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1

Ullsten, Sara, Joey Lau e Per-Ola Carlsson. "Decreased β-Cell Proliferation and Vascular Density in a Subpopulation of Low-Oxygenated Male Rat Islets". Journal of the Endocrine Society 3, n. 8 (17 giugno 2019): 1608–16. http://dx.doi.org/10.1210/js.2019-00101.

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Abstract Low-oxygenated and dormant islets with a capacity to become activated when needed may play a crucial role in the complex machinery behind glucose homeostasis. We hypothesized that low-oxygenated islets, when not functionally challenged, do not rapidly cycle between activation and inactivation but are a stable population that remain low-oxygenated. As this was confirmed, we aimed to characterize these islets with regard to cell composition, vascular density, and endocrine cell proliferation. The 2-nitroimidazole low-oxygenation marker pimonidazole was administered as a single or repeated dose to Wistar Furth rats. The stability of oxygen status of islets was evaluated by immunohistochemistry as the number of islets with incorporated pimonidazole adducts after one or repeated pimonidazole injections. Adjacent sections were evaluated for islet cell composition, vascular density, and endocrine cell proliferation. Single and repeated pimonidazole injections over an 8-hour period yielded accumulation of pimonidazole adducts in the same islets. An average of 30% of all islets was in all cases positively stained for pimonidazole adducts. These islets showed a similar endocrine cell composition as other islets but had lower vascular density and β-cell proliferation. In conclusion, low-oxygenated islets were found to be a stable subpopulation of islets for at least 8 hours. Although they have previously been observed to be less functionally active, their islet cell composition was similar to that of other islets. Consistent with their lower oxygenation, they had fewer blood vessels than other islets. Notably, β-cell regeneration preferentially occurred in better-oxygenated islets.
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2

Doege, Kathrin, Sandra Heine, Inga Jensen, Wolfgang Jelkmann e Eric Metzen. "Inhibition of mitochondrial respiration elevates oxygen concentration but leaves regulation of hypoxia-inducible factor (HIF) intact". Blood 106, n. 7 (1 ottobre 2005): 2311–17. http://dx.doi.org/10.1182/blood-2005-03-1138.

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Abstract The transcription factor hypoxia-inducible factor-1 (HIF-1) is critical for erythropoietin and other factors involved in the adaptation of the organism to hypoxic stress. Conflicting results have been published regarding the role of the mitochondrial electron transport chain (ETC) in the regulation of HIF-1α. We assessed cellular hypoxia by pimonidazole staining and blotting of the O2-labile HIF-1 α-subunit in human osteosarcoma cell cultures (U2OS and 143B). In conventional, gas-impermeable cell culture dishes, ETC inhibitors had no effect on pimonidazole staining or HIF-1α abundance in a 20% O2 atmosphere; both parameters were undetectable. Pimonidazole staining and HIF activity were substantial in 0.1% O2 irrespective of ETC inhibition. At an intermediate oxygen concentration (3% O2) pimonidazole staining and HIF-α expression were detectable but strongly reduced after ETC inhibition in conventional cell cultures. All effects of ETC inhibition on HIF-1α regulation were eliminated in gas-permeable dishes. As shown in a 143B subclone deficient in mitochondrial DNA (206ρ0), genetic inactivation of the ETC led to similar responses with respect to HIF-1α regulation as ETC inhibitors. Our data demonstrate that reduction of oxygen consumption reduces the O2 gradient in conventional cell cultures, causing elevation of the cellular O2 concentration, which leads to degradation of HIF-α.
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3

Arteel, G. E., J. A. Raleigh, B. U. Bradford e R. G. Thurman. "Acute alcohol produces hypoxia directly in rat liver tissue in vivo: role of Kupffer cells". American Journal of Physiology-Gastrointestinal and Liver Physiology 271, n. 3 (1 settembre 1996): G494—G500. http://dx.doi.org/10.1152/ajpgi.1996.271.3.g494.

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Previous studies using liver slices and isolated perfused rat liver have suggested that ethanol causes hypoxia by increasing oxygen consumption. However, ethanol also increases blood flow to the liver, a phenomenon that may counteract the effects of hypermetabolism by increasing oxygen delivery. Thus whether ethanol causes hypoxia in vivo remains unclear. To clarify this important point, female Sprague-Dawley rats (100-125 g) simultaneously received pimonidazole (120 mg/kg ip), a 2-nitroimidazole hypoxia marker, and one large dose of ethanol (5 g/kg ig), which increase hepatic oxygen uptake dramatically and elevate ethanol metabolism (swift increase in alcohol metabolism) in 2-3 h. After 2 h, ethanol significantly increased the accumulation of bound pimonidazole in pericentral regions of the liver lobule. Treatment of animals with the Kupffer cell-specific toxicant, GdCl3 (10 mg/kg iv, 24 h before experiment), blocked ethanol-induced increases in pimonidazole binding. It is concluded that one large dose of ethanol causes pericentral hypoxia in rat liver tissue in vivo and that Kupffer cells are involved.
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4

Ow, Connie P. C., Md Mahbub Ullah, Jennifer P. Ngo, Adheeshee Sayakkarage e Roger G. Evans. "Detection of cellular hypoxia by pimonidazole adduct immunohistochemistry in kidney disease: methodological pitfalls and their solution". American Journal of Physiology-Renal Physiology 317, n. 2 (1 agosto 2019): F322—F332. http://dx.doi.org/10.1152/ajprenal.00219.2019.

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Pimonidazole adduct immunohistochemistry is one of the few available methods for assessing renal tissue hypoxia at the cellular level. It appears to be prone to artifactual false positive staining under some circumstances. Here, we assessed the nature of this false positive staining and, having determined how to avoid it, reexamined the nature of cellular hypoxia in rat models of kidney disease. When a mouse-derived anti-pimonidazole primary antibody was used, two types of staining were observed. First, there was diffuse staining of the cytoplasm of tubular epithelial cells, which was largely absent when the primary antibody was omitted from the incubation protocol or in tissues known not to contain pimonidazole adducts. Second, there was staining of the apical membranes of tubular epithelial cells, debris within the lumen of renal tubules, including tubular casts, and the interstitium; this latter staining was present even when the primary antibody was omitted from the incubation protocol. Such false positive staining was particularly prominent in acutely injured kidneys. It could not be avoided by preincubation of sections with a mouse IgG blocking reagent. Furthermore, preadsorption of the secondary antibody against rat Ig abolished all staining; however, when a rabbit-derived polyclonal anti-pimonidazole primary antibody was used, the false positive staining was largely avoided. Using this method, we confirmed the presence of hypoxia, localized mainly to the tubular epithelium, in the acute phase of severe renal ischemia-reperfusion injury, adenine-induced chronic kidney disease, and polycystic kidney disease. We conclude that this new method provides improved detection of renal cellular hypoxia.
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5

Gabellieri, Cristina, Thomas R. Eykyn e Martin O. Leach. "Conformational exchange in pimonidazole—a hypoxia marker". Magnetic Resonance in Chemistry 45, n. 8 (2007): 621–23. http://dx.doi.org/10.1002/mrc.2024.

