Pacher Pál, Liaudet Lucas, Bai Péter, Mabley Jon G, Kaminski Pawel M, Virág László, Deb Amitabha, Szabó Eva, Ungvári Zoltán, Wolin Michael S, Groves John T, Szabó Csaba
Inotek Pharmaceuticals Corp, Beverly, Mass 01915, USA.
Circulation. 2003 Feb 18;107(6):896-904. doi: 10.1161/01.cir.0000048192.52098.dd.
Increased oxidative stress and dysregulation of nitric oxide have been implicated in the cardiotoxicity of doxorubicin (DOX), a commonly used antitumor agent. Peroxynitrite is a reactive oxidant produced from nitric oxide and superoxide in various forms of cardiac injury. Using a novel metalloporphyrinic peroxynitrite decomposition catalyst, FP15, and nitric oxide synthase inhibitors or knockout mice, we now delineate the pathogenetic role of peroxynitrite in rodent models of DOX-induced cardiac dysfunction.
Mice received a single injection of DOX (25 mg/kg IP). Five days after DOX administration, left ventricular performance was significantly depressed, and high mortality was noted. Treatment with FP15 and an inducible nitric oxide synthase inhibitor, aminoguanidine, reduced DOX-induced mortality and improved cardiac function. Genetic deletion of the inducible nitric oxide synthase gene was also accompanied by better preservation of cardiac performance. In contrast, inhibition of the endothelial isoform of nitric oxide synthase with N-nitro-L-arginine methyl ester increased DOX-induced mortality. FP15 reduced the DOX-induced increase in serum LDH and creatine kinase activities. Furthermore, FP15 prevented the DOX-induced increase in lipid peroxidation, nitrotyrosine formation, and metalloproteinase activation in the heart but not NAD(P)H-driven superoxide generation. Peroxynitrite neutralization did not interfere with the antitumor effect of DOX. FP15 also decreased ischemic injury in rats and improved cardiac function and survival of mice in a chronic model of DOX-induced cardiotoxicity.
Thus, peroxynitrite plays a key role in the pathogenesis of DOX-induced cardiac failure. Targeting peroxynitrite formation may represent a new cardioprotective strategy after DOX exposure or in other conditions associated with peroxynitrite formation, including myocardial ischemia/reperfusion injury.
氧化应激增加和一氧化氮调节异常与常用抗肿瘤药物阿霉素(DOX)的心脏毒性有关。过氧亚硝酸盐是在各种形式的心脏损伤中由一氧化氮和超氧化物产生的一种活性氧化剂。我们使用一种新型金属卟啉过氧亚硝酸盐分解催化剂FP15以及一氧化氮合酶抑制剂或基因敲除小鼠,现在阐述过氧亚硝酸盐在DOX诱导的心脏功能障碍啮齿动物模型中的致病作用。
小鼠单次腹腔注射DOX(25mg/kg)。DOX给药后5天,左心室功能显著降低,且死亡率高。用FP15和诱导型一氧化氮合酶抑制剂氨基胍治疗可降低DOX诱导的死亡率并改善心脏功能。诱导型一氧化氮合酶基因的基因缺失也伴随着心脏功能的更好保留。相反,用N-硝基-L-精氨酸甲酯抑制内皮型一氧化氮合酶会增加DOX诱导的死亡率。FP降低了DOX诱导的血清乳酸脱氢酶和肌酸激酶活性的增加。此外,FP15可防止DOX诱导的心脏脂质过氧化增加、硝基酪氨酸形成和金属蛋白酶激活,但不影响NAD(P)H驱动的超氧化物生成。过氧亚硝酸盐中和不干扰DOX的抗肿瘤作用。在DOX诱导的心脏毒性慢性模型中,FP15还可降低大鼠的缺血性损伤并改善小鼠的心脏功能和存活率。
因此,过氧亚硝酸盐在DOX诱导的心力衰竭发病机制中起关键作用。靶向过氧亚硝酸盐的形成可能代表DOX暴露后或在与过氧亚硝酸盐形成相关的其他条件下(包括心肌缺血/再灌注损伤)的一种新的心脏保护策略。