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AQ4N: a new approach to hypoxia-activated cancer chemotherapy
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  • Mini Review
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  • Published: 05 December 2000

Mini-Review

AQ4N: a new approach to hypoxia-activated cancer chemotherapy

  • L H Patterson1 &
  • S R McKeown2 

British Journal of Cancer volume 83, pages 1589–1593 (2000)Cite this article

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Abstract

Preclinical studies demonstrate that in vivo AQ4N enhances the anti-tumour effects of radiation and chemotherapeutic agents with a dose-modifying factor of approximately 2.0. With careful scheduling no, or very little, additional normal tissue toxicity should be observed. AQ4N is a bioreductive prodrug of a potent, stable, reduction product which binds non-covalently to DNA, facilitating antitumour activity in both hypoxic and proximate oxic tumour cells. AQ4N is clearly different in both its mechanism of action and potential bystander effect compared to previously identified bioreductive drugs. In particular AQ4N is the only bioreductive prodrug topoisomerase II inhibitor to enter clinical trials. Targeting this enzyme, which is crucial to cell division, may help sensitize tumours to repeated (fractionated) courses of radiotherapy. This is because in principle, the bioreduction product of AQ4N can inhibit the topoisomerase activity of hypoxic cells as they attempt to re-enter the cell cycle. © 2000 Cancer Research Campaign http://www.bjcancer.com

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Change history

  • 16 November 2011

    This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication

References

  • Brown JM (1999) The hypoxic cell: a target for selective cancer therapy – 18th Bruce F. Caine Memorial Award Lecture. Cancer Res 59( 23): 5863–5870

    PubMed  CAS  Google Scholar 

  • Brown JM (2000) Exploiting the hypoxic cancer cell: mechanisms and therapeutic strategies. Mol Med Today 6(4): 157–162

    Article  CAS  PubMed  Google Scholar 

  • Fisher GR and Patterson LH (1992) Lack of involvement of reactive oxygen in the cytotoxicity of mitoxantrone, CI941 and ametantrone in MCF-7 cells: comparison with doxorubicin. Cancer Chemother Pharmacol 30(6): 451–458

    Article  CAS  PubMed  Google Scholar 

  • Friery OP, Gallagher R, Murray MM, Hughes CM, Galligan ES, McIntyre IA, Patterson LH, Hirst DG and McKeown SR (2000) Enhancement of the anti-tumour effect of cyclophosphamide by the bioreductive drugs AQ4N and tirapazamine. Br J Cancer 2(8): 1469–1473

    Article  Google Scholar 

  • Garner AP, Paine MJ, Rodriguez-Crespo I, Chinje EC, Ortiz De Montallano P, Stratford IJ, Tew DG and Wolf CR (1999) Nitric oxide synthases catalyse the activation of redox cycling and bioreductive anticancer agents. Cancer Res 59(8): 1929–1934

    PubMed  CAS  Google Scholar 

  • Graeber TG, Osmanian C, Jacks T, Housman DE, Koch CJ, Loke SW and Giaccia AJ (1996) Hypoxia-mediated selection of cells with diminished apoptotic potential in solid tumours. Nature 379(6560): 88–91

    Article  CAS  PubMed  Google Scholar 

  • Hejmadi MV, McKeown SR, Friery OP, McIntyre IA, Patterson LH and Hirst DG (1996) DNA damage following combination of radiation with the bioreductive drug AQ4N: possible selective toxicity to oxic and hypoxic tumour cells. Br J Cancer 73(4): 499–505

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Koch J (1993) Unusual oxygen concentration-dependence of toxicity of SR-4233, a hypoxic cell cytotoxin. Cancer Res 53(17): 3992–3997

    CAS  PubMed  Google Scholar 

  • Lee HH and Denny WAA (1999) large-scale synthesis of the bioreductive drug 1,4-bis{[2-(dimethylamino)ethyl]amino}-5,8-dihydroxyanthracene-9,10-dione bis-N-oxide (AQ4N). J Chem Soc Perkins Trans I 19: 2755–2758

    Article  Google Scholar 

  • Lee AE and Wilson WR (2000) Hypoxia-dependent retinal toxicity of bioreductive anticancer prodrugs in mice. Toxicol Appl Pharmacol 163(1): 50–59

    Article  CAS  PubMed  Google Scholar 

  • McKeown SR, Hejmadi MV, McIntyre IA, McAleer JJ and Patterson LH (1995) AQ4N: an alkylaminoanthraquinone N-oxide showing bioreductive potential and positive interaction with radiation in vivo. Br J Cancer 72(1): 76–81

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • McKeown SR, Friery OP, McIntyre IA, Hejmadi MV, Patterson LH and Hirst DG (1996) Evidence for a therapeutic gain when AQ4N or tirapazamine is combined with radiation. Br J Cancer Suppl 27: S39–42

    PubMed  PubMed Central  CAS  Google Scholar 

  • Murray GI, McFadyen MCE, Mitchell RT, Cheung YL, Kerr AC and Melvin WT (1999) Cytochrome P450CYP3A in human renal cell cancer. British Journal of Cancer 79: 1836–1842

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Patterson LH (1993) Rationale for the use of aliphatic N-oxides of cytotoxic anthraquinones as prodrug DNA binding agents: a new class of bioreductive agent. Cancer Metastasis Rev 12(2): 119–134