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6

Via, Laura E., P. Ling Lin, Sonja M. Ray, Jose Carrillo, Shannon Sedberry Allen, Seok Yong Eum, Kimberly Taylor et al. "Tuberculous Granulomas Are Hypoxic in Guinea Pigs, Rabbits, and Nonhuman Primates". Infection and Immunity 76, n. 6 (17 marzo 2008): 2333–40. http://dx.doi.org/10.1128/iai.01515-07.

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ABSTRACT Understanding the physical characteristics of the local microenvironment in which Mycobacterium tuberculosis resides is an important goal that may allow the targeting of metabolic processes to shorten drug regimens. Pimonidazole hydrochloride (Hypoxyprobe) is an imaging agent that is bioreductively activated only under hypoxic conditions in mammalian tissue. We employed this probe to evaluate the oxygen tension in tuberculous granulomas in four animal models of disease: mouse, guinea pig, rabbit, and nonhuman primate. Following infusion of pimonidazole into animals with established infections, lung tissues from the guinea pig, rabbit, and nonhuman primate showed discrete areas of pimonidazole adduct formation surrounding necrotic and caseous regions of pulmonary granulomas by immunohistochemical staining. This labeling could be substantially reduced by housing the animal under an atmosphere of 95% O2. Direct measurement of tissue oxygen partial pressure by surgical insertion of a fiber optic oxygen probe into granulomas in the lungs of living infected rabbits demonstrated that even small (3-mm) pulmonary lesions were severely hypoxic (1.6 ± 0.7 mm Hg). Finally, metronidazole, which has potent bactericidal activity in vitro only under low-oxygen culture conditions, was highly effective at reducing total-lung bacterial burdens in infected rabbits. Thus, three independent lines of evidence support the hypothesis that hypoxic microenvironments are an important feature of some lesions in these animal models of tuberculosis.
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7

Lin, Yu, Ying-Na Bao, Cong-Xiu Huang, Ji-Hong Zhang, Zhi-Long Yu, Ye Tian, Xiang-Cheng Wang e Yi-Tong Cui. "The Effect of Carbogen Breathing on 18F-FDG Uptake in Non-Small-Cell Lung Cancer". BioMed Research International 2019 (22 novembre 2019): 1–6. http://dx.doi.org/10.1155/2019/2920169.

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It has been reported that 18F-FDG uptake is higher in hypoxic cancer cells than in well-oxygenated cells. We demonstrated that 18F-FDG uptake in lung cancer would be affected by high concentration oxygen breathing. Methods. Overnight fasted non-small-cell lung cancer A549 subcutaneous (s.c.) xenografts bearing mice (n = 10) underwent 18F-FDG micro-PET scans, animals breathed room air on day 1, and same animals breathed carbogen (95% O2 + 5% CO2) on the subsequent day. In separated studies, autoradiography and immunohistochemical staining visualization of frozen section of A549 s.c. tumors were applied, and to compare between carbogen-breathing mice and those with air breathing, a combination of 18F-FDG and hypoxia marker pimonidazole was injected 1 h before animal sacrifice, and 18F-FDG accumulation was compared with pimonidazole binding and glucose transporter 1 (GLUT-1) expression. Results. PET studies revealed that tumor 18F-FDG uptake was significantly decreased in carbogen-breathing mice than those with air breathing (P<0.05). Ex vivo studies confirmed that carbogen breathing significantly decreased hypoxic fraction detected by pimonidazole staining, referring to GLUT-1 expression, and significantly decreased 18F-FDG accumulation in tumors. Conclusions. High concentration of O2 breathing during 18F-FDG uptake phase significantly decreases 18F-FDG uptake in non-small-cell lung cancer A549 xenografts growing in mice.
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8

Busk, Morten, Steen Jakobsen, Michael R. Horsman, Lise S. Mortensen, Ane B. Iversen, Jens Overgaard, Marianne Nordsmark, Xiaosheng Ji, David Y. Lee e James R. Raleigh. "PET imaging of tumor hypoxia using18F-labeled pimonidazole". Acta Oncologica 52, n. 7 (21 agosto 2013): 1300–1307. http://dx.doi.org/10.3109/0284186x.2013.815797.

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9

Workman, Paul. "Accelerated elimination of pimonidazole following microsomal enzyme induction in mice: A possible approach to reduced neurotoxicity of the pimonidazole-etanidazole combination". International Journal of Radiation Oncology*Biology*Physics 16, n. 4 (aprile 1989): 1011–14. http://dx.doi.org/10.1016/0360-3016(89)90905-x.

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10

Down, Julian D., Kalindi Parmar, James Clyne, Peter M. Mauch e Robert Sackstein. "Defining the Bone Marrow Stem Cell Niche According to a Hoechst Dye Diffusion Gradient and Hypoxia." Blood 104, n. 11 (16 novembre 2004): 666. http://dx.doi.org/10.1182/blood.v104.11.666.666.

