Screening for deficits in DNA repair by the response of irradiated human lymphocytes to phytohemagglutinin.

An assay has been developed to measure the ability of human lymphocytes to repair damage to DNA. In this assay, purified human lymphocytes are exposed to graded doses of radiation and then stimulated with phytohemagglutinin to undergo DNA replication. The rate of incorporation of thymidine in irradiated lymphocytes during the second and subsequent rounds of DNA replication is taken to be indicative of the ability of the cells to repair damage to DNA. In lymphocytes from normal individuals, X-irradiation with doses of 100 to 800 rads was found to inhibit phytohemagglutinin-stimulated thymidine incorporation proportionally to the dose of radiation without curtailing the induction of DNA polymerase. The response to phytohemagglutinin of lymphocytes from a patient with xeroderma pigmentosum after exposure to graded doses of X-irradiation was found to be similar to that of the normal controls, whereas the response after ultraviolet irradiation was markedly impaired. In contrast, lymphocytes from patients with ataxia telangiectasia were hypersensitive to X-irradiation. The data on these clinical syndromes support the idea that this assay measures DNA repair and indicates the feasibility of using this method for screening individuals for genetic deficits in DNA repair.

Early results of the screening program for radioprotectors.

Although WR-2721, S-2-(3-aminopropylamino)ethylphosphorothioc acid, is the most widely studied and most effective radioprotective drug at present, it is nevertheless clear from animal studies that it has important shortcomings as the ideal radioprotector in clinical radiotherapy. More effective and less toxic radioprotective drugs are needed. For this reason, a chemical radioprotector screening program has been initiated at the Fox Chase Cancer Center under a contract with the National Cancer Institute. Most of the 20 compounds that have now entered the screening program provide good protection of the mouse hematopoietic system as indicated by 30 day survival following the radiation LD100/30. Administration of a radioprotector dose equal to one half of the maximum tolerated dose (MTD/2) gave hematopoietic dose reduction factors (DRF's) as high as 2.3. No radioprotector appeared to be superior to WR-2721, although four others gave DRF's exceeding 1.8.

Differential radioprotection of normal tissues by hydrophilic chemical protectors.

Analogous to certain radiosensitizers which are too hydrophilic to enter tumor cells, certain radioprotectors, because of their hydrophilicity, may also be hindered from entering tumor cells and thus protect only normal tissues. In testing this hypothesis, we utilized thin layer chromatography as convenient means to measure radioprotector hydrophilicity. Dose reduction factors (DRF's) for hematopoietic radioprotection were determined in BALB/c mice given half maximum tolerated doses (MTD/2) of 11 radioprotectors 30 min prior to graded doses of gamma rays. DRF's for tumor protection were determined in MCa-11 tumor-bearing mice using a regrowth delay assay. Differential radioprotection was found to be significantly correlated (r = 0.86) with hydrophilicity. Thus, radioprotector hydrophilicity appears to be a significant factor in the differential radioprotection observed and should be useful in designing or selecting better differential radioprotectors.

Circumvention of the tumor membrane barrier to WR-2721 absorption by reduction of drug hydrophilicity.

In attempting to account for the ability of most solid tumors to restrict the absorption of WR-2721, aminopropyl-aminoethylphosphorothioate, we examined a number of drug characteristics which might allow for this restriction, and observed that drug hydrophilicity was a major contributing factor. When the highly hydrophilic WR-2721 was dephosphorylated, the drug became less hydrophilic and could readily cross tumor cell membranes. In addition, conventional radioprotectants, such as cysteine and mercaptoethylamine, were shown to be less hydrophilic than WR-2721 and also to cross tumor membranes readily. Therefore, drug hydrophilicity would appear to be the factor underlying the ability of WR-2721 to selectively protect normal tissues while most other protectors alter the radiation resistance of normal and tumor tissue alike. A red blood cell model for studying this problem in greater detail is described.

Modification of WR-2721 toxicity and radioprotection by an inhibitor of alkaline phosphatase.

