卡非佐米诱导小鼠心脏毒性的分子机制和二甲双胍的新兴心脏保护作用。

Molecular mechanisms of carfilzomib-induced cardiotoxicity in mice and the emerging cardioprotective role of metformin.

机构信息

Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece.

Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.

出版信息

Blood. 2019 Feb 14;133(7):710-723. doi: 10.1182/blood-2018-06-858415. Epub 2018 Nov 27.

Abstract

Carfilzomib (Cfz), an irreversible proteasome inhibitor licensed for relapsed/refractory myeloma, is associated with cardiotoxicity in humans. We sought to establish the optimal protocol of Cfz-induced cardiac dysfunction, to investigate the underlying molecular-signaling and, based on the findings, to evaluate the cardioprotective potency of metformin (Met). Mice were randomized into protocols 1 and 2 (control and Cfz for 1 and 2 consecutive days, respectively); protocols 3 and 4 (control and alternate doses of Cfz for 6 and 14 days, respectively); protocols 5A and 5B (control and Cfz, intermittent doses on days 0, 1 [5A] and 0, 1, 7, and 8 [5B] for 13 days); protocols 6A and 6B (pharmacological intervention; control, Cfz, Cfz+Met and Met for 2 and 6 days, respectively); and protocol 7 (bortezomib). Cfz was administered at 8 mg/kg (IP) and Met at 140 mg/kg (per os). Cfz resulted in significant reduction of proteasomal activity in heart and peripheral blood mononuclear cells in all protocols except protocols 5A and 5B. Echocardiography demonstrated that Cfz led to a significant fractional shortening (FS) depression in protocols 2 and 3, a borderline dysfunction in protocols 1 and 4, and had no detrimental effect on protocols 5A and 5B. Molecular analysis revealed that Cfz inhibited AMPKα/mTORC1 pathways derived from increased PP2A activity in protocol 2, whereas it additionally inhibited phosphatidylinositol 3-kinase/Akt/endothelial nitric oxide synthase pathway in protocol 3. Coadministration of Met prevented Cfz-induced FS reduction and restored AMPKα phosphorylation and autophagic signaling. Conclusively, Cfz decreased left ventricular function through increased PP2A activity and inhibition of AMPKα and its downstream autophagic targets, whereas Met represents a novel promising intervention against Cfz-induced cardiotoxicity.

摘要

卡非佐米(Cfz)是一种不可逆的蛋白酶体抑制剂,已获得批准用于治疗复发性/难治性骨髓瘤,与人类的心脏毒性相关。我们旨在建立 Cfz 诱导的心脏功能障碍的最佳方案,研究其潜在的分子信号,并根据研究结果评估二甲双胍(Met)的心脏保护效力。小鼠被随机分为方案 1 和 2(对照组和 Cfz 连续 1 天和 2 天给药);方案 3 和 4(对照组和 Cfz 交替剂量连续 6 天和 14 天给药);方案 5A 和 5B(对照组和 Cfz,间歇性剂量在第 0 天、第 1 天[5A]和第 0 天、第 1 天、第 7 天和第 8 天[5B],共 13 天);方案 6A 和 6B(药物干预;对照组、Cfz、Cfz+Met 和 Met 连续给药 2 天和 6 天);以及方案 7(硼替佐米)。Cfz 以 8mg/kg(腹腔内注射)给药,Met 以 140mg/kg(口服)给药。除了方案 5A 和 5B 之外,所有方案中 Cfz 导致心脏和外周血单核细胞中的蛋白酶体活性显著降低。超声心动图显示,Cfz 导致方案 2 和 3 的部分缩短率(FS)明显降低,方案 1 和 4 的功能接近异常,而对方案 5A 和 5B 则没有不利影响。分子分析表明,Cfz 通过增加的 PP2A 活性抑制了 AMPKα/mTORC1 通路,而在方案 3 中,它还抑制了磷酸肌醇 3-激酶/Akt/内皮型一氧化氮合酶通路。Met 的共同给药可预防 Cfz 诱导的 FS 降低,并恢复 AMPKα 磷酸化和自噬信号。总而言之,Cfz 通过增加的 PP2A 活性和抑制 AMPKα 及其下游自噬靶标来降低左心室功能,而 Met 是一种针对 Cfz 诱导的心脏毒性的新型有前途的干预措施。

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