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Abstract The spatial organization of hematopoietic cell subsets of differing proliferative potential within the bone marrow microenvironment has come under increasing interest. In particular, it has been suggested that hematopoietic stem cells (HSCs) normally reside in a regulatory niche situated at the endosteal bone surface and in close proximity to osteoblasts. In the present study we have investigated how different hematopoietic cell subsets are distributed along a Hoechst dye perfusion gradient that may reflect the distance from marrow blood vessels and the level of oxygenation. C57BL/6J mice were intravenously injected with two doses of Hoechst 33342 at 10 and 5 min before marrow cell harvesting, a period that we determined was insufficient for active dye exclusion in vitro. Flow cytometric analysis revealed a wide distribution of Hoechst staining over 3 logs fluorescence intensity. The cells were then sorted from 6 different regions of the Hoechst gradient and evaluated for short- and long-term in vitro repopulating cells in the cobblestone area-forming cell (CAFC) assay. The primitive CAFC subset appearing at day 28 in culture was shown to be progressively enriched with decreasing Hoechst fluorescence while the short-term repopulating day 7 CAFC subset frequencies was the highest at an intermediate level of Hoechst staining. We further investigated whether primitive HSCs exist in a very low oxygen tension by administering the reductive 2-nitroimidazole compound pimonidazole in vivo and performed flow cytometric analysis on sorted primitive HSCs residing in high Hoechst dye effluxing side population (SP). In comparison to whole bone marrow or non-SP cells, the SP fraction showed increased intracellular staining with an anti-pimonidazole antibody that recognizes pimonidazole adducts formed only under hypoxic conditions (less than pO2 of 10 mm Hg). Comparison with thymocytes that are already known to be hypoxic in vivo (Hale et al. Am J Physiol Heart Circ Physiol282: H1467–H1477, 2002) showed both low Hoechst dye perfusion and positive anti-pimonidazole antibody staining. These results represent the first direct evidence that the hematopoietic cell hierarchy is spatially organized in relation to blood vessels and that the stem cell niche exists at the lowest end of an oxygen gradient. These findings have important implications in hematopoiesis and stem cell lodgement, and suggest that the location of hematopoietic stem cells in situ may render them more resistant to oxygen-dependent mutagenic and cytotoxic agents.
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11

Hale, Laura P., Rod D. Braun, William M. Gwinn, Paula K. Greer e Mark W. Dewhirst. "Hypoxia in the thymus: role of oxygen tension in thymocyte survival". American Journal of Physiology-Heart and Circulatory Physiology 282, n. 4 (1 aprile 2002): H1467—H1477. http://dx.doi.org/10.1152/ajpheart.00682.2001.

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Our previous studies using oxygen microelectrodes showed that the thymus is grossly hypoxic under normal physiological conditions. We now have investigated how oxygen tension affects the thymus at the cellular and molecular level. Adducts of the hypoxia marker drug pimonidazole accumulated in foci within the cortex and medulla and at the corticomedullary junction, consistent with the presence of widespread cellular hypoxia in the normal thymus. Hypoxia-associated pimonidazole accumulation was decreased but not abrogated by oxygen administration. Genes previously reported to be induced by hypoxia were expressed at baseline levels in the normal thymus, indicating that physiological adaptation to hypoxia occurred. Despite changes in thymus size and cellularity, thymic Po 2 did not change with age. Combined assays for hypoxia and cell death showed that hypoxia achieved using either hypoxic gas mixtures or high-density culture in normoxia decreased spontaneous thymocyte apoptosis in vitro. Taken together, these data suggest that regulatory mechanisms exist to maintain thymic cellular hypoxia in vivo and that oxygen tension may regulate thymocyte survival both in vitro and in vivo.
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12

Nordsmark, Marianne, Juliette Loncaster, Shu-Chuan Chou, Hanne Havsteen, Jacob C. Lindegaard, Susan E. Davidson, Mahesh Varia et al. "Invasive oxygen measurements and pimonidazole labeling in human cervix carcinoma". International Journal of Radiation Oncology*Biology*Physics 49, n. 2 (febbraio 2001): 581–86. http://dx.doi.org/10.1016/s0360-3016(00)01493-0.

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13

Arcasoy, Murat O., Khalid Amin, Shu-Chuan Chou, Zishan A. Haroon, Mahesh Varia e James A. Raleigh. "Expression of Erythropoietin and Erythropoietin Receptor in Squamous Cell Carcinomas of the Head and Neck: Levels of Erythropoietin Expression Correlate with Tumor Hypoxia." Blood 104, n. 11 (16 novembre 2004): 2908. http://dx.doi.org/10.1182/blood.v104.11.2908.2908.

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Abstract Erythropoietin (EPO), an oxygen-regulated glycoprotein hormone, is a hematopoietic cytokine that stimulates erythropoiesis by binding to its cellular receptor EPOR. The recombinant form of human EPO is widely used in clinical practice for the prevention or treatment of anemia associated with cancer and chemo-radiation therapy. However, in a recent randomized, placebo-controlled trial involving patients receiving curative radiotherapy for squamous cell carcinoma of the head and neck, EPO treatment was associated with poorer loco-regional progression-free survival. The purpose of this study was to determine whether EPOR and its ligand EPO are expressed in primary squamous cell carcinomas of the head and neck. We also investigated the hypothesis that EPO expression in malignant cells may be associated with the presence of tumor hypoxia, an important factor involved in resistance to radiation treatment, tumor aggressiveness and poor prognosis. Twenty-one patients with squamous cell carcinoma of the head and neck were enrolled in a tumor hypoxia study under a research protocol approved by the Institutional Review Board at the University of North Carolina Hospitals. All patients provided signed informed consent. The patients received an intravenous infusion of the hypoxia marker pimonidazole hydrochloride (Hypoxyprobe-1™) prior to multiple tumor biopsies. Two or more biopsies were available from all except one primary tumor. The tissue specimen from one patient with laryngeal carcinoma was excluded because of availability of only a single, small and fragmented biopsy. Contiguous sections from 74 biopsies were analyzed by immunohistochemistry for expression of EPOR and EPO as well as pimonidazole binding. We found EPOR expression in tumor cells in 97% of the biopsies. The pattern of EPOR immunoreactivity was predominantly cytoplasmic but was found to be localized to the membrane in some sections. Co-expression of EPO was observed in 90% of biopsies. Qualitative and semi-quantitative analyes for EPO staining and tumor hypoxia on a section-by-section basis revealed that EPO and pimonidazole adduct staining did not always co-localize within tumors but there was a significant positive correlation between levels of micro-regional EPO expression and pimonidazole binding (r = 0.736, P &lt; 0.001, n=20 by two-tailed Spearman’s rank correlation analysis). These data demonstrate the co-expression of EPOR and its ligand EPO in squamous carcinoma cells suggesting that EPO may play a novel role as a potential autocrine or paracrine growth factor in head and neck cancer. Furthermore, EPO expression in tumor cells may be modulated, at least in part, by tumor hypoxia. The expression of EPOR needs to be taken into consideration in the design of future clinical trials investigating the role of recombinant human EPO in head and neck cancer.
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De Galan, Cara, Martine De Vos, Pieter Hindryckx, Debby Laukens e Sophie Van Welden. "Long-Term Environmental Hypoxia Exposure and Haematopoietic Prolyl Hydroxylase-1 Deletion Do Not Impact Experimental Crohn’s Like Ileitis". Biology 10, n. 9 (8 settembre 2021): 887. http://dx.doi.org/10.3390/biology10090887.

