Donate Help Contact The AHA Sign In Home
American Heart Association
Circulation
Search: search_blue_button Advanced Search
Circulation. 2000;102:572-578

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Nakamura, T.
Right arrow Articles by Koh, E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Nakamura, T.
Right arrow Articles by Koh, E.
Related Collections
Right arrow Apoptosis

(Circulation. 2000;102:572.)
© 2000 American Heart Association, Inc.


Basic Science Reports

Fas-Mediated Apoptosis in Adriamycin-Induced Cardiomyopathy in Rats

In Vivo Study

Tsuneyuki Nakamura, MD; Yoshimichi Ueda, MD; Yang Juan, PhD; Shogo Katsuda, MD; Hiroaki Takahashi, MD; Eikan Koh, MD

From the Departments of Pediatrics (T.N., H.T., E.K.) and Pathology (Y.U., Y.J., S.K.), Kanazawa Medical University, Ishikawa, Japan.

Correspondence to Eikan Koh, Department of Pediatrics, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Ishikawa 920-0293, Japan. E-mail p-koh{at}kanazawa-med.ac.jp


*    Abstract
up arrowTop
*Abstract
down arrowIntroduction
down arrowMethods
down arrowResults
down arrowDiscussion
down arrowReferences
 
Background—The precise molecular mechanism of Adriamycin-induced cardiomyopathy (ADR-CM) is still unknown. We address the demonstration of apoptotic myocardial cell death and the apoptosis-inducing molecules in ADR-CM induced in rats.

Methods and Results—Until 8 weeks after the first administration of ADR, there was no increase in the number of labeled cells by terminal deoxynucleotidyl transferase assay (TUNEL method). Apoptotic indices increased significantly at weeks 9 and 10 in hearts of the ADR-treated group but not in those of the control group (0.42±0.12% versus 0.10±0.02% and 0.86±0.11% versus 0.09±0.04% at weeks 9 and 10, respectively). DNA ladder formation was also observed in the myocardial tissues during the late stages of the ADR-CM of rats. There was no significant difference in expression of p53 gene between the ADR group and the control group at either the message or the protein level. An overexpression of Fas antigen was shown in myocardial cells of ADR-treated hearts at weeks 9 and 10 by both Western blotting and immunofluorescent staining. Furthermore, we confirmed that neutralization of anti–Fas ligand antibody inhibited ADR-induced apoptosis.

Conclusions—Apoptotic cell death was observed in the hearts of ADR-CM rats, and the number of apoptotic myocardial cells increased with the deterioration of morphological findings and cardiac function, indicating that apoptosis may be an important mechanism of loss of myocardial cells and cardiac dysfunction in ADR-CM. Apoptosis in ADR-CM rats is not p53-dependent but rather is executed through a Fas-mediated pathway.


Key Words: apoptosis • cardiomyopathy • doxorubicin hydrochloride


*    Introduction
up arrowTop
up arrowAbstract
*Introduction
down arrowMethods
down arrowResults
down arrowDiscussion
down arrowReferences
 
Doxorubicin HCl (Adriamycin, ADR) is one of the most effective and useful antineoplastic agents for the treatment of a variety of malignancies, including lymphoma, leukemia, and solid tumors. However, its practical therapeutic use is sometimes limited by late-onset and acute and chronic cardiotoxicities.1 2 The chronic cardiotoxicity is dose-dependent and causes irreversible myocardial damage, resulting in dilated cardiomyopathy (DCM) with fatal congestive heart failure.3 Previous studies on the pathogenesis of ADR-induced cardiomyopathy (ADR-CM) have reported that free-radical–mediated myocyte damage,4 disturbance in myocardial adrenergic function,5 intracellular calcium overload,6 and release of cardiotoxic cytokines7 might be involved in the pathogenesis of ADR-CM. ADR causes the selective inhibition of gene expression specific for cardiac muscles, such as {alpha}-actin, troponin, myosin light chain-2, and the M isoform of creatine kinase, that may explain the myofibrillar loss associated with ADR-CM.8

Apoptosis plays a pivotal role in loss of cells not only during physiological phenomena, such as embryogenesis and normal turnover, but also in many pathological processes.9 Evidence is accumulating that the apoptotic mechanism is involved in loss of myocytes in various human heart disorders, including DCM,10 11 chronic myocarditis,12 and myocardial infarction.13 As to apoptosis-related genes, bax, bcl-2, and Fas antigen were shown to be overexpressed in myocytes of DCM, chronic heart failure, and myocardial infarction,11 14 15 although the precise mechanism of apoptosis induction in those heart disorders is still to be investigated. In ADR-CM, however, the significance of apoptotic cell death and the apoptosis-related genes involved have not yet been investigated.

The purpose of our present study was to investigate whether apoptotic cell death contributes to the loss of myocytes in ADR-CM and to analyze the mechanism of apoptosis induction in ADR-CM, concentrating on p53 and Fas antigen, which are 2 important apoptosis-inducing molecules, in an ADR-CM model induced in rats.


*    Methods
up arrowTop
up arrowAbstract
up arrowIntroduction
*Methods
down arrowResults
down arrowDiscussion
down arrowReferences
 
Experimental Animals
ADR-CM was induced in male Wister rats weighing 276.6±5.7 g by weekly administration of 2 mg/kg of ADR (supplied from Kyowa Hakko Kogyo Co Ltd) via a tail vein for 8 weeks according to Podesta et al.16 Instead of ADR, the same volume of physiological saline was injected into control rats. Batches of 3 rats were euthanized 24 hours after the beginning of administration of ADR or saline and also on the same day of weeks 5, 8, 9, and 10. Week 0 is taken to be the time of the first administration of ADR. After anesthesia with ether, the chest was opened and the heart immediately isolated. The blood in the heart was removed and the heart weighed. Ventricles were cut horizontally and separated into 3 slices. The midslice of the ventricle was fixed in 4% paraformaldehyde at 4°C for 8 hours, dehydrated in graded alcohol series, and then embedded in paraffin. The apical and basal portions of the left ventricle (LV) were rapidly frozen in liquid nitrogen and were preserved at -80°C until use. A part of the LV was also embedded in OCT compound and rapidly frozen.

