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Zhao LY, Wang XY, Wen ML, Pan NN, Yin XQ, An MW, Wang L, Liu Y, Song JB. Advances in injectable hydrogels for radiation-induced heart disease. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2024; 35:1031-1063. [PMID: 38340315 DOI: 10.1080/09205063.2024.2314364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
Radiological heart damage (RIHD) is damage caused by unavoidable irradiation of the heart during chest radiotherapy, with a long latency period and a progressively increasing proportion of delayed cardiac damage due to conventional doses of chest radiotherapy. There is a risk of inducing diseases such as acute/chronic pericarditis, myocarditis, delayed myocardial fibrosis and damage to the cardiac conduction system in humans, which can lead to myocardial infarction or even death in severe cases. This paper details the pathogenesis of RIHD and gives potential targets for treatment at the molecular and cellular level, avoiding the drawbacks of high invasiveness and immune rejection due to drug therapy, medical device implantation and heart transplantation. Injectable hydrogel therapy has emerged as a minimally invasive tissue engineering therapy to provide necessary mechanical support to the infarcted myocardium and to act as a carrier for various bioactive factors and cells to improve the cellular microenvironment in the infarcted area and induce myocardial tissue regeneration. Therefore, this paper combines bioactive factors and cellular therapeutic mechanisms with injectable hydrogels, presents recent advances in the treatment of cardiac injury after RIHD with different injectable gels, and summarizes the therapeutic potential of various types of injectable hydrogels as a potential solution.
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Affiliation(s)
- Lu-Yao Zhao
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan, China
| | - Xin-Yue Wang
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan, China
| | - Mei-Ling Wen
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan, China
| | - Ning-Ning Pan
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan, China
| | - Xing-Qi Yin
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan, China
| | - Mei-Wen An
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan, China
| | - Li Wang
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan, China
| | - Yang Liu
- Institute of Biomedical Engineering, College of Biomedical Engineering, Taiyuan University of Technology, Shanxi Key Laboratory of Material Strength & Structural Impact, Taiyuan, China
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jian-Bo Song
- Shanghai NewMed Medical Corporation, Shanghai, China
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2
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Che M, Duan Y, Yin R. A bibliometric analysis of cardiotoxicity in cancer radiotherapy. Front Oncol 2024; 14:1362673. [PMID: 38655134 PMCID: PMC11035836 DOI: 10.3389/fonc.2024.1362673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Background Radiotherapy, a primary treatment for malignant cancer, presents significant clinical challenges globally due to its associated adverse effects, especially with the increased survival rates of cancer patients. Radiation induced heart disease (RIHD) significantly impacts the long-term survival and quality of life of cancer survivors as one of the most devastating consequences. Quite a few studies have been conducted on preclinical and clinical trials of RIHD, showing promising success to some extent. However, no researchers have performed a comprehensive bibliometric study so far. Objective This study attempts to gain a deeper understanding of the focal points and patterns in RIHD research and to pinpoint prospective new research avenues using bibliometrics. Methods The study group obtained related 1554 publications between 1990 and 2023 on the Web of Science Core Collection (WOSCC) through a scientific search query. Visualization tools like CiteSpace and VOSviewer were utilized to realize the visual analysis of countries, authors, journals, references and keywords, identifying the hotspots and frontiers in this research field. Results After collecting all the data, a total of 1554 documents were categorized and analyzed using the above tools. The annual number of publications in the field of RIHD shows a continuous growth trend. In 2013, there was a significant rise in the number of linked publications, with the majority of authors being from the USA, according to the statistics. Among all the journals, INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS published the most relevant papers. Cluster analysis of the references showed that research on RIHD has focused on breast cancer, non-small cell lung cancer (NSCLC), and Hodgkin's lymphoma (also among the three main clusters), preclinical research, childhood cancer, heart dose, coronary artery disease, etc, which are also hot topics in the field. High-frequency keywords in the analysis include risk factors, cancer types, heart disease, survival, trials, proton therapy (PT), etc. Conclusion Future research on RIHD will mostly focus on thoracic cancer, whose exact cause is yet unknown, with preclinical trials playing an important role. Preventing, consistently monitoring, promptly diagnosing, and timely treating are crucial to decreasing RIHD and extending the life expectancy of cancer survivors.
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Affiliation(s)
- Mengting Che
- Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Yuanqiong Duan
- Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Rutie Yin
- Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
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3
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Verhaegen F, Butterworth KT, Chalmers AJ, Coppes RP, de Ruysscher D, Dobiasch S, Fenwick JD, Granton PV, Heijmans SHJ, Hill MA, Koumenis C, Lauber K, Marples B, Parodi K, Persoon LCGG, Staut N, Subiel A, Vaes RDW, van Hoof S, Verginadis IL, Wilkens JJ, Williams KJ, Wilson GD, Dubois LJ. Roadmap for precision preclinical x-ray radiation studies. Phys Med Biol 2023; 68:06RM01. [PMID: 36584393 DOI: 10.1088/1361-6560/acaf45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/30/2022] [Indexed: 12/31/2022]
Abstract
This Roadmap paper covers the field of precision preclinical x-ray radiation studies in animal models. It is mostly focused on models for cancer and normal tissue response to radiation, but also discusses other disease models. The recent technological evolution in imaging, irradiation, dosimetry and monitoring that have empowered these kinds of studies is discussed, and many developments in the near future are outlined. Finally, clinical translation and reverse translation are discussed.
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Affiliation(s)
- Frank Verhaegen
- MAASTRO Clinic, Radiotherapy Division, GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
- SmART Scientific Solutions BV, Maastricht, The Netherlands
| | - Karl T Butterworth
- Patrick G. Johnston, Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Anthony J Chalmers
- School of Cancer Sciences, University of Glasgow, Glasgow G61 1QH, United Kingdom
| | - Rob P Coppes
- Departments of Biomedical Sciences of Cells & Systems, Section Molecular Cell Biology and Radiation Oncology, University Medical Center Groningen, University of Groningen, 9700 AD Groningen, The Netherlands
| | - Dirk de Ruysscher
- MAASTRO Clinic, Radiotherapy Division, GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sophie Dobiasch
- Department of Radiation Oncology, Technical University of Munich (TUM), School of Medicine and Klinikum rechts der Isar, Germany
- Department of Medical Physics, Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Germany
| | - John D Fenwick
- Department of Medical Physics & Biomedical Engineering University College LondonMalet Place Engineering Building, London WC1E 6BT, United Kingdom
| | | | | | - Mark A Hill
- MRC Oxford Institute for Radiation Oncology, University of Oxford, ORCRB Roosevelt Drive, Oxford OX3 7DQ, United Kingdom
| | - Constantinos Koumenis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Kirsten Lauber
- Department of Radiation Oncology, University Hospital, LMU München, Munich, Germany
- German Cancer Consortium (DKTK), Partner site Munich, Germany
| | - Brian Marples
- Department of Radiation Oncology, University of Rochester, NY, United States of America
| | - Katia Parodi
- German Cancer Consortium (DKTK), Partner site Munich, Germany
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Garching b. Munich, Germany
| | | | - Nick Staut
- SmART Scientific Solutions BV, Maastricht, The Netherlands
| | - Anna Subiel
- National Physical Laboratory, Medical Radiation Science Hampton Road, Teddington, Middlesex, TW11 0LW, United Kingdom
| | - Rianne D W Vaes
- MAASTRO Clinic, Radiotherapy Division, GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Ioannis L Verginadis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jan J Wilkens
- Department of Radiation Oncology, Technical University of Munich (TUM), School of Medicine and Klinikum rechts der Isar, Germany
- Physics Department, Technical University of Munich (TUM), Germany
| | - Kaye J Williams
- Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom
| | - George D Wilson
- Department of Radiation Oncology, Beaumont Health, MI, United States of America
- Henry Ford Health, Detroit, MI, United States of America
| | - Ludwig J Dubois
- The M-Lab, Department of Precision Medicine, GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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Zafar MR, Sharma A, Sunder SS, Karthikeyan B, Nagahama M, Atia A, Bahuva R, Pokharel S, Iyer V, Kattel S, Sharma UC. Left atrial appendage volume as a prognostic Indicator of long-term mortality in Cancer survivors treated with thoracic radiation. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:2. [PMID: 36641509 PMCID: PMC9840329 DOI: 10.1186/s40959-023-00155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/09/2023] [Indexed: 01/16/2023]
Abstract
BACKGROUND Cancer survivors with prior chest radiation therapy (CXRT) frequently present with atrial fibrillation, heart failure, and have higher overall long-term mortality. There are no data examining the utility of left atrial (LA) and LA appendage (LAA) volume-indices to predict clinical outcomes in these patients. OBJECTIVES We examined the prognostic value of cardiac phase-dependent 3-D volume-rendered cardiac computerized tomography (CT)-derived LA and LAA volume-indices to predict mortality and major adverse cardiac events (MACE) in cancer survivors treated with thoracic irradiation. METHOD We screened 625 consecutive patients with severe aortic stenosis who had undergone transcatheter aortic valve replacement from 2012 to 2017. Based on the gated cardiac CT image quality, we included 184 patients (CXRT:43, non-CXRT:141) for further analysis. We utilized multiplane-3D-reconstructed cardiac CT images to calculate LA and LAA volume-indices, and examined the prognostic role of CCT-derived LA and LAA volume-indices in predicting the all-cause mortality, cardiovascular (CV) mortality, and MACE. We used multivariate cox-proportional hazard analysis to identify the clinical predictors of survival. RESULTS Overall, the CXRT group had significantly elevated LAA volume-index compared to non-CXRT group (CXRT:11.2 ± 8.9 ml/m2; non-CXRT:8.6 ± 4.5 ml/m2, p = 0.03). On multivariate cox-proportional hazard analysis, the elevated LAA volume and LAA volume-index were the strongest predictors of reduced survival in CXRT group compared to non-CXRT group (LAA volume: RR = 1.03,95% CI 1.0-1.01, p = 0.01; and LAA volume index: RR = 1.05, 95% CI 1.0-1.01, p = 0.03). LAA volume > 21.9 ml was associated with increased mortality. In contrast, LA volume was not a significant predictor of mortality. CONCLUSION We describe a novel technique to assess LA and LAA volume using 3-D volume-rendered cardiac CT. This study shows enlarged LAA volume rather than LA volume carries a poor prognosis in cancer-survivors treated with prior CXRT. Compared to conventionally reported markers, LAA volume of > 21.9 ml was incremental to that of other risk factors.