We used levamisole, an inhibitor of alkaline phosphatase, to study the role of that enzyme in mediating the metabolic activation, toxicity, and radioprotection of WR-2721 in intact mice. We found the toxicity of WR-2721 was slightly decreased by prior subcutaneous (SQ) injection of 40 mg/kg of levamisole. In studying the effect of levamisole on WR-2721 radioprotection, we found that intraperitoneal (i.p.) injection of levamisole had little or no effect on radioprotection of the gastrointestinal and the hematopoietic systems. Even this small reduction of protection was due in part to the toxicity of levamisole as demonstrated when levamisole was injected following, rather than before, WR-2721-radiation treatment. To determine whether levamisole inhibited the activation (i.e., dephosphorylation) of WR-2721 to WR-1065, we assayed WR-1065 in the jejunum using an HPLC electrochemical assay. SQ injection of 75 mg/kg levamisole 10 min prior to WR-2721 reduced the WR-1065 observed 10 min after WR-2721 administration by 37%. In conclusion, levamisole appears to be too toxic and non-specific to be useful in studying and regulating the metabolism, toxicity and radioprotection of WR-2721.

Technique, pharmacokinetics, toxicity, and efficacy of intratumoral etanidazole and radiotherapy for treatment of spontaneous feline oral squamous cell carcinoma.

The histologic appearance, locoregional recurrence, and rate/site of metastases of spontaneous feline oral squamous cell carcinoma are similar to head and neck cancer in humans. A feasibility study of intratumoral Etanidazole, a hypoxic cell sensitizer, and radiation therapy were instituted in this model. Eleven cats with feline squamous cell carcinoma were treated with intratumoral Etanidazole and radiation therapy. Total Etanidazole doses were 1.5-24.0 gms/m2 (0.5-6.9 gms). The tumor partial response rate was 100% (11/11); the median volume regression was 70%. All cats have died as a result of tumor recurrence or tumor-related complications. Median survival was 116 days. Ten cats have been autopsied. Non-necrotic and necrotic tumor cells were identified at the treatment site in all cats. Pharmacokinetic studies were performed in six cats. Following intravenous infusion, the plasma elimination of the Etanidazole was biexponential. The systemic availability following intratumoral administration was 61.2 +/- 21.1%. Peak plasma Etanidazole levels were observed 14 minutes following intratumoral injection, after which elimination was biexponential. Thirty minutes following intratumoral Etanidazole administration, tumor Etanidazole levels were 62.8% of plasma levels. Feline squamous cell carcinoma appears to be a useful model of human head and neck cancer. Cats tolerate substantial doses of intratumoral and intravenous Etanidazole. Etanidazole and radiation therapy cause rapid regression, but not cure, of feline squamous cell carcinoma. There is a similarity between the intravenous kinetics of Etanidazole in humans and cats. Further studies in this model are planned.

Polarographic needle electrode measurements of oxygen in rat prostate carcinomas: accuracy and reproducibility.

PURPOSE: The oxygenation status of tumors may be important for predicting tumor response to therapy. Previous studies with the anaplastic (R3327-AT) and well-differentiated (R3327-H) Dunning rat prostate tumors using indirect assays of tumor oxygenation indicated the relative hypoxic and radioresistant nature of the anaplastic tumor. We now report direct measurements of oxygen in these tumors made with the pO2 histograph to determine: (a) whether a significant difference in oxygenation status could be detected between them: (b) whether sequential measurements on the same tumor gave similar values; and (c) whether tumor oxygenation correlated with tumor volume. METHODS AND MATERIALS: R3327-AT and R3327-H tumors were grown in Fischer X Copenhagen rat to volumes of 1.0-7.0 cm3. Electrode measurements (100-200) were made in tumors in anesthetized animals along two parallel tracks. Repeat measurements were made at 1-5 days along different parallel tracks. Oxygen partial pressures of muscle tissue were measured and served as a normal tissue control. Statistical analyses were applied to determine whether tumor oxygen levels were different between the two tumor histologies, whether sequential measurements in the same tumor were reproducible, and whether tumor oxygenation correlated with tumor volume. RESULTS: The average median pO2 of the well-differentiated (n = 15) and the anaplastic (n = 15) tumors was 6.0 mmHg (SE +/- 1.3) and 2.2 mmHg (SE +/- 0.3), respectively. The average median pO2 of normal rat muscle (n = 15) was 23.6 mmHg (SE +/- 2.0). These values represent highly significant differences in oxygen concentration between the two tumors and rat muscle. The differences in average mean pO2 values were also highly significant. Repeat measurements in the same tumors on different days gave average median values of 4.7 and 2.2 mmHg in the R3327-H (n = 15) and R3327-AT (n = 15) tumors, respectively. For these repeat measurements, median pO2 values decreased in 15 and increased in 15 tumors, and were not significantly different from the first measurements. The average differences observed in median pO2 were 37% (SE +/- 7) and 58% (SE +/- 10) for the R3327-H and R3327-AT tumors, respectively. No significant correlation was observed between pO2 levels and the tumor volumes investigated in this study. CONCLUSIONS: The median pO2 values of the anaplastic Dunning tumors were significantly lower than those of the well-differentiated tumors (p < 0.001). Oxygen levels in both tumors were significantly lower than those measured in normal rat muscle (p < 0.00005). Repeat measurements of median pO2 in the same tumors were not significantly different for either tumor model (p > 0.5). The changes observed in pO2 distributions within individual tumors from day to day may indicate true dynamics of its oxygenation status and/or the limits of electrode measurements, by sampling along only two insertion sites. The electrode measurements of pO2 in these tumor models are reproducible and confirm previously detected oxygenation differences between the anaplastic and well-differentiated tumors.