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Environmental hypoxia and hypoxia-induced signalling in the gut influence inflammatory bowel disease pathogenesis, however data is limited to colitis. Hence, we investigated the effect of environmental hypoxia and immune cell-specific deletion of oxygen sensor prolyl hydroxylase (PHD) 1 in a Crohn’s like ileitis mouse model. Therefore, 5-week-old C57/BL6 TNF∆ARE/+ mice and wildtype (WT) littermates were housed in normoxia (21% O2) or hypoxia (8% O2) for 10 weeks. Systemic inflammation was assessed by haematology. Distal ileal hypoxia was evaluated by pimonidazole staining. The ileitis degree was scored on histology, characterized via qPCR and validated in haematopoietic Phd1-deficient TNF∆ARE/+ mice. Our results demonstrated that hypoxia did not impact body weight evolution in WT and TNF∆ARE/+ mice. Hypoxia increased red blood cell count, haemoglobin, haematocrit and increased pimonidazole intensity in the ileum. Interestingly, hypoxia evoked an increase in circulatory monocytes, ileal mononuclear phagocytes and proinflammatory cytokine expression in WT mice. Despite these alterations, no histological or ileal gene expression differences could be identified between TNF∆ARE/+ mice housed in hypoxia versus normoxia nor between haematopoietic Phd1-deficient TNF∆ARE/+ and their WT counterparts. Therefore, we demonstrated for the first time that long-term environmental hypoxia or haematopoietic Phd1-deletion does not impact experimental ileitis development.
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Iwanicki, Isabella J., Lydia Wu, Fernando Flores-Guzman, Connor Centner, Kenneth B. Bader e Sonia Hernandez. "Histotripsy significantly decreases tumor viability in neuroblastoma xenograft model". Journal of the Acoustical Society of America 152, n. 4 (ottobre 2022): A248. http://dx.doi.org/10.1121/10.0016165.

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Children diagnosed with high-stage neuroblastoma (NB) have a <50% 5-year survival rate, resisting intensive treatment. Histotripsy, a focused ultrasound method, can ablate subcutaneous tumors. Here, we characterize histotripsy in an abdominal NB-xenograft model.Intrarenal injection of NGP-Luciferase cells in female NCr Nude mice generated 1–2 g NB tumors after 5–6 weeks. We assessed tumor viability with bioluminescence before, after, and 24h after Histotripsy. A 1-MHz focused source under ultrasound image guidance delivered 4–6 pulses per tumor with individual targets separated by ∼1 mm. Immunostains of the apoptosis marker TUNEL, endothelial marker Isolectin-B4, and hypoxia-marker pimonidazole were imaged or scanned. Statistics were performed using Graphpad.Histotripsy decreased bioluminescence by ∼50% (p = 0.02, n = 7), suggesting a decrease in viability. Untreated tumors did not change (n = 4). TUNEL staining increased in Histotripsy-treated tumors compared to controls (56 ± 6 versus 9 ± 3 %area, n = 3 to 8, p < 0.0001). Histotripsy increased pimonidazole positivity adjacent to targeted areas, suggesting hypoxia. Finally, Histotripsy increased red blood cells compared to controls. Histotripsy dramatically reduces tumor viability by inducing apoptosis of targeted areas. Hypoxia patterns suggest histotripsy alters perfusion and/or permeability within the tumor, indicating potential for synergy with chemotherapy.
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Shin, Kyung Hwan, Juan A. Diaz-Gonzalez, James Russell, Qing Chen, Paul Burgman, Xiao-Feng Li e C. Cliffton Ling. "Detecting changes in tumor hypoxia with carbonic anhydrase IX and pimonidazole". Cancer Biology & Therapy 6, n. 1 (gennaio 2007): 70–75. http://dx.doi.org/10.4161/cbt.6.1.3550.

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Cobb, LM, J. Nolan e SA Butler. "Distribution of pimonidazole and RSU 1069 in tumour and normal tissues". British Journal of Cancer 62, n. 6 (dicembre 1990): 915–18. http://dx.doi.org/10.1038/bjc.1990.408.

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Stone, Helen B., V. Kate Hirst, Randolph Cribbs, Yung H. Luu e J. Martin Brown. "A comparison of radiosensitization by etanidazole and pimonidazole in mouse tumors". International Journal of Radiation Oncology*Biology*Physics 20, n. 5 (maggio 1991): 987–95. http://dx.doi.org/10.1016/0360-3016(91)90195-a.

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Metran Nascente, Cristiane, Neesha C. Dhani, Douglass Vines, Ivan Yeung, Ur Metser, Stefano Serra, Michael Milosevic, Steven Gallinger e David W. Hedley. "Clinical characterization of hypoxia in pancreatic ductal adenocarcinoma (PDAC) by 18F-FAZA PET and pimonidazole." Journal of Clinical Oncology 31, n. 15_suppl (20 maggio 2013): 4049. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.4049.

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4049 Background: We previously demonstrated correlation between hypoxia and aggressive tumor biology in orthotopic, patient-derived pancreatic xenografts (Chang et al. Cancer Res 2011). With the development of hypoxia-directed therapies, there is a need to understand the range and relevance of hypoxia in PDAC patients. We therefore launched two complementary clinical trials using 2-nitroimidazole-based hypoxia probes. Methods: PIMO-PANC involves pre-operative administration of pimonidazole to patients (pts) undergoing PDAC resection. Hypoxic percent (HP) of tumors is determined by semi-automated image analysis (on Aperio’s Genie) of multiple histological sections stained for pimonidazole by immunohistochemistry (IHC). FAZA-PANC uses the positron emission tomography (PET) tracer fluoroazomycin arabinoside (18F-FAZA) to evaluate hypoxia by functional imaging. 2 hours post-injection of (5.2 MBq/kg) 18F-FAZA, static scans are acquired followed by computed tomography for anatomic registration. Skeletal muscle is a non-hypoxic reference tissue to define standardized uptake values (SUV), tumor to muscle uptake ratios (T/M’s) and a threshold for hypoxia. Results: PIMO-PANC has enrolled 29 pts and FAZA-PANC 16. IHC analysis of the first 10 pt tumors demonstrates considerable intra- and inter-tumoral heterogeneity of hypoxia (HP: 1 to 26% across pt tumors); minimal hypoxia (< 5%) was observed in 3 pts. 18F-FAZA-PET in the first 11 pts demonstrates SUVmax from 1.02 to 1.83, median T/M's from 0.84 to 1.31. A threshold of 1.27 SUVmax defines HP of 0 to 60% with minimal hypoxia (<10%) in 5 pts. Conclusions: There is significant heterogeneity of hypoxia across the spectrum of clinical PDAC (local to metastatic disease) using the 2-nitroimidazole hypoxia probes pimonidazole and 18F-FAZA. Given the intra-tumoral heterogeneity of hypoxia by histopathology, functional imaging is the preferred method to assess hypoxia in PDAC patients. Importantly, both methods identified a group of PDAC tumors with low levels of hypoxia. This is relevant to the on-going development of hypoxia-targeting strategies. Accrual to PIMO-PANC is on-going and will address the prognostic relevance of hypoxia in PDAC. Clinical trial information: NCT01542177 and NCT01248637.
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Elming, Pernille B., Thomas R. Wittenborn, Morten Busk, Brita S. Sørensen, Mathilde Borg Houlberg Thomsen, Trine Strandgaard, Lars Dyrskjøt, Steffen Nielsen e Michael R. Horsman. "Refinement of an Established Procedure and Its Application for Identification of Hypoxia in Prostate Cancer Xenografts". Cancers 13, n. 11 (26 maggio 2021): 2602. http://dx.doi.org/10.3390/cancers13112602.

