tirapazamine and Necrosis

Transarterial chemoembolization (TACE) is the main treatment for intermediate stage hepatocellular carcinoma (HCC) with Barcelona Clinic Liver Cancer classification because of its exclusive arterial blood supply. Although TACE achieves substantial necrosis of the tumor, complete tumor necrosis is uncommon, and the residual tumor generally rapidly recurs. We combined tirapazamine (TPZ), a hypoxia-activated cytotoxic agent, with hepatic artery ligation (HAL), which recapitulates transarterial embolization in mouse models, to enhance the efficacy of TACE. The effectiveness of this combination treatment was examined in HCC that spontaneously developed in hepatitis B virus X protein (HBx) transgenic mice. We proved that the tumor blood flow in this model was exclusively supplied by the hepatic artery, in contrast to conventional orthotopic HCC xenografts that receive both arterial and venous blood supplies. At levels below the threshold oxygen levels created by HAL, TPZ was activated and killed the hypoxic cells, but spared the normoxic cells. This combination treatment clearly limited the toxicity of TPZ to HCC, which caused the rapid and near-complete necrosis of HCC. In conclusion, the combination of TPZ and HAL showed a synergistic tumor killing activity that was specific for HCC in HBx transgenic mice. This preclinical study forms the basis for the ongoing clinical program for the TPZ-TACE regimen in HCC treatment.

Topics: Animals; Antineoplastic Agents; Biomarkers; Carcinoma, Hepatocellular; Cell Line, Tumor; Combined Modality Therapy; Disease Models, Animal; Dose-Response Relationship, Drug; Hepatic Artery; Humans; Immunohistochemistry; Ligation; Liver Neoplasms; Magnetic Resonance Imaging; Mice; Mice, Inbred NOD; Mice, SCID; Mice, Transgenic; Necrosis; Recurrence; Tirapazamine; Trans-Activators; Triazines; Tumor Burden; Viral Regulatory and Accessory Proteins; Xenograft Model Antitumor Assays

To determine whether vascular-targeting effects can be detected in vivo using magnetic resonance imaging (MRI).. MR images of HCT-116 xenograft-bearing mice were acquired at 7 Tesla before and 24 hours after intraperitoneal injections of tirapazamine. Quantitative dynamic contrast-enhanced MRI analyses were performed to evaluate changes in tumor perfusion using two biomarkers: the volume transfer constant (K(trans)) and the initial area under the concentration-time curve (IAUC). We used novel implanted fiducial markers to obtain cryosections that corresponded to MR image planes from excised tumors; quantitative immunohistochemical mapping of tumor vasculature, perfusion, and necrosis enabled correlative analysis between these and MR images.. Conventional histological analysis showed lower vascular perfusion or greater amounts of necrosis in the central regions of five of eight tirapazamine-treated tumors, with three treated tumors showing no vascular dysfunction response. MRI data reflected this result, and a striking decrease in both K(trans) and IAUC values was seen with the responsive tumors. Retrospective evaluation of pretreatment MRI parameters revealed that those tumors that did not respond to the vascular-targeting effects of tirapazamine had significantly higher pretreatment K(trans) and IAUC values.. MRI-derived parameter maps showed good agreement with histological tumor mapping. MRI was found to be an effective tool for noninvasively monitoring and predicting tirapazamine-mediated central vascular dysfunction.