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Affiliation(s)
- Meer R. Zafar
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
| | - Ashutosh Sharma
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
- grid.425214.40000 0000 9963 6690Department of Medicine at the Icahn School of Medicine, Mount Sinai Health System, New York, NY USA
| | - Sunitha Shyam Sunder
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
| | - Badri Karthikeyan
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
| | - Makoto Nagahama
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
- grid.415875.a0000 0004 0368 6175Division of Cardiology, Lehigh Valley Health Network, Allentown, PA USA
| | - Andrew Atia
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
| | - Ronak Bahuva
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
| | - Saraswati Pokharel
- grid.240614.50000 0001 2181 8635Department of Pathology and Laboratory Medicine, Roswell Park Comprehensive Cancer Centre, Buffalo, NY USA
| | - Vijay Iyer
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
| | - Sharma Kattel
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
- grid.47100.320000000419368710Department of Medicine, Division of Cardiology, Yale School of Medicine, New Haven, CT USA
| | - Umesh C. Sharma
- grid.273335.30000 0004 1936 9887Department of Medicine, Division of Cardiology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY USA
- Advanced Cardiovascular Imaging, Division of Cardiovascular Medicine, 875 Ellicott Street, Buffalo, New York, 14203 USA
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5
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Liang Z, Luo K, Wang Y, Zeng Q, Ling X, Wang S, Dragomir MP, Li Q, Yang H, Xi M, Chen B. Clinical and Dosimetric Predictors for Postoperative Cardiopulmonary Complications in Esophageal Squamous Cell Carcinoma Patients Receiving Neoadjuvant Chemoradiotherapy and Surgery. Ann Surg Oncol 2023; 30:529-538. [PMID: 36127527 DOI: 10.1245/s10434-022-12526-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy followed by esophagectomy is the standard treatment for patients with locally advanced esophageal squamous cell carcinoma (ESCC). This study explored correlations of clinical factors and dose-volume histogram (DVH) parameters with postoperative cardiopulmonary complications and predicted their risk by establishing a nomogram model. METHODS Clinical and DVH parameters of ESCC patients who underwent trimodality treatment from 2002 to 2020 were collected. Postoperative cardiopulmonary complications were recorded. Logistic regression analysis was applied, and a nomogram model was constructed. Area under the receiver operating characteristic (AUC) curve, calibration curve, and decision curve analyses were performed to evaluate the performance of the nomogram. RESULTS Of the 307 ESCC patients enrolled in this study, 65 (21.2%) experienced pulmonary complications and 57 (18.6%) experienced cardiac complications. The following six risk factors were identified as independent risk factors for pulmonary complications by multivariate logistic regression analyses in the integrated model: male sex (odds ratio [OR], 3.26; 95% confidence interval [CI], 1.27-9.70; P = 0.021), post-radiation therapy (RT) forced expiratory volume in 1 s (FEV1) (OR, 0.51; 95% CI 0.28-0.90; P = 0.023), mean lung dose (MLD) (OR, 1.13; 95% CI 1.01-1.28; P = 0.041), and pre-RT monocyte (OR, 8.36; 95% CI 1.23-11.7; P = 0.03). The AUC of this integrated model was 0.705 (95% CI 0.64-0.77). The paclitaxel and cisplatin (TP) concurrent chemotherapy regimen was the independent predictor of cardiac complication (OR, 2.50; 95% CI 1.22-5.55; P = 0.016). CONCLUSIONS For ESCC patients who underwent trimodality treatment, male sex, post-RT FEV1, MLD, and pre-RT monocyte were confirmed as significant predictors of postoperative pulmonary complications. A nomogram model including six risk factors was further established. The independent predictor of cardiac complication was TP concurrent chemotherapy.
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Affiliation(s)
- Zhaohui Liang
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.,Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong, People's Republic of China
| | - Kongjia Luo
- Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong, People's Republic of China.,State Key Laboratory of Oncology in South China, Department of Thoracic Surgery, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Yuting Wang
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Qiuli Zeng
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Xiuzhen Ling
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Sifen Wang
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.,Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong, People's Republic of China
| | - Mihnea P Dragomir
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Qiaoqiao Li
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.,Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong, People's Republic of China
| | - Hong Yang
- Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong, People's Republic of China.,State Key Laboratory of Oncology in South China, Department of Thoracic Surgery, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Mian Xi
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China. .,Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong, People's Republic of China.
| | - Baoqing Chen
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China. .,Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong, People's Republic of China.
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6
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Dreyfuss AD, Velalopoulou A, Avgousti H, Bell BI, Verginadis II. Preclinical models of radiation-induced cardiac toxicity: Potential mechanisms and biomarkers. Front Oncol 2022; 12:920867. [PMID: 36313656 PMCID: PMC9596809 DOI: 10.3389/fonc.2022.920867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 09/12/2022] [Indexed: 12/24/2022] Open
Abstract
Radiation therapy (RT) is an important modality in cancer treatment with >50% of cancer patients undergoing RT for curative or palliative intent. In patients with breast, lung, and esophageal cancer, as well as mediastinal malignancies, incidental RT dose to heart or vascular structures has been linked to the development of Radiation-Induced Heart Disease (RIHD) which manifests as ischemic heart disease, cardiomyopathy, cardiac dysfunction, and heart failure. Despite the remarkable progress in the delivery of radiotherapy treatment, off-target cardiac toxicities are unavoidable. One of the best-studied pathological consequences of incidental exposure of the heart to RT is collagen deposition and fibrosis, leading to the development of radiation-induced myocardial fibrosis (RIMF). However, the pathogenesis of RIMF is still largely unknown. Moreover, there are no available clinical approaches to reverse RIMF once it occurs and it continues to impair the quality of life of long-term cancer survivors. Hence, there is an increasing need for more clinically relevant preclinical models to elucidate the molecular and cellular mechanisms involved in the development of RIMF. This review offers an insight into the existing preclinical models to study RIHD and the suggested mechanisms of RIMF, as well as available multi-modality treatments and outcomes. Moreover, we summarize the valuable detection methods of RIHD/RIMF, and the clinical use of sensitive radiographic and circulating biomarkers.
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7
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Yin H, Zhao Y, Sun Y, Liu J, Han Y, Dai Z. Effectiveness of Proanthocyanidin plus Trimetazidine in the Treatment of Non-Small-Cell Lung Cancer with Radiation Heart Injury. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:2338622. [PMID: 35692580 PMCID: PMC9187471 DOI: 10.1155/2022/2338622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 12/11/2022]
Abstract
This study was intended to explore the effect of proanthocyanidin (PC) combined with trimetazidine in non-small-cell lung cancer (NSCLC) with radiation-induced heart damage (RIHD). It was a prospective randomized controlled study that 86 NSCLC patients with radiation treatment in Cangzhou People's Hospital from January 2019 and June 2021 were enrolled and randomized to either the control group or the study group via the random table method, 43 cases in each group. The control group received trimetazidine, and the study group additionally received PC. The incidence of RIHD-related clinical manifestation, RIHD-related ECG, and RIHD-related cardiac ultrasound change were all lower in the study group. After radiotherapy, the serum level of superoxide dismutase (SOD) was higher, and malondialdehyde (MDA) was lower in the study group when compared with the control group. After radiotherapy, the serum levels of brain natriuretic peptide (BNP), cardiac troponin (cTnT), creatine kinase (CK), and creatine kinase isoenzymes (CKMB) were all lower in the study group when compared with the control group. The efficacy of PC plus trimetazidine for NSCLC with RIHD is superior to trimetazidine alone, and it significantly mitigates radiation-induced inflammatory response and oxidative stress.
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Affiliation(s)
- Hang Yin
- Ward I, Department of Cardiovascular Medicine, Cangzhou People's Hospital, Cangzhou, China
| | - Yue Zhao
- Department II of Radiotherapy, Cangzhou Central Hospital, Cangzhou, China
| | - Yucui Sun
- Ward I, Department of Cardiovascular Medicine, Cangzhou People's Hospital, Cangzhou, China
| | - Jia Liu
- Ward I, Department of Cardiovascular Medicine, Cangzhou People's Hospital, Cangzhou, China
| | - Yingjun Han
- Ward I, Department of Cardiovascular Medicine, Cangzhou People's Hospital, Cangzhou, China
| | - Zhentao Dai
- Ward I, Department of Cardiovascular Medicine, Cangzhou People's Hospital, Cangzhou, China
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8
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Abd Elmonem HA, Mater SN, Eldeighdye SM. Protective role of vitamin D against radiation hazards in rats fed on high fat diet. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Yao Y, Chen LF, Li J, Chen J, Tian XL, Wang H, Mei ZJ, Xie CH, Zhong YH. Altered DNA Methylation and Gene Expression Profiles in Radiation-Induced Heart Fibrosis of Sprague-Dawley Rats. Radiat Res 2022; 198:154-161. [PMID: 35476803 DOI: 10.1667/rade-20-00130.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 04/08/2022] [Indexed: 11/03/2022]
Abstract
Radiation-induced heart disease (RIHD) is a serious side effect of radiotherapy for thoracic tumors. Advanced myocardial fibrosis in the late phase of RIHD can lead to myocardial remodeling, heart function impairing and heart failure, resulting in serious clinical consequences, and its pathogenesis remains vague. DNA methylation is one of the important epigenetic mechanisms which often occurs in response to environmental stimuli and is crucial in regulating gene expression. We hypothesized DNA methylation may contribute to pathogenesis in radiation-induced heart fibrosis (RIHF) and altered DNA methylation patterns probably influenced the genes expression in RIHF. In present study, we found genome-wide differences in DNA methylation status and RNA expression were demonstrated and we screened out 44 genes whose altered expression maybe were regulated by CpG island methylation within the gene promoter in RIHF of Sprague-Dawley rat by employing gene expression arrays and human CpG island microarrays. Gene expression and CpG island methylation levels of several candidate genes were further validated. Our investigation provided a new dimension to reveal the specific mechanisms of RIHF and explore the potential therapeutic targets for it.
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Affiliation(s)
- Ye Yao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Radiation Oncology and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China.,Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Li-Feng Chen
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jin Li
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cardiovascular Sciences, 1081HV Amsterdam, The Netherlands
| | - Jing Chen
- Department of Radiation Oncology and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China.,Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Xiao-Li Tian
- Department of Radiation Oncology and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China.,Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Hui Wang
- Department of Radiation Oncology and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China.,Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Zi-Jie Mei
- Department of Radiation Oncology and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China.,Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Cong-Hua Xie
- Department of Radiation Oncology and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China.,Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Ya-Hua Zhong
- Department of Radiation Oncology and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China.,Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
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10
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Wu Y, Liu L, Lv S, Wang Y, Wang S, Wang S, Zhang J, Wang J. Pyrrolidine Dithiocarbamate Might Mitigate Radiation-Induced Heart Damage at an Early Stage in Rats. Front Pharmacol 2022; 13:832045. [PMID: 35392554 PMCID: PMC8981468 DOI: 10.3389/fphar.2022.832045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Radiation-induced heart damage (RIHD) is becoming an increasing concern due to offsetting clinical benefits of radiotherapy to a certain extent. Pyrrolidine dithiocarbamate (PDTC) as an antioxidant has been implicated in cardioprotective effects. We aimed to investigate whether pyrrolidine dithiocarbamate could attenuate heart damage at an early stage post-irradiation and unveil the potential mechanisms. Methods: A total of 15 adult male Sprague-Dawley rats were randomized into the control, irradiation (IR), and PDTC plus irradiation (PDTC + IR) groups. Hearts were irradiated with a single fraction of 20.0 Gy. Rats received daily intraperitoneal injection of PDTC for 14 days. At the 14th day post-irradiation, echocardiography was performed, and rats were killed. Morphological damage was examined by hematoxylin-eosin (HE) stain and Masson's trichrome stain. The collagen volume fraction (CVF) was applied for semi-quantitative analysis. The protein levels were analyzed by Western blot and mRNA levels by quantitative real-time PCR. Results: No significant damage to systolic function of left ventricular was induced at an early stage post-irradiation. HE staining of cardiac tissue showed that the disordered arrangement of myocardial cells and abnormal cell infiltration were alleviated in the PDTC + IR group. The increased CVF in the irradiation group was inhibited in the PDTC + IR group (22.05 ± 2.64% vs. 9.99 ± 1.65%, p < 0.05). The protein levels of nuclear factor-kappa B (NF-κB), hypoxia-inducible factor-1α (HIF-1α), and COL-1 were downregulated after treatment with PDTC (p < 0.05), and there was a declining trend in the protein of the connective tissue growth factor (CTGF). The mRNA expression of NF-κB and HIF-1α in the PDTC plus irradiation group was lower than that in the irradiation group (p < 0.05), and there was a declining trend in the mRNA expression of the connective tissue growth factor and COL-1. Conclusion: PDTC alleviates myocardial cell disordered arrangement, abnormal cell infiltration, and pro-fibrotic change at an early stage in rats with radiation-induced heart damage. Such a protective effect is closely associated with the downregulation of NF-κB.
