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肿瘤发病率逐年升高[1],化疗作为一种强而有效的治疗手段被广泛应用于肿瘤治疗。阿霉素作为一种高效、广谱的蒽环类抗癌药,可用于治疗成人以及儿童的多种实体肿瘤(如乳腺、卵巢和胃肠道肿瘤)和血液恶性肿瘤(如淋巴瘤和白血病),然而,因阿霉素可引起剂量依赖性的心脏毒性,导致严重心肌病和充血性心力衰竭,严重限制了其在临床上的应用[2],因此老年肿瘤病人及有严重心脏病者属限制性用药,克服阿霉素的心脏毒性将有助于扩宽阿霉素的适用人群。
黄芪甲苷(astragaloside Ⅳ,AST Ⅳ)是中药黄芪主要的有效成分,具有抗癌、抗氧化、抗老化、抗炎等多种效应[3]。AST Ⅳ具有明显的心脏保护作用,主要表现为抑制心脏重构、改善血管内皮细胞功能、保护心肌缺血以及抑制心肌细胞凋亡等[4]。已有研究[5]表明,AST Ⅳ能缓解柯萨奇病毒B3感染引起的以严重的心脏炎症为特征的病毒性心肌炎。AST Ⅳ的心脏保护作用的机制尚不明确。Mer酪氨酸激酶(Mer tyrosine kinase,MerTK)是TAM受体酪氨酸激酶家族成员之一。MerTK缺乏已被证明在动脉粥样硬化模型中是有害的,因为它具有抑制炎症,促进分解和驱动斑块坏死核心中凋亡小体清除的能力[6]。我们的预实验提示AST Ⅳ能够维持MerTK的水平,因此提出假说,AST Ⅳ可能通过抑制MerTK裂解从而缓解阿霉素引起的心肌损伤。本研究旨在探究AST Ⅳ对阿霉素诱导的心肌损伤的保护作用,以及MerTK是否在其中发挥作用。
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对照组小鼠精神状态良好,进食情况正常;DOX组、DOX+AST Ⅳ 20 mg/kg组、DOX+AST Ⅳ 40 mg/kg组出现精神萎靡不振、中度腹泻等症状;DOX+AST Ⅳ 80 mg/kg组小鼠精神状态尚可,有轻度腹泻的症状。造模第10天,对照组小鼠存活10只,DOX组小鼠存活3只,DOX+AST Ⅳ 20 mg/kg组小鼠存活3只,DOX+AST Ⅳ 40 mg/kg组小鼠存活4只,DOX+AST Ⅳ 80 mg/kg组小鼠存活6只。DOX组小鼠死亡率高;DOX+AST Ⅳ 80 mg/kg组第10天小鼠存活率明显改善;DOX+AST Ⅳ 20 mg/kg组、DOX+AST Ⅳ 40 mg/kg组第10天小鼠存活率低,且精神状态欠佳。因此,其他实验中AST Ⅳ剂量为80 mg/kg。
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与对照组相比,DOX组小鼠心率明显减慢、QT间期明显延长(P<0.01);与DOX组相比,DOX+AST Ⅳ 80mg/kg组小鼠QT间期明显缩短(P<0.01),心率改善几乎达到正常水平(见表 1)。
分组 心率/(次/分) QT间期/s 对照组 431.00±21.92 0.020±0.001 DOX组 290.70±17.20** 0.035±0.001** DOX+AST Ⅳ 80 mg/kg组 410.30±23.55## 0.026±0.001**## F 38.79 171.00 P <0.01 <0.01 MS组内 443.640 0.000 q检验:与对照组比较**P<0.01;与DOX组比较##P<0.01 表 1 AST Ⅳ改善阿霉素引起的小鼠心电异常(ni=3;x±s)
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与对照组相比,DOX组小鼠EF和FS均明显降低(P<0.01);与DOX组相比,DOX+AST Ⅳ 80 mg/kg组小鼠EF、FS下降程度明显改善(P<0.01)(见表 2)。
分组 EF/% FS/% 对照组 61.37±0.80 31.64±0.86 DOX组 48.56±0.34** 25.38±0.41** DOX+AST Ⅳ组 57.08±0.54**## 29.32±0.58**## F 365.39 72.45 P < 0.01 <0.01 MS组内 0.349 0.415 q检验:与对照组比较**P<0.01;与DOX组比较##P<0.01 表 2 3组小鼠心脏超声心动图检查结果(ni=3;x±s)
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与对照组相比,DOX组CK-MB和LDH含量均明显增加(P<0.01);与DOX组相比,DOX+AST Ⅳ 80 mg/kg组CK-MB和LDH含量均明显降低(P<0.01)(见表 3)。
分组 LDH/(U/L) CK-MB/(U/L) 对照组 546.20±15.61 168.10±6.81 DOX组 3 368.00±55.46** 289.30±5.80** DOX+AST Ⅳ 80mg/kg组 1 406.00±71.98**## 201.10±6.39**## F 2 214.77 292.40 P <0.01 <0.01 MS组内 2 833.535 40.283 q检验:与对照组比较**P<0.01;与DOX组比较##P<0.01 表 3 AST Ⅳ改善阿霉素引起的心肌酶改变(ni=3;x±s)
