蒽环类药物引起的心脏毒性和衰老。

Anthracycline-induced cardiotoxicity and senescence.

作者信息

Booth Laura K, Redgrave Rachael E, Folaranmi Omowumi, Gill Jason H, Richardson Gavin D

机构信息

School of Pharmacy, Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Newcastle University, Newcastle upon Tyne, United Kingdom.

Biosciences Institute, Vascular Biology and Medicine Theme, Newcastle University, Newcastle upon Tyne, United Kingdom.

出版信息

Front Aging. 2022 Nov 14;3:1058435. doi: 10.3389/fragi.2022.1058435. eCollection 2022.

Abstract

Cancer continues to place a heavy burden on healthcare systems around the world. Although cancer survivorship continues to improve, cardiotoxicity leading to cardiomyopathy and heart failure as a consequence of cancer therapy is rising, and yesterday's cancer survivors are fast becoming today's heart failure patients. Although the mechanisms driving cardiotoxicity are complex, cellular senescence is gaining attention as a major contributor to chemotherapy-induced cardiotoxicity and, therefore, may also represent a novel therapeutic target to prevent this disease. Cellular senescence is a well-recognized response to clinical doses of chemotherapies, including anthracyclines, and is defined by cell cycle exit, phenotypic alterations which include mitochondrial dysfunction, and the expression of the pro-senescent, pro-fibrotic, and pro-inflammatory senescence-associated phenotype. Senescence has an established involvement in promoting myocardial remodeling during aging, and studies have demonstrated that the elimination of senescence can attenuate the pathophysiology of several cardiovascular diseases. Most recently, pharmacology-mediated elimination of senescence, using a class of drugs termed senolytics, has been demonstrated to prevent myocardial dysfunction in preclinical models of chemotherapy-induced cardiotoxicity. In this review, we will discuss the evidence that anthracycline-induced senescence causes the long-term cardiotoxicity of anticancer chemotherapies, consider how the senescent phenotype may promote myocardial dysfunction, and examine the exciting possibility that targeting senescence may prove a therapeutic strategy to prevent or even reverse chemotherapy-induced cardiac dysfunction.

摘要

癌症继续给全球医疗系统带来沉重负担。尽管癌症幸存者的生存率持续提高,但因癌症治疗导致的心脏毒性,进而引发心肌病和心力衰竭的情况却在增加,昔日的癌症幸存者正迅速成为如今的心力衰竭患者。尽管导致心脏毒性的机制复杂,但细胞衰老作为化疗诱导心脏毒性的主要促成因素正受到关注,因此,它也可能代表一种预防该疾病的新治疗靶点。细胞衰老是对包括蒽环类药物在内的临床剂量化疗的一种公认反应,其定义为细胞周期停滞、包括线粒体功能障碍在内的表型改变,以及衰老相关表型(包括促衰老、促纤维化和促炎症表型)的表达。衰老在衰老过程中已被证实参与促进心肌重塑,并且研究表明消除衰老可减轻几种心血管疾病的病理生理过程。最近,在化疗诱导心脏毒性的临床前模型中,已证明使用一类称为衰老溶解剂的药物通过药理学方法消除衰老可预防心肌功能障碍。在这篇综述中,我们将讨论蒽环类药物诱导的衰老导致抗癌化疗长期心脏毒性的证据,思考衰老表型如何促进心肌功能障碍,并探讨靶向衰老可能成为预防甚至逆转化疗诱导心脏功能障碍的治疗策略这一令人兴奋的可能性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f6a/9701822/387170f5b767/fragi-03-1058435-g001.jpg

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