Histological Assessment of Myocardial Damage
Paraffin sections 3 µm thick were stained with hematoxylin and eosin, reticulin silver impregnation, and Azan-Mallory stain.

Analysis of LV Performance
LV performance was examined by echocardiography at weeks 9 and 10 after the first injection of ADR or saline. LV dimensions (end-diastolic diameter [LVDd] and end-systolic diameter [LVDs]) were measured by echocardiogram with an HP SONOS 1000 with a 7.5-MHz transducer (Hewlett-Packard Co). The percent fractional shortening (%FS) of LV was calculated from the formula %FS=[(LVDd-LVDs)/LVDd]x100.

In Situ Terminal Deoxynucleotidyl Transferase Assay (TUNEL Method)
The TUNEL method is based on the specific binding of terminal deoxynucleotidyl transferase (TdT) to the 3'-OH ends of DNA and the ensuing synthesis of a polydeoxynucleotide polymer. The TUNEL method was applied to 4% paraformaldehyde–fixed, paraffin-embedded sections 3 µm thick with an ApoTag In Apoptosis Detection Kit (Oncor) according to the manufacturer’s instructions.

Quantitative Analysis of DNA Strand Breaks in Myocytes
Myocardial nuclei of 3-µm horizontal sections of the heart, including the left and right ventricles and intraventricular septum, were labeled by the TUNEL method. Their numbers were counted, and an apoptotic index (number of myocardial nuclei labeled by the TUNEL method/number of total myocardial nuclei) was calculated. The numbers of apoptotic cells were counted by 3 persons, 1 pathologist and 2 pediatricians, without knowledge of other information about the samples.

DNA Gel Electrophoresis
DNA was extracted from fresh-frozen myocardial tissues. Tissues were homogenized and lysed in a solution containing 50 mmol/L Tris-HCl (pH 8.0), 100 mmol/L EDTA, 100 mmol/L NaCl, and 1% SDS and digested in 0.5 mg/mL proteinase K (Sigma Chemical Co) at 55°C for 16 hours. RNase A (Sigma Chemical Co) was added to each sample to achieve a final concentration of 0.2 mg/mL of RNase A, and the samples were incubated at 37°C for 2 hours. After phenol/chloroform extraction, DNA was precipitated by ethanol and dissolved in TE solution (10 mmol/L Tris-HCl [pH 8.0], 1 mmol/L EDTA). DNA samples (10 µg) were subjected to electrophoresis on 2% agarose gel, stained with ethidium bromide, and photographed under ultraviolet illumination.

Reverse Transcription–Polymerase Chain Reaction Analysis
Total RNA was extracted from fresh-frozen myocardium by the Isogen RNA extraction system (Nippon Gene). cDNA was synthesized from 5 µg of each RNA sample by use of random hexamers and reverse transcriptase at 37°C for 30 minutes. Rat p53 mRNA was amplified with a Multiplex polymerase chain reaction (PCR) kit (Maxim Bioteck Inc) and rat G3PDH with the following primers: 5'-TGAAGGTCGGAGTCAACGGATTTGGT-3', 5'-CATGTGG-GCCATGAGGTCCACCAC-3' (983-bp products). Cycling parameters were as follows: the cycle consisted of 1 minute of denaturation at 94°C, 1 minute of annealing at 60°C, and 1 minute of extension at 74°C. PCR amplification for 30 cycles, which was determined to be within the linear range of product amplification for both p53 and G3PDH mRNA, was carried out for semiquantitative PCR analysis. Then, 2.5 µL of the PCR products was analyzed by electrophoresis on a 1% agarose gel, followed by ethidium bromide staining to determine the levels of p53 mRNAs relative to the control G3PDH transcript. Further verification of the PCR product identity was determined by comparison with standards supplied by the kit manufacturer (Maxim Bioteck Inc).

Western Blot Analysis
Proteins were extracted from fresh-frozen LV myocardium. Homogenized myocardial tissue was lysed in a solution containing 50 mmol/L Tris-HCl (pH 7.2), 50 mmol/L NaCl, 1% Nonidet P-40, 1% sodium deoxycholic acid, and 2% SDS with protease inhibitor cocktail (Boehringer-Mannheim). Protein concentration was evaluated against standard BSA with a Bio-Rad assay reagent.17 Twenty micrograms of each protein preparation was electrophoretically separated on a 15% SDS-PAGE gel and transferred to a nitrocellulose membrane. The membrane was then incubated with either anti-p53 protein (Nichirei, diluted at 1:2000), anti-Fas antigen antibody (Transduction Laboratories, diluted at 1:2500), or anti–ß-actin antibody (Sigma Chemical Co, diluted at 1:2000) for 1 hour at room temperature. Western blots were exposed on an x-ray film with an enhanced chemiluminescence kit (Pierce). Bands were identified by comparison to standards purchased from the same companies that supplied antibodies.

Immunofluorescence Stain for Fas Antigen
Frozen sections 4 µm thick were briefly fixed in 4% paraformaldehyde, and anti-Fas antibody (Transduction Laboratories) was applied for 1 hour at room temperature after blocking with 10% normal goat serum. Slides were incubated in FITC-conjugated goat anti-mouse IgG diluted at a ratio of 1:50 for 30 minutes and observed with an Olympus BX60-FLB.