Topics: Animals; Antineoplastic Agents; Area Under Curve; Blood Volume; Blood Volume Determination; Cell Hypoxia; Contrast Media; Magnetic Resonance Imaging; Mice; Mice, Inbred NOD; Mice, SCID; Necrosis; Neoplasm Transplantation; Neoplasms; Prostheses and Implants; Radiation-Sensitizing Agents; Regional Blood Flow; Tirapazamine; Transplantation, Heterologous; Triazines

We have previously reported that the hypoxic cytotoxin tirapazamine causes central vascular dysfunction in HCT-116 xenografts. Here we further extend this finding to SiHa xenografts and SCCVII murine tumors. Within 1 day after treatment with tirapazamine both tumor types develop areas of non-perfused tissue in central regions of tumors. To explore the mechanism by which the hypoxic cytotoxin tirapazamine causes vascular dysfunction we altered the blood oxygen content with carbogen (95% O(2) and 5% CO(2)) breathing in tumor bearing mice. Carbogen treatment was able to decrease the number of tumors responding to tirapazamine but was not able to eradicate the vascular dysfunction completely. In complementary in vitro studies, immunohistochemical staining of tirapazamine-treated endothelial cells indicated that, unlike the vascular targeting agent (VTA) combretastatin-A-4-phosphate, the vascular effects caused by tirapazamine are not due to microtubule disruption. Another possible mechanism of action for tirapazamine could involve its ability to inhibit nitric oxide synthase (NOS). Studies combining other vascular targeting agents (VTAs) such as the combretastatins have shown a potentiation of vascular disruption in tumors when combined with NOS inhibitors, possibly due to vessel constriction from decreased nitric oxide (NO) levels. We propose the theory that vascular dysfunction caused by tirapazamine may be via NOS inhibition. In support of this hypothesis preliminary experiments showed NOS inhibition with L-NNA (N-omega-nitro-L-arginine) increases tumor necrosis, 1 day after administration, in our HCT-116 tumor model.

Topics: Animals; Antineoplastic Agents; Carbon Dioxide; Cell Hypoxia; Cells, Cultured; Dose-Response Relationship, Drug; Endothelial Cells; Endothelium, Vascular; Enzyme Inhibitors; HCT116 Cells; Humans; Mice; Mice, Inbred C3H; Mice, Inbred NOD; Mice, SCID; Necrosis; Neoplasms, Experimental; Nitric Oxide Synthase; Nitroarginine; Oxygen; Regional Blood Flow; Time Factors; Tirapazamine; Triazines

Tirapazamine is a hypoxic cytotoxin currently undergoing Phase II/III clinical evaluation in combination with radiation and chemotherapeutics for the treatment of non-hematological cancers. Tissue penetration studies using multicellular models have suggested that tirapazamine exposure may be limited to cells close to blood vessels. However, animal studies show tirapazamine enhances the anti-tumour activity of radiation and chemotherapy and clinical studies with tirapazamine, so far, are promising. To investigate this apparent paradox we examined the microregional effects of tirapazamine in vivo by mapping drug effects with respect to the position of blood vessels in tumour cryosections.. Tirapazamine was administered i.p. to mice bearing HCT-116 tumours, which were excised at various times after treatment. Images of multiple-stained cryosections were overlaid to provide microregional information on the relative position of proliferating cells, hypoxia, perfusion and vasculature.. We observed extensive and permanent vascular dysfunction in a large proportion of tumours from mice treated with tirapazamine. In the affected tumours, blood flow ceased in the centrally located tumour vessels, leaving a rim of functional vessels around the periphery of the tumour. This vascular dysfunction commenced within 24 h after tirapazamine administration and the areas affected appeared to be replaced by necrosis over the following 24-48 h.. Because the majority of hypoxic cells are located in the center of tumours we propose that the activity of tirapazamine in vivo may be related to its effects on tumour vasculature and that its activity against hypoxic cells located distal to functional blood vessels may not be as important as previously believed.

Topics: Animals; Antimetabolites; Antineoplastic Agents; Blood Vessels; Bromodeoxyuridine; Cell Hypoxia; Cell Proliferation; Coloring Agents; Female; HCT116 Cells; Humans; Image Processing, Computer-Assisted; Immunohistochemistry; Mice; Mice, Inbred NOD; Mice, SCID; Necrosis; Platelet Endothelial Cell Adhesion Molecule-1; Regional Blood Flow; Skin Neoplasms; Tirapazamine; Transplantation, Heterologous; Triazines