Radiation-chemical properties of the hypoxic cell radiosensitizer doranidazole (PR-350)

2-Nitroimidazoles induce mitochondrial stress and ferroptosis in glioma stem cells residing in a hypoxic niche

Under hypoxic conditions, nitroimidazoles can replace oxygen as electron acceptors, thereby enhancing the effects of radiation on malignant cells. These compounds also accumulate in hypoxic cells, where they can act as cytotoxins or imaging agents. However, whether these effects apply to cancer stem cells has not been sufficiently explored. Here we show that the 2-nitroimidazole doranidazole potentiates radiation-induced DNA damage in hypoxic glioma stem cells (GSCs) and confers a significant survival benefit in mice harboring GSC-derived tumors in radiotherapy settings. Furthermore, doranidazole and misonidazole, but not metronidazole, manifested radiation-independent cytotoxicity for hypoxic GSCs that was mediated by ferroptosis induced partially through blockade of mitochondrial complexes I and II and resultant metabolic alterations in oxidative stress responses. Doranidazole also limited the growth of GSC-derived subcutaneous tumors and that of tumors in orthotopic brain slices. Our results thus reveal the theranostic potential of 2-nitroimidazoles as ferroptosis inducers that enable targeting GSCs in their hypoxic niche.

Koike et al. show that the 2-nitroimidazole doranidazole increases radiation-induced DNA damage in hypoxic glioma stem cells (GSCs). They further demonstrate that additional radiation-independent cytotoxicity of 2-nitroimidazoles is due to ferroptosis that occurs through blockade of mitochondrial complexes I and II leading to metabolic changes in the oxidative stress response.

Hypoxia-targeted drug delivery

Hypoxia is a state of low oxygen tension found in numerous solid tumours. It is typically associated with abnormal vasculature, which results in a reduced supply of oxygen and nutrients, as well as impaired delivery of drugs. The hypoxic nature of tumours often leads to the development of localized heterogeneous environments characterized by variable oxygen concentrations, relatively low pH, and increased levels of reactive oxygen species (ROS). The hypoxic heterogeneity promotes tumour invasiveness, metastasis, angiogenesis, and an increase in multidrug-resistant proteins. These factors decrease the therapeutic efficacy of anticancer drugs and can provide a barrier to advancing drug leads beyond the early stages of preclinical development. This review highlights various hypoxia-targeted and activated design strategies for the formulation of drugs or prodrugs and their mechanism of action for tumour diagnosis and treatment.

The prospective application of a hypoxic radiosensitizer, doranidazole to rat intracranial glioblastoma with blood brain barrier disruption

Background

Glioblastoma is one of the intractable cancers and is highly resistant to ionizing radiation. This radioresistance is partly due to the presence of a hypoxic region which is widely found in advanced malignant gliomas. In the present study, we evaluated the effectiveness of the hypoxic cell sensitizer doranidazole (PR-350) using the C6 rat glioblastoma model, focusing on the status of blood brain barrier (BBB).

Methods

Reproductive cell death in the rat C6 glioma cell line was determined by means of clonogenic assay. An intracranial C6 glioma model was established for the in vivo experiments. To investigate the status of the BBB in C6 glioma bearing brain, we performed the Evans blue extravasation test. Autoradiography with [¹⁴C]-doranidazole was performed to examine the distribution of doranidazole in the glioma tumor. T2-weighted MRI was employed to examine the effects of X-irradiation and/or doranidazole on tumor growth.

Results

Doranidazole significantly enhanced radiation-induced reproductive cell death in vitro under hypoxia, but not under normoxia. The BBB in C6-bearing brain was completely disrupted and [¹⁴C]-doranidazole specifically penetrated the tumor regions. Combined treatment with X-irradiation and doranidazole significantly inhibited the growth of C6 gliomas.

Conclusions

Our results revealed that BBB disruption in glioma enables BBB-impermeable radiosensitizers to penetrate and distribute in the target region. This study is the first to propose that in malignant glioma the administration of hydrophilic hypoxic radiosensitizers could be a potent strategy for improving the clinical outcome of radiotherapy without side effects.