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Background: This pre-clinical study was designed to refine a dissection method for validating the use of a 15-gene hypoxia classifier, which was previously established for head and neck squamous cell carcinoma (HNSCC) patients, to identify hypoxia in prostate cancer. Methods: PC3 and DU-145 adenocarcinoma cells, in vitro, were gassed with various oxygen concentrations (0–21%) for 24 h, followed by real-time PCR. Xenografts were established in vivo, and the mice were injected with the hypoxic markers [18F]-FAZA and pimonidazole. Subsequently, tumors were excised, frozen, cryo-sectioned, and analyzed using autoradiography ([18F]-FAZA) and immunohistochemistry (pimonidazole); the autoradiograms used as templates for laser capture microdissection of hypoxic and non-hypoxic areas, which were lysed, and real-time PCR was performed. Results: In vitro, all 15 genes were increasingly up-regulated as oxygen concentrations decreased. With the xenografts, all 15 genes were up-regulated in the hypoxic compared to non-hypoxic areas for both cell lines, although this effect was greater in the DU-145. Conclusions: We have developed a combined autoradiographic/laser-guided microdissection method with broad applicability. Using this approach on fresh frozen tumor material, thereby minimizing the degree of RNA degradation, we showed that the 15-gene hypoxia gene classifier developed in HNSCC may be applicable for adenocarcinomas such as prostate cancer.
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Zhong, Zhi, Gavin E. Arteel, Henry D. Connor, Ming Yin, Moritz V. Frankenberg, Robert F. Stachlewitz, James A. Raleigh, Ronald P. Mason e Ronald G. Thurman. "Cyclosporin A increases hypoxia and free radical production in rat kidneys: prevention by dietary glycine". American Journal of Physiology-Renal Physiology 275, n. 4 (1 ottobre 1998): F595—F604. http://dx.doi.org/10.1152/ajprenal.1998.275.4.f595.

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The major side effect of cyclosporin A is severe nephrotoxicity. It is likely that cyclosporin A causes vasoconstriction leading to hypoxia-reperfusion injury; therefore, these experiments were designed to attempt to obtain physical evidence for hypoxia and free radical production in kidney following cyclosporin A. Rats were treated daily with cyclosporin A (25 mg/kg ig) for 5 days, and pimonidazole, a hypoxia marker, was injected 2 h after the last dose of cyclosporin A. A dose of α-(4-pyridyl-1-oxide)- N- tert-butylnitrone (4-POBN) was injected 3 h after cyclosporin A to trap free radicals. Cyclosporin A doubled serum creatinine and decreased glomerular filtration rates by 65% as expected. Pimonidazole adduct binding in the kidney was increased nearly threefold by cyclosporin A, providing physical evidence for tissue hypoxia. Moreover, cyclosporin A increased 4-POBN/radical adducts nearly sixfold in the urine but did not alter levels in the serum. Glycine, which causes vasodilatation and prevents cyclosporin A toxicity, minimized hypoxia and blocked free radical production; however, it did not alter cyclosporin A blood levels. These results demonstrate for the first time that cyclosporin A causes hypoxia and increases production of a new free radical species exclusively in the kidney. Therefore, it is concluded that cyclosporin A causes renal injury by mechanisms involving hypoxia-reoxygenation, effects which can be prevented effectively by dietary glycine.
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Janssen, Hilde L. K., Frank J. Hoebers, Debbie Sprong, Laurence Goethals, Kaye J. Williams, Ian J. Stratford, Karin M. Haustermans, Alfons J. Balm e Adrian C. Begg. "Differentiation-associated staining with anti-pimonidazole antibodies in head and neck tumors". Radiotherapy and Oncology 70, n. 1 (gennaio 2004): 91–97. http://dx.doi.org/10.1016/j.radonc.2003.09.012.

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23

Olive, P. L., R. E. Durand, J. A. Raleigh, C. Luo e C. Aquino-Parsons. "Comparison between the comet assay and pimonidazole binding for measuring tumour hypoxia". British Journal of Cancer 83, n. 11 (dicembre 2000): 1525–31. http://dx.doi.org/10.1054/bjoc.2000.1489.

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24

Zoula, S., P. F. J. W. Rijken, J. P. W. Peters, R. Farion, B. P. J. Van der Sanden, A. J. Van der Kogel, M. Décorps e C. Rémy. "Pimonidazole binding in C6 rat brain glioma: relation with lipid droplet detection". British Journal of Cancer 88, n. 9 (29 aprile 2003): 1439–44. http://dx.doi.org/10.1038/sj.bjc.6600837.

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25

Böke, S., A. Yaromina, L. Koi, M. Baumann e D. Zips. "EP-2040: Can pimonidazole be used to detect cycling hypoxia in tumours?" Radiotherapy and Oncology 119 (aprile 2016): S963. http://dx.doi.org/10.1016/s0167-8140(16)33291-1.