Inhibition of ADR-Induced Apoptosis by Neutralizing Anti–Fas Ligand Antibody
Initially, we investigated by Western blot whether anti–mouse Fas ligand (Fas L) (Pharmingen) cross-reacted to rat. Anti–Fas L antibody (10 µg/kg) was injected twice via the tail vein of rats every 12 hours 9 weeks after the first administration of ADR. Instead of anti–Fas L antibody, a similar amount of normal mouse IgG serum was injected into control rats. Batches of 4 rats underwent echocardiography and were euthanized 6 hours after the last injection of anti–Fas L antibody. Sections of the heart 3 µm thick were fixed in 4% paraformaldehyde and embedded in paraffin as stated above. Myocardial nuclei were labeled by the TUNEL method, and an apoptotic index was calculated.

Data Collection and Analysis
All results are presented as mean±SD. Statistical significances for comparisons of cardiac weights, %FS, and apoptotic ratios between the ADR-injected group and the control group were determined with Student’s t test. Differences in apoptotic ratios among ADR-injected groups were statistically analyzed with Scheffé’s method. Values of P<0.05 were considered to be significant.


*    Results
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMethods
*Results
down arrowDiscussion
down arrowReferences
 
Both body and cardiac weights of ADR-injected rats were significantly decreased at week 8 after the first administration of ADR compared with those of the control group. Pleural effusions began to appear in 2 of 3 ADR-injected rats at week 9 and were observed in all rats at week 10 after the first administration (Table 1Down).


View this table:
[in this window]
[in a new window]
 
Table 1. Body and Cardiac Weights and Occurrences of Pleural Effusion in ADR-Injected and Control Rats

LV Performance
The %FS of the LV diminished significantly in ADR-injected rats at weeks 9 and 10 compared with those of control rats (28.5±4.3% versus 41.5±1.3% at week 9 and 23.1±5.0% versus 39.2±0.4% at week 10, respectively, P<0.005 at each week) (Table 3Down).


View this table:
[in this window]
[in a new window]
 
Table 3. LV Performance in ADR-Treated, anti–Fas L Antibody+ADR–Treated, and Control Rats

Histopathology
No histopathological difference between the ADR-injected group and the control group was detected until 8 weeks after the beginning of administration of ADR or saline, when vacuolation and myofibrillar loss appeared to be observed in focal areas of ADR-injected rats. In the ADR-injected group, the histological degenerative changes rapidly increased at weeks 9 and 10, in association with compensatory myocardial hypertrophy and interstitial fibrosis (Figure 1ADown). Pyknotic nuclei and fragmentation of the nuclei were sometimes found in the ADR-injected group (Figure 1ADown and inset).



View larger version (131K):
[in this window]
[in a new window]
 
Figure 1. Light microscopic findings of LV of ADR-treated myocardium at week 10 after beginning of administration of ADR or saline. Vacuolization and hypertrophy are seen in ADR-injected rat heart (A). Pyknotic and fragmented myocardial nucleus is observed in inset. Hematoxylin-eosin stain; magnification: A and B, x50; inset, x160.

Apoptotic Cells
The TUNEL method labeled not only fragmented nuclei of myocardial cells but also pyknotic ones. A small number of cells labeled by the TUNEL method were detected even in the control group and in the early stages of ADR-treated hearts. The number of labeled nuclei increased significantly in ADR-injected rats during the late stages, especially at weeks 9 and 10, compared with those of controls (Figure 2ADown and 2BDown; Table 2Down). Apoptotic ratios of ADR-injected versus control rats were 0.42±0.12% versus 0.10±0.02% at week 9 and 0.86±0.11% versus 0.09±0.04% at week 10, respectively, and a statistically significant increase in the ratio of labeled cells was detected at week 10 after the beginning of ADR administration (P<0.05).



View larger version (94K):
[in this window]
[in a new window]
 
Figure 2. Photomicrographs of in situ TUNEL method in LV of ADR-treated (A) and saline-treated (B) rats at week 10 after administration of ADR or saline. Arrows indicate labeled myocardial nuclei. Magnification x80.


View this table:
[in this window]
[in a new window]
 
Table 2. Number of Apoptotic Cells in the ADR-Treated Group and Control Group During the Course of the Experiment

DNA Gel Electrophoresis
DNA laddering with the lowest band at 180 bp, indicating nucleosomal breakdown of genomic DNA, was seen in the ADR-injected group at week 10, whereas no DNA fragments were detected in the control group at any stage (Figure 3Down).



View larger version (80K):
[in this window]
[in a new window]
 
Figure 3. Electrophoresis of DNA extracted from LV of ADR-treated (lane 2) and control (lane 3) rats at week 10 after first administration. Lane 1 shows molecular weight markers. DNA ladder formation is seen in lane 2 but not in lane 3.

Expression of p53 Gene
mRNA of the p53 gene was detected in both the control and the ADR-injected groups by reverse transcription (RT)-PCR. A semiquantitative study disclosed no difference in expression of p53-mRNA between the 2 groups (Figure 4ADown). Furthermore, there was no difference in expression of the p53 gene at the message level during the experimental course of the ADR-treated group. Western blot analysis showed no difference in the expression of the p53 protein between the ADR-injected and control groups (Figure 5BDown).



View larger version (62K):
[in this window]
[in a new window]
 
Figure 4. Expression of p53 gene at message level: A, RT-PCR of p53; B, RT-PCR of G3PDH as internal standard. Lanes 1 and 3 show LV tissues of saline-injected rats at weeks 9 and 10, respectively. Lanes 2 and 4 show those of ADR-injected rats at same times. Each band was identified by comparison with standards provided by manufacturer. There is no difference in p53 expression between ADR-treated and control groups at message level at either week 9 or 10 after beginning of administration.