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Massson染色结果显示,与对照组相比,DOX组小鼠心肌细胞间质出现严重纤维化(蓝色部分);与DOX组相比,DOX+AST Ⅳ 80 mg/kg组小鼠心肌纤维化面积明显减少(蓝色部分)(见图 1)。
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与对照组相比,DOX组p-MerTK的蛋白表达明显增加(P<0.01);与DOX组相比,DOX+AST Ⅳ 80 mg/kg组p-MerTK的表达水平明显下降(P<0.01)(见图 2、表 4)。
分组 p-MerTK F P MS组内 对照组 1.00±0.00 6 337.57 <0.01 0.001 DOX组 3.47±0.04** DOX+AST Ⅳ 80 mg/kg组 1.93±0.02## q检验:与对照组比较**P<0.01;与DOX组比较##<0.01 表 4 各组p-MerTK蛋白表达比较(ni=3;x±s)
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与对照组相比,DOX组小鼠IL-1β、IL-6、TNF-α水平均明显升高(P<0.01);与DOX组相比,DOX+AST Ⅳ 80 mg/kg组IL-1β、IL-6、TNF-α水平均明显下降(P<0.01)(见表 5)。
分组 IL-1β/(ng/L) IL-6/(ng/L) TNF-α/(ng/L) 对照组 908.70±23.90 178.30±3.34 41.03±0.91 DOX组 1 949.00±52.34** 284.20±7.58** 145.80±3.33** DOX+AST Ⅳ 80 mg/kg组 1 650.00±35.71**## 243.00±4.76**## 123.00±4.83**## F 562.97 281.01 775.23 P < 0.01 < 0.01 <0.01 MS组内 1 528.630 30.423 11.749 q检验:与对照组比较**P<0.01;与DOX组比较##P<0.01 表 5 各组炎症指标水平比较(ni=3;x±s)
黄芪甲苷通过抑制MerTK缓解阿霉素引起的心脏毒性
Study on astragaloside Ⅳ alleviating the cardiotoxicity caused by doxorubicin by inhibiting MerTK
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摘要:
目的探讨黄芪甲苷对阿霉素诱导的心肌损伤的作用及机制。 方法6周龄ICR雄性小鼠随机分为对照组、阿霉素组、阿霉素+黄芪甲苷组。对照组给予单次腹腔注射0.9%氯化钠溶液,其余组均给予单次腹腔注射20 mg/kg阿霉素造模。阿霉素+黄芪甲苷80 mg/kg组行每天1次黄芪甲苷80 mg/kg灌胃,其余组给予0.5%羧甲基纤维素钠灌胃,持续至造模第10天。于第10天进行心脏超声检测小鼠心肌功能指标射血分数和缩短分数,进行心电图测试监测小鼠心率;于第10天取小鼠血清和心脏组织采用Masson染色法检测心肌组织结构的变化,使用全自动血清生化仪检测血清中乳酸脱氢酶(LDH)、肌酸激酶(CK-MB)水平,采用ELISA法检测血清中白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平,以Western blotting检测心肌中Mer酪氨酸激酶(MerTK)蛋白表达。 结果与对照组相比,阿霉素组小鼠心率明显减慢、QT间期明显延长(P < 0.01);心脏射血分数和缩短分数均明显降低(P < 0.01);心肌酶CK-MB和LDH含量均明显增加(P < 0.01);p-MerTK的蛋白表达明显增加(P < 0.01);IL-1β、IL-6、TNF-α水平均明显升高(P < 0.01);小鼠心肌细胞间质出现严重纤维化。与阿霉素组相比,阿霉素+黄芪甲苷80 mg/kg组小鼠QT间期明显缩短(P < 0.01),心率改善几乎达到正常水平;心脏射血分数和缩短分数下降程度明显改善(P < 0.01);CK-MB和LDH含量均明显降低(P < 0.01);p-MerTK的表达水平明显下降(P < 0.01);IL-1β、IL-6、TNF-α水平均明显下降(P < 0.01);小鼠心肌纤维化面积明显减少。 结论黄芪甲苷可能通过抑制MerTK裂解减轻心肌损伤,减轻阿霉素诱导的心脏毒性。 Abstract:ObjectiveTo investigate the effects and mechanism of astragaloside Ⅳ on the doxorubicin-induced myocardial injury. MethodsThe 6-week-old ICR male mice were randomly divided into the control group, doxorubicin group, doxorubicin+Astragaloside Ⅳ group.The control group was given a single intraperitoneal injection of 0.9% sodium chloride solution, and the other groups were given a single intraperitoneal