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Published in: BMC Complementary Medicine and Therapies 1/2019

Open Access 01-12-2019 | Research article

Protective effect of Shenmai injection on doxorubicin-induced cardiotoxicity via regulation of inflammatory mediators

Authors: Sheng Zhang, Zhen-Qiang You, Lin Yang, Li-Li Li, You-Ping Wu, Li-Qiang Gu, Yan-Fei Xin

Published in: BMC Complementary Medicine and Therapies | Issue 1/2019

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Abstract

Background

Doxorubicin (DOX) is a chemotherapy drug for malignant tumors. The clinical application of DOX is limited due to its dosage relative cardiotoxicity. Oxidative damage and cardiac inflammation appear to be involved in DOX-related cardiotoxicity. Shenmai injection (SMI), which mainly consists of Panax ginsengC.A.Mey.and Ophiopogon japonicus (Thunb.) Ker Gawl, is widely used for the treatment of atherosclerotic coronary heart disease and viral myocarditis in China. In this study, we investigated the protective effect of Shenmai injection on doxorubicin-induced acute cardiac injury via the regulation of inflammatory mediators.

Methods

Male ICR mice were randomly divided into seven groups: control, DOX (10 mg/kg), SMI (5 g/kg), DOX with pretreatment with SMI (0.5 g/kg, 1.5 g/kg or 5 g/kg) and DOX with post-treatment with SMI (5 g/kg). Forty-eight hours after the last DOX administration, all mice were anesthetized for ultrasound echocardiography. Then, serum was collected for biochemical and inflammatory cytokine detection, and heart tissue was collected for histological and Western blot detection.

Results

A cumulative dose of DOX (10 mg/kg) induced acute cardiotoxicity in mice manifested by altered echocardiographic outcome, and increased tumor necrosis factor, interleukin 6 (IL-6), monocyte chemotactic protein 1, interferon-γ, and serum AST and LDH levels, as well as cardiac cytoplasmic vacuolation and myofibrillar disarrangement. DOX also caused the increase in the expression of IKK-α and iNOS and produced a large amount of NO, resulting in the accumulation of nitrotyrosine in the heart tissue. Pretreatment with SMI elicited a dose-dependent cardioprotective effect in DOX-dosed mice as evidenced by the normalization of serum inflammatory mediators, as well as improve dcardiac function and myofibril disarrangement.