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26

Arcasoy, Murat O., Khalid Amin, Shu-Chuan Chou, Ruth Lininger, James A. Raleigh e Mahesh A. Varia. "The Expression of Erythropoietin and Its Receptor in Breast Cancer Is Associated with In Vivo Tumor Hypoxia." Blood 106, n. 11 (16 novembre 2005): 4256. http://dx.doi.org/10.1182/blood.v106.11.4256.4256.

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Abstract (sommario):
Abstract Erythropoietin (EPO) is primarily produced in the adult kidney where hypoxia is the major stimulus for EPO expression under the control of an oxygen-sensing mechanism. A series of previous studies in our laboratories and others have demonstrated the expression of EPO and its receptor (EPOR) in breast cancer cells. In previous work, we found that the administration of antagonists of EPO-EPOR signaling was associated with delayed tumor growth in a rodent syngeneic breast cancer model, suggesting the presence of a functional EPO-EPOR system in cancer. The mechanisms of EPO and EPOR expression in tumor cells requires further study. In vitro experiments using monolayer cultures of breast cancer cells have suggested that EPO and EPOR expression in tumor cells may be hypoxia-regulated. The objective of our current studies was to determine the relationship between the expression of EPO, EPOR and tumor hypoxia in breast cancer to test the hypothesis that EPO or EPOR expression in malignant cells may be associated with the presence of in vivo tumor hypoxia, an important factor involved in resistance to radiation treatment, tumor aggressiveness and poor prognosis. Thirty-eight patients with primary breast cancer were enrolled in a tumor hypoxia study under a research protocol approved by the Institutional Review Board at the University of North Carolina Hospitals. All patients provided signed informed consent. The patients received an intravenous infusion of the hypoxia marker pimonidazole hydrochloride (Hypoxyprobe-1™) prior to tumor biopsy. Two or more biopsies were obtained from 33 tumors and 5 primary tumors had a single biopsy available. Contiguous sections from a total of 93 biopsies were analyzed by immunohistochemistry using monoclonal antibodies for the expression of EPO and EPOR and pimonidazole binding. We found EPO expression in tumor cells in 94% of the biopsies. Focal EPO expression pattern was observed in many tumors. EPOR expression was present in 93% of biopsies. The pattern of EPOR immunoreactivity was predominantly cytoplasmic but was found to be localized to the membrane in some sections. In many tumors, co-localization of EPO and EPOR expression in tumor cells was present when contiguous sections were examined. Tumor hypoxia was detected in 83% of the biopsies at variable levels and did not always co-localize with EPO or EPOR expression in tumor cells. Semi-quantitative analyses for EPO immunostaining and tumor hypoxia on a section-by-section basis revealed a significant positive correlation between levels of micro-regional EPO expression and pimonidazole binding (r = 0.6, P &lt; 0.0001, n=93 by two-tailed Spearman’s rank correlation analysis). A similar significant positive correlation was found between levels of EPOR expression and pimonidazole binding (r = 0.63, P &lt; 0.0001, n=93). In addition, there was a significant association between the semi-quantitative EPO score in tumor cells and the EPOR score (r = 0.6, P &lt; 0.0001, n=93). We also determined the micro-vessel density (MVD), a marker of tumor angiogenesis, in 35 biopsies using factor VIII immunostaining. There was no correlation between EPO or EPOR expression and MVD in these samples. In conclusion, these data demonstrate for the first time that EPO and EPOR expression in breast cancer cells correlates with in vivo tumor hypoxia in clinical specimens of primary breast cancer.
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27

Wang, Pei-Xuan, e Paul W. Sanders. "Mechanism of hypertensive nephropathy in the Dahl/Rapp rat: a primary disorder of vascular smooth muscle". American Journal of Physiology-Renal Physiology 288, n. 1 (gennaio 2005): F236—F242. http://dx.doi.org/10.1152/ajprenal.00213.2004.

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Abstract (sommario):
The Dahl/Rapp salt-sensitive (S) rat is a model of salt-sensitive hypertension and hypertensive renal disease. This study explored the role of vascular remodeling in the development of renal failure in S rats. Groups of S and Sprague-Dawley rats were given 0.3 and 8.0% NaCl diets for up to 21 days and evidence of smooth muscle proliferation identified using immunohistochemistry that showed nuclear accumulation of proliferating cell nuclear antigen and 5-bromo-2′-deoxy-uridine. Compared with the other three groups, S rats on 8.0% NaCl diet showed increased nuclear labeling of cells of the aorta and arteries and arterioles of the kidney by the end of the first week of study. Progressive luminal narrowing of the interlobular arteries and preglomerular arterioles occurred in S rats over the 3 wk on the 8.0% NaCl diet. Accumulation of pimonidazole adducts and nuclear accumulation of hypoxia-inducible factor-1α (HIF-1α) were used as markers of tissue hypoxia. By the end of the second week of study, pimonidazole levels increased in S rats on 8.0% NaCl diet and deposition was apparent in tubular cells in the cortex and medulla. At the completion of the experiment, HIF-1α levels were increased in nuclear extracts from the cortex and medulla of S rats on this diet, compared with the other three groups of rats. The data demonstrated a disorder of the vascular remodeling process with proliferation of vascular smooth muscle cells temporally followed by development of tissue hypoxia in the hypertensive nephropathy of S rats on 8.0% NaCl diet.
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28

Walton, MI, NM Bleehen e P. Workman. "Effects of localised tumour hyperthermia on pimonidazole (Ro 03-8799) pharmacokinetics in mice". British Journal of Cancer 59, n. 5 (maggio 1989): 667–73. http://dx.doi.org/10.1038/bjc.1989.138.

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29

Ragnum, H. B., L. Vlatkovic, A. K. Lie, K. Axcrona, C. H. Julin, K. H. Hole, T. Seierstad e H. Lyng. "OC-0320: Relationships between pimonidazole immunostaining and gene expression in prostate cancer patients". Radiotherapy and Oncology 111 (2014): S125. http://dx.doi.org/10.1016/s0167-8140(15)30425-4.

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30

Rademakers, S., I. Hoogsteen, H. A. Marres, R. de Bree, P. Doornaert, A. van der Kogel, J. Bussink e J. Kaanders. "PREDICTIVE VALUE OF PIMONIDAZOLE FOR ARCON THERAPY IN ADVANCED HEAD AND NECK CANCER". Radiotherapy and Oncology 98 (febbraio 2011): S40—S41. http://dx.doi.org/10.1016/s0167-8140(11)70107-4.

