the radiation chemical processes leading to cell killing and cell transformation, respectively, are affected similarly by these two enhancers of radiation action.

The contribution of hydroxyl radical to radiosensitization: a study of DNA damage

Using the radioprotector dimethylsulfoxide, DMSO, as a scavenger of hydroxyl radicals, the proportions of DNA damage caused by OH. were determined in mammalian cells irradiated in hypoxia with or without the radiosensitizers misonidazole and TAN or in air. Yields of both single-strand breaks (SSB) and base/sugar damage (MLS for Micrococcus luteus sensitive sites) were measured for each situation. Most of the damage enhanced by the sensitizers was found to be OH. dependent, for both MLS and SSB classes of damage: most breaks (greater than 80%) enhanced by oxygen and about two-thirds of the breaks enhanced by misonidazole (hypoxia) occur at OH.-damaged sites; most if not all base/sugar damage enhanced by the sensitizers misonidazole and TAN (in hypoxia) occurs only in the presence of OH., whereas in air, some (about one-quarter) of the enhanced MLS damage does not require OH.. The sensitizer enhancement ratios in the presence of scavenger and the degree of protection afforded by the scavenger determined for total (MLS + SSB) damage agree well with those derived from corresponding survival experiments.

Chemosensitization: do thiols matter?

It is well known that endogenous sulfhydryls are radioprotective in mammalian cells. Their comparable role in chemotherapeutic drug toxicity has been known for almost as long but less well defined. Thiol depletion as a mechanism responsible for enhanced cytotoxicity of melphalan was assayed by pretreatment of cells in vitro with misonidazole and buthionine sulfoximine (BSO). Hypoxic cell sensitizers, such as MISO, deplete endogenous thiols by metabolic activation under hypoxic conditions to thiol reactive intermediates, whereas BSO specifically inhibits a key enzyme in the synthesis of glutathione. For a given level of thiol reduction, sensitization to melphalan was far greater by preincubation with MISO than it was for BSO. This indicated that thiol reduction itself was not the sole factor involved in chemosensitization by MISO. As evidence that the method of thiol depletion predisposes to the expression of biological damage, it was shown that cells preincubated with MISO were appreciably more vulnerable to oxidative stress than those exposed to BSO. BSO was shown to totally inhibit the repair of damage from a preincubation treatment with MISO, demonstrating that recovery is dependent upon thiol regeneration. Thiol depletion "per se" is a good qualitative but not necessarily a quantitative indicator of chemosensitization--the biological and biochemical function of the thiol depleting agents used influences further drug interactions. The results of the study with these two agents suggest that thiols may play a potentially more critical role in the repair rather than the initiation of drug-induced damage.

Mechanism of melphalan crosslink enhancement by misonidazole pretreatment

Sensitization of Chinese hamster ovary cells to melphalan (L-PAM) toxicity by prior treatment with misonidazole (MISO, 5 mM, 2 hr, hypoxic conditions, 37 degrees C) is associated with increased levels of DNA crosslinks believed to be the critical lesion for bifunctional alkylating agent toxicity. Enhanced L-PAM crosslinking of DNA could occur by a variety of mechanisms in MISO-pretreated cells including: (1) increased transport or binding of L-PAM, (2) decreased repair of L-PAM monoadducts which would allow more time for their conversion to crosslinks, (3) decreased crosslink repair (unhooking of one arm), or (4) chemical modification of the DNA structure, presumably by bound MISO derivatives, such that crosslink formation is facilitated. Previous studies have eliminated mechanisms (1) and (3). Mechanism (4) was investigated by following MISO-pretreatments of whole cells with L-PAM treatments of the isolated DNA from these cells. This was accomplished by using a modification of the alkaline elution assay for DNA crosslink measurement in which a 1 hr treatment with L-PAM (0-12 micrograms/ml) was inserted between the cell lysis steps and DNA elution procedure. Treatment of bare DNA with L-PAM modeled very well the crosslinking behavior in whole cells although it was somewhat more efficient (more crosslinks at a given L-PAM dose). In the presence of double stranded DNA and absence of repair systems during and after the L-PAM exposure, it was determined that MISO-pretreatments did not increase the crosslinking efficiency of L-PAM (mechanism [4] above). Inhibition of repair of L-PAM monoadducts (mechanism [2] above) still remains as a possible means for crosslink enhancement by MISO-pretreatment.

Nitroimidazoles as modifiers of nitrosourea pharmacokinetics

We have studied the effect of a number of nitroimidazole sensitizers of varying lipophilicity on the pharmacokinetics of CCNU in mice. It was found that the effectiveness of these compounds in producing pharmacokinetic effects correlated directly with their lipophilicity, viz. in the order: benznidazole (Benzo) greater than Ro07-1902 misonidazole greater than (MISO) greater than Ro05-9963. The effects of MISO on the pharmacokinetics of 4 nitrosoureas of differing lipophilicity were also investigated. The plasma clearances of CCNU, BCNU and MeCCNU (high lipophilicity) were slowed by MISO whereas that of chlorozotocin (Chlz) (low lipophilicity) was unaffected. Thus, it seems that for a pharmacokinetic interaction to occur between a nitroimidazole and a nitrosourea, both the modifier and the cytotoxic agent must have a requisite degree of lipophilicity. As the same requirement appears to hold for enhancement of tumor response, these data provide further evidence that pharmacokinetic modification plays a major role in chemosensitization.

Repair of DNA breaks after irradiation in misonidazole or oxygen

Biphasic kinetics (half-times 7' and 250') adequately describe the aerobic repair of DNA breaks after irradiation of mammalian cells. The proportions repaired by the two components are affected by conditions prior to, during and after irradiation. DNA of cells irradiated in hypoxia have approximately twice as much of the damage which is repaired by the slow component as cells irradiated in air. If, instead of oxygen, misonidazole is present during hypoxic radiation, the repair resembles the repair of oxic damage more closely than repair of hypoxic damage. The biphasic nature of the repair curves is interpreted to be due to two classes of initial damage, proportions of which can be altered by sensitizers such as O2 and misonidazole.