View larger version (38K):
[in this window]
[in a new window]
 
Figure 5. Expression of Fas antigen (A), p53 (B), and ß-actin (C) examined by Western blotting. Lanes 1 and 3 show LV tissues of saline-injected rats at weeks 9 and 10, respectively. Lanes 2 and 4 show those of ADR-injected rat at same time. Expression of Fas antigen is increased in ADR-injected heart tissues at both weeks 9 and 10 compared with saline-injected tissues. There is no significant difference of expression of p53 between ADR- and saline-injected groups.

Expression of Fas Antigen
Until 5 weeks after the first administration, no difference was detected by Western blot in the expression of Fas antigen at the protein level between the control and the ADR-injected groups. However, at weeks 9 and 10, Fas antigen was overexpressed in the ADR-injected hearts compared with the control hearts (Figure 5AUp). In the ADR-injected rats, fluorescent staining showed dominant overexpression of Fas antigen on the cell membrane of some myocardial cells in the late stages (Figure 6ADown and 6BDown).



View larger version (86K):
[in this window]
[in a new window]
 
Figure 6. Photomicrographs of immunofluorescent staining for Fas antigen in LV of ADR-treated (A) and control (B) rats at week 10 after first administration. Overexpression of Fas antigen is seen in some myocardia of ADR-injected rats. Magnification x100.

Inhibition of Apoptosis by Neutralizing Anti–Fas L Antigen
The neutralizing anti–mouse Fas L antibody recognized rat Fas L by Western blot (data not shown). The %FS of the LV in rats treated with anti–Fas L antibody plus ADR versus rats treated with ADR only was 45.3±5.0% versus 32.6±3.4%, and statistically significant improvement of %FS was detected in rats treated with anti–Fas L antibody (P<0.01) (Table 3Up). Furthermore, apoptotic indexes (number of apoptotic cells) of rats treated with anti–Fas L antibody plus ADR versus rats treated with ADR only were 0.25±0.01% (44.7±4.1%) versus 0.37±0.06% (57.7±9.9%), and a statistically significant decrease of the ratio in labeled cells was detected in rats treated with anti–Fas L antibody plus ADR (P<0.05).


*    Discussion
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMethods
up arrowResults
*Discussion
down arrowReferences
 
This study indicates that apoptosis may play an important role in ADR-CM. In the present study, we used a model of ADR-CM–induced rats, because it has been reported that ADR-CM could be established reproducibly in rats.16 18 19 The present ADR-CM model in rats showed histological changes similar to those in human ADR-CM: degeneration and loss of myocytes, compensatory hypertrophy of residual myocytes and interstitial fibrosis. These histological findings deteriorated according to the cumulative dosages of ADR equivalent to the human ADR-CM dose. Diminished LV function demonstrated by echocardiogram and decreased cardiac weights with the appearance of pleural effusion in the late stages of the ADR-treated heart further support the usefulness of the present rat ADR-CM as an experimental model for the investigation of the mechanism of ADR-CM occurring in humans.

With the ADR-injected group, fragmented nuclei, in addition to pyknotic ones, were sometimes observed in myocardial cells in the late stages, suggesting the possibility of apoptotic death.9 Several recent reports have described myocardial cell death through apoptotic mechanisms in a variety of cardiac diseases and pathophysiological states: end-stage heart failure due to DCM and ischemic cardiomyopathy,10 11 myocardial infarction,13 chronic myocarditis,12 and complete heart block20 in humans; chronic heart failure in dogs21 ; reperfusion injury in rabbits22 ; myocardial infarction in rats14 ; and hypoxia in rats.23 In the present study, apoptotic death of myocardial cells was demonstrated in ADR-CM–induced rats by both the TUNEL method and DNA agarose-gel electrophoresis. With accumulation of ADR, the increase in the number of apoptotic myocardial cells seems to be concomitant with the progression of ADR-CM both morphologically and functionally, indicating that apoptotic myocardial cell death may also play an important role in the pathogenesis of ADR-CM in rats.

Our findings differ from those of a previous report regarding the proportion of apoptotic cells in human end-stage heart failure described by Narula et al.10 The percentages of apoptotic cells in the present study (0.86±0.11% at week 10) are much smaller than those reported by Narula et al10 (5% to 35.5%). If we take into consideration that apoptosis is completed in at most a few hours,24 25 the high values of the apoptotic index reported by Narula et al would be incompatible with real life and would be unreliable, as pointed out by Olivetti et al.11 Our findings appear to be consistent with the apoptotic ratio of 0.23±0.20% in the failing human heart reported by Olivetti et al. Because most rats in this study died within 12 weeks of the first administration of ADR due to heart failure, our values of the apoptotic index would be the upper limit during the late stage of congestive heart failure.

In the present study, apoptosis was counted as 0.1% (0.09% to 0.14%) even in the hearts of the control group. Fragmented nuclei of cardiomyocytes on the TUNEL stains were distinguished from infiltrating lymphocytes by immunohistochemistry of lymphocyte common antigen (data not shown).

Apoptosis-induction mechanisms were recently separated into p53-dependent and p53-independent pathways.26 p53 is a cell cycle–regulatory molecule. Many exogenous stimuli, including genotoxic agents, promote the accumulation of the p53 protein in the nucleus, which induces growth arrest and apoptosis. This study examined whether apoptosis induced by ADR in rats was dependent on overexpression of p53. There were no significant differences of the expression of p53 between the ADR and the control groups at either the message or the protein level, suggesting that apoptotic cell death of ADR-CM induced in rats is p53-independent. In previous reports regarding apoptosis of cardiomyocytes, overexpression of Fas antigen, bcl-2, and bax have been demonstrated in myocardial tissue with infarction,14 15 DCM,11 hypoxia,23 and chronic heart failure. Bax, a conserved homolog of bcl-2, heteromerizes in vivo with bcl-2, which accelerates apoptosis.27 Miyashita and Reed28 recently demonstrated that p53 is a transcriptional activator of the human bax gene. We have also found that bax is overexpressed in cardiomyocytes of ADR-CM induced in rats (data not shown). According to the present finding on p53, it appears that a novel p53-independent pathway is working in activating transcription of the bax gene in ADR-CM–induced rats.