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Affiliation(s)
- Yajing Wu
- Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lina Liu
- Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shengliang Lv
- Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yi Wang
- Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shuai Wang
- Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Sheng Wang
- Hebei Key Laboratory of Neurophysiology, Shijiazhuang, China
| | - Jiandong Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jun Wang
- Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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11
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Guo H, Zhao X, Li H, Liu K, Jiang H, Zeng X, Chang J, Ma C, Fu Z, Lv X, Wang T, Guo H, Liu K, Su H, Li Y. GDF15 Promotes Cardiac Fibrosis and Proliferation of Cardiac Fibroblasts via the MAPK/ERK1/2 Pathway after Irradiation in Rats. Radiat Res 2021; 196:183-191. [PMID: 34019665 DOI: 10.1667/rade-20-00206.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 04/22/2021] [Indexed: 11/03/2022]
Abstract
Ionizing radiation exposure is associated with a risk of cardiac fibrosis; however, the underlying molecular mechanism remains unclear. Growth/differentiation factor-15 (GDF15), a fibroblast factor, is a divergent member of the transforming growth factor β superfamily. Next-generation sequencing analyses has revealed that Gdf15 is increased in cardiac fibroblasts during radiation-induced fibrosis. However, the role of Gdf15 in cardiac fibrosis remains unclear. In this study, we demonstrated that the upregulated expression of GDF15 in newborn rat cardiac fibroblasts and adult rats after irradiation could induce fibrosis, which was confirmed by the increased cell proliferation rate and the increased expression of fibrosis markers (Col1α and αSMA) in newborn rat cardiac fibroblasts after transfection with Gdf15 in vitro. Conversely, the downregulation of GDF15 inhibited cardiac fibrosis, as confirmed by G2/M-cell cycle arrest, suppression of cell proliferation, and low levels of Col1α and αSMA expression. We also found that suppressing the expression of Gdf15 in cardiac fibroblasts could lead to a decrease in CDK1 and inhibit phosphorylation of ERK1/2. Thus, GDF15 might promote cardiac fibroblast fibrosis through the MAPK/ERK1/2 pathway and thus contribute to the pathogenesis of radiation-induced heart disease.
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Affiliation(s)
- Huan Guo
- Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China.,School of Basic Medical Sciences, Lan Zhou University, Lanzhou, Gansu, People's Republic of China.,Gansu Provincial Academic Institute for Medical Sciences, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, People's Republic of China
| | - Xinke Zhao
- Department of Interventional Section, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China.,Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, People's Republic of China
| | - Haining Li
- Gansu Provincial Academic Institute for Medical Sciences, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, People's Republic of China
| | - Kedan Liu
- Gansu Provincial Academic Institute for Medical Sciences, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, People's Republic of China
| | - Hugang Jiang
- Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China
| | - Xiangting Zeng
- Lan Zhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Juan Chang
- Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China
| | - Chengxu Ma
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Zhaoyuan Fu
- Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China
| | - Xinfang Lv
- Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China
| | - Tao Wang
- Gansu Provincial Academic Institute for Medical Sciences, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, People's Republic of China
| | - Hongyun Guo
- Gansu Provincial Academic Institute for Medical Sciences, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, People's Republic of China
| | - Kai Liu
- Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China.,Department of Interventional Section, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China
| | - Haixiang Su
- Gansu Provincial Academic Institute for Medical Sciences, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, People's Republic of China
| | - Yingdong Li
- Gansu University of Chinese Medicine, Lanzhou, Gansu, People's Republic of China.,School of Basic Medical Sciences, Lan Zhou University, Lanzhou, Gansu, People's Republic of China
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12
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Zhang X, Pawlikowski M, Olivo-Marston S, Williams KP, Bower JK, Felix AS. Ten-year cardiovascular risk among cancer survivors: The National Health and Nutrition Examination Survey. PLoS One 2021; 16:e0247919. [PMID: 33661978 PMCID: PMC7932508 DOI: 10.1371/journal.pone.0247919] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/16/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cancer survivors have a higher risk of developing and dying from cardiovascular disease (CVD) compared to the general population. We sought to determine whether 10-year risk of atherosclerotic CVD (ASCVD) is elevated among those with vs. without a cancer history in a nationally representative U.S. sample. METHODS Participants aged 40-79 years with no CVD history were included from the 2007-2016 National Health and Nutrition Examination Survey. Cancer history was self-reported and 10-year risk of ASCVD was estimated using Pooled Cohort Equations. We used logistic regression to estimate associations between cancer history and odds of elevated (≥7.5%) vs. low (<7.5%) 10-year ASCVD risk. An interaction between age and cancer history was examined. RESULTS A total of 15,095 participants were included (mean age = 55.2 years) with 12.3% (n = 1,604) reporting a cancer history. Individuals with vs. without a cancer history had increased odds of elevated 10-year ASCVD risk (OR = 3.42, 95% CI: 2.51-4.66). Specifically, those with bladder/kidney, prostate, colorectal, lung, melanoma, or testicular cancer had a 2.72-10.47 higher odds of elevated 10-year ASCVD risk. Additionally, age was an effect modifier: a cancer history was associated with 1.24 (95% CI: 1.19-4.21) times higher odds of elevated 10-year ASCVD risk among those aged 60-69, but not with other age groups. CONCLUSIONS Adults with a history of self-reported cancer had higher 10-year ASCVD risk. ASCVD risk assessment and clinical surveillance of cardiovascular health following a cancer diagnosis could potentially reduce disease burden and prolong survival, especially for patients with specific cancers and high ASCVD risk.
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Affiliation(s)
- Xiaochen Zhang
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
| | - Meghan Pawlikowski
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Susan Olivo-Marston
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Karen Patricia Williams
- Martha S. Pitzer Center for Women, Children, and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, United States of America
| | - Julie K. Bower
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Ashley S. Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
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13
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Xie J, Zhao M, Wang C, Yong Y, Gu Z, Zhao Y. Rational Design of Nanomaterials for Various Radiation-Induced Diseases Prevention and Treatment. Adv Healthc Mater 2021; 10:e2001615. [PMID: 33506624 DOI: 10.1002/adhm.202001615] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/05/2020] [Indexed: 12/17/2022]
Abstract
Radiation treatments often unfavorably damage neighboring healthy organs and cause a series of radiation sequelae, such as radiation-induced hematopoietic system diseases, radiation-induced gastrointestinal diseases, radiation-induced lung diseases, and radiation-induced skin diseases. Recently, emerging nanomaterials have exhibited good superiority for these radiation-induced disease treatments. Given this background, the rational design principle of nanomaterials, which helps to optimize the therapeutic efficiency, has been an increasing need. Consequently, it is of great significance to perform a systematic summarization of the advances in this field, which can trigger the development of new high-performance nanoradioprotectors with drug efficiency maximization. Herein, this review highlights the advances and perspectives in the rational design of nanomaterials for preventing and treating various common radiation-induced diseases. Furthermore, the sources, clinical symptoms, and pathogenesis/injury mechanisms of these radiation-induced diseases will also be introduced. Furthermore, current challenges and directions for future efforts in this field are also discussed.
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Affiliation(s)
- Jiani Xie
- School of Food and Biological Engineering Chengdu University Chengdu 610106 China
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety Institute of High Energy Physics Chinese Academy of Sciences Beijing 100049 China
| | - Maoru Zhao
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety Institute of High Energy Physics Chinese Academy of Sciences Beijing 100049 China
- Center of Materials Science and Optoelectronics Engineering College of Materials Science and Optoelectronic Technology University of Chinese Academy of Sciences Beijing 100049 China
| | - Chengyan Wang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety Institute of High Energy Physics Chinese Academy of Sciences Beijing 100049 China
- Center of Materials Science and Optoelectronics Engineering College of Materials Science and Optoelectronic Technology University of Chinese Academy of Sciences Beijing 100049 China
| | - Yuan Yong
- College of Chemistry and Environment Protection Engineering Southwest Minzu University Chengdu 610041 China
| | - Zhanjun Gu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety Institute of High Energy Physics Chinese Academy of Sciences Beijing 100049 China
- Center of Materials Science and Optoelectronics Engineering College of Materials Science and Optoelectronic Technology University of Chinese Academy of Sciences Beijing 100049 China
- GBA Research Innovation Institute for Nanotechnology Guangdong 510700 China
| | - Yuliang Zhao
- Center of Materials Science and Optoelectronics Engineering College of Materials Science and Optoelectronic Technology University of Chinese Academy of Sciences Beijing 100049 China
- GBA Research Innovation Institute for Nanotechnology Guangdong 510700 China
- CAS Center for Excellence in Nanoscience National Center for Nanoscience and Technology of China Chinese Academy of Sciences Beijing 100190 China
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14
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Dreyfuss AD, Goia D, Shoniyozov K, Shewale SV, Velalopoulou A, Mazzoni S, Avgousti H, Metzler SD, Bravo PE, Feigenberg SJ, Ky B, Verginadis II, Koumenis C. A Novel Mouse Model of Radiation-Induced Cardiac Injury Reveals Biological and Radiological Biomarkers of Cardiac Dysfunction with Potential Clinical Relevance. Clin Cancer Res 2021; 27:2266-2276. [DOI: 10.1158/1078-0432.ccr-20-3882] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/03/2020] [Accepted: 02/01/2021] [Indexed: 11/16/2022]
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15
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Yan R, Li X, Song J, Guo M, Cai H, Wu Z, Wu P, Li L, Yang M, Wang Y, Li S. Metabolic Changes Precede Radiation-Induced Cardiac Remodeling in Beagles: Using Noninvasive 18F-FDG ( 18F-Fludeoxyglucose) and 13N-Ammonia Positron Emission Tomography/Computed Tomography Scans. J Am Heart Assoc 2020; 9:e016875. [PMID: 32914660 PMCID: PMC7727013 DOI: 10.1161/jaha.120.016875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background This study was performed to characterize the metabolic, functional, and structural cardiac changes in a canine model of radiation‐induced heart disease by serial in vivo imaging and ex vivo analyses. Methods and Results Thirty‐six dogs were randomly assigned to control or irradiated groups at 3 time points (months 3, 6, and 12 after radiation; each group comprised 6 dogs). The left anterior myocardium of dogs in irradiated groups was irradiated locally with a single dose of 20‐Gy X‐ray. The irradiated myocardial regions showed increased myocardial uptake of 18F‐FDG (18F‐fludeoxyglucose) in the irradiated beagles, but the increased uptake area decreased at months 6 and 12 compared with month 3 after radiation. Abnormality of myocardial perfusion and cardiac function were detected at month 6 after radiation. Compared with the control groups, the protein expression of GLUT4 (glucose transporter 4) was upregulated in the irradiated groups, correlating with significantly decreased CPT1 (carnitine acyltransferase 1) expression. Mitochondria degeneration, swelling, and count reduction in the irradiated groups were observed. The difference in CD68 of macrophage markers and the inflammatory cytokines (IL‐6 [interleukin 6], TNF‐α [tumor necrosis factor α]) between the irradiation and control groups was not significant. Furthermore, the progressive aggravation of apoptosis and fibrosis was displayed. Conclusions Elevated 18F‐FDG uptake occurred after irradiation and subsequently led to ventricular perfusion defects and dysfunction. The process was associated with myocardial metabolic substrate remodeling, cardiac muscle cell apoptosis, and myocardial fibrosis rather than inflammation.