Conclusions

SMI could recover inflammatory cytokine levels and suppress the expression of IKK-α and iNOS in vivo, which was increased by DOX. Overall, there was evidence that SMI could ameliorate DOX-induced cardiotoxicity by inhibiting inflammation and recovering heart dysfunction.
Literature
1.
go back to reference Riad A, Bien S, Westermann D, Becher PM, Loya K, Landmesser U, Kroemer HK, Schultheiss HP, Tschope C. Pretreatment with statin attenuates the cardiotoxicity of doxorubicin in mice. Cancer Res. 2009;69:695–9.CrossRef Riad A, Bien S, Westermann D, Becher PM, Loya K, Landmesser U, Kroemer HK, Schultheiss HP, Tschope C. Pretreatment with statin attenuates the cardiotoxicity of doxorubicin in mice. Cancer Res. 2009;69:695–9.CrossRef
2.
go back to reference Christiansen S, Autschbach R. Doxorubicin in experimental and clinical heart failure. Eur J Cardiothorac Surg. 2006;30:611–6.CrossRef Christiansen S, Autschbach R. Doxorubicin in experimental and clinical heart failure. Eur J Cardiothorac Surg. 2006;30:611–6.CrossRef
3.
go back to reference Chan KY, Xiang P, Zhou L, Li K, Ng PC, Wang CC, Zhang L, Deng HY, Pong NH, Zhao H, Chan WY, Sung RY. Thrombopoietin protects against doxorubicin-induced cardiomyopathy, improves cardiac function, and reversely alters specific signalling networks. Eur J Heart Fail. 2011;13:366–76.CrossRef Chan KY, Xiang P, Zhou L, Li K, Ng PC, Wang CC, Zhang L, Deng HY, Pong NH, Zhao H, Chan WY, Sung RY. Thrombopoietin protects against doxorubicin-induced cardiomyopathy, improves cardiac function, and reversely alters specific signalling networks. Eur J Heart Fail. 2011;13:366–76.CrossRef
4.
go back to reference Wouters KA, Kremer LC, Miller TL, Herman EH, Lipshultz SE. Protecting against anthracycline-induced myocardial damage: a review of the most promising strategies. Br J Haematol. 2005;131:561–78.CrossRef Wouters KA, Kremer LC, Miller TL, Herman EH, Lipshultz SE. Protecting against anthracycline-induced myocardial damage: a review of the most promising strategies. Br J Haematol. 2005;131:561–78.CrossRef
5.
go back to reference Octavia Y, Tocchetti CG, Gabrielson KL, Janssens S, Crijns HJ, Moens AL. Doxorubicin-induced cardiomyopathy: from molecular mechanisms to therapeutic strategies. J Mol Cell Cardiol. 2012;52:1213–25.CrossRef Octavia Y, Tocchetti CG, Gabrielson KL, Janssens S, Crijns HJ, Moens AL. Doxorubicin-induced cardiomyopathy: from molecular mechanisms to therapeutic strategies. J Mol Cell Cardiol. 2012;52:1213–25.CrossRef
6.
go back to reference Minotti G, Menna P, Salvatorelli E, Cairo G, Gianni L. Anthracyclines: molecular advances and pharmacologic developments in antitumor activity and cardiotoxicity. Pharmacol Rev. 2004;56:185–229.CrossRef Minotti G, Menna P, Salvatorelli E, Cairo G, Gianni L. Anthracyclines: molecular advances and pharmacologic developments in antitumor activity and cardiotoxicity. Pharmacol Rev. 2004;56:185–229.CrossRef
7.
go back to reference Wang XY, Yang CT, Zheng DD, Mo LQ, Lan AP, Yang ZL, Hu F, Chen PX, Liao XX, Feng JQ. Hydrogen sulfide protects H9c2 cells against doxorubicin-induced cardiotoxicity through inhibition of endoplasmic reticulum stress. Mol Cell Biochem. 2012;363:419–26.CrossRef Wang XY, Yang CT, Zheng DD, Mo LQ, Lan AP, Yang ZL, Hu F, Chen PX, Liao XX, Feng JQ. Hydrogen sulfide protects H9c2 cells against doxorubicin-induced cardiotoxicity through inhibition of endoplasmic reticulum stress. Mol Cell Biochem. 2012;363:419–26.CrossRef
8.
go back to reference Ikegami E, Fukazawa R, Kanbe M, Watanabe M, Abe M, Watanabe M, Kamisago M, Hajikano M, Katsube Y, Ogawa S. Edaravone, a potent free radical scavenger, prevents anthracycline-induced myocardial cell death. Circ J. 2007;71:1815–20.CrossRef Ikegami E, Fukazawa R, Kanbe M, Watanabe M, Abe M, Watanabe M, Kamisago M, Hajikano M, Katsube Y, Ogawa S. Edaravone, a potent free radical scavenger, prevents anthracycline-induced myocardial cell death. Circ J. 2007;71:1815–20.CrossRef
9.
go back to reference Guo RM, Xu WM, Lin JC, Mo LQ, Hua XX, Chen PX, Wu K, Zheng DD, Feng JQ. Activation of the p38 MAPK/NF-kappaB pathway contributes to doxorubicin-induced inflammation and cytotoxicity in H9c2 cardiac cells. Mol Med Rep. 2013;8:603–8.CrossRef Guo RM, Xu WM, Lin JC, Mo LQ, Hua XX, Chen PX, Wu K, Zheng DD, Feng JQ. Activation of the p38 MAPK/NF-kappaB pathway contributes to doxorubicin-induced inflammation and cytotoxicity in H9c2 cardiac cells. Mol Med Rep. 2013;8:603–8.CrossRef
