Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
Curr Drug Targets. 2011 Dec;12(13):1909-24. doi: 10.2174/138945011798184227.
Cardiovascular diseases and cancer are the leading causes of death in most countries. These diseases share many common risk factors as well as pathogenetic determinants, and their incidence is related to age in an exponential manner. Furthermore, it has become apparent that several treatments used in therapy or even in prevention of cancer can impair the structural and functional integrity of the cardiovascular system, giving rise to an interdisciplinary field: cardio-oncology. However, tumors and cardiovascular diseases also share common protective factors: they can be prevented either by avoiding exposure to recognized risk factors, and/or by favoring the intake of protective compounds and by modulating the host defense machinery. These latter approaches are generally known as chemoprevention. A great variety of dietary and pharmacological agents have been shown to be potentially capable of preventing cancer in preclinical models, most of which are of plant origin. Phytochemicals, in particular diet-derived compounds, have therefore been proposed and applied in clinical trials as cancer chemopreventive agents. There is now increasing evidence that some phytochemicals can be also protective for the heart, having the potential to reduce cancer, cardiovascular disease and even anticancer drug-induced cardiotoxicity. We introduce the concept that these compounds induce pre-conditioning, a low level cellular stress that induces strong protective mechanisms conferring resistance to toxins such as cancer chemotherapeutics. Cancer cells and cardiomyocytes have fundamental differences in their metabolism and sensitivity to preconditioning, autophagy and apoptosis, so that dosage of the prevention compounds is important. Here we discuss the mechanisms responsible for the cardiotoxicity of anticancer drugs, the possibility to prevent them and provide examples of diet-derived phytochemicals and other biological substances that could be exploited for protecting the cardiovascular system according to a joint cardio-oncological preventative approach.
心血管疾病和癌症是大多数国家的主要死亡原因。这些疾病有许多共同的危险因素和发病机制，其发病率与年龄呈指数关系。此外，已经明显的是，一些用于治疗甚至预防癌症的治疗方法可能会损害心血管系统的结构和功能完整性，从而产生一个跨学科领域：心脏肿瘤学。然而，肿瘤和心血管疾病也有共同的保护因素：它们可以通过避免暴露于已知的危险因素来预防，和/或通过促进保护化合物的摄入和调节宿主防御机制来预防。这些后一种方法通常被称为化学预防。大量的饮食和药理学药物已被证明在临床前模型中具有潜在的预防癌症的能力，其中大多数是植物来源的。植物化学物质，特别是饮食衍生的化合物，因此被提出并应用于临床试验中作为癌症化学预防剂。越来越多的证据表明，一些植物化学物质也可以保护心脏，具有降低癌症、心血管疾病甚至抗癌药物引起的心脏毒性的潜力。我们介绍了这样一个概念，即这些化合物诱导预处理，一种低水平的细胞应激，诱导强烈的保护机制，使细胞对毒素如癌症化疗药物产生抗性。癌细胞和心肌细胞在代谢和对预处理、自噬和细胞凋亡的敏感性方面存在根本差异，因此预防化合物的剂量很重要。在这里，我们讨论了抗癌药物心脏毒性的机制，预防它们的可能性，并提供了饮食衍生的植物化学物质和其他生物物质的例子，这些物质可以根据联合的心脏肿瘤学预防方法来保护心血管系统。