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Affiliation(s)
- Rui Yan
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Xiang Li
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China.,Division of Nuclear Medicine Department of Biomedical Imaging and Image-Guided Therapy Medical University of Vienna Vienna Austria
| | - Jianbo Song
- Department of Radiotherapy Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) Taiyuan China
| | - Min Guo
- Department of Cardiology of First Hospital Shanxi Medical University Taiyuan China
| | - Honghong Cai
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Zhifang Wu
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Ping Wu
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Li Li
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Minfu Yang
- Department of Nuclear Medicine Beijing Chao-Yang Hospital Capital Medical University Beijing China
| | - Yuetao Wang
- Department of Nuclear Medicine The Third Affiliated Hospital of Soochow University The First People's Hospital of Changzhou Changzhou China
| | - Sijin Li
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China.,Province-Ministry Co-construction Cooperative Innovation Center of Precise Diagnosis and Treatment of Molecular Image Taiyuan China
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16
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Zhang GJ, Wei LH, Lu HW, Xiao YF, Wang WR, He YL, Wang XM, Tian JH. Study on the mechanism of anti-MIRI action of total flavones of Fructus Chorspondiatis by PET/CT imaging. Cardiovasc Diagn Ther 2020; 10:796-810. [PMID: 32968635 DOI: 10.21037/cdt-20-305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate anti myocardial ischemia/reperfusion injury (MIRI) action of total flavones of Fructus Chorspondiatis (TFFC) in rats by 13N-ammonia micro PET/CT imaging, etc. Methods Male Sprague-Dawley rats were randomly divided into 6 groups. Micro PET/CT imaging was performed before and after modeling to calculate the volume (VOI) and SUVmean of myocardial ischemic area. The oxidative stress index [(superoxide dismutase (SOD), malondialdehyde (MDA)] and the marker enzymes [creatine kinase (CK), lactate dehydrogenase (LDH)] of myocardial injury were detected. The pathological changes of myocardial were observed via HE staining. A MIRI model of rat cardiomyocytes in vitro was established, the damage and apoptosis of myocardial cells in each group were observed, and the apoptosis rate of cardiomyocytes was detected. Results The imaging viscosities of the imaging agents were observed at 24 and 48 h in each group. The VOI of 24 h imaging was (6.33±2.02), (6.01±1.56) and (3.32±0.86) mm3, respectively. The VOI of 48 h imaging was (3.31±1.33), (2.61±1.01) and (1.32±0.58) mm3. The 72 h imaging medium and high dose group recovered, while the low dose group still saw sparseness with (1.26±0.68) mm3 VOI. The ischemic (SUVmean) gradually increased with time. Metabolism gradually recovered (F=121.82, 450.82, 435.75, P<0.05). The three doses of TFFC can eliminate free radicals and reduce the damage of myocardial injury. Amongst them, the high-dose group had a better effect on SOD, and the middle-dose group had a better effect on MDA and LDH. The low-dose group affected CK, and a significant difference was observed compared with the control group (P<0.05). After administration, the morphology of myocardial cells in each dose group was improved to some extent. Nuclear pyknosis, rupture, the apoptosis rate, etc. were significantly reduced, the number of cells increased. The high dose group showed the most obvious improvement. Conclusions The PET/CT imaging method can detect non-invasive, in vivo and dynamic MIRI, and can accurately evaluate the protective effect of traditional Mongolian medicine TFFC on MIRI. The Anti-MIRI of TFFC can scavenge free radicals, reduce oxidative stress damage, inhibit apoptosis, affect the activity of related enzymes.
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Affiliation(s)
- Guo-Jian Zhang
- Medical School of Chinese PLA, Beijing, China.,Department of Nuclear Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Li-Hong Wei
- Department of Pharmacy, Inner Mongolia International Mongolian Hospital, Hohhot, China
| | - Hai-Wen Lu
- Department of Imaging, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yun-Feng Xiao
- Center for New Drug Safety Evaluation and Research, Inner Mongolia Medical University, Hohhot, China
| | - Wen-Rui Wang
- Department of Nuclear Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yu-Lin He
- Department of Nuclear Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xue-Mei Wang
- Department of Nuclear Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Jia-He Tian
- Medical School of Chinese PLA, Beijing, China
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17
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Schlaak RA, Frei A, Fish BL, Harmann L, Gasperetti T, Pipke JL, Sun Y, Rui H, Flister MJ, Gantner BN, Bergom C. Acquired Immunity Is Not Essential for Radiation-Induced Heart Dysfunction but Exerts a Complex Impact on Injury. Cancers (Basel) 2020; 12:E983. [PMID: 32316187 PMCID: PMC7226421 DOI: 10.3390/cancers12040983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 12/24/2022] Open
Abstract
While radiation therapy (RT) can improve cancer outcomes, it can lead to radiation-induced heart dysfunction (RIHD) in patients with thoracic tumors. This study examines the role of adaptive immune cells in RIHD. In Salt-Sensitive (SS) rats, image-guided whole-heart RT increased cardiac T-cell infiltration. We analyzed the functional requirement for these cells in RIHD using a genetic model of T- and B-cell deficiency (interleukin-2 receptor gamma chain knockout (IL2RG-/-)) and observed a complex role for these cells. Surprisingly, while IL2RG deficiency conferred protection from cardiac hypertrophy, it worsened heart function via echocardiogram three months after a large single RT dose, including increased end-systolic volume (ESV) and reduced ejection fraction (EF) and fractional shortening (FS) (p < 0.05). Fractionated RT, however, did not yield similarly increased injury. Our results indicate that T cells are not uniformly required for RIHD in this model, nor do they account for our previously reported differences in cardiac RT sensitivity between SS and SS.BN3 rats. The increasing use of immunotherapies in conjunction with traditional cancer treatments demands better models to study the interactions between immunity and RT for effective therapy. We present a model that reveals complex roles for adaptive immune cells in cardiac injury that vary depending on clinically relevant factors, including RT dose/fractionation, sex, and genetic background.
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Affiliation(s)
- Rachel A. Schlaak
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Anne Frei
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (A.F.); (B.L.F.); (T.G.); (J.L.P.)
| | - Brian L. Fish
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (A.F.); (B.L.F.); (T.G.); (J.L.P.)
| | - Leanne Harmann
- Department of Medicine, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee WI 53226, USA;
| | - Tracy Gasperetti
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (A.F.); (B.L.F.); (T.G.); (J.L.P.)
| | - Jamie L. Pipke
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (A.F.); (B.L.F.); (T.G.); (J.L.P.)
| | - Yunguang Sun
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (Y.S.); (H.R.)
- Cancer Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (M.J.F.); (B.N.G.)
| | - Hallgeir Rui
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (Y.S.); (H.R.)
- Cancer Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (M.J.F.); (B.N.G.)
| | - Michael J. Flister
- Cancer Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (M.J.F.); (B.N.G.)
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Genomic Sciences and Precision Medicine Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Benjamin N. Gantner
- Cancer Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (M.J.F.); (B.N.G.)
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Medicine, Division of Endocrinology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Carmen Bergom
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (A.F.); (B.L.F.); (T.G.); (J.L.P.)
- Cancer Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (M.J.F.); (B.N.G.)
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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18
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Mrotzek SM, Rassaf T, Totzeck M. Cardiovascular Damage Associated With Chest Irradiation. Front Cardiovasc Med 2020; 7:41. [PMID: 32266294 PMCID: PMC7103638 DOI: 10.3389/fcvm.2020.00041] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/03/2020] [Indexed: 12/24/2022] Open
Abstract
The improvement of anticancer-therapies results in a greater amount of long-term survivors after radiotherapy. Therefore, the understanding of cardiotoxicity after irradiation is of increasing importance. Cardiovascular adverse events after chest irradiation have been acknowledged for a long time but remain difficult to diagnose. Long-term cardiovascular adverse events may become evident years or decades after radiotherapy and the spectrum of potential cardiovascular side effects is large. Recent experimental and clinical data indicate that cardiovascular symptoms may be caused especially by heart failure with preserved ejection fraction, which remains incompletely understood in patients after radiation therapy. Heart radiation dose and co-existing cardiovascular risk factors represent some of the most important contributors for incidence and severity of radiation-induced cardiovascular side effects. In this review, we aim to elucidate the underlying patho-mechanisms and to characterize the development of radiation-induced cardiovascular damage. Additionally, approaches for clinical management and treatment options are presented.
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Affiliation(s)
- Simone M Mrotzek
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
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Huang S, Che J, Chu Q, Zhang P. The Role of NLRP3 Inflammasome in Radiation-Induced Cardiovascular Injury. Front Cell Dev Biol 2020; 8:140. [PMID: 32226786 PMCID: PMC7080656 DOI: 10.3389/fcell.2020.00140] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/19/2020] [Indexed: 12/24/2022] Open
Abstract
The increasing risk of long-term adverse effects from radiotherapy on the cardiovascular structure is receiving increasing attention. However, the mechanisms underlying this increased risk remain poorly understood. Recently, the nucleotide-binding domain and leucine-rich-repeat-containing family pyrin 3 (NLRP3) inflammasome was suggested to play a critical role in radiation-induced cardiovascular injury. However, the relationship between ionizing radiation and the NLRP3 inflammasome in acute and chronic inflammation is complex. We reviewed literature detailing pathological changes and molecular mechanisms associated with radiation-induced damage to the cardiovascular structure, with a specific focus on NLRP3 inflammasome-related cardiovascular diseases. We also summarized possible therapeutic strategies for the prevention of radiation-induced heart disease (RIHD).