10.
go back to reference Lu LY, Zheng GQ. An overview of systematic reviews of shenmai injection for healthcare. 2014;2014:840650. Lu LY, Zheng GQ. An overview of systematic reviews of shenmai injection for healthcare. 2014;2014:840650.
11.
go back to reference Liu R, Nie LX, Li XF, Cheng XL, Zhang YY, Wang GL, Lin RC. Simultaneous determination of ginsenosides and lignans in sheng-mai injection by ultra-performance liquid chromatography with diode array detection. Pharmazie. 2012;67:14–9.CrossRef Liu R, Nie LX, Li XF, Cheng XL, Zhang YY, Wang GL, Lin RC. Simultaneous determination of ginsenosides and lignans in sheng-mai injection by ultra-performance liquid chromatography with diode array detection. Pharmazie. 2012;67:14–9.CrossRef
12.
go back to reference Wang L, Huang XE, Cao J. Clinical study on safety of cantharidin sodium and shenmai injection combined with chemotherapy in treating patients with breast cancer postoperatively. Asian Pac J Cancer Prev. 2014;15:5597–600.CrossRef Wang L, Huang XE, Cao J. Clinical study on safety of cantharidin sodium and shenmai injection combined with chemotherapy in treating patients with breast cancer postoperatively. Asian Pac J Cancer Prev. 2014;15:5597–600.CrossRef
13.
go back to reference Takimoto Y, Aoyama T, Tanaka K, Keyamura R, Yui Y, Sasayama S. Augmented expression of neuronal nitric oxide synthase in the atria parasympathetically decreases heart rate during acute myocardial infarction in rats. Circulation. 2002;105:490–6.CrossRef Takimoto Y, Aoyama T, Tanaka K, Keyamura R, Yui Y, Sasayama S. Augmented expression of neuronal nitric oxide synthase in the atria parasympathetically decreases heart rate during acute myocardial infarction in rats. Circulation. 2002;105:490–6.CrossRef
14.
go back to reference Billingham ME, Mason JW, Bristow MR, Daniels JR. Anthracycline cardiomyopathy monitored by morphologic changes. Cancer Treat Rep. 1978;62:865–72.PubMed Billingham ME, Mason JW, Bristow MR, Daniels JR. Anthracycline cardiomyopathy monitored by morphologic changes. Cancer Treat Rep. 1978;62:865–72.PubMed
15.
go back to reference Karin M, Delhase M. The I kappa B kinase (IKK) and NF-kappa B: key elements of proinflammatory signalling. Semin Immunol. 2000;12:85–98.CrossRef Karin M, Delhase M. The I kappa B kinase (IKK) and NF-kappa B: key elements of proinflammatory signalling. Semin Immunol. 2000;12:85–98.CrossRef
16.
go back to reference Tak PP, Firestein GS. NF-kappaB: a key role in inflammatory diseases. J Clin Invest. 2001;107:7–11.CrossRef Tak PP, Firestein GS. NF-kappaB: a key role in inflammatory diseases. J Clin Invest. 2001;107:7–11.CrossRef
17.
go back to reference Nitiss KC, Nitiss JL. Twisting and ironing: doxorubicin cardiotoxicity by mitochondrial DNA damage. Clin Cancer Res. 2014;20:4737–9.CrossRef Nitiss KC, Nitiss JL. Twisting and ironing: doxorubicin cardiotoxicity by mitochondrial DNA damage. Clin Cancer Res. 2014;20:4737–9.CrossRef
18.
go back to reference Hadi N, Yousif NG, Al-amran FG, Huntei NK, Mohammad BI, Ali SJ. Vitamin E and telmisartan attenuates doxorubicin induced cardiac injury in rat through down regulation of inflammatory response. BMC Cardiovasc Disord. 2012;12:63.CrossRef Hadi N, Yousif NG, Al-amran FG, Huntei NK, Mohammad BI, Ali SJ. Vitamin E and telmisartan attenuates doxorubicin induced cardiac injury in rat through down regulation of inflammatory response. BMC Cardiovasc Disord. 2012;12:63.CrossRef
19.
go back to reference Hou G, Dick R, Abrams GD, Brewer GJ. Tetrathiomolybdate protects against cardiac damage by doxorubicin in mice. J Lab Clin Med. 2005;146:299–303.CrossRef Hou G, Dick R, Abrams GD, Brewer GJ. Tetrathiomolybdate protects against cardiac damage by doxorubicin in mice. J Lab Clin Med. 2005;146:299–303.CrossRef
20.
go back to reference Mercuro G, Cadeddu C, Piras A, Dessi M, Madeddu C, Deidda M, Serpe R, Massa E, Mantovani G. Early epirubicin-induced myocardial dysfunction revealed by serial tissue Doppler echocardiography: correlation with inflammatory and oxidative stress markers. Oncologist. 2007;12:1124–33.CrossRef Mercuro G, Cadeddu C, Piras A, Dessi M, Madeddu C, Deidda M, Serpe R, Massa E, Mantovani G. Early epirubicin-induced myocardial dysfunction revealed by serial tissue Doppler echocardiography: correlation with inflammatory and oxidative stress markers. Oncologist. 2007;12:1124–33.CrossRef
21.