Hydrolysis of WR2721 by mouse liver cell fractions.

A study of the dephosphorylation of WR2721 by broken cell preparations of mouse liver revealed the presence of at least two distinctive activities. One activity was inactivated by heat treatment and was present in the nuclear and microsomal fractions. It had an optimum pH at 9 and was inhibited by sodium vanadate, EDTA, and phenylalanine. Further subcellular fractionation demonstrated the localization of this activity in plasma membrane. A second WR2721 hydrolysis activity was detected in the cytosol fraction (postmicrosomal supernatant), which changed little with pH over the range of 5 to 10; sodium vanadate did not inhibit it. The cytosolic activity in response to heat treatment was complicated since there was an initial decrease followed by an increase in catalytic activity as a function of time at 55 degrees C. Enzyme kinetic analysis of the plasma membrane-associated activity in the microsomal fraction was performed, and Km and Vmax values of 12.5 and 69.9 nmol/min/mg protein, respectively, were obtained.

Mu-, but not delta-, opioid receptor-mediated antinociception in mice is attenuated by gamma-irradiation.

Mice were exposed to whole-body irradiation (500 rads) from a 137Cs gamma-source and tested 2 h later for antinociception (tail-flick test) produced by intracerebroventricular administration of morphine or the more delta-selective opioid peptide, [D-Pen2,L-Pen5]enkephalin (DPLPE). Irradiation significantly attenuated the antinociception produced by morphine, but not by DPLPE. These results demonstrate a differential sensitivity of mu- and delta-opioid receptors to gamma-irradiation and, in addition, may be of clinical relevance for cancer patients receiving concurrent radiation therapy and opioid analgesics.

Photodosimetry of interstitial light delivery to solid tumors.

Both anaplastic and well-differentiated Dunning prostate adenocarcinomas were illuminated in anesthetized Fischer X Copenhagen rats by single-fiber and multiple-fiber illuminators. Each illuminator consisted of a 2-cm laterally diffusing optical fiber placed within a plastic brachytherapy needle which was implanted into a tumor. Light attenuation coefficients for various wavelengths were obtained from measures of the radial falloff of intensity with distance from single fibers. These coefficients served as input to a 2-dimensional (2-D) photodosimetry computer code which calculated relative light intensities in planes perpendicular to single-fiber and various multiple-fiber configurations. These calculations assumed uniform optical property of tissue throughout each tumor, uniform and equal illuminance from diffusing fibers, and precise needle implantation. Relative light intensities along specific tumor tracks were measured and compared with those predicted by the 2-D photodosimetry code. Agreement within +/- 14% was observed for all configurations studied. Variations in relative intensity in tumor planes perpendicular to a standard seven-fiber illuminator were determined as a function of the distance between the implanted needles. Light wavelengths of 700 nm and greater produced relatively uniform light fields (approximately +/- 20%) in the R3327-AT tumor with needle spacings of at least 1 cm. The addition of two fibers at the periphery of this illuminator (a nine-fiber illuminator) improved the uniformity of light delivery to the encompassed tumor volumes. The importance of precision photodosimetry for interstitial applications of photodynamic therapy is discussed.