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Affiliation(s)
- Shanshan Huang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Che
- College of Life Sciences, Wuhan University, Wuhan, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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20
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Schlaak RA, Frei A, SenthilKumar G, Tsaih SW, Wells C, Mishra J, Flister MJ, Camara AKS, Bergom C. Differences in Expression of Mitochondrial Complexes Due to Genetic Variants May Alter Sensitivity to Radiation-Induced Cardiac Dysfunction. Front Cardiovasc Med 2020; 7:23. [PMID: 32195269 PMCID: PMC7066205 DOI: 10.3389/fcvm.2020.00023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/11/2020] [Indexed: 01/02/2023] Open
Abstract
Radiation therapy is received by over half of all cancer patients. However, radiation doses may be constricted due to normal tissue side effects. In thoracic cancers, including breast and lung cancers, cardiac radiation is a major concern in treatment planning. There are currently no biomarkers of radiation-induced cardiotoxicity. Complex genetic modifiers can contribute to the risk of radiation-induced cardiotoxicities, yet these modifiers are largely unknown and poorly understood. We have previously reported the SS (Dahl salt-sensitive/Mcwi) rat strain is a highly sensitized model of radiation-induced cardiotoxicity compared to the more resistant Brown Norway (BN) rat strain. When rat chromosome 3 from the resistant BN rat strain is substituted into the SS background (SS.BN3 consomic), it significantly attenuates radiation-induced cardiotoxicity, demonstrating inherited genetic variants on rat chromosome 3 modify radiation sensitivity. Genes involved with mitochondrial function were differentially expressed in the hearts of SS and SS.BN3 rats 1 week after radiation. Here we further assessed differences in mitochondria-related genes between the sensitive SS and resistant SS.BN3 rats. We found mitochondrial-related gene expression differed in untreated hearts, while no differences in mitochondrial morphology were seen 1 week after localized heart radiation. At 12 weeks after localized cardiac radiation, differences in mitochondrial complex protein expression in the left ventricles were seen between the SS and SS.BN3 rats. These studies suggest that differences in mitochondrial gene expression caused by inherited genetic variants may contribute to differences in sensitivity to cardiac radiation.
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Affiliation(s)
- Rachel A Schlaak
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Anne Frei
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Gopika SenthilKumar
- Medical Scientist Training Program, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Shirng-Wern Tsaih
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Clive Wells
- Electron Microscope Facility, Department of Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jyotsna Mishra
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Michael J Flister
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Amadou K S Camara
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Carmen Bergom
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States.,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States.,Cancer Center, Medical College of Wisconsin, Milwaukee, WI, United States
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21
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Schlaak RA, SenthilKumar G, Boerma M, Bergom C. Advances in Preclinical Research Models of Radiation-Induced Cardiac Toxicity. Cancers (Basel) 2020; 12:E415. [PMID: 32053873 PMCID: PMC7072196 DOI: 10.3390/cancers12020415] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/08/2020] [Accepted: 02/08/2020] [Indexed: 12/12/2022] Open
Abstract
Radiation therapy (RT) is an important component of cancer therapy, with >50% of cancer patients receiving RT. As the number of cancer survivors increases, the short- and long-term side effects of cancer therapy are of growing concern. Side effects of RT for thoracic tumors, notably cardiac and pulmonary toxicities, can cause morbidity and mortality in long-term cancer survivors. An understanding of the biological pathways and mechanisms involved in normal tissue toxicity from RT will improve future cancer treatments by reducing the risk of long-term side effects. Many of these mechanistic studies are performed in animal models of radiation exposure. In this area of research, the use of small animal image-guided RT with treatment planning systems that allow more accurate dose determination has the potential to revolutionize knowledge of clinically relevant tumor and normal tissue radiobiology. However, there are still a number of challenges to overcome to optimize such radiation delivery, including dose verification and calibration, determination of doses received by adjacent normal tissues that can affect outcomes, and motion management and identifying variation in doses due to animal heterogeneity. In addition, recent studies have begun to determine how animal strain and sex affect normal tissue radiation injuries. This review article discusses the known and potential benefits and caveats of newer technologies and methods used for small animal radiation delivery, as well as how the choice of animal models, including variables such as species, strain, and age, can alter the severity of cardiac radiation toxicities and impact their clinical relevance.
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Affiliation(s)
- Rachel A. Schlaak
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Gopika SenthilKumar
- Medical Scientist Training Program, Medical College of Wisconsin; Milwaukee, WI 53226, USA;
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Marjan Boerma
- Division of Radiation Health, Department of Pharmaceutical Sciences, The University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Carmen Bergom
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Cancer Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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22
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Sharma UC, Sonkawade SD, Spernyak JA, Sexton S, Nguyen J, Dahal S, Attwood KM, Singh AK, van Berlo JH, Pokharel S. A Small Peptide Ac-SDKP Inhibits Radiation-Induced Cardiomyopathy. Circ Heart Fail 2019; 11:e004867. [PMID: 30354563 DOI: 10.1161/circheartfailure.117.004867] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Advances in radiotherapy for thoracic cancers have resulted in improvement of survival. However, radiation exposure to the heart can induce cardiotoxicity. No therapy is currently available to inhibit these untoward effects. We examined whether a small tetrapeptide, N-acetyl-Ser-Asp-Lys-Pro (Ac-SDKP), can counteract radiation-induced cardiotoxicity by inhibiting macrophage-dependent inflammatory and fibrotic pathways. METHODS AND RESULTS After characterizing a rat model of cardiac irradiation with magnetic resonance imaging protocols, we examined the effects of Ac-SDKP in radiation-induced cardiomyopathy. We treated rats with Ac-SDKP for 18 weeks. We then compared myocardial contractile function and extracellular matrix by cardiac magnetic resonance imaging and the extent of inflammation, fibrosis, and Mac-2 (galectin-3) release by tissue analyses. Because Mac-2 is a crucial macrophage-derived mediator of fibrosis, we performed studies to determine Mac-2 synthesis by macrophages in response to radiation, and change in profibrotic responses by Mac-2 gene depleted cardiac fibroblasts after radiation. Cardiac irradiation diminished myocardial contractile velocities and enhanced extracellular matrix deposition. This was accompanied by macrophage infiltration, fibrosis, cardiomyocyte apoptosis, and cardiac Mac-2 expression. Ac-SDKP strongly inhibited these detrimental effects. Ac-SDKP migrated into the perinuclear cytoplasm of the macrophages and inhibited radiation-induced Mac-2 release. Cardiac fibroblasts lacking the Mac-2 gene showed reduced transforming growth factor β1, collagen I, and collagen III expression after radiation exposure. CONCLUSIONS Our study identifies novel cardioprotective effects of Ac-SDKP in a model of cardiac irradiation. These protective effects are exerted by inhibiting inflammation, fibrosis, and reducing macrophage activation. This study shows a therapeutic potential of this endogenously released peptide to counteract radiation-induced cardiomyopathy.
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Affiliation(s)
- Umesh C Sharma
- From the Division of Advanced Cardiovascular Imaging in Cardiology, Department of Medicine, Jacob's School of Medicine and Biomedical Sciences, Buffalo, NY (U.C.S., S.D.S., S.D.)
| | - Swati D Sonkawade
- From the Division of Advanced Cardiovascular Imaging in Cardiology, Department of Medicine, Jacob's School of Medicine and Biomedical Sciences, Buffalo, NY (U.C.S., S.D.S., S.D.)
| | | | | | - Juliane Nguyen
- Roswell Park Cancer Institute, Buffalo, NY. Department of Pharmaceutical Sciences, School of Pharmacy, Buffalo, NY (J.N.)
| | - Suraj Dahal
- From the Division of Advanced Cardiovascular Imaging in Cardiology, Department of Medicine, Jacob's School of Medicine and Biomedical Sciences, Buffalo, NY (U.C.S., S.D.S., S.D.)
| | | | | | - Jop H van Berlo
- Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.H.v.B.)
| | - Saraswati Pokharel
- Department of Pathology, Division of Thoracic Pathology and Oncology (S.P.)
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MacVittie TJ, Farese AM, Parker GA, Jackson W. The Time Course of Radiation-induced Lung Injury in a Nonhuman Primate Model of Partial-body Irradiation With Minimal Bone Marrow Sparing: Clinical and Radiographic Evidence and the Effect of Neupogen Administration. HEALTH PHYSICS 2019; 116:366-382. [PMID: 30624350 DOI: 10.1097/hp.0000000000000968] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The primary objectives of two companion manuscripts were to assess the natural history of delayed radiation-induced lung injury in a nonhuman primate model of acute high-dose, partial-body irradiation with 5% bone marrow sparing, to include the clinical, radiographic, and histopathological evidence and the effect of Neupogen administration on the morbidity and mortality. Nonhuman primates were exposed to 10.0 or 11.0 Gy with 6 MV linac-derived photons at approximately 0.80 Gy min. All nonhuman primates received subject-based, medical management. Subsets of nonhuman primates were administered Neupogen (10 μg kg) starting on day 1, day 3, or day 5 until recovery (absolute neutrophil count ≥ 1,000 cells μL for three consecutive days). Mortality due to multiple organ injury at 180 d study duration: Mortality at 180 d post either 10.0 Gy or 11.0 Gy was the consequence of concurrent injury due to the acute radiation syndrome (gastrointestinal and hematological) and delayed radiation-induced lung injury. The 180-d all-cause mortality observed in the control cohorts at 10.0 Gy (53%) or 11.0 Gy (86%) did not vary from cohorts that received Neupogen at any administration schedule. Mortality ranged from 43-50% (10 Gy) to 75-100% (11.0 Gy) in the Neupogen-treated cohorts. The study, however, was not powered to detect statistical significant differences between mortality in the control and Neupogen-treated cohorts. Clinical and radiographic evidence of radiation-induced lung injury: The mean nonsedated respiratory rate in the control cohorts exposed to 10 or 11 Gy increased from a baseline value of 37 breaths min to >60 breaths min within 103 d and 94 d postexposure, and the incidence of nonsedated respiratory rate > 80 breaths min was 50% and 70%, respectively. The mean duration of latency to development of clinical pneumonitis and/or fibrosis (nonsedated respiratory rate > 80 breaths min) was not significantly different between the 10.0-Gy or 11.0 Gy-cohorts (range 100-107 d). Neupogen (granulocyte colony-stimulating factor) administration had no apparent effect of the latency, incidence, or severity of nonsedated respiratory rate within either radiation dose or administration schedule. Computed tomography scans were obtained and images were analyzed for evidence of lung injury, e.g., pneumonitis and/or fibrosis, pleural and pericardial effusion. A quantitative, semiautomated method was developed based on differences in radiodensity (Hounsfield units) and lung morphology to extract the volume of pneumonitis/fibrosis and pleural effusion as indexed against total lung at each time point obtained. At both irradiation doses, 100% of the nonhuman primates surviving acute radiation syndrome manifested radiographic evidence of radiation-induced lung injury as pneumonitis and/or fibrosis. There was no apparent effect of Neupogen administration on the latency, incidence, severity, or progression of pneumonitis/fibrosis:total lung volume or pleural effusion:total lung volume at either exposure. A comparative review of the data illustrated the concomitant time course of increased mortality, nonsedated respiratory rate, and pneumonitis/fibrosis:total lung volume and pleural effusion:total lung volume consequent to 10.0-Gy or 11.0-Gy partial-body irradiation with 5% bone marrow sparing. All key parameters proceeded from a latent period of approximately 60 d followed by an increase in all three indices of clinical and radiographic evidence of radiation-induced lung injury within the next 60 d to 120 d postexposure. The subsequent time course and longitudinal analysis was influenced by the persistent progression of radiation-induced lung injury, administration of dexamethasone, and loss of nonhuman primates due to lethality. Companion paper: Lung and Heart Injury in a Nonhuman Primate Model of Partial-body Irradiation With Minimal Bone Marrow Sparing: Histopathological Evidence of Lung and Heart Injury (Parker et al. 2019): Note that the computed tomography-based radiodensity data do not permit differentiation of pneumonitis and fibrosis. The companion paper employed Masson's trichrome, collagen 1, and selected staining to identify the key time and incidence parameters relative to excessive collagen deposition indicative of fibrosis and associated histopathology in the lung. This histological database provided valuable longitudinal analysis in support of the clinical and radiographic evidence associated with the time course of radiation-induced lung injury.
