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Pedersen LN, Valenzuela Ripoll C, Ozcan M, Guo Z, Lotfinaghsh A, Zhang S, Ng S, Weinheimer C, Nigro J, Kovacs A, Diab A, Klaas A, Grogan F, Cho Y, Ataran A, Luehmann H, Heck A, Kolb K, Strong L, Navara R, Walls GM, Hugo G, Samson P, Cooper D, Reynoso FJ, Schwarz JK, Moore K, Lavine K, Rentschler SL, Liu Y, Woodard PK, Robinson C, Cuculich PS, Bergom C, Javaheri A. Cardiac radiation improves ventricular function in mice and humans with cardiomyopathy. Med 2023; 4:928-943.e5. [PMID: 38029754 PMCID: PMC10994563 DOI: 10.1016/j.medj.2023.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/30/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Rapidly dividing cells are more sensitive to radiation therapy (RT) than quiescent cells. In the failing myocardium, macrophages and fibroblasts mediate collateral tissue injury, leading to progressive myocardial remodeling, fibrosis, and pump failure. Because these cells divide more rapidly than cardiomyocytes, we hypothesized that macrophages and fibroblasts would be more susceptible to lower doses of radiation and that cardiac radiation could therefore attenuate myocardial remodeling. METHODS In three independent murine heart failure models, including models of metabolic stress, ischemia, and pressure overload, mice underwent 5 Gy cardiac radiation or sham treatment followed by echocardiography. Immunofluorescence, flow cytometry, and non-invasive PET imaging were employed to evaluate cardiac macrophages and fibroblasts. Serial cardiac magnetic resonance imaging (cMRI) from patients with cardiomyopathy treated with 25 Gy cardiac RT for ventricular tachycardia (VT) was evaluated to determine changes in cardiac function. FINDINGS In murine heart failure models, cardiac radiation significantly increased LV ejection fraction and reduced end-diastolic volume vs. sham. Radiation resulted in reduced mRNA abundance of B-type natriuretic peptide and fibrotic genes, and histological assessment of the LV showed reduced fibrosis. PET and flow cytometry demonstrated reductions in pro-inflammatory macrophages, and immunofluorescence demonstrated reduced proliferation of macrophages and fibroblasts with RT. In patients who were treated with RT for VT, cMRI demonstrated decreases in LV end-diastolic volume and improvements in LV ejection fraction early after treatment. CONCLUSIONS These results suggest that 5 Gy cardiac radiation attenuates cardiac remodeling in mice and humans with heart failure. FUNDING NIH, ASTRO, AHA, Longer Life Foundation.
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Affiliation(s)
- Lauren N Pedersen
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | | | - Mualla Ozcan
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Zhen Guo
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Aynaz Lotfinaghsh
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Shiyang Zhang
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Sherwin Ng
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Carla Weinheimer
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Jessica Nigro
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Attila Kovacs
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Ahmed Diab
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Amanda Klaas
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Felicia Grogan
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Yoonje Cho
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Anahita Ataran
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Hannah Luehmann
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Abigail Heck
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Kollin Kolb
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Lori Strong
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Rachita Navara
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Gerard M Walls
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast BT97AE, Northern Ireland
| | - Geoff Hugo
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Pamela Samson
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Daniel Cooper
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Francisco J Reynoso
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Julie K Schwarz
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Kaitlin Moore
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Kory Lavine
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Stacey L Rentschler
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Yongjian Liu
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Pamela K Woodard
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Clifford Robinson
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Phillip S Cuculich
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Carmen Bergom
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA.
| | - Ali Javaheri
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA; John J. Cochran Veterans Affairs Medical Center, St. Louis, MO 63106, USA.
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