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Cheng KH, Contreras GP, Yeh TY. Potential Role of Neutrophil Extracellular Traps in Cardio-Oncology. Int J Mol Sci 2022; 23:ijms23073573. [PMID: 35408933 PMCID: PMC8998890 DOI: 10.3390/ijms23073573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular toxicity has emerged as the leading cause of death in patients undergoing cancer treatment. Thus, cardio-oncology (CO) care must also focus on the prevention and management of related cardiovascular (CV) complications caused by cancer therapy. Neutrophil extracellular traps (NETs)—entities with released DNA, proteases, proinflammatory and prooxidative substances from blasted neutrophils—play an important role in cancer proliferation, propagation metastasis, and incident CV events (acute coronary syndrome, thromboembolic events, and heart failure). Although NETs have been shown to be involved in cancer progression and incident CV events, little is known about their relationship with cardio-oncology, especially on cancer treatment-related cardiovascular toxicity (CTRCT). This review aims to explore the evidence of the impact of NETs on cancer, CV events, and CTRCT, and the possible solutions based on the mechanism of NETs activation and NETs released toxic substances.
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Affiliation(s)
- Kai-Hung Cheng
- Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan;
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Gregory P. Contreras
- Auxergen Inc., Columbus Center, 701 East Pratt Street, Baltimore, MD 21202, USA;
| | - Ting-Yu Yeh
- Auxergen Inc., Columbus Center, 701 East Pratt Street, Baltimore, MD 21202, USA;
- Correspondence:
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Cheng KH, Wu YW, Hou CJY, Hung CM. An Overview of Cardio-Oncology, a New Frontier to Be Explored. ACTA CARDIOLOGICA SINICA 2021; 37:457-463. [PMID: 34584378 DOI: 10.6515/acs.202109_37(5).20210706a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022]
Abstract
Advances in cancer treatments have led to an increasing number of cancer survivors, but also high rates of short- and long-term cardiovascular (CV) toxicities. The number of new cancer drugs is constantly increasing, and the uncertain CV toxicities of these drugs make long-term care and monitoring difficult. Moreover, traditional type I and type II cardiotoxicities may not be applicable to all of these agents. Multidisciplinary care with expertise in oncology, cardiology and other related specialties is required to mitigate cancer therapeutics-related cardiovascular dysfunction (CTRCD). The aim of this review is to provide an overview of the main CTRCD, risk assessment, early diagnosis, and strategies for the prevention and management of patients receiving cancer therapies. There are still unmet needs for cardio- oncology researchers with regards to early detection measures, better treatment strategies, better follow-up protocols, and better management of CTRCD. Experts in cardiology, oncology, hematology, and radio-oncology should thus work closely in an attempt to foster patient awareness and research in this field, as well as call for support from public and industrial sources to initiate pivotal clinical trials to solve these unmet needs.
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Affiliation(s)
- Kai-Hung Cheng
- Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital.,College of Medicine, I-Shou University, Kaohsiung
| | - Yen-Wen Wu
- Department of Nuclear Medicine.,Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City.,School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Charles Jia-Yin Hou
- Department of Medicine, MacKay Medical College, New Taipei City.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei
| | - Chao-Ming Hung
- College of Medicine, I-Shou University, Kaohsiung.,Department of General Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan
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Protective Effects of Statin and Angiotensin Receptor Blocker in a Rat Model of Doxorubicin- and Trastuzumab-Induced Cardiomyopathy. J Am Soc Echocardiogr 2020; 33:1253-1263. [PMID: 32778498 DOI: 10.1016/j.echo.2020.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chemotherapy has led to improved survival in patients with breast cancer; however, it is associated with an increased risk of cardiac dysfunction and heart failure. We investigated the protective effects of rosuvastatin and candesartan, alone and in combination, in a doxorubicin- and trastuzumab-induced rat model of cardiomyopathy. METHODS Forty-two rats were allocated into six groups (G1-G6): G1, control; G2, doxorubicin only; G3, doxorubicin + trastuzumab; G4, doxorubicin + trastuzumab + rosuvastatin; G5, doxorubicin + trastuzumab + candesartan; and G6, doxorubicin + trastuzumab + rosuvastatin + candesartan. Doxorubicin and trastuzumab were sequentially administered for 28 days. Left ventricular end-systolic dimension and longitudinal strain (LS) were assessed via echocardiography. Left ventricular (LV) performance was evaluated using a microcatheter in the LV apex on day 28. Blood for biomarker analysis was collected from the inferior vena cava before sacrifice. RESULTS Doxorubicin in combination with trastuzumab increased the LV end-systolic dimension but worsened LS compared with the control group (all P < .05). The level of C-reactive protein was lower in the rosuvastatin treatment group (P = .007) than in the controls but not in the candesartan treatment group. Both rosuvastatin and candesartan attenuated the increase in glutathione. Candesartan treatment improved +dP/dt (P = .011), whereas rosuvastatin did not. In the combination treatment group, the worsening of LS was significantly attenuated compared with that in either the rosuvastatin or candesartan group (all P < .05). CONCLUSIONS In a rat model of doxorubicin- and trastuzumab-induced cardiomyopathy, rosuvastatin alleviated systemic inflammation, while candesartan improved LV performance. Combination therapy with rosuvastatin and candesartan demonstrated additional preventive effects on myocardial strain. The protective mechanisms of rosuvastatin and candesartan appear to be different but complementary in chemotherapy-induced cardiomyopathy.
