Department of Pediatrics, Faculty of Medicine and Dentistry, Cardiovascular Research Centre, University of Alberta, 87th Avenue and 112 Street, Edmonton, Alberta T6G 2S2, Canada.
Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Cardiovasc Res. 2018 Aug 1;114(10):1350-1359. doi: 10.1093/cvr/cvy064.
Doxorubicin (DOX) is among the most effective chemotherapies used in paediatric cancer patients. However, the clinical utility of DOX is offset by its well-known cardiotoxicity, which often does not appear until later in life. Since hypertension significantly increases the risk of late-onset heart failure in childhood cancer survivors, we investigated whether juvenile DOX exposure impairs the ability to adapt to angiotensin II (Ang II)-induced hypertension later in life and tested a treatment that could prevent this.
Five-week-old male mice were administered a low dose of DOX (4 mg/kg) or saline once a week for 3 weeks and then allowed to recover for 5 weeks. Following the 5-week recovery period, mice were infused with Ang II or saline for 2 weeks. In another cohort, mice were fed chow containing 0.4% resveratrol 1 week before, during, and 1 week after the DOX administrations. One week after the last DOX administration, p38 mitogen-activated protein kinase (MAPK) was activated in hearts of DOX-treated mice demonstrating molecular signs of cardiac stress; yet, there was no change in cardiac function between groups. However, DOX-treated mice failed to develop compensatory cardiac hypertrophy in response to Ang II-induced hypertension later in life. Of importance, mice receiving DOX with resveratrol co-administration displayed normalization in p38 MAPK activation in the heart and a restored capacity for cardiac hypertrophy in response to Ang II-induced hypertension.
We have developed a juvenile mouse model of DOX-induced cardiotoxicity that displays no immediate overt physiological dysfunction; but, leads to an impaired ability of the heart to adapt to hypertension later in life. We also show that co-administration of resveratrol during DOX treatment was sufficient to normalize molecular markers of cardiotoxicity and restore the ability of the heart to undergo adaptive remodelling in response to hypertension later in life.
多柔比星(DOX)是儿科癌症患者中最有效的化疗药物之一。然而,DOX 的临床应用受到其众所周知的心脏毒性的限制,这种毒性通常在以后的生活中才会出现。由于高血压显著增加了儿童癌症幸存者发生迟发性心力衰竭的风险,我们研究了幼年 DOX 暴露是否会损害其在以后的生活中适应血管紧张素 II(Ang II)诱导的高血压的能力,并测试了一种可以预防这种情况的治疗方法。
5 周龄雄性小鼠每周接受一次低剂量 DOX(4mg/kg)或生理盐水治疗,共 3 周,然后恢复 5 周。在 5 周恢复期后,小鼠接受 Ang II 或生理盐水输注 2 周。在另一队列中,小鼠在 DOX 给药前 1 周、给药期间和给药后 1 周内食用含有 0.4%白藜芦醇的饮食。最后一次 DOX 给药后 1 周,DOX 处理的小鼠心脏中 p38 丝裂原活化蛋白激酶(MAPK)被激活,表明心脏应激的分子迹象;然而,各组之间的心脏功能没有变化。然而,DOX 处理的小鼠在以后的生活中对 Ang II 诱导的高血压没有产生代偿性心肌肥厚。重要的是,接受 DOX 和白藜芦醇共同给药的小鼠心脏中 p38 MAPK 激活恢复正常,并恢复了对 Ang II 诱导的高血压的心脏肥厚能力。
我们建立了一种幼年小鼠 DOX 诱导的心脏毒性模型,该模型没有立即出现明显的生理功能障碍,但导致心脏在以后的生活中对高血压的适应能力受损。我们还表明,在 DOX 治疗期间共同给予白藜芦醇足以使心脏毒性的分子标志物正常化,并恢复心脏在以后的生活中对高血压进行适应性重塑的能力。