Tumour hypoxia is thought to contribute to some failures of radiotherapy to
achieve local control. Polarographic measurements of tumour oxygenation ha
ve been shown to predict clinical response to radiotherapy and patient surv
ival. Hypoxia is also involved in many common types of normal tissue morbid
ity. However, at present there is no widely used method of measuring hypoxi
a in the clinic, or for individualizing therapy on the basis of tumour or t
issue oxygenation. The bioreductive metabolism of 2-nitroimidazoles provide
s a way of labelling hypoxic cells in vivo and a variety of isotopic labels
have been proposed for the non-invasive detection of bound metabolites of
these markers. Several 2-nitroimidazoles with immunologically identifiable
side-chains have been described and conventional immunostaining procedures
can be used to locate their metabolites, bound to hypoxic cells in histolog
ical sections. Use of fluorescent immunoreagents allows flow cytometric ass
essment of hypoxia and multiple colour fluorescent staining allows hypoxia
to be correlated with other markers on a cell by cell basis. 2-Nitroimidazo
le hypoxia markers show considerable promise for clinical use in diagnosing
hypoxia and their use could allow rational application of hypoxia-related
therapies to those patients most likely to benefit from them.