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Affiliation(s)
| | - Ann M Farese
- University of Maryland School of Medicine, Baltimore, MD
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24
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Du S, Zhou L, Alexander GS, Park K, Yang L, Wang N, Zaorsky NG, Ma X, Wang Y, Dicker AP, Lu B. PD-1 Modulates Radiation-Induced Cardiac Toxicity through Cytotoxic T Lymphocytes. J Thorac Oncol 2018; 13:510-520. [DOI: 10.1016/j.jtho.2017.12.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/20/2017] [Accepted: 12/01/2017] [Indexed: 12/20/2022]
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25
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Mehta LS, Watson KE, Barac A, Beckie TM, Bittner V, Cruz-Flores S, Dent S, Kondapalli L, Ky B, Okwuosa T, Piña IL, Volgman AS. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e30-e66. [PMID: 29437116 PMCID: PMC6722327 DOI: 10.1161/cir.0000000000000556] [Citation(s) in RCA: 468] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease (CVD) remains the leading cause of mortality in women, yet many people perceive breast cancer to be the number one threat to women's health. CVD and breast cancer have several overlapping risk factors, such as obesity and smoking. Additionally, current breast cancer treatments can have a negative impact on cardiovascular health (eg, left ventricular dysfunction, accelerated CVD), and for women with pre-existing CVD, this might influence cancer treatment decisions by both the patient and the provider. Improvements in early detection and treatment of breast cancer have led to an increasing number of breast cancer survivors who are at risk of long-term cardiac complications from cancer treatments. For older women, CVD poses a greater mortality threat than breast cancer itself. This is the first scientific statement from the American Heart Association on CVD and breast cancer. This document will provide a comprehensive overview of the prevalence of these diseases, shared risk factors, the cardiotoxic effects of therapy, and the prevention and treatment of CVD in breast cancer patients.
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26
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Zeinali-Rafsanjani B, Mosleh-Shirazi MA, Haghighatafshar M, Jalli R, Saeedi-Moghadam M. Assessment of the dose distribution of Minibeam radiotherapy for lung tumors in an anthropomorphic phantom: A feasibility study. Technol Health Care 2017; 25:683-692. [DOI: 10.3233/thc-170818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Banafsheh Zeinali-Rafsanjani
- Nuclear Medicine and Molecular Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Amin Mosleh-Shirazi
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Radiotherapy and Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Haghighatafshar
- Nuclear Medicine and Molecular Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Jalli
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Saeedi-Moghadam
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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27
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l -carnitine preserves cardiac function by activating p38 MAPK/Nrf2 signalling in hearts exposed to irradiation. Eur J Pharmacol 2017; 804:7-12. [DOI: 10.1016/j.ejphar.2017.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 03/29/2017] [Accepted: 04/05/2017] [Indexed: 01/31/2023]
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Liu LK, Ouyang W, Zhao X, Su SF, Yang Y, Ding WJ, Luo DX, He ZX, Lu B. Pathogenesis and Prevention of Radiation-induced Myocardial
Fibrosis. Asian Pac J Cancer Prev 2017; 18:583-587. [PMID: 28440606 PMCID: PMC5464468 DOI: 10.22034/apjcp.2017.18.3.583] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Radiation therapy is one of the most important methods for the treatment of malignant tumors. However, in radiotherapy for thoracic tumors such as breast cancer, lung cancer, esophageal cancer, and mediastinal lymphoma, the heart, located in the mediastinum, is inevitably affected by the irradiation, leading to pericardial disease, myocardial fibrosis, coronary artery disease, valvular lesions, and cardiac conduction system injury, which are considered radiation-induced heart diseases. Delayed cardiac injury especially myocardial fibrosis is more prominent, and its incidence is as high as 20–80%. Myocardial fibrosis is the final stage of radiation-induced heart diseases, and it increases the stiffness of the myocardium and decreases myocardial systolic and diastolic function, resulting in myocardial electrical physiological disorder, arrhythmia, incomplete heart function, or even sudden death. This article reviews the pathogenesis and prevention of radiation-induced myocardial fibrosis for providing references for the prevention and treatment of radiation-induced myocardial fibrosis.
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Affiliation(s)
- Li Kun Liu
- Department of Thoracic Oncology, Guizhou Cancer Hospital, Guizhou Medical University, Guiyang , China.
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Tadic M, Cuspidi C, Hering D, Venneri L, Grozdic-Milojevic I. Radiotherapy-induced right ventricular remodelling: The missing piece of the puzzle. Arch Cardiovasc Dis 2017; 110:116-123. [DOI: 10.1016/j.acvd.2016.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 10/15/2016] [Accepted: 10/18/2016] [Indexed: 11/27/2022]
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Tapio S. Pathology and biology of radiation-induced cardiac disease. JOURNAL OF RADIATION RESEARCH 2016; 57:439-448. [PMID: 27422929 PMCID: PMC5045085 DOI: 10.1093/jrr/rrw064] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/09/2016] [Indexed: 05/08/2023]
Abstract
Heart disease is the leading global cause of death. The risk for this disease is significantly increased in populations exposed to ionizing radiation, but the mechanisms are not fully elucidated yet. This review aims to gather and discuss the latest data about pathological and biological consequences in the radiation-exposed heart in a comprehensive manner. A better understanding of the molecular and cellular mechanisms underlying radiation-induced damage in heart tissue and cardiac vasculature will provide novel targets for therapeutic interventions. These may be valuable for individuals clinically or occupationally exposed to varying doses of ionizing radiation.
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Affiliation(s)
- Soile Tapio
- Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Institute of Radiation Biology, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany
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31
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Chronic intermittent hypobaric hypoxia attenuates radiation induced heart damage in rats. Life Sci 2016; 160:57-63. [DOI: 10.1016/j.lfs.2016.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/01/2016] [Accepted: 07/08/2016] [Indexed: 11/18/2022]
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Beer LA, Kossenkov AV, Liu Q, Luning Prak E, Domchek S, Speicher DW, Ky B. Baseline Immunoglobulin E Levels as a Marker of Doxorubicin- and Trastuzumab-Associated Cardiac Dysfunction. Circ Res 2016; 119:1135-1144. [PMID: 27582370 DOI: 10.1161/circresaha.116.309004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/31/2016] [Indexed: 01/06/2023]
Abstract
RATIONALE There is a critical need to develop robust, mechanistic strategies to identify patients at increased risk of cancer therapeutics-related cardiac dysfunction (CTRCD). OBJECTIVE We aimed to discover new biomarkers associated with doxorubicin- and trastuzumab-induced CTRCD using high-throughput proteomic profiling. METHODS AND RESULTS Plasma, echocardiograms, and clinical outcomes were collected at standardized intervals in breast cancer patients undergoing doxorubicin and trastuzumab cancer therapy. Thirty-one longitudinal plasma samples from 3 cases with CTRCD and 4 age- and cancer-matched controls without CTRCD were processed and analyzed using label-free liquid chromatography-mass spectrometry. From these analyses, 862 proteins were identified from case/control pairs 1 and 2 and 1360 proteins from case/control pair 3. Proteins with a >1.5-fold change in cases compared with controls with a P<0.05 either at the time of CTRCD diagnosis or across all time points were considered candidate diagnostic or predictive biomarkers, respectively. The protein that demonstrated the largest differences between cases and controls was immunoglobulin E, with higher levels detected at baseline and across all time points in controls without CTRCD as compared with matched CTRCD cases (P<0.05). Similarly, in a validation study of 35 participants treated with doxorubicin and trastuzumab, high baseline immunoglobulin E levels were associated with a significantly lower risk of CTRCD (P=0.018). CONCLUSIONS In patients receiving doxorubicin and trastuzumab, high baseline immunoglobulin E levels are associated with a lower risk of CTRCD. These novel findings suggest a new paradigm in cardio-oncology, implicating the immune system as a potential mediator of doxorubicin- and trastuzumab-induced cardiac dysfunction.
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Affiliation(s)
- Lynn A Beer
- From the Center for Systems and Computational Biology, and Molecular and Cellular Oncogenesis Program, The Wistar Institute, Philadelphia, PA (L.A.B., A.V.K., Q.L., D.W.S.); Department of Pathology and Laboratory Medicine (E.L.P.), Division of Hematology and Oncology (S.D.), Abramson Cancer Center (S.D., B.K.), and Division of Cardiovascular Medicine (B.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Andrew V Kossenkov
- From the Center for Systems and Computational Biology, and Molecular and Cellular Oncogenesis Program, The Wistar Institute, Philadelphia, PA (L.A.B., A.V.K., Q.L., D.W.S.); Department of Pathology and Laboratory Medicine (E.L.P.), Division of Hematology and Oncology (S.D.), Abramson Cancer Center (S.D., B.K.), and Division of Cardiovascular Medicine (B.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Qin Liu
- From the Center for Systems and Computational Biology, and Molecular and Cellular Oncogenesis Program, The Wistar Institute, Philadelphia, PA (L.A.B., A.V.K., Q.L., D.W.S.); Department of Pathology and Laboratory Medicine (E.L.P.), Division of Hematology and Oncology (S.D.), Abramson Cancer Center (S.D., B.K.), and Division of Cardiovascular Medicine (B.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Eline Luning Prak
- From the Center for Systems and Computational Biology, and Molecular and Cellular Oncogenesis Program, The Wistar Institute, Philadelphia, PA (L.A.B., A.V.K., Q.L., D.W.S.); Department of Pathology and Laboratory Medicine (E.L.P.), Division of Hematology and Oncology (S.D.), Abramson Cancer Center (S.D., B.K.), and Division of Cardiovascular Medicine (B.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Susan Domchek
- From the Center for Systems and Computational Biology, and Molecular and Cellular Oncogenesis Program, The Wistar Institute, Philadelphia, PA (L.A.B., A.V.K., Q.L., D.W.S.); Department of Pathology and Laboratory Medicine (E.L.P.), Division of Hematology and Oncology (S.D.), Abramson Cancer Center (S.D., B.K.), and Division of Cardiovascular Medicine (B.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - David W Speicher
- From the Center for Systems and Computational Biology, and Molecular and Cellular Oncogenesis Program, The Wistar Institute, Philadelphia, PA (L.A.B., A.V.K., Q.L., D.W.S.); Department of Pathology and Laboratory Medicine (E.L.P.), Division of Hematology and Oncology (S.D.), Abramson Cancer Center (S.D., B.K.), and Division of Cardiovascular Medicine (B.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Bonnie Ky
- From the Center for Systems and Computational Biology, and Molecular and Cellular Oncogenesis Program, The Wistar Institute, Philadelphia, PA (L.A.B., A.V.K., Q.L., D.W.S.); Department of Pathology and Laboratory Medicine (E.L.P.), Division of Hematology and Oncology (S.D.), Abramson Cancer Center (S.D., B.K.), and Division of Cardiovascular Medicine (B.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
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Abstract
Through the success of basic and disease-specific research, cancer survivors are one of the largest growing subsets of individuals accessing the healthcare system. Interestingly, cardiovascular disease is the second leading cause of morbidity and mortality in cancer survivors after recurrent malignancy. This recognition has helped stimulate a collaboration between oncology and cardiology practitioners and researchers, and the portmanteau cardio-oncology (also known as onco-cardiology) can now be found in many medical centers. This collaboration promises new insights into how cancer therapies impact cardiovascular homeostasis and long-term effects on cancer survivors. In this review, we will discuss the most recent views on the cardiotoxicity related to various classes of chemotherapy agents and radiation. We will also discuss broadly the current strategies for treating and preventing cardiovascular effects of cancer therapy.