Regulation of cell survival and death signals induced by oxidative stress

Oxidative stress stimulates two opposite signaling pathways leading to cell death and cell survival. Preferential selection of survival signals leads to the protection of cells against damage induced by reactive oxygen species, whereas preferential acceleration of death signals can be used to advantage in tumor therapy with oxidizing agents such as ionizing radiation and anticancer drugs. In vitro and in vivo experiments using cultured mammalian cells and experimental animals showed that ERK was included in survival signals and SAPK and p38 MAPK in death signals in oxidative stress. The activation of SAPK/JNK and subsequent expression of death receptor Fas on the cell surface caused the induction of cell death. The results mean that the acceleration of the activation of SAPK/JNK might lead to the enhancement of cell death by oxidizing agents like ionizing radiation and anticancer drugs. In fact, when cultured mammalian cells were exposed to ionizing radiation with 2-nitroimidazole derivatives having electrophilicity, the lethal effect of ionizing radiation was found to be enhanced together with the activation of SAPK/JNK and the enhancement of Fas expression. The activation of both survival and death signals was suppressed by the antioxidants N-acetylcystein and Trolox, suggesting that both signaling pathways are redox-regulated.

Post-irradiation hypoxic incubation of X-irradiated MOLT-4 cells reduces apoptotic cell death by changing the intracellular redox state and modulating SAPK/JNK pathways

To elucidate radiobiological effects of hypoxia on X-ray-induced apoptosis, MOLT-4 cells were treated under four set of conditions: (1) both X irradiation and incubation under normoxia, (2) X irradiation under hypoxia and subsequent incubation under normoxia, (3) X irradiation under normoxia and subsequent incubation under hypoxia, and (4) both X irradiation and incubation under hypoxia, and the induction of apoptosis was examined by fluorescence microscopy. About 28-33% apoptosis was observed in cells treated under conditions 1 and 2, but this value was significantly reduced to around 18-20% in cells treated under conditions 3 and 4, suggesting that post-irradiation hypoxic incubation rather than hypoxic irradiation mainly caused the reduction of apoptosis. The activation and expression of apoptosis signal-related molecules SAPK/JNK, Fas and caspase-3 were also suppressed by hypoxic incubation. Effects of hypoxic incubation were canceled when cells were treated under conditions 3 and 4 with an oxygen-mimicking hypoxic cell radiosensitizer, whereas the addition of N-acetyl-L-cysteine again reduced the induction of apoptosis. From these results it was concluded that hypoxia reduced the induction of apoptosis by changing the intracellular redox state, followed by the regulation of apoptotic signals in X-irradiated MOLT-4 cells.

Radiation effect on poly(vinylbenzyltrimethylammonium chloride) in aqueous solution: pulse radiolysis and steady-state study

Poly(vinylbenzyltrimethylammonium chloride) (PVBT) has been synthesized by radiation-induced polymerization of Vinylbenzyltrimethylammonium chloride (VBT). The viscosity average molecular weight of synthesized polymer was estimated to be approximately 10(5) by viscosity measurements. The radiation-induced affects on PVBT have been investigated by steady-state and pulse radiolysis (PR) techniques. The reactions of primary radicals (*)OH, e(aq)(-), and H(*) generated by the radiolysis of water with PVBT were studied. The reactions of some other species such as N(3)(*), Cl(2)(*-), Br(2)(*-), SO(4)(*-), and CO(2)(*-) with PVBT were also investigated. The results indicate that the reactivity of these species toward PVBT is lower then that with the monomer VBT. The rate constants for the reactions of OH radical and H atom with PVBT were evaluated both by competition kinetics and by direct observation of the buildup of transient species. The difference in the rate constant values evaluated by the two methods indicated that (*)OH and H(*) react with PVBT to give more than one species. It was observed that the OH radical and H atom react with PVBT in different manners. Near neutral pH, the OH radicals react to form an adduct and to generate a radical by abstracting methylenic H atom. The H atom, however, also abstracts the H atom from the PVBT backbone. The rate constant value for the reaction of hydrated electron with PVBT was found to be 3.1 currency 10(9) dm(3) mol(-1) s(-1). Steady-state irradiation studies of the aqueous PVBT solution indicated that PVBT predominantly undergoes cross-linking on irradiation. Cross-linking is a function of dose rate, concentration, and ambient of irradiation. At concentrations < 2%, only intramolecular cross-linking takes place, whereas beyond this concentration, the intermolecular cross-linking of polymer chains takes place to form a soft gel. The gel dose (D(gel)) is a function of the ambient of irradiation.

