Damage to cardiac vasculature may be associated with breast cancer treatment-induced cardiotoxicity
Abstract Background Breast cancer is the most common female cancer worldwide. Effective therapies including doxorubicin and trastuzumab have improved survival, but are associated with a substantial risk of cardiovascular disease. Mechanisms underlying cancer treatment-induced cardiotoxicity (CTC) ar...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-04-01
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| Series: | Cardio-Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40959-021-00100-3 |
| _version_ | 1818451488008044544 |
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| author | Rebecca K. Hoffman Bang-Jin Kim Payal D. Shah Joseph Carver Bonnie Ky Sandra Ryeom |
| author_facet | Rebecca K. Hoffman Bang-Jin Kim Payal D. Shah Joseph Carver Bonnie Ky Sandra Ryeom |
| author_sort | Rebecca K. Hoffman |
| collection | DOAJ |
| description | Abstract Background Breast cancer is the most common female cancer worldwide. Effective therapies including doxorubicin and trastuzumab have improved survival, but are associated with a substantial risk of cardiovascular disease. Mechanisms underlying cancer treatment-induced cardiotoxicity (CTC) are poorly understood and have largely focused on cardiomyocyte damage, although other cellular populations in the heart such as the cardiac endothelium, may play an important role in cardiac damage. We treated a breast tumor-bearing mouse model with doxorubicin and trastuzumab to investigate the role of the cardiac endothelium in the development of CTC. Methods Immune compromised mice were inoculated in the 4th mammary fat pad with human breast cancer cells overexpressing HER2 (BT474). When tumors were palpable, mice were treated weekly with doxorubicin (5 mg/kg) and trastuzumab (4 mg/kg). The cardiac phenotype of mice was assessed by echocardiography and histological evaluation of the heart. Cardiac vascular damage was assayed by in vivo permeability assays and primary cultures of murine cardiac endothelial cells were used to assay doxorubicin toxicity in vitro. Results The growth of BT474 breast tumors in Balb/c Nude mice was suppressed upon treatment with doxorubicin and trastuzumab. Mice treated for 4 months with doxorubicin and trastuzumab maintained body weights, but demonstrated an echocardiographic phenotype consistent with preserved left ventricular (LV) ejection fraction, decreased LV mass and increased filling pressures (E/e’). Histological staining with Masson’s trichrome and Picrosirius red showed extensive fibrosis and increased collagen deposition in the ventricular myocardium surrounding blood vessels of treated mice compared to untreated mice. Evans blue permeability assays demonstrated increased cardiac vasculature permeability while primary cardiac endothelial cells exposed to doxorubicin in vitro showed increased cell death as compared to lung or liver endothelial cells. Conclusions An orthotopic mouse model of human breast cancer in Nude mice treated with doxorubicin and trastuzumab resulted in a cardiac vascular defect accompanied by preserved LV ejection fraction, decreased LV mass, suggesting mild diastolic dysfunction and cardiac remodeling consistent with subclinical cardiotoxicity. Our data suggest that cardiac endothelium is more sensitive to doxorubicin therapy as compared to other organ endothelium and cardiac endothelial damage may correlate with breast cancer treatment-induced cardiotoxicity. |
| first_indexed | 2024-12-14T21:07:59Z |
| format | Article |
| id | doaj.art-c438f4ad1cb2412487e4b6afafff1839 |
| institution | Directory Open Access Journal |
| issn | 2057-3804 |
| language | English |
| last_indexed | 2024-12-14T21:07:59Z |
| publishDate | 2021-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardio-Oncology |