Fas antigen was demonstrated by both immunofluorescent staining and Western blotting to be overexpressed in the ADR-CM rat model. It has been reported that Fas antigen belongs to the tumor necrosis factor receptor superfamily29 and that apoptosis could be induced by ligation of Fas by Fas L.29 30 31 32 Furthermore, overexpression of Fas antigen has been reported in a variety of conditions: cardiomyopathy induced by rapid pacing in dogs, myocardial infarction in rats,14 or hypoxia in cultured neonatal rat cardiomyocytes.23 However, no reports have documented a cause-and-effect relationship between apoptosis and Fas antigen in heart diseases. Recently, some investigators reported that induction of Fas L and upregulation of Fas after treatment with anticancer drugs, including ADR, had been observed in a variety of tumor cell lines and that blockade of the Fas/Fas L interaction by an antagonistic antibody inhibited drug-induced cell death in vitro.33 34 35 36 Kamitani et al37 reported that high-molecular-mass Fas aggregates (>200 kDa) were immunoprecipitated with antibodies against the extracellular domain and detected in Western blotting under reducing conditions with antibodies against the death domain or the carboxyl terminus. However, we could detect only small Fas aggregates, not large ones (>200 kDa), because only anti–extracellular domain antibodies were used. In this study, overexpression of Fas antigen was associated with increased numbers of apoptotic myocytes, and neutralizing anti–Fas L antibody not only induced the prevention of deterioration of LV performance but also decreased the number of apoptotic myocytes. These results indicated that ADR-induced myocyte death occurred through a Fas-dependent pathway in ADR-CM. Thus, ADR not only kills the tumor cells acutely but also facilitates myocardial cell death at the late stage via a Fas-mediated pathway. Fulda et al33 reported that mitochondria played a central role in the regulation of drug-induced apoptosis by controlling activation of the caspase cascade. However, it has been reported that one of the pathogeneses of ADR-CM might be a histochemical mitochondrial effect.5 Mitochondrial function might also play a central role in the regulation of ADR-induced myocardial cell death in ADR-CM. Our findings support a possibility of preventing ADR-CM clinically by blockade of the Fas/Fas L interaction by neutralizing either Fas L antibody or soluble Fas.


*    Acknowledgments
 
This work was supported in part by a grant from the Japanese Ministry of Education.

Received December 30, 1999; revision received March 1, 2000; accepted March 8, 2000.


*    References
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMethods
up arrowResults
up arrowDiscussion
*References
 
1. Henderson IC, Frei E. Adriamycin and the heart. N Engl J Med. 1979;300:310–312.[Medline] [Order article via Infotrieve]

2. Lefrak EA, Pitha J, Rosenheim S, et al. A clinicopathologic analysis of adriamycin cardiotoxicity. Cancer. 1973;32:302–314.[Medline] [Order article via Infotrieve]

3. Von Hoff DD, Layard MW, Basa P, et al. Risk factors for doxorubicin-induced congestive heart failure. Ann Intern Med.. 1979;91:710–717.

4. Iliskovic N, Singal PK. Lipid lowering: an important factor in preventing adriamycin-induced heart failure. Am J Pathol. 1997;150:727–734.[Abstract]

5. Valdes Olmos RA, ten Bokkei Huinink WW, ten Hoeve RF, et al. Assessment of anthracycline-related myocardial adrenergic derangement by (123I) metaiodobenzylguanidine scintigraphy. Eur J Cancer. 1995;31A:26–31.

6. Wang YX, Korth M. Effects of doxorubicin on excitation-contraction coupling in guinea pig ventricular myocardium. Circ Res. 1995;76:645–653.[Abstract/Free Full Text]

7. Torre-Amione G, Kapadia S, Benedict C, et al. Proinflammatory cytokine levels in patients with depressed left ventricular ejection fraction: a report from the studies of left ventricular dysfunction. J Am Coll Cardiol. 1996;27:1201–1206.[Abstract]

8. Ito H, Miller SC, Billingham ME, et al. Doxorubicin selectively inhibits muscle gene expression in cardiac muscle cells in vivo and in vitro. Proc Natl Acad Sci U S A. 1990;87:4275–4279.[Abstract/Free Full Text]

9. Majno G, Joris I. Apoptosis, oncosis, and necrosis: an overview of cell death. Am J Pathol. 1995;146:3–15.[Abstract]

10. Narula J, Haider N, Virmani R, et al. Apoptosis in myocytes in end-stage heart failure. N Engl J Med. 1996;335:1182–1189.[Abstract/Free Full Text]

11. Olivetti G, Abbi R, Quaini F, et al. Apoptosis in the failing human heart. N Engl J Med. 1997;336:1131–1141.[Abstract/Free Full Text]

12. Kawano H, Okada R, Kawano Y, et al. Apoptosis in acute and chronic myocarditis. Jpn Heart J. 1994;35:745–750.[Medline] [Order article via Infotrieve]

13. Itoh G, Tamura J, Suzuki M, et al. DNA fragmentation of human infarcted myocardial cells demonstrated by the nick end labeling method and DNA agarose gel electrophoresis. Am J Pathol. 1995;146:1325–1331.[Abstract]

14. Kajstura J, Cheng W, Reiss K, et al. Apoptotic and necrotic myocyte cell death are independent contributing variables of infarct size in rats. Lab Invest. 1996;74:86–107.[Medline] [Order article via Infotrieve]