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Lin K, Lengacher C. Anthracycline Chemotherapy–Induced Cardiotoxicity in Breast Cancer Survivors: A Systematic Review. Oncol Nurs Forum 2019; 46:E145-E158. [DOI: 10.1188/19.onf.e145-e158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bergamini C, Dolci G, Truong S, Zanolla L, Benfari G, Fiorio E, Rossi A, Ribichini FL. Role of Speckle Tracking Echocardiography in the Evaluation of Breast Cancer Patients Undergoing Chemotherapy: Review and Meta-analysis of the Literature. Cardiovasc Toxicol 2019; 19:485-492. [DOI: 10.1007/s12012-019-09523-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yazaki K, Takahashi K, Shigemitsu S, Yamada M, Iso T, Kobayashi M, Akimoto K, Tamaichi H, Fujimura J, Saito M, Nii M, Shimizu T. In-Depth Insight Into the Mechanisms of Cardiac Dysfunction in Patients With Childhood Cancer After Anthracycline Treatment Using Layer-Specific Strain Analysis. Circ J 2018; 82:715-723. [DOI: 10.1253/circj.cj-17-0874] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kana Yazaki
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine
| | | | - Mariko Yamada
- Department of Pediatrics, Juntendo University Faculty of Medicine
| | - Takeshi Iso
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine
| | - Maki Kobayashi
- Department of Pediatrics, Juntendo University Faculty of Medicine
| | - Katsumi Akimoto
- Department of Pediatrics, Juntendo University Faculty of Medicine
| | | | - Junya Fujimura
- Department of Pediatrics, Juntendo University Faculty of Medicine
| | - Masahiro Saito
- Department of Pediatrics, Juntendo University Faculty of Medicine
| | - Masaki Nii
- Department of Cardiology, Shizuoka Children’s Hospital
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine
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Tadic M, Genger M, Baudisch A, Kelle S, Cuspidi C, Belyavskiy E, Burkhardt F, Venneri L, Attanasio P, Pieske B. Left Ventricular Strain in Chemotherapy-Naive and Radiotherapy-Naive Patients With Cancer. Can J Cardiol 2017; 34:281-287. [PMID: 29395702 DOI: 10.1016/j.cjca.2017.11.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/26/2017] [Accepted: 11/26/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We sought to investigate left ventricular (LV) function and mechanics in patients with cancer before they received chemotherapy or radiotherapy, as well as the relationship between cancer and reduced LV multidirectional strain in the whole study population. METHODS The retrospective study involved 122 chemotherapy- and radiotherapy-naive patients with cancer and 45 age- and sex-matched controls with a cardiovascular risk profile similar to that of the patients with cancer. All the patients underwent echocardiographic examination before introduction of chemotherapy or radiotherapy. RESULTS LV longitudinal (-19.1% ± 2.1% vs -17.8% ± 3.5%; P = 0.022), circumferential (-22.9% ± 3.5% vs -20.1% ± 4.1%; P < 0.001), and radial (40.5% ± 8.8% vs 35.2% ± 10.7%; P = 0.004) strain was significantly lower in the patients with cancer than in the control group. Endocardial and midmyocardial longitudinal LV strain was significantly reduced in the patients with cancer compared with the controls, whereas epicardial longitudinal strain was similar between these groups. Endocardial, midmyocardial, and epicardial circumferential strain was significantly lower in the chemotherapy- or radiotherapy-naive patients with cancer than in the controls. Cancer was associated with reduced longitudinal (odds ratio [OR], 9.0; 95% confidence interval [CI], 2.20-23.50; P < 0.001), reduced circumferential (OR, 7.1; 95% CI, 3.80-20.40; P < 0.001), and reduced radial strain (OR, 7.2; 95% CI, 3.41-25.10; P < 0.001) independent of age, sex, body mass index, diabetes, and hypertension. CONCLUSIONS LV mechanics was impaired in the patients with cancer compared with the controls even before initiation of chemotherapy and radiotherapy. Cancer and hypertension were associated with reduced LV multidirectional strain independent of other clinical parameters. The present results indicate that cancer itself potentially induces cardiac remodelling independent of chemotherapy and radiotherapy.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany.
| | - Martin Genger
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Ana Baudisch
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, DeutschesHerzzentrum Berlin (DHZB), Berlin, Germany
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
| | - Evgeny Belyavskiy
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Franziska Burkhardt
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Lucia Venneri
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | - Philipp Attanasio
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Burkert Pieske
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Berlin/Charité, Berlin, Germany; Department of Cardiology, DeutschesHerzzentrum Berlin (DHZB), Berlin, Germany
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