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31

Mascini, Nadine E., Menglin Cheng, Lu Jiang, Asif Rizwan, Helen Podmore, Dhaka R. Bhandari, Andreas Römpp, Kristine Glunde e Ron M. A. Heeren. "Mass Spectrometry Imaging of the Hypoxia Marker Pimonidazole in a Breast Tumor Model". Analytical Chemistry 88, n. 6 (29 febbraio 2016): 3107–14. http://dx.doi.org/10.1021/acs.analchem.5b04032.

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32

Carnell, Dawn M., Rowena E. Smith, Frances M. Daley, Michele I. Saunders, Søren M. Bentzen e Peter J. Hoskin. "An immunohistochemical assessment of hypoxia in prostate carcinoma using pimonidazole: Implications for radioresistance". International Journal of Radiation Oncology*Biology*Physics 65, n. 1 (maggio 2006): 91–99. http://dx.doi.org/10.1016/j.ijrobp.2005.11.044.

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33

Hoskin, Peter J., Dawn M. Carnell, N. Jane Taylor, Rowena E. Smith, J. James Stirling, Frances M. Daley, Michele I. Saunders et al. "Hypoxia in Prostate Cancer: Correlation of BOLD-MRI With Pimonidazole Immunohistochemistry—Initial Observations". International Journal of Radiation Oncology*Biology*Physics 68, n. 4 (luglio 2007): 1065–71. http://dx.doi.org/10.1016/j.ijrobp.2007.01.018.

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34

Chang, F. L., e B. Hong-Goka. "Using Pimonidazole Delineated Penumbra To Improve Translational Research on Acute Stroke Neuroprotection (P01.013)". Neurology 78, Meeting Abstracts 1 (22 aprile 2012): P01.013. http://dx.doi.org/10.1212/wnl.78.1_meetingabstracts.p01.013.

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35

Chang, F. L., e B. Hong-Goka. "Using Pimonidazole Delineated Penumbra To Improve Translational Research on Acute Stroke Neuroprotection (SC02.005)". Neurology 78, Meeting Abstracts 1 (22 aprile 2012): SC02.005. http://dx.doi.org/10.1212/wnl.78.1_meetingabstracts.sc02.005.

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36

Gulliksrud, Kristine, Ida K. Vestvik, Kanthi Galappathi, Berit Mathiesen e Einar K. Rofstad. "Detection of Different Hypoxic Cell Subpopulations in Human Melanoma Xenografts by Pimonidazole Immunohistochemistry". Radiation Research 170, n. 5 (novembre 2008): 638–50. http://dx.doi.org/10.1667/rr1400.1.

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37

Kato, Shinya, Masatsugu Kimura, Katsuhiro Kageyama, Hiroshi Tanaka e Nobuhiko Miwa. "Enhanced Radiosensitization by Liposome-Encapsulated Pimonidazole for Anticancer Effects on Human Melanoma Cells". Journal of Nanoscience and Nanotechnology 12, n. 6 (1 giugno 2012): 4472–77. http://dx.doi.org/10.1166/jnn.2012.6180.

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38

Dische, Stanley, Michael H. Bennett, Rosalind Orchard, Michael R. L. StartforD e Peter Wardman. "The uptake of the radiosensitizing compound Ro 03-8799 (pimonidazole) in human tumors". International Journal of Radiation Oncology*Biology*Physics 16, n. 4 (aprile 1989): 1089–92. http://dx.doi.org/10.1016/0360-3016(89)90923-1.

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39

Thurman, R. G. "II. Alcoholic liver injury involves activation of Kupffer cells by endotoxin". American Journal of Physiology-Gastrointestinal and Liver Physiology 275, n. 4 (1 ottobre 1998): G605—G611. http://dx.doi.org/10.1152/ajpgi.1998.275.4.g605.

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Abstract (sommario):
It is well known that females show a greater susceptibility to alcohol-induced liver injury than males. Additionally, females who consume alcohol regularly and have been obese for 10 years or more are at greater risk for both hepatitis and cirrhosis. Female rats on an enteral alcohol protocol exhibit injury more quickly than males, with widespread fatty changes over a larger portion of the liver lobule. Levels of plasma endotoxin, intercellular adhesion molecule-1, free radical adducts, infiltrating neutrophils, and nuclear factor-κB are increased about twofold more in livers from female than male rats after enteral alcohol treatment. Estrogen treatment in vivo increases the sensitivity of Kupffer cells to endotoxin. Evidence has been presented that Kupffer cells are pivotal in the development of alcohol-induced liver injury. Destruction of Kupffer cells with gadolinium chloride (GdCl3) or reduction of bacterial endotoxin by sterilization of the gut with antibiotics blocks early inflammation due to alcohol. Similar results have been obtained with anti-tumor necrosis factor-α antibody. These findings led to the hypothesis that alcohol-induced liver injury involves increases in circulating endotoxin, leading to activation of Kupffer cells, which causes a hypoxia-reoxygenation injury. This idea has been tested using pimonidazole, a nitroimidazole marker, to quantitate hypoxia in downstream pericentral regions of the liver lobule. After chronic enteral alcohol, pimonidazole binding increases twofold. Enteral alcohol also increases free radicals detected with electron spin resonance. Importantly, hepatic hypoxia and radical production detected in bile are decreased by destruction of Kupffer cells with GdCl3. These data are consistent with the hypothesis that Kupffer cells participate in important gender differences in liver injury caused by alcohol.
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40

Low, Quentin, Veronica Calderon, Aimei Chen, Yizhen Hu, Bhaskar Mandavilli, Xin Wang e Mike O’Grady. "Fluorescent hypoxia probe for flow cytometry". Journal of Immunology 200, n. 1_Supplement (1 maggio 2018): 174.32. http://dx.doi.org/10.4049/jimmunol.200.supp.174.32.