WR-2721 as cytotoxic and radioprotective agent in treatment of murine lymphoma with total body irradiation.

The effectiveness of fractionated total body irradiation (TBI) in treatment of non-Hodgkin's lymphoma is limited by bone marrow toxicity. Because WR-2721 effectively protects bone marrow, we tested its potential in treatment of I-347 lymphoma in BALB/c mice, using various single and fractionated TBI regimens. In most treatment schedules, WR-2721 did not cause net lymphoma protection; in fact, it was cytotoxic. Lymphoma regrowth delay times for the 21 treatment groups were quite effectively fitted by a mathematical model with three components: 1) a dose-dependent radiation effect; 2) a small radioprotective effect by WR-2721; and 3) significant cytotoxicity of WR-2721. Bone marrow radioprotection was reduced when TBI was fractionated, but there was no evidence of WR-2721 cytotoxicity to marrow. The therapeutic gain due to WR-2721 was 2.5 for the five-fraction regimen, compared to 2.3 for a single fraction. The cumulative WR-2721 toxicity to lymphoma combined with marrow protection suggests that WR-2721 could increase the clinical therapeutic ratio of TBI, particularly fractionated TBI, in treatment of lymphoma.

Tumor therapy with hematoporphyrin derivative and lasers via a percutaneous fiberoptic technique: preclinical experiments.

Photodynamic therapy relies on uptake of a photosensitizer (hematoporphyrin derivative [HpD]) by tumor cells and subsequent interaction of the photosensitizer with penetrating light. This technique has been applied in multiple animal systems and several clinical trials. The therapeutic results in large, deep tumors are limited by poor uptake and distribution of the HpD and limited penetration of tumors by light, even at high wavelengths. In various experiments with mice, HpD was injected into tumors, and light was applied via laser fiberoptics inserted through a sheath catheter. Preliminary findings indicated that intratumoral injection enables excellent distribution of HpD in high concentrations, thus optimizing the sensitivity of the tumor cells. The sheath catheter and fiberoptics enable excellent distribution of light. Experiments with T-cell lymphomas demonstrated significant response of the tumors to the combination of intratumoral HpD and interstitial light application.

Metabolic pathways of WR-2721 (ethyol, amifostine) in the BALB/c mouse.

This study investigated the metabolism of the radio- and chemoprotector compound, WR-2721 [amifostine; s-2-(3- aminopropylamino)ethylphosphorothioate], in the Balb/c mouse. The latter was selected for these studies because considerable radiation protection data have been published for this mouse strain using the WR-2721 dose, route of administration, and optimal time for protection following intraperitoneal injection used herein. It is known that protection requires conversion of the parent drug to its free thiol metabolite, WR-1065, in cultured cells. Because it is possible that metabolites of WR-1065 could be involved in protection and because thiols are metabolically very reactive molecules, we investigated the metabolism of WR-2721 using electrochemical detection-HPLC methods. The following are the major findings in this study: 1) WR-2721 drug was rapidly cleared from the bloodstream. Blood concentration of the parent drug decreased 10-fold 30 min after administration from the maximal observed value at 5 min 2) WR-1065 rapidly appeared in the perchloric acid (PCA)-soluble fraction of normal solid tissues. The highest WR-1065 concentrations in liver and kidney were 965 and 2195 mumol/kg, respectively, 10 min after parent drug administration, whereas for heart and small intestine the highest values were 739 and 410 mumol/kg at 30 min. 3) WR-1065 accumulated in the PCA-soluble fraction of two experimental tumors at a lower rate than for the other tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

Oxygen tension in human tumors: in vivo mapping using CT-guided probes.

The role of oxygen in tumor response to therapy has been studied for several decades. We describe a technique that allows in vivo measurement of oxygen in tumors using computed tomography to guide probes. In the evaluation of 16 tumors, oxygen tensions were found to be substantially lower than surrounding tissue and varied nonrandomly. This technique has allowed construction of detailed tumor oxygen level maps.