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Misonidazole (MISO), a hypoxic cell radiosensitizer, is selectively metabolized by hypoxic cells to reactive products that bind covalently to cellular constituents. The drug also possesses a substantial cytotoxic effect, independent of radiation, which is selectively expressed in hypoxic cells. Misonidazole may be cytotoxic to the normal hypoxic tissues in the human body, making this became a major concern in the clinical application of the drug. Misonidazole leads to strand breaks in cellular DNA and those cells which fail to survive also fail to repair these strand breaks. Misonidazole depletes intracellular glutathione and is more toxic in glutathione depleted cells. The depletion is time, temperature, drug concentration and cell line dependent.

In vitro: In cultured CHO cells, pretreatment with 5 mM MISO for 2 hr exihibited the marginal toxicity [2].

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