15. Misao J, Hayakawa Y, Ohno M, et al. Expression of bcl-2 protein, an inhibitor of apoptosis, and Bax, an accelerator of apoptosis, in ventricular myocardial infarction. Circulation. 1996;94:1506–1512.[Abstract/Free Full Text]

16. Podesta A, Della P, Pinciroli G, et al. Evaluation of 4'-iodo-4'-deoxydoxorubicin-induced cardiotoxicity in two experimental rat models. Toxicol Pathol. 1994;22:68–71.[Medline] [Order article via Infotrieve]

17. Bradford MM. A rapid and sensitive method for the quantitation of microgram quantities of protein utilizing the principle of protein-dye binding. Anal Biochem. 1976;72:238–245.[Medline] [Order article via Infotrieve]

18. Mettler FP, Young DM, Ward MJ. Adriamycin-induced cardiotoxicity (cardiomyopathy and congestive heart failure) in rats. Cancer Res. 1977;37:2705–2713.[Abstract/Free Full Text]

19. Zbinden G, Bachmann E, Holderegger C. Model systems for cardiotoxic effects of anthracyclines. Antibiot Chemother. 1978;23:255–270.[Medline] [Order article via Infotrieve]

20. James TN, Nichols MM, Sapire DW, et al. Complete heart block and fatal right ventricular failure in an infant. Circulation. 1996;93:1588–1600.[Free Full Text]

21. Shrov VG, Sabbah HN, Shimoyama H, et al. Evidence of cardiocyte apoptosis in myocardium of dogs with chronic heart failure. Am J Pathol. 1996;148:141–149.[Abstract]

22. Gottlieb RA, Burleson KO, Kloner RA, et al. Reperfusion injury induced apoptosis in rabbit cardiomyocytes. J Clin Invest. 1994;94:1621–1628.

23. Tanaka M, Ito H, Adachi S, et al. Hypoxia induces apoptosis with enhanced expression of Fas antigen messenger RNA in cultured neonatal rat cardiomyocytes. Circ Res. 1994;75:426–433.[Abstract/Free Full Text]

24. Bursch W, Oberhammer F, Schulte-Hermann R. Cell death by apoptosis and its protective role against disease. Trends Pharmacol Sci. 1992;13:245–251.[Medline] [Order article via Infotrieve]

25. Resnicoff M, Braham D, Yutanawiboonchai W, et al. The insulin-like growth factor I receptor protects tumor cells from apoptosis in vivo. Cancer Res. 1995;55:2463–2469.[Abstract/Free Full Text]

26. Liebermann DA, Hoffman B, Steinman R. Molecular control of growth arrest and apoptosis: p53-dependent and independent pathways. Oncogene. 1995;11:199–210.[Medline] [Order article via Infotrieve]

27. Oltvani ZN, Milliman CL, Korsmeyer SJ. Bcl-2 heterodimerizes in vivo with a conserved homolog, bax, that accelerates programmed cell death. Cell. 1993;74:609–619.[Medline] [Order article via Infotrieve]

28. Miyashita T, Reed JC. Tumor suppressor p53 is a direct transcription activator of the human bax gene. Cell. 1995;80:293–299.[Medline] [Order article via Infotrieve]

29. Watanabe-Fukunaga R, Brannan CI, Copeland NJ, et al. Lympho-proliferation disorder in mice explained by defects in Fas antigen that mediates apoptosis. Nature. 1992;356:314–317.[Medline] [Order article via Infotrieve]

30. Itoh N, Yonehara S, Ishii A, et al. The polypeptide encoded by the cDNA for human cell surface antigen Fas can mediate apoptosis. Cell. 1991;66:233–243.[Medline] [Order article via Infotrieve]

31. Yonehara S, Ishii A, Yonehara M. A cell-killing monoclonal antibody (anti-Fas) to a cell surface antigen co-downregulated with the receptor of tumor necrosis factor. J Exp Med. 1989;169:1747–1756.[Abstract/Free Full Text]

32. Nagata S, Golstein P. The Fas death factor. Science. 1995;267:1449–1456.[Abstract/Free Full Text]

33. Fulda S, Susin SA, Kroemer G, et al. Molecular ordering of apoptosis induced by anticancer drugs in neuroblastoma cells. Cancer Res. 1998;58:4453–4460.[Abstract/Free Full Text]

34. Friesen C, Herr I, Krammer PH, et al. Involvement of the CD95 (APO-1/Fas) receptor/ligand system in drug-induced apoptosis in leukemia cells. Nat Med. 1996;2:574–577.[Medline] [Order article via Infotrieve]

35. Fulda S, Sieverts H, Friesen C, et al. The CD95 (APO-1/Fas) system mediates drug-induced apoptosis in neuroblastoma cells. Cancer Res. 1997;57:3823–3829.[Abstract/Free Full Text]

36. Muller M, Strand S, Hug H, et al. Drug-induced apoptosis in hepatoma cells is mediated by the CD95 (APO-1/Fas) receptor/ligand system and involves activation of wide-type p53. J Clin Invest. 1997;99:403–413.[Medline] [Order article via Infotrieve]

37. Kamitani T, Nguyen HP, Yeh E-TH. Activation-induced aggregation and processing of the human Fas antigen. J Biol Chem. 1997;272:22307–22329.[Abstract/Free Full Text]




This article has been cited by other articles:


Home page
J. Pharmacol. Exp. Ther.Home page
J. Niu, A. Azfer, K. Wang, X. Wang, and P. E. Kolattukudy
Cardiac-Targeted Expression of Soluble Fas Attenuates Doxorubicin-Induced Cardiotoxicity in Mice
J. Pharmacol. Exp. Ther., March 1, 2009; 328(3): 740 - 748.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
C. C. Chua, J. Gao, Y.-S. Ho, X. Xu, I-C. Kuo, K.-Y. Chua, H. Wang, R. C. Hamdy, J. C. Reed, and B. H.L. Chua
Over-expression of a modified bifunctional apoptosis regulator protects against cardiac injury and doxorubicin-induced cardiotoxicity in transgenic mice
Cardiovasc Res, January 1, 2009; 81(1): 20 - 27.
[Abstract] [Full Text] [PDF]


Home page
Eur J Heart FailHome page
S. Deng, B. Kulle, M. Hosseini, G. Schluter, G. Hasenfuss, L. Wojnowski, and A. Schmidt
Dystrophin-deficiency increases the susceptibility to doxorubicin-induced cardiotoxicity
Eur J Heart Fail, October 1, 2007; 9(10): 986 - 994.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
T. G. Neilan, G. A. Doherty, G. Chen, C. Deflandre, H. McAllister, R. K. Butler, S. E. McClelland, E. Kay, L. R. Ballou, and D. J. Fitzgerald
Disruption of COX-2 modulates gene expression and the cardiac injury response to doxorubicin
Am J Physiol Heart Circ Physiol, August 1, 2006; 291(2): H532 - H536.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
K. Li, R. Y. T. Sung, W. Z. Huang, M. Yang, N. H. Pong, S. M. Lee, W. Y. Chan, H. Zhao, M. Y. To, T. F. Fok, et al.
Thrombopoietin Protects Against In Vitro and In Vivo Cardiotoxicity Induced by Doxorubicin
Circulation, May 9, 2006; 113(18): 2211 - 2220.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
T. G. Neilan, D. S. Jassal, M. F. Scully, G. Chen, C. Deflandre, H. McAllister, E. Kay, S. C. Austin, E. F. Halpern, J. H. Harmey, et al.
Iloprost attenuates doxorubicin-induced cardiac injury in a murine model without compromising tumour suppression
Eur. Heart J., May 2, 2006; 27(10): 1251 - 1256.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
X. Yi, R. Bekeredjian, N. J. DeFilippis, Z. Siddiquee, E. Fernandez, and R. V. Shohet
Transcriptional analysis of doxorubicin-induced cardiotoxicity
Am J Physiol Heart Circ Physiol, March 1, 2006; 290(3): H1098 - H1102.
[Abstract] [Full Text] [PDF]


Home page
Molecular Cancer TherapeuticsHome page
A. Thorburn and A. E. Frankel
Apoptosis and anthracycline cardiotoxicity.
Mol. Cancer Ther., February 1, 2006; 5(2): 197 - 199.
[Full Text] [PDF]


Home page
Molecular Cancer TherapeuticsHome page
Y.-C. Lien, S.-M. Lin, R. Nithipongvanitch, T. D. Oberley, T. Noel, Q. Zhao, C. Daosukho, and D. K. St. Clair
Tumor necrosis factor receptor deficiency exacerbated Adriamycin-induced cardiomyocytes apoptosis: an insight into the Fas connection.
Mol. Cancer Ther., February 1, 2006; 5(2): 261 - 269.
[Abstract] [Full Text] [PDF]


Home page
JCOHome page
S. E. Lipshultz, S. R. Lipsitz, S. E. Sallan, V. M. Dalton, S. M. Mone, R. D. Gelber, and S. D. Colan
Chronic Progressive Cardiac Dysfunction Years After Doxorubicin Therapy for Childhood Acute Lymphoblastic Leukemia
J. Clin. Oncol., April 20, 2005; 23(12): 2629 - 2636.
[Abstract] [Full Text] [PDF]


Home page
J. Biol. Chem.Home page
S. Wang, E. A. Konorev, S. Kotamraju, J. Joseph, S. Kalivendi, and B. Kalyanaraman
Doxorubicin Induces Apoptosis in Normal and Tumor Cells via Distinctly Different Mechanisms: INTERMEDIACY OF H2O2- AND p53-DEPENDENT PATHWAYS
J. Biol. Chem., June 11, 2004; 279(24): 25535 - 25543.
[Abstract] [Full Text] [PDF]


Home page
Pharmacol. Rev.Home page
G. Minotti, P. Menna, E. Salvatorelli, G. Cairo, and L. Gianni
Anthracyclines: Molecular Advances and Pharmacologic Developments in Antitumor Activity and Cardiotoxicity
Pharmacol. Rev., June 1, 2004; 56(2): 185 - 229.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
T. L'Ecuyer, Z. Allebban, R. Thomas, and R. Vander Heide
Glutathione S-transferase overexpression protects against anthracycline-induced H9C2 cell death
Am J Physiol Heart Circ Physiol, June 1, 2004; 286(6): H2057 - H2064.
[Abstract] [Full Text] [PDF]


Home page
FASEB J.Home page
S. FOGLI, P. NIERI, and M. C. BRESCHI
The role of nitric oxide in anthracycline toxicity and prospects for pharmacologic prevention of cardiac damage
FASEB J, April 1, 2004; 18(6): 664 - 675.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
X. Liu, C. C. Chua, J. Gao, Z. Chen, C. L. C. Landy, R. Hamdy, and B. H. L. Chua
Pifithrin-{alpha} protects against doxorubicin-induced apoptosis and acute cardiotoxicity in mice
Am J Physiol Heart Circ Physiol, March 1, 2004; 286(3): H933 - H939.
[Abstract] [Full Text] [PDF]