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Affiliation(s)
- Carrie G Lenneman
- From the Department of Medicine, University of Louisville School of Medicine, KY (C.G.L.); and Cardiovascular Institute, Maine Medical Center, Portland (D.B.S.).
| | - Douglas B Sawyer
- From the Department of Medicine, University of Louisville School of Medicine, KY (C.G.L.); and Cardiovascular Institute, Maine Medical Center, Portland (D.B.S.)
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DeBo RJ, Lees CJ, Dugan GO, Caudell DL, Michalson KT, Hanbury DB, Kavanagh K, Cline JM, Register TC. Late Effects of Total-Body Gamma Irradiation on Cardiac Structure and Function in Male Rhesus Macaques. Radiat Res 2016; 186:55-64. [PMID: 27333082 PMCID: PMC5068576 DOI: 10.1667/rr14357.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Heart disease is an increasingly recognized, serious late effect of radiation exposure, most notably among breast cancer and Hodgkin's disease survivors, as well as the Hiroshima and Nagasaki atomic bomb survivors. The purpose of this study was to evaluate the late effects of total-body irradiation (TBI) on cardiac morphology, function and selected circulating biomarkers in a well-established nonhuman primate model. For this study we used male rhesus macaques that were exposed to a single total-body dose of ionizing gamma radiation (6.5-8.4 Gy) 5.6-9.7 years earlier at ages ranging from ∼3-10 years old and a cohort of nonirradiated controls. Transthoracic echocardiography was performed annually for 3 years on 20 irradiated and 11 control animals. Myocardium was examined grossly and histologically, and myocardial fibrosis/collagen was assessed microscopically and by morphometric analysis of Masson's trichrome-stained sections. Serum/plasma from 27 irradiated and 13 control animals was evaluated for circulating biomarkers of cardiac damage [N-terminal pro B-type natriuretic protein (nt-proBNP) and troponin-I], inflammation (CRP, IL-6, MCP-1, sICAM) and microbial translocation [LPS-binding protein (LBP) and sCD14]. A higher prevalence of histological myocardial fibrosis was observed in the hearts obtained from the irradiated animals (9/14) relative to controls (0/3) (P = 0.04, χ(2)). Echocardiographically determined left ventricular end diastolic and systolic diameters were significantly smaller in irradiated animals (repeated measures ANOVA, P < 0.001 and P < 0.008, respectively). Histomorphometric analysis of trichrome-stained sections of heart tissue demonstrated ∼14.9 ± 1.4% (mean ± SEM) of myocardial area staining for collagen in irradiated animals compared to 9.1 ± 0.9 % in control animals. Circulating levels of MCP-1 and LBP were significantly higher in irradiated animals (P < 0.05). A high incidence of diabetes in the irradiated animals was associated with higher plasma triglyceride and lower HDLc but did not appear to be associated with cardiovascular phenotypes. These results demonstrate that single total-body doses of 6.5-8.4 Gy produced long-term effects including a high incidence of myocardial fibrosis, reduced left ventricular diameter and elevated systemic inflammation. Additional prospective studies are required to define the time course and mechanisms underlying radiation-induced heart disease in this model.
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Affiliation(s)
| | - Cynthia J. Lees
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Greg O. Dugan
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - David L. Caudell
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kris T. Michalson
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - David B. Hanbury
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kylie Kavanagh
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - J. Mark Cline
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Thomas C. Register
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Wang Z, Liu D, Varin A, Nicolas V, Courilleau D, Mateo P, Caubere C, Rouet P, Gomez AM, Vandecasteele G, Fischmeister R, Brenner C. A cardiac mitochondrial cAMP signaling pathway regulates calcium accumulation, permeability transition and cell death. Cell Death Dis 2016; 7:e2198. [PMID: 27100892 PMCID: PMC4855650 DOI: 10.1038/cddis.2016.106] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 12/19/2022]
Abstract
Although cardiac cytosolic cyclic 3',5'-adenosine monophosphate (cAMP) regulates multiple processes, such as beating, contractility, metabolism and apoptosis, little is known yet on the role of this second messenger within cardiac mitochondria. Using cellular and subcellular approaches, we demonstrate here the local expression of several actors of cAMP signaling within cardiac mitochondria, namely a truncated form of soluble AC (sACt) and the exchange protein directly activated by cAMP 1 (Epac1), and show a protective role for sACt against cell death, apoptosis as well as necrosis in primary cardiomyocytes. Upon stimulation with bicarbonate (HCO3(-)) and Ca(2+), sACt produces cAMP, which in turn stimulates oxygen consumption, increases the mitochondrial membrane potential (ΔΨm) and ATP production. cAMP is rate limiting for matrix Ca(2+) entry via Epac1 and the mitochondrial calcium uniporter and, as a consequence, prevents mitochondrial permeability transition (MPT). The mitochondrial cAMP effects involve neither protein kinase A, Epac2 nor the mitochondrial Na(+)/Ca(2+) exchanger. In addition, in mitochondria isolated from failing rat hearts, stimulation of the mitochondrial cAMP pathway by HCO3(-) rescued the sensitization of mitochondria to Ca(2+)-induced MPT. Thus, our study identifies a link between mitochondrial cAMP, mitochondrial metabolism and cell death in the heart, which is independent of cytosolic cAMP signaling. Our results might have implications for therapeutic prevention of cell death in cardiac pathologies.
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Affiliation(s)
- Z Wang
- INSERM UMR-S 1180, Faculté de Pharmacie, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - D Liu
- INSERM UMR-S 1180, Faculté de Pharmacie, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - A Varin
- INSERM UMR-S 1180, Faculté de Pharmacie, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - V Nicolas
- UMS-IPSIT, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - D Courilleau
- UMS-IPSIT, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - P Mateo
- INSERM UMR-S 1180, Faculté de Pharmacie, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - C Caubere
- INSERM I2MC, UMR 1048, Université Paul Sabatier, Toulouse, France
| | - P Rouet
- INSERM I2MC, UMR 1048, Université Paul Sabatier, Toulouse, France
| | - A-M Gomez
- INSERM UMR-S 1180, Faculté de Pharmacie, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - G Vandecasteele
- INSERM UMR-S 1180, Faculté de Pharmacie, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - R Fischmeister
- INSERM UMR-S 1180, Faculté de Pharmacie, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France.,UMS-IPSIT, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - C Brenner
- INSERM UMR-S 1180, Faculté de Pharmacie, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France.,UMS-IPSIT, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
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Dijos M, Reynaud A, Leroux L, Réant P, Cornolle C, Roudaut R, Dos Santos P, Lafitte S. Efficacy and follow-up of transcatheter aortic valve implantation in patients with radiation-induced aortic stenosis. Open Heart 2015; 2:e000252. [PMID: 26339494 PMCID: PMC4555069 DOI: 10.1136/openhrt-2015-000252] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/22/2015] [Accepted: 07/31/2015] [Indexed: 02/07/2023] Open
Abstract
Objective To investigate transcatheter aortic valve implantation (TAVI) feasibility, effectiveness and safety in radiation-induced aortic valve stenosis cases. Methods 198 consecutive patients referred for TAVI were prospectively enrolled. They were divided into two groups: patients with a history of chest radiation therapy with suspected radiation-induced valvular disease (RXT) and others with suspected degenerative aortic valve stenosis (NRXT). Procedural, early and mid-term clinical outcomes were compared. Results Of the 198 patients enrolled in our study, 9.6% qualified for inclusion in the RXT group. A comparison of baseline characteristics revealed that patients with RXT were younger than patients with NRXT (68.3 vs 82.5 years; p<0.05) and exhibited a lower surgical risk score (Euroscore: 7.1% vs 21.8%; p<0.05) and a higher frequency of hostile thorax and porcelain aorta (52.6% vs 28.5%; p<0.05; 63.2% vs 10.6%; p<0.05, respectively). In both groups, the implantation success rate was high and the 30-day safety end point acceptable (RXT: 94.7% and 83.3%; NRXT: 93.9% and 75.6%, respectively). At 6 months, overall mortality was significantly lower in the RXT group (0% vs 18%; p=0.048). Conclusions In patients suffering from radiation-induced aortic valve stenosis and contraindicated for surgery, TAVI is a promising approach, with high feasibility, acceptable risk, low mortality and high clinical effectiveness at mid-term follow-up.
