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McKenna et al                                                                                                                                                                                     Hypoxia in prostate cancer

           drug  from  molecular  profiling  to  potentially  single   pharmacodynamics readouts, such as that provided
           cell  functional  analysis.  Thus  here  we  consider   by a truncated 53BP1 double-strand reporter, recently
           approaches aimed at developing novel and functional   shown to accentuate the approach for in situ single
           assays for tumor stratification.                   cell analysis of cancer therapeutics [68] . Applying
                                                              this PK-PD linked imaging at the single cell would
           Many hypoxia-targeting small molecules, for example,   provide the evidence and mechanisms essential for
           [(18)F]FAZA,  [(18)F]FMISO,  [(18)F]EF5,  and  [(123)  the development of HAP therapeutic strategies that
           I]IAZA, have been shown to accrue selectively in   address changing patterns of target presentation in
           hypoxic cells. These positron emission tomography   different cellular microenvironments, and prostate
           molecular contrast  agents have been  extensively   tissue architecture.
           applied  in  clinical hypoxia  imaging, including
           cancer [63] . However the outstanding challenge is to   BH3 PROFILING TO PREDICT CAPACITY FOR
           multiplex  these  imaging  readouts  with  the  delivery   CELL DEATH AT THE SINGLE CELL LEVEL
           and  conversion  of  prodrug  in  the  same  tumor  and
           package the acquisition and analysis algorithms such
           that they offer pragmatic solutions for advancing our   The  primary  action  of  the  AQ4N  and  OCT1002
           understanding of HAP bioavailability and conversion.   metabolites is through DNA damage and subsequently
                                                              apoptosis. Despite much research into the molecular
           Many bioactive molecules have chromophores    [64]    pathways that regulate cell death, the signalling
           thus offering the prospect for tracking target     networks involved  are  so  complex that molecular
           interactions through  methods  such as steady-state   profiling  of  key  pro-and  anti-apoptotic  players  alone
           fluorescence  readouts,  or  determining  fluorescence   does not provide the predictive capability needed to
                                                                                           [69]
           quenching  properties  and  fluorescence  lifetime   assess chemo-responsiveness  . Thus, functional
                                                              BH3 profiling would lead to the derivation of cell death
           measurements for detecting drug tethering to target.   fingerprinting,  determining  the  sensitivity  thresholds
           Fluorescence life-time and quenching analyses can   for apoptosis between and within heterogeneous
           lead to a unique means for dissecting sub-resolution   cancer cell populations. The underlying principle of
           molecular interactions  in situ [65] . For instance,   BH3  profiling  is  that  mitochondrial  depolarization
           recent spectroscopic investigations show molecular   or  subsequent  processes  such  as  BAK/BAX
           properties of doxorubicin change due to alterations   oligomerisation or cytochrome release following BH3
           in the local environment, such as when the drug is   peptide exposure serves as a functional biomarker
           encapsulated to nanoparticles. Thus we suggest that   for cellular response to pro-apoptotic cues. A recent
           fluorescence  imaging  provides  a  powerful  tool  for   technology innovation has led to the development
           investigating drug delivery in tumor cells and tissue,   and implementation of novel nano-tools (cross-linked
           and  further  allows  for  the  linking  of  multi-scalar   stapled peptides) to aid the understanding of apoptotic
           features  of  drug  design,  stability  and  metabolism   responses  using  flow  and  image  cytometry [70,71] .
           together  with  the  complexities  imposed  by  the   Feasibility  studies  have  shown  that  BH3-derived
           biological system including tissue penetration and   peptides alkylated with azobenzene cross-linkers have
           drug-target interactions.                          the ability to induce detectable physiological changes

                                                              paralleling the early events in apoptotic cell death. The
           All  these  fluorescent  modalities  are  very  much   objective now is to establish a validated BH3-profiling
           applicable for the uHAPs such as AQ4N and OCT1002   pipeline suitable for sample stratification, using these
           which  are  fluorescent  due  to  the  anthraquinone   peptide  BH3  pathway  inducers  and  sensitizers [72] .
           chromophore and detectable in vitro and in vivo [55,66]    In short, BH3 profiling provides a functional readout
           and also retained in tissue even after snap-freezing   for the primed apoptotic state of a heterogenous
           of xenograft material. Cryosections of frozen      population of cells, again which can be directly linked
           xenograft tumor tissue slices were examined for    to drug bioreduction and retention at the single cell
           AQ4  fluorescence  and  distribution  by  fluorescence   level.
           microscopy,  alongside  HPLC/mass  spectroscopy
           analysis [67] . To extend  the concept  further,  the
           efficiency of drug-target interaction of the prodrug is   MOLECULAR PROFILING AND
           driven by not only pharmacokinetic factors but a host   BIOINFORMATIC ANALYSIS
           of parallel cellular status and events that are required
           to elicit the sought pharmacodynamic responses,    The drive towards personalised medicine depends
           which are also heterogeneously expressed through   on the discovery of biomarkers which can allow
           the tumor. Hence the requirement for  in vivo      molecular stratification of patients. Such information

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