Home page
Mol. Pathol.Home page
Q Z Feng, T D Li, L X Wei, X Qiao, J Yi, L Wang, and T S Yang
Tempero-spatial dissociation between the expression of Fas and apoptosis after coronary occlusion
Mol. Pathol., December 1, 2003; 56(6): 362 - 367.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
A. Gonzalez, M. A Fortuno, R. Querejeta, S. Ravassa, B. Lopez, N. Lopez, and J. Diez
Cardiomyocyte apoptosis in hypertensive cardiomyopathy
Cardiovasc Res, September 1, 2003; 59(3): 549 - 562.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
F. Qin, J. Shite, and C.-s. Liang
Antioxidants attenuate myocyte apoptosis and improve cardiac function in CHF: association with changes in MAPK pathways
Am J Physiol Heart Circ Physiol, July 11, 2003; 285(2): H822 - H832.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
S. Yamanaka, T. Tatsumi, J. Shiraishi, A. Mano, N. Keira, S. Matoba, J. Asayama, S. Fushiki, H. Fliss, and M. Nakagawa
Amlodipine inhibits doxorubicin-induced apoptosis in neonatal rat cardiac myocytes
J. Am. Coll. Cardiol., March 5, 2003; 41(5): 870 - 878.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
P. Lee, M. Sata, D. J. Lefer, S. M. Factor, K. Walsh, and R. N. Kitsis
Fas pathway is a critical mediator of cardiac myocyte death and MI during ischemia-reperfusion in vivo
Am J Physiol Heart Circ Physiol, February 1, 2003; 284(2): H456 - H463.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
J. Nitobe, S. Yamaguchi, M. Okuyama, N. Nozaki, M. Sata, T. Miyamoto, Y. Takeishi, I. Kubota, and H. Tomoike
Reactive oxygen species regulate FLICE inhibitory protein (FLIP) and susceptibility to Fas-mediated apoptosis in cardiac myocytes
Cardiovasc Res, January 1, 2003; 57(1): 119 - 128.
[Abstract] [Full Text] [PDF]


Home page
JCBHome page
G. Baldanzi, N. Filigheddu, S. Cutrupi, F. Catapano, S. Bonissoni, A. Fubini, D. Malan, G. Baj, R. Granata, F. Broglio, et al.
Ghrelin and des-acyl ghrelin inhibit cell death in cardiomyocytes and endothelial cells through ERK1/2 and PI 3-kinase/AKT
J. Cell Biol., December 23, 2002; 159(6): 1029 - 1037.
[Abstract] [Full Text] [PDF]


Home page
Toxicol PatholHome page
H. Roger Brown, Hong Ni, G. Benavides, L. Yoon, K. Hyder, J. Giridhar, G. Gardner, R. D. Tyler, and K. T. Morgan
Correlation of Simultaneous Differential Gene Expression in the Blood and Heart with Known Mechanisms of Adriamycin-Induced Cardiomyopathy in the Rat
Toxicol Pathol, June 1, 2002; 30(4): 452 - 469.
[Abstract] [PDF]


Home page
J. Biol. Chem.Home page
E. Lorenzo, C. Ruiz-Ruiz, A. J. Quesada, G. Hernandez, A. Rodriguez, A. Lopez-Rivas, and J. M. Redondo
Doxorubicin Induces Apoptosis and CD95 Gene Expression in Human Primary Endothelial Cells through a p53-dependent Mechanism
J. Biol. Chem., March 22, 2002; 277(13): 10883 - 10892.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
K. Kunisada, E. Tone, S. Negoro, Y. Nakaoka, Y. Oshima, T. Osugi, M. Funamoto, M. Izumi, Y. Fujio, H. Hirota, et al.
Bcl-xl reduces doxorubicin-induced myocardial damage but fails to control cardiac gene downregulation
Cardiovasc Res, March 1, 2002; 53(4): 936 - 943.
[Abstract] [Full Text] [PDF]


Home page
FASEB J.Home page
C. GILL, R. MESTRIL, and A. SAMALI
Losing heart: the role of apoptosis in heart disease--a novel therapeutic target?
FASEB J, February 1, 2002; 16(2): 135 - 146.
[Abstract] [Full Text] [PDF]


Home page
J. Biol. Chem.Home page
S. V. Kalivendi, S. Kotamraju, H. Zhao, J. Joseph, and B. Kalyanaraman
Doxorubicin-induced Apoptosis Is Associated with Increased Transcription of Endothelial Nitric-oxide Synthase. EFFECT OF ANTIAPOPTOTIC ANTIOXIDANTS AND CALCIUM
J. Biol. Chem., December 7, 2001; 276(50): 47266 - 47276.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
F. Qin, N. K. Rounds, W. Mao, K. Kawai, and C.-s. Liang
Antioxidant vitamins prevent cardiomyocyte apoptosis produced by norepinephrine infusion in ferrets
Cardiovasc Res, September 1, 2001; 51(4): 736 - 748.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Pathol.Home page
R. Maruyama, G. Takemura, T. Aoyama, K. Hayakawa, M. Koda, Y. Kawase, X. Qiu, Y. Ohno, S. Minatoguchi, K. Miyata, et al.
Dynamic Process of Apoptosis in Adult Rat Cardiomyocytes Analyzed Using 48-Hour Videomicroscopy and Electron Microscopy : Beating and Rate are Associated with the Apoptotic Process
Am. J. Pathol., August 1, 2001; 159(2): 683 - 691.
[Abstract] [Full Text]


Home page
Am. J. Pathol.Home page
Z. Zhou, X. Sun, and Y. J. Kang
Ethanol-Induced Apoptosis in Mouse Liver : Fas- and Cytochrome c-Mediated Caspase-3 Activation Pathway
Am. J. Pathol., July 1, 2001; 159(1): 329 - 338.
[Abstract] [Full Text] [PDF]


This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Nakamura, T.
Right arrow Articles by Koh, E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Nakamura, T.
Right arrow Articles by Koh, E.
Related Collections
Right arrow Apoptosis