    Article  CAS  PubMed  Google Scholar 

  • Patterson LH and Raleigh SM (1998) Reductive metabolism: Its application to prodrug activation. In: NJ Gooderham (ed) Drug Metabolism: Towards the Next Millennium. IOS Press: Amsterdam, pp. 72–79

    Google Scholar 

  • Patterson LH, Craven MR, Fisher GR and Teesdale-Spittle P (1994) Aliphatic amine N-oxides of DNA binding agents as bioreductive drugs. Oncol Res 6(10–11): 533–538

    PubMed  CAS  Google Scholar 

  • Patterson AV, Saunders MP, Chinje EC, Patterson LH and ratford IJ (1998) Enzymology of tirapazamine metabolism: a review. Anticancer Drug Des 13: 541–573

    PubMed  CAS  Google Scholar 

  • Patterson LH, McKeown SR, Robson T, Gallagher R, Raleigh SM and Orr S (1999) Antitumour prodrug development using cytochrome P450 (CYP) mediated activation. Anticancer Drug Des 14(6): 473–486

    PubMed  CAS  Google Scholar 

  • Patterson LH, McKeown SR, Ruparelia K, Double JA, Bibby MC, Cole S and Stratford IJ (2000) Enhancement of chemotherapy and radiotherapy of murine tumours by AQ4N, a bioreductively activated anti-tumour agent. Br J Cancer 82(12): 1984–1990

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Raleigh SM (1998) Involvement of cytochrome P450 (CYP) and other haem associated enzymes in the bioreduction of AQ4N, an antitumour produrg. PhD thesis, De Montfort University, Leicester

  • Raleigh SM, Wanogho E, Burke MD, McKeown SR and Patterson LH (1998) Involvement of human cytochromes P450 (CYP) in the reductive metabolism of AQ4N, a hypoxia activated anthraquinone di-N-oxide prodrug. Int J Radiat Oncol Biol Phys 42(4): 763–767

    Article  CAS  PubMed  Google Scholar 

  • Raleigh SM, Wanogho E, Burke MD and Patterson LH (1999) Rat cytochromes P450 (CYP) specifically contribute to the reductive bioactivation of AQ4N, an alkylaminoanthraquinone-di-N-oxide anticancer prodrug. Xenobiotica (11): 1115–1122

    Article  CAS  PubMed  Google Scholar 

  • Saunders MP, Patterson AV, Chinje EC, Harris AL and Stratford IJ (2000) NADPH: cytochrome c(P450) reductase activates tirapazamine (SR4233) to restore hypoxic and oxic cytotoxicity in an aerobic resistant derivative of the A549 lung cancer cell line. Br J Cancer 82(3): 651–656

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Smith PJ, Desnoyers R, Blunt N, Giles Y, Patterson LH and Watson JV (1997a) Flow cytometric analysis and confocal imaging of anticancer alkylaminoanthraquinones and their N-oxides in intact human cells using 647-nm krypton laser excitation. Cytometry 27( 1): 43–53

    Article  CAS  PubMed  Google Scholar 

  • Smith PJ, Blunt NJ, Desnoyers R, Giles Y and Patterson LH (1997b) DNA topoisomerase II-dependent cytotoxicity to alkylaminoanthraquinones and their N-oxides. Cancer Chemother Pharmacol 39(5): 455–461

    Article  CAS  PubMed  Google Scholar 

  • Swaine DJ, Loadman PM, Bibby MC, Graham MA and Patterson LH (2000) High-performance liquid chromatographic analysis of AQ4N, an alkylaminoanthraquinone N-oxide. J Chromatogr B Biomed Sci Appl 742(2): 239–245

    Article  CAS  PubMed  Google Scholar 

  • Thomsen LL, Lawton FG, Knowles RG, Beesley JE, Riveros-Moreno V and Moncada S (1994) Nitric oxide synthase activity in human gynaecological cancer. Cancer Res 54( 5): 1352–1354

    PubMed  CAS  Google Scholar 

  • Thomsen LL, Miles DW, Happerfield L, Bobrow LG, Knowles RG and Moncada S (1995) Nitric oxide synthase activity in human breast cancer. Br J Cancer 72( 1): 41–44

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wilson WR, Denny WA, Pullen SM, Thompson KM, Li AE, Patterson LH and Lee HH (1996) Tertiary amine N-oxides as bioreductive drugs: DACA N-oxide, nitracrine N-oxide and AQ4N. Br J Cancer Suppl 27: S43–47

    PubMed  PubMed Central  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Pharmaceutical and Biological Chemistry, School of Pharmacy, University of London, Brunswick Square, London, WC1N 1AX, UK

    L H Patterson

  2. School of Biomedical Sciences, University of Ulster at Jordanstown, BT37 0QB, Northern Ireland, UK

    S R McKeown

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  1. L H Patterson
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  2. S R McKeown
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From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/

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Patterson, L., McKeown, S. AQ4N: a new approach to hypoxia-activated cancer chemotherapy. Br J Cancer 83, 1589–1593 (2000). https://doi.org/10.1054/bjoc.2000.1564

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  • Received: 09 October 2000

  • Accepted: 19 October 2000

  • Published: 05 December 2000

  • Issue date: 01 December 2000

  • DOI: https://doi.org/10.1054/bjoc.2000.1564

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Keywords

  • bioreductive
  • prodrug
  • topoisomerase II
  • in vivo
  • AQ4N
  • Tirapazamine

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