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Affiliation(s)
- Marina Dijos
- Valvular Disease Department and Echocardiography Laboratory , Haut-Lévêque Bordeaux University Hospital-CIC0005-France , Pessac , France
| | - Amélie Reynaud
- Valvular Disease Department and Echocardiography Laboratory , Haut-Lévêque Bordeaux University Hospital-CIC0005-France , Pessac , France
| | - Lionel Leroux
- Valvular Disease Department and Echocardiography Laboratory , Haut-Lévêque Bordeaux University Hospital-CIC0005-France , Pessac , France
| | - Patricia Réant
- Valvular Disease Department and Echocardiography Laboratory , Haut-Lévêque Bordeaux University Hospital-CIC0005-France , Pessac , France
| | - Claire Cornolle
- Valvular Disease Department and Echocardiography Laboratory , Haut-Lévêque Bordeaux University Hospital-CIC0005-France , Pessac , France
| | - Raymond Roudaut
- Valvular Disease Department and Echocardiography Laboratory , Haut-Lévêque Bordeaux University Hospital-CIC0005-France , Pessac , France
| | - Pierre Dos Santos
- Valvular Disease Department and Echocardiography Laboratory , Haut-Lévêque Bordeaux University Hospital-CIC0005-France , Pessac , France
| | - Stéphane Lafitte
- Valvular Disease Department and Echocardiography Laboratory , Haut-Lévêque Bordeaux University Hospital-CIC0005-France , Pessac , France
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Zhang P, Hu X, Yue J, Meng X, Han D, Sun X, Yang G, Wang S, Wang X, Yu J. Early detection of radiation-induced heart disease using (99m)Tc-MIBI SPECT gated myocardial perfusion imaging in patients with oesophageal cancer during radiotherapy. Radiother Oncol 2015; 115:171-8. [PMID: 26072421 DOI: 10.1016/j.radonc.2015.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 04/05/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE The primary aim of this prospective study was to investigate the value of (99m)Tc-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) gated myocardial perfusion imaging (GMPI) in the detection of radiation-induced heart disease (RIHD) as early as during radiotherapy (RT) for oesophageal cancer (EC). The second aim was to analyse the correlation between cardiac toxicity and the dose-volume factors. MATERIALS AND METHODS The (99m)Tc-MIBI SPECT GMPI was performed both pre-RT and during RT (40Gray). The results of the SPECT were quantitatively analysed with QGS/QPS software and read by two experienced nuclear medicine physicians. The correlation between the changes in the SPECT parameters and the RT dosimetric data was analysed. RESULTS Eighteen patients with locally advanced EC were enrolled in the study. Compared with the baseline, the imaging during RT showed not only significant decreases in the wall motion (WM) (1/20 segments), wall thickening (WT) (2/20 segments), end-diastolic perfusion (EDP) (5/20 segments) and end-systolic perfusion (ESP) (8/20 segments) (p<0.05) but also a significant increase in the heart rate (74.63±7.79 vs 81.49±9.90, p=0.036). New myocardial perfusion defects were observed in 8 of the 18 patients. The V37-V40 was significantly higher (p<0.05) in the patients with the new perfusion defects during RT than in the patients who did not exhibit these defects. CONCLUSIONS Radiotherapy for EC induces cardiac damage from an early stage. (99m)Tc-MIBI SPECT GMPI can detect the occurrence of cardiac impairment during RT. The WM, WT, EDP and ESP may be valuable as early indicators of RIHD. The percentage of the heart volume that receives a high dose is an important factor that is correlated with RIHD.
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Affiliation(s)
- Peng Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan University, China
| | - Xudong Hu
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan University, China
| | - Jinbo Yue
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan University, China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan University, China
| | - Dali Han
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan University, China
| | - Xindong Sun
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan University, China
| | - Guoren Yang
- Department of Nuclear Medicine, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan University, China
| | - Shijiang Wang
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan University, China
| | - Xiaohui Wang
- Department of Nuclear Medicine, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan University, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan University, China.
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Freeman JL, Weber GJ, Peterson SM, Nie LH. Embryonic ionizing radiation exposure results in expression alterations of genes associated with cardiovascular and neurological development, function, and disease and modified cardiovascular function in zebrafish. Front Genet 2014; 5:268. [PMID: 25147559 PMCID: PMC4124797 DOI: 10.3389/fgene.2014.00268] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/21/2014] [Indexed: 01/16/2023] Open
Abstract
The relationship between ionizing radiation (IR) and carcinogenesis is long established, but recently the association between IR and other diseases is starting to be recognized. Currently, there is limited information on the genetic mechanisms governing the role of IR in non-cancer related adverse health effects and in regards to an early developmental exposure. In this study, zebrafish embryos were exposed to a range of IR doses (0, 1, 2, 5, 10 Gy) at 26 h post fertilization (hpf). No significant increase in mortality or hatching rate was observed, but a significant decrease in total larval length, head length, and eye diameter was observed in the 10 Gy dose. Transcriptomic analysis was conducted at 120 hpf to compare gene expression profiles between the control and highest IR dose at which no significant differences were observed in morphological measurements (5 Gy). 253 genes with well-established function or orthology to human genes were significantly altered. Gene ontology and molecular network analysis revealed enrichment of genes associated with cardiovascular and neurological development, function, and disease. Expression of a subset of genetic targets with an emphasis on those associated with the cardiovascular system was assessed using Quantitative PCR (qPCR) to confirm altered expression at 5 Gy and then to investigate alterations at lower doses (1 and 2 Gy). Strong correlation between microarray and qPCR expression values was observed, but zebrafish exposed to 1 or 2 Gy resulted in a significant expression alteration in only one of these genes (LIN7B). Moreover, heart rate was analyzed through 120 hpf following IR dosing at 26 hpf. A significant decrease in heart rate was observed at 10 Gy, while a significant increase in heart rate was observed at 1, 2, and 5 Gy. Overall these findings indicate IR exposure at doses below those that induce gross morphological changes alters heart rate and expression of genes associated with cardiovascular and neurological functions.
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Affiliation(s)
| | - Gregory J Weber
- School of Health Sciences, Purdue University West Lafayette, IN, USA
| | - Samuel M Peterson
- School of Health Sciences, Purdue University West Lafayette, IN, USA
| | - Linda H Nie
- School of Health Sciences, Purdue University West Lafayette, IN, USA
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Santoro F, Tarantino N, Pellegrino PL, Caivano M, Lopizzo A, Di Biase M, Brunetti ND. Cardiovascular sequelae of radiation therapy. Clin Res Cardiol 2014; 103:955-67. [DOI: 10.1007/s00392-014-0718-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/15/2014] [Indexed: 01/13/2023]
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Blanck O, Bode F, Gebhard M, Hunold P, Brandt S, Bruder R, Grossherr M, Vonthein R, Rades D, Dunst J. Dose-escalation study for cardiac radiosurgery in a porcine model. Int J Radiat Oncol Biol Phys 2014; 89:590-8. [PMID: 24751407 DOI: 10.1016/j.ijrobp.2014.02.036] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To perform a proof-of-principle dose-escalation study to radiosurgically induce scarring in cardiac muscle tissue to block veno-atrial electrical connections at the pulmonary vein antrum, similar to catheter ablation. METHODS AND MATERIALS Nine mini-pigs underwent pretreatment magnetic resonance imaging (MRI) evaluation of heart function and electrophysiology assessment by catheter measurements in the right superior pulmonary vein (RSPV). Immediately after examination, radiosurgery with randomized single-fraction doses of 0 and 17.5-35 Gy in 2.5-Gy steps were delivered to the RSPV antrum (target volume 5-8 cm(3)). MRI and electrophysiology were repeated 6 months after therapy, followed by histopathologic examination. RESULTS Transmural scarring of cardiac muscle tissue was noted with doses ≥32.5 Gy. However, complete circumferential scarring of the RSPV was not achieved. Logistic regressions showed that extent and intensity of fibrosis significantly increased with dose. The 50% effective dose for intense fibrosis was 31.3 Gy (odds ratio 2.47/Gy, P<.01). Heart function was not affected, as verified by MRI and electrocardiogram evaluation. Adjacent critical structures were not damaged, as verified by pathology, demonstrating the short-term safety of small-volume cardiac radiosurgery with doses up to 35 Gy. CONCLUSIONS Radiosurgery with doses >32.5 Gy in the healthy pig heart can induce circumscribed scars at the RSPV antrum noninvasively, mimicking the effect of catheter ablation. In our study we established a significant dose-response relationship for cardiac radiosurgery. The long-term effects and toxicity of such high radiation doses need further investigation in the pursuit of cardiac radiosurgery for noninvasive treatment of atrial fibrillation.
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Affiliation(s)
- Oliver Blanck
- Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Germany; CyberKnife Center Northern Germany, Guestrow, Germany.
| | - Frank Bode
- Medical Department II, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Maximilian Gebhard
- Institute of Pathology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Peter Hunold
- Department of Radiology and Nuclear Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Sebastian Brandt
- Department of Anaesthesiology and Intensive Care Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Ralf Bruder
- Institute for Robotics and Cognitive Systems, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Martin Grossherr
- Department of Anaesthesiology and Intensive Care Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Reinhard Vonthein
- Institute of Medical Biometry and Statistics, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Germany
| | - Juergen Dunst
- Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Germany; University Copenhagen, Denmark
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Radiation-induced heart and vessel atherosclerosis disease. Int J Cardiol 2014; 172:505-6. [DOI: 10.1016/j.ijcard.2014.01.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/10/2014] [Indexed: 11/20/2022]
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Wondergem J, Boerma M, Kodama K, Stewart FA, Trott KR. Cardiovascular effects after low-dose exposure and radiotherapy: what research is needed? RADIATION AND ENVIRONMENTAL BIOPHYSICS 2013; 52:425-434. [PMID: 23999657 DOI: 10.1007/s00411-013-0489-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/19/2013] [Indexed: 06/02/2023]
Abstract
The authors of this report met at the Head Quarter of the International Atomic Energy Agency (IAEA) in Vienna, Austria, on 2-4 July 2012, for intensive discussions of an abundance of original publications on new epidemiological studies on cardiovascular effects after low-dose exposure and radiotherapy and radiobiological experiments as well as several comprehensive reviews that were published since the previous meeting by experts sponsored by the IAEA in June 2006. The data necessitated a re-evaluation of the situation with special emphasis on the consequences current experimental and clinical data may have for clinical oncology/radiotherapy and radiobiological research. The authors jointly arrived at the conclusions and recommendations presented here.
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Affiliation(s)
- Jan Wondergem
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Wagrammer Strasse 5, PO box 100, 1400, Vienna, Austria,
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Szabó G, Schmack B, Bulut C, Soós P, Weymann A, Stadtfeld S, Karck M. Constrictive pericarditis: risks, aetiologies and outcomes after total pericardiectomy: 24 years of experience. Eur J Cardiothorac Surg 2013; 44:1023-8; discussion 1028. [PMID: 23761416 DOI: 10.1093/ejcts/ezt138] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Constrictive pericarditis is the result of a spectrum of primary cardiac and non-cardiac conditions. Few data exist on the preoperative risk specific to survival after pericardiectomy. This study was designed to compare the association of aetiology of constrictive pericarditis and other clinical variables, with long-term survival after total pericardiectomy. METHODS A total of 89 patients were studied, who underwent pericardiectomy for constrictive pericarditis at a single surgical centre between 1988 and 2012. Constrictive pericarditis was confirmed by the surgical report. Demographic, pre-, intra- and postoperative data and long-term outcome were investigated. Survival was assessed by the Kaplan-Meier method. RESULTS Aetiology of constrictive pericarditis was idiopathic in 49 patients (55%), prior cardiac surgery in 21 patients (23.6%), tuberculosis in 5 patients (5.6%), radiation treatment in 5 (5.6%), uraemia in 4 (4.5%), inflammation in 3 (3.5%) myocardial infarction in 2 (2.2%), and perioperative mortality was 7%. Seventy-five percent of patients were in New York Heart Association (NYHA) class III-IV, which status significantly improved in long-term survivors (95% in NYHA I-II). Idiopathic constrictive pericarditis had the best prognosis (5-year Kaplan-Meier survival: 81%) followed by post-surgical (50%) and post-radiation pericarditis (no survivors after 5 years). Tuberculosis, myocardial infarction and uraemia have survival rates comparable with idiopathic aetiology. In addition, preoperative NYHA class IV was associated with significantly lower long-term survival. CONCLUSIONS Long-term survival after pericardiectomy for constrictive pericarditis is related to underlying aetiology and overall clinical condition. The relatively good survival with idiopathic constrictive pericarditis emphasizes the safety of pericardiectomy in this subgroup.
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Affiliation(s)
- Gábor Szabó
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
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