Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
University of Toronto, Institute of Medical Science, Toronto, Canada.
Clin Sci (Lond). 2021 Jun 25;135(12):1487-1503. doi: 10.1042/CS20210059.
Significant improvements in cancer survival have brought to light unintended long-term adverse cardiovascular effects associated with cancer treatment. Although capable of manifesting a broad range of cardiovascular complications, cancer therapy-related cardiac dysfunction (CTRCD) remains particularly common among the mainstay anthracycline-based and human epidermal growth factor receptor-targeted therapies. Unfortunately, the early asymptomatic stages of CTRCD are difficult to detect by cardiac imaging alone, and the initiating mechanisms remain incompletely understood. More recently, circulating inflammatory markers, cardiac biomarkers, microRNAs, and extracellular vesicles (EVs) have been considered as early markers of cardiovascular injury. Concomitantly, the role of the endothelium in regulating cardiac function in the context of CTRCD is starting to be understood. In this review, we highlight the impact of breast cancer therapies on the cardiovascular system with a focus on the endothelium, and examine the status of circulating biomarkers, including inflammatory markers, cardiac biomarkers, microRNAs, and endothelial cell-derived EVs. Investigation of these emerging biomarkers may uncover mechanisms of injury, detect early stages of cardiovascular damage, and elucidate novel therapeutic approaches.
癌症存活率的显著提高凸显了与癌症治疗相关的意外的长期不良心血管影响。尽管癌症治疗相关的心脏功能障碍 (CTRCD) 能够表现出广泛的心血管并发症，但它在基于蒽环类药物和人表皮生长因子受体靶向治疗的主要治疗方法中仍然特别常见。不幸的是，CTRCD 的早期无症状阶段仅通过心脏成像很难检测到，并且其起始机制仍不完全清楚。最近，循环炎症标志物、心脏生物标志物、microRNAs 和细胞外囊泡 (EVs) 被认为是心血管损伤的早期标志物。同时，内皮在 CTRCD 背景下调节心脏功能的作用开始被理解。在这篇综述中，我们重点关注内皮细胞，强调了乳腺癌治疗对心血管系统的影响，并检查了循环生物标志物的状况，包括炎症标志物、心脏生物标志物、microRNAs 和内皮细胞衍生的 EVs。对这些新兴生物标志物的研究可能揭示损伤机制，检测心血管损伤的早期阶段，并阐明新的治疗方法。