Radiosensitizer sanazole (AK-2123) enhances gamma-radiation-induced apoptosis in murine fibrosarcoma

Sanazole (AK-2123) (N-2'-methoxy ethyl)-2-(3"-nitro-1"-triazolyl)acetamide, which has completed phase III clinical trials as a radiosensitizer, enhanced gamma-radiation induced apoptosis in murine fibrosarcoma upon i.p. administration at 40 mg/kg body weight one hour prior to irradiation. A microscopic examination of Giemsa-May-Grunwald stained cells has shown a higher frequency of condensed nuclei and fragmented nuclei in the tumor cells. The administration of sanazole to tumor-bearing animals enhanced the radiation-induced internucleosomal fragmentation in the nuclear genome of tumor cells. Higher levels of caspase-3 activity were also observed in the cell extracts of tumours from AK-2123 administered mice. Exposure to gamma-radiation of AK-2123-treated mouse further enhanced the caspase-3 activity, indicating the induction of apoptosis. The radiation sensitization property of sanazole was discernible by comparing the relative tumor diameter following irradiation after i.p. administration of AK-2123 and irradiation alone; it was higher during the first few days followed by the treatment.

Induction of apoptosis through the activation of SAPK/JNK followed by the expression of death receptor Fas in X-irradiated cells

A post-irradiation treatment of the human leukemia cell line MOLT-4 with the antioxidant Trolox attenuated caspase-3 dependent apoptosis. The increase in the p53 expression and SAPK/JNK activation after X irradiation was also inhibited by a Trolox treatment, but the expression of BCL-2 and BAX, which would occur downstream from p53, was not changed. Studies on the effects of the intracellular calcium chelator BAPTA-AM on the induction of apoptosis and the activation of SAPK/JNK and caspase-3 proved that the chelation of calcium merely delayed the onset of radiation-induced apoptosis and the activation of SAPK/JNK and caspase-3. When the effects of the protein synthesis inhibitor cycloheximde on the apoptotic signaling pathways, including the activation of caspase family proteins and SAPK/JNK, were investigated, the expression of death receptor Fas through SAPK/JNK activation was found to be required for radiation-induced apoptosis. Finally, the relationship between the amounts of DNA dsb and induction of apoptosis was examined by irradiating BrdU-incorporated cells. An increase in DNA dsb caused by BrdU was found, but the induction of apoptosis was not enhanced. From these data, we could get no positive evidence for DNA as a target of X-rays and p53 as an indispensable factor to induced apoptosis in X-irradiated MOLT-4 cells.

The role of radiolytically generated species in radiation-induced polymerization of vinylbenzyltrimethylammonium chloride (VBT) in aqueous solution: steady-state and pulse radiolysis study

Radiation-induced polymerization of vinylbenzyltrimethylammonium chloride (VBT) in aqueous solution has been investigated by steady-state and pulse radiolysis techniques. The effects of dose, dose rate, monomer concentration, pH, and ambient conditions on steady state polymerization were investigated. The reactions of primary radicals of water radiolysis, such as OH radical, e(-)aq, and H atom, were studied. The reactions of other chemically active species such as O*-, oxidizing radicals such as N3*, Cl2(*-), Br(2*), SO4(*-), and a reducing specie such as CO2(*-) with VBT were also investigated. The reaction of VBT with OH radical and H atom were investigated by formation kinetics and by competition kinetics. The rate constant values for the reaction of OH radical with VBT were 4.7 x 10(9) dm3 mol(-1) s(-1) and 1.7 x 10(10) dm3 mol(-1) s(-1) by formation kinetics and by competition kinetics, respectively. The results indicate that OH radicals undergo electron transfer reactions (resulting in a radical cation) and addition reactions. The hydrated electron reacts with VBT with a rate constant of 1.9 x 10(10) dm3 mol(-1) s(-1) to form an anion. At pH approximately 1, H atom reaction with VBT is diffusion controlled with a rate constant of 5.1 x 10(9) dm3 mol(-1) s(-1) as determined by formation kinetics and 1.7 x 10(10) dm3 mol(-1) s(-1) as determined by competition kinetics. VBT radical anion reacts with VBT at a rate that is almost twice the rate at which VBT radical cation reacts with VBT, indicating anionic initiation of the polymerization of VBT. VBT undergoes very fast steady-state polymerization and dose rate; the presence of efficient radical quenchers such as oxygen and concentration of VBT in the aqueous solution affects the extent of polymerization. Typically, a dose of 4 kGy is sufficient to achieve 80-85% polymerization. The monomer solution shows a drastic increase in the viscosity of the solution, which finally gels to a soft rubbery mass.