| spelling | doaj.art-c438f4ad1cb2412487e4b6afafff18392022-12-21T22:47:22ZengBMCCardio-Oncology2057-38042021-04-017111310.1186/s40959-021-00100-3Damage to cardiac vasculature may be associated with breast cancer treatment-induced cardiotoxicityRebecca K. Hoffman0Bang-Jin Kim1Payal D. Shah2Joseph Carver3Bonnie Ky4Sandra Ryeom5Department of Cancer Biology, Perelman School of Medicine at the University of PennsylvaniaDepartment of Cancer Biology, Perelman School of Medicine at the University of PennsylvaniaDivision of Hematology-Oncology, Department of Medicine, Perelman School of Medicine at the University of PennsylvaniaCardio-Oncology Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of PennsylvaniaCardio-Oncology Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of PennsylvaniaDepartment of Cancer Biology, Perelman School of Medicine at the University of PennsylvaniaAbstract Background Breast cancer is the most common female cancer worldwide. Effective therapies including doxorubicin and trastuzumab have improved survival, but are associated with a substantial risk of cardiovascular disease. Mechanisms underlying cancer treatment-induced cardiotoxicity (CTC) are poorly understood and have largely focused on cardiomyocyte damage, although other cellular populations in the heart such as the cardiac endothelium, may play an important role in cardiac damage. We treated a breast tumor-bearing mouse model with doxorubicin and trastuzumab to investigate the role of the cardiac endothelium in the development of CTC. Methods Immune compromised mice were inoculated in the 4th mammary fat pad with human breast cancer cells overexpressing HER2 (BT474). When tumors were palpable, mice were treated weekly with doxorubicin (5 mg/kg) and trastuzumab (4 mg/kg). The cardiac phenotype of mice was assessed by echocardiography and histological evaluation of the heart. Cardiac vascular damage was assayed by in vivo permeability assays and primary cultures of murine cardiac endothelial cells were used to assay doxorubicin toxicity in vitro. Results The growth of BT474 breast tumors in Balb/c Nude mice was suppressed upon treatment with doxorubicin and trastuzumab. Mice treated for 4 months with doxorubicin and trastuzumab maintained body weights, but demonstrated an echocardiographic phenotype consistent with preserved left ventricular (LV) ejection fraction, decreased LV mass and increased filling pressures (E/e’). Histological staining with Masson’s trichrome and Picrosirius red showed extensive fibrosis and increased collagen deposition in the ventricular myocardium surrounding blood vessels of treated mice compared to untreated mice. Evans blue permeability assays demonstrated increased cardiac vasculature permeability while primary cardiac endothelial cells exposed to doxorubicin in vitro showed increased cell death as compared to lung or liver endothelial cells. Conclusions An orthotopic mouse model of human breast cancer in Nude mice treated with doxorubicin and trastuzumab resulted in a cardiac vascular defect accompanied by preserved LV ejection fraction, decreased LV mass, suggesting mild diastolic dysfunction and cardiac remodeling consistent with subclinical cardiotoxicity. Our data suggest that cardiac endothelium is more sensitive to doxorubicin therapy as compared to other organ endothelium and cardiac endothelial damage may correlate with breast cancer treatment-induced cardiotoxicity.https://doi.org/10.1186/s40959-021-00100-3Breast cancerChemotherapy-induced toxicityDoxorubicinCardiac vasculatureEndothelial cells |
| spellingShingle | Rebecca K. Hoffman Bang-Jin Kim Payal D. Shah Joseph Carver Bonnie Ky Sandra Ryeom Damage to cardiac vasculature may be associated with breast cancer treatment-induced cardiotoxicity Cardio-Oncology Breast cancer Chemotherapy-induced toxicity Doxorubicin Cardiac vasculature Endothelial cells |
| title | Damage to cardiac vasculature may be associated with breast cancer treatment-induced cardiotoxicity |
| title_full | Damage to cardiac vasculature may be associated with breast cancer treatment-induced cardiotoxicity |
| title_fullStr | Damage to cardiac vasculature may be associated with breast cancer treatment-induced cardiotoxicity |
| title_full_unstemmed | Damage to cardiac vasculature may be associated with breast cancer treatment-induced cardiotoxicity |
| title_short | Damage to cardiac vasculature may be associated with breast cancer treatment-induced cardiotoxicity |
| title_sort | damage to cardiac vasculature may be associated with breast cancer treatment induced cardiotoxicity |
| topic | Breast cancer Chemotherapy-induced toxicity Doxorubicin Cardiac vasculature Endothelial cells |
| url | https://doi.org/10.1186/s40959-021-00100-3 |
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