The Second Department of Cardiology, The Third Hospital of Nanchang, Nanchang 330009, China.
Department of Cardiology, and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai 200032, China; National Clinical Research Center for Interventional Medicine, Shanghai 200032, China.
Life Sci. 2023 Jan 1;312:121207. doi: 10.1016/j.lfs.2022.121207. Epub 2022 Nov 17.
Trastuzumab (TZM) is commonly used for target therapy in breast cancer patients with high HER2 although the cardiotoxicity restricts its clinical usage. DNA damage and ferroptosis are implicated in anti-tumor drug cardiotoxicity. Given the emerging use of SGLT2 inhibitors in clinical cardiology, this study evaluated the impact of SGLT2 inhibitor Empagliflozin on TZM-induced cardiotoxicity, and mechanism involved with a focus on DNA damage and ferroptosis. Adult C57BL/6 mice were challenged with TZM (10 mg/kg/week, i.p.) or saline for six weeks. A cohort of mice received Empagliflozin (10 mg/kg, i.p.) at the same time. Myocardial function, morphology, ultrastructure, mitochondrial integrity, oxidative stress, DNA damage and various cell death domains were evaluated in TZM-challenged mice with or without Empagliflozin treatment. Our data revealed that TZM challenge overtly increased levels of serum LDH and troponin I, promoted adverse myocardial remodeling (increased heart weight, chamber size, cardiomyocyte area and interstitial fibrosis), contractile dysfunction and intracellular Ca mishandling, oxidative stress, lipid peroxidation, mitochondrial ultrastructural damage, DNA damage, apoptosis and ferroptosis, the effects of which were greatly attenuated or mitigated by Empagliflozin with little effects from Empagliflozin itself. In vitro study indicated that induction of DNA damage mimicked TZM-induced lipid peroxidation and cardiomyocyte contractile dysfunction while the ferroptosis inducer erastin mitigated Empagliflozin-offered protection against lipid peroxidation and cardiomyocyte dysfunction (but not DNA damage). Likewise, in vivo and in vitro inhibition of ferroptosis recapitulated Empagliflozin-offered cardioprotection against TZM exposure. Taken together, these data demonstrated that Empagliflozin may be possible candidate drug for TZM cardiotoxicity likely through a DNA damage-ferroptosis-mediated mechanism.
曲妥珠单抗(TZM)常用于治疗 HER2 高表达的乳腺癌患者的靶向治疗,但心脏毒性限制了其临床应用。DNA 损伤和铁死亡与抗肿瘤药物的心脏毒性有关。鉴于 SGLT2 抑制剂在临床心脏病学中的新兴应用,本研究评估了 SGLT2 抑制剂恩格列净对 TZM 诱导的心脏毒性的影响,以及涉及 DNA 损伤和铁死亡的机制。成年 C57BL/6 小鼠接受 TZM(10mg/kg/周,腹腔注射)或生理盐水处理 6 周。一组小鼠同时接受恩格列净(10mg/kg,腹腔注射)治疗。在 TZM 处理的小鼠中评估心肌功能、形态、超微结构、线粒体完整性、氧化应激、DNA 损伤和各种细胞死亡域,同时评估有无恩格列净治疗。我们的数据显示,TZM 处理明显增加血清 LDH 和肌钙蛋白 I 水平,促进不良的心肌重构(增加心脏重量、心室大小、心肌细胞面积和间质纤维化)、收缩功能障碍和细胞内 Ca 处理异常、氧化应激、脂质过氧化、线粒体超微结构损伤、DNA 损伤、细胞凋亡和铁死亡,而恩格列净显著减轻或缓解了这些作用,恩格列净本身的作用很小。体外研究表明,DNA 损伤的诱导模拟了 TZM 诱导的脂质过氧化和心肌细胞收缩功能障碍,而铁死亡诱导剂 erastin 减轻了恩格列净对脂质过氧化和心肌细胞功能障碍(但不是 DNA 损伤)的保护作用。同样,体内和体外抑制铁死亡再现了恩格列净对 TZM 暴露的心脏保护作用。总之,这些数据表明,恩格列净可能是 TZM 心脏毒性的潜在候选药物,可能通过 DNA 损伤-铁死亡介导的机制。
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