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Abstract (sommario):
Abstract Hypoxia is a condition where low levels of oxygen levels are present (1% to 2% O2). Hypoxia play a wide role in physiological and pathological conditions, from developmental angiogenesis to tumor progression and evasion. Hypoxia also modulates a number of immune functions from promoting inflammation to suppressing adaptive immunity. The current method for detecting hypoxic cells relies on an immunochemical approach. Pimonidazole react with peptide thiols in hypoxic cells and the resulting adduct is detected with an anti-pimonidazole antibody. To increase the availability of hypoxia detection reagents, we have developed a rhodamine-based hypoxia reagent (HR) for live cells. Using Jurkat leukemia cells incubated in hypoxic or normoxic conditions and stained with HR, we were able to clearly distinguish hypoxic cells from normoxic cells on a flow cytometer. We were also able to resolve cells incubated at differing levels of O2 (10%, 5% and 2.5% O2). To demonstrate that HR is compatible with other reagents, hypoxic cells were co-stained with a viability dye (SYTOX Red), a dye retained in intact mitochondria (TMRM) and with staining for a marker of apoptosis (annexin V). The results show that hypoxic cells excluded the dead cells dye while retaining TMRM, and were negative for annexin V staining at early time points. As expected, prolong incubation at hypoxia resulted in dead and apoptotic cells as evident in an increase in dead cells staining, a loss of mitochondrial integrity and an increase in annexin V+ cells. In summary, we present a sensitive reagent for detecting hypoxic cells without the need for cellular fixation and permeablization, while retaining it usage with other live cell flow cytometry detection reagents.
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41

HERRICK, ARIANE L., RACHEL GORODKIN, MARIA JEZIORSKA e IAN J. STRATFORD. "Testing for Hypoxia in Forearm Skin of Patients with Systemic Sclerosis, Assessed by Pimonidazole". Journal of Rheumatology 37, n. 9 (settembre 2010): 1968.2–1969. http://dx.doi.org/10.3899/jrheum.100174.

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42

Ragnum, H. B., L. Vlatkovic, A. K. Lie, K. Axcrona, C. H. Julin, K. M. Frikstad, K. H. Hole, T. Seierstad e H. Lyng. "The tumour hypoxia marker pimonidazole reflects a transcriptional programme associated with aggressive prostate cancer". British Journal of Cancer 112, n. 2 (2 dicembre 2014): 382–90. http://dx.doi.org/10.1038/bjc.2014.604.

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43

Raleigh, J. A., S.-C. Chou, G. E. Arteel e M. R. Horsman. "Comparisons among Pimonidazole Binding, Oxygen Electrode Measurements, and Radiation Response in C3H Mouse Tumors". Radiation Research 151, n. 5 (maggio 1999): 580. http://dx.doi.org/10.2307/3580034.

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44

C. Begg, Hilde Janssen, Debbie Spro, Adrian. "Hypoxia and Perfusion Measurements in Human Tumors&Initial Experience with Pimonidazole and IUdR". Acta Oncologica 40, n. 8 (gennaio 2001): 924–28. http://dx.doi.org/10.1080/02841860152708198.

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45

Wack, L. J., D. Mönnich, A. Yaromina, D. Zips, M. Baumann e D. Thorwarth. "Correlation of FMISO simulations with pimonidazole-stained tumor xenografts: A question of O2 consumption?" Medical Physics 43, n. 7 (13 giugno 2016): 4113–21. http://dx.doi.org/10.1118/1.4951728.

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46

Durand, Ralph E., e Christina Aquino-Parsons. "The fate of hypoxic (pimonidazole-labelled) cells in human cervix tumours undergoing chemo-radiotherapy". Radiotherapy and Oncology 80, n. 2 (agosto 2006): 138–42. http://dx.doi.org/10.1016/j.radonc.2006.07.022.

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47

Watts, M. E., M. F. Dennis e I. J. Roberts. "Radiosensitization by Misonidazole, Pimonidazole and Azomycin and Intracellular Uptake in Human Tumour Cell Lines". International Journal of Radiation Biology 57, n. 2 (gennaio 1990): 361–72. http://dx.doi.org/10.1080/09553009014552461.

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48

Nordsmark, Marianne, Juliette Loncaster, Christina Aquino-Parsons, Shu-Chuan Chou, Morten Ladekarl, Hanne Havsteen, Jacob C. Lindegaard et al. "Measurements of hypoxia using pimonidazole and polarographic oxygen-sensitive electrodes in human cervix carcinomas". Radiotherapy and Oncology 67, n. 1 (aprile 2003): 35–44. http://dx.doi.org/10.1016/s0167-8140(03)00010-0.

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49

Durand, R., e C. Aquino-Parsons. "191 The fate of hypoxic (Pimonidazole-labeled) cells in human cervix tumours undergoing chemoradiotherapy". Radiotherapy and Oncology 78 (marzo 2006): S66—S67. http://dx.doi.org/10.1016/s0167-8140(06)80668-7.

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50

Harms, Julia K., Tet-Woo Lee, Tao Wang, Amy Lai, Dennis Kee, John M. Chaplin, Nick P. McIvor et al. "Impact of Tumour Hypoxia on Evofosfamide Sensitivity in Head and Neck Squamous Cell Carcinoma Patient-Derived Xenograft Models". Cells 8, n. 7 (13 luglio 2019): 717. http://dx.doi.org/10.3390/cells8070717.

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Abstract (sommario):
Tumour hypoxia is a marker of poor prognosis and failure of chemoradiotherapy in head and neck squamous cell carcinoma (HNSCC), providing a strategy for therapeutic intervention in this setting. To evaluate the utility of the hypoxia-activated prodrug evofosfamide (TH-302) in HNSCC, we established ten early passage patient-derived xenograft (PDX) models of HNSCC that were characterised by their histopathology, hypoxia status, gene expression, and sensitivity to evofosfamide. All PDX models closely resembled the histology of the patient tumours they were derived from. Pimonidazole-positive tumour hypoxic fractions ranged from 1.7–7.9% in line with reported HNSCC clinical values, while mRNA expression of the Toustrup hypoxia gene signature showed close correlations between PDX and matched patient tumours, together suggesting the PDX models may accurately model clinical tumour hypoxia. Evofosfamide as a single agent (50 mg/kg IP, qd × 5 for three weeks) demonstrated antitumour efficacy that was variable across the PDX models, ranging from complete regressions in one p16-positive PDX model to lack of significant activity in the three most resistant models. Despite all PDX models showing evidence of tumour hypoxia, and hypoxia being essential for activation of evofosfamide, the antitumour activity of evofosfamide only weakly correlated with tumour hypoxia status determined by pimonidazole immunohistochemistry. Other candidate evofosfamide sensitivity genes—MKI67, POR, and SLFN11—did not strongly influence evofosfamide sensitivity in univariate analyses, although a weak significant relationship with MKI67 was observed, while SLFN11 expression was lost in PDX tumours. Overall, these data confirm that evofosfamide has antitumour activity in clinically-relevant PDX tumour models of HNSCC and support further clinical evaluation of this drug in HNSCC patients. Further research is required to identify those factors that, alongside hypoxia, can influence sensitivity to evofosfamide and could act as predictive biomarkers to support its use in precision medicine therapy of HNSCC.
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