go back to reference Pecoraro M, Del Pizzo M, Marzocco S, Sorrentino R, Ciccarelli M, Iaccarino G, Pinto A, Popolo A. Inflammatory mediators in a short-time mouse model of doxorubicin-induced cardiotoxicity. Toxicol Appl Pharmacol. 2016;293:44–52.CrossRef Pecoraro M, Del Pizzo M, Marzocco S, Sorrentino R, Ciccarelli M, Iaccarino G, Pinto A, Popolo A. Inflammatory mediators in a short-time mouse model of doxorubicin-induced cardiotoxicity. Toxicol Appl Pharmacol. 2016;293:44–52.CrossRef
22.
go back to reference Liu ZL, Liu ZJ, Liu JP, Kwong JS. Herbal medicines for viral myocarditis. Cochrane Database Syst Rev. 2012;11:Cd003711.PubMed Liu ZL, Liu ZJ, Liu JP, Kwong JS. Herbal medicines for viral myocarditis. Cochrane Database Syst Rev. 2012;11:Cd003711.PubMed
23.
go back to reference Elsharkawy AM, Mann DA. Nuclear factor-kappaB and the hepatic inflammation-fibrosis-cancer axis. Hepatology. 2007;46:590–7.CrossRef Elsharkawy AM, Mann DA. Nuclear factor-kappaB and the hepatic inflammation-fibrosis-cancer axis. Hepatology. 2007;46:590–7.CrossRef
24.
go back to reference Liu ZM, Li N, Yu H, Chen Y. Experimental study of the effect of Shenmai injection on post-cardiac arrest syndrome in rabbit. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2013;25:664–8.PubMed Liu ZM, Li N, Yu H, Chen Y. Experimental study of the effect of Shenmai injection on post-cardiac arrest syndrome in rabbit. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2013;25:664–8.PubMed
25.
go back to reference Renu K, GA V, BT P, Arunachalam S. Molecular mechanism of doxorubicin-induced cardiomyopathy - an update. Eur J Pharmacol. 2017;818:241–53.CrossRef Renu K, GA V, BT P, Arunachalam S. Molecular mechanism of doxorubicin-induced cardiomyopathy - an update. Eur J Pharmacol. 2017;818:241–53.CrossRef
26.
go back to reference Wang ZQ, Chen MT, Zhang R, Zhang Y, Li W, Li YG. Docosahexaenoic acid attenuates doxorubicin-induced cytotoxicity and inflammation by suppressing NF-kappaB/iNOS/NO signaling pathway activation in H9C2 cardiac cells. J Cardiovasc Pharmacol. 2016;67:283–9.CrossRef Wang ZQ, Chen MT, Zhang R, Zhang Y, Li W, Li YG. Docosahexaenoic acid attenuates doxorubicin-induced cytotoxicity and inflammation by suppressing NF-kappaB/iNOS/NO signaling pathway activation in H9C2 cardiac cells. J Cardiovasc Pharmacol. 2016;67:283–9.CrossRef
27.
go back to reference Pacher P, Liaudet L, Bai P, Mabley JG, Kaminski PM, Virag L, Deb A, Szabo E, Ungvari Z, Wolin MS, Groves JT, Szabo C. Potent metalloporphyrin peroxynitrite decomposition catalyst protects against the development of doxorubicin-induced cardiac dysfunction. Circulation. 2003;107:896–904.CrossRef Pacher P, Liaudet L, Bai P, Mabley JG, Kaminski PM, Virag L, Deb A, Szabo E, Ungvari Z, Wolin MS, Groves JT, Szabo C. Potent metalloporphyrin peroxynitrite decomposition catalyst protects against the development of doxorubicin-induced cardiac dysfunction. Circulation. 2003;107:896–904.CrossRef
28.
go back to reference Ma S, Li X, Dong L, Zhu J, Zhang H, Jia Y. Protective effect of Sheng-Mai Yin, a traditional Chinese preparation, against doxorubicin-induced cardiac toxicity in rats. BMC Complement Altern Med. 2016;16:61.CrossRef Ma S, Li X, Dong L, Zhu J, Zhang H, Jia Y. Protective effect of Sheng-Mai Yin, a traditional Chinese preparation, against doxorubicin-induced cardiac toxicity in rats. BMC Complement Altern Med. 2016;16:61.CrossRef
29.
go back to reference Liu WY, Zhang JW, Yao XQ, Jiang C, He JC, Ni P, Liu JL, Chen QY, Li QR, Zang XJ, Yao L, Liu YZ, Wang ML, Shen PQ, Wang GJ, Zhou F. Shenmai injection enhances the cytotoxicity of chemotherapeutic drugs against colorectal cancers via improving their subcellular distribution. Acta Pharmacol Sin. 2017;38:264–76.CrossRef Liu WY, Zhang JW, Yao XQ, Jiang C, He JC, Ni P, Liu JL, Chen QY, Li QR, Zang XJ, Yao L, Liu YZ, Wang ML, Shen PQ, Wang GJ, Zhou F. Shenmai injection enhances the cytotoxicity of chemotherapeutic drugs against colorectal cancers via improving their subcellular distribution. Acta Pharmacol Sin. 2017;38:264–76.CrossRef
Metadata
Title
Protective effect of Shenmai injection on doxorubicin-induced cardiotoxicity via regulation of inflammatory mediators
Authors
Sheng Zhang
Zhen-Qiang You
Lin Yang
Li-Li Li
You-Ping Wu
Li-Qiang Gu
Yan-Fei Xin
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2019
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-019-2686-2

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