injection of 20 mg/kg doxorubicin for modeling.The doxorubicin+astragaloside Ⅳ 80 mg/kg group were given astragaloside Ⅳ once a day by gavage, and the other groups were given a solvent(0.5% sodium carboxymethyl cellulose) by gavage for 10 days.On the 10th day, the mice's myocardial function(ejection fraction and fractional shortening) were detected using the echocardiography, and the heart rate of mice were monitored by the electrocardiogram test.On the 10th day, the serum and heart tissue of mice were collected, and the changes in the myocardial tissue structure were detected using Masson staining, and the levels of lactate dehydrogenase(LDH) and creatine kinase(CK-MB) were detected using biochemistry.The serum levels of interleukin-1β(IL-1β), interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in mice were examined using ELISA, and the protein levels of Mer tyrosine kinase(MerTK) in the myocardium were detected using Western blotting. ResultsCompared with the control group, the heart rate and QT interval were significantly slower(P < 0.01), the cardiac ejection fraction and fractional shortening significantly decreased(P < 0.01), the contents of myocardial enzyme CK-MB and LDH significantly increased(P < 0.01), the protein expression lev el of p-MerTK significantly increased(P < 0.01), the levels of IL-1β, IL-6 and TNF-α significantly increased(P < 0.01), and there was severe fibrosis in the interstitium of mouse myocardial cells in adriamycin group.Compared with the doxorubicin group, the QT interval was significantly shortened(P < 0.01), the heart rate was improved almost to the normal level, the decreasing of cardiac ejection fraction and fractional shortening was significantly improved(P < 0.01), the contents of myocardial enzyme CK-MB and LDH significantly decreased(P < 0.01), the expression level of p-MerTK significantly decreased(P < 0.01), the levels of IL-1β, IL-6 and TNF-α significantly decreased(P < 0.01), and the area of myocardial fibrosis was significantly reduced in doxorubicin+astragaloside Ⅳ 80 mg/kg group. ConclusionsAstragaloside Ⅳ may reduce the myocardial injury and cardiotoxicity induced by doxorubicin through inhibiting MerTK cleavage. -
Key words:
- doxorubicin /
- cardiotoxicity /
- astragaloside Ⅳ
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表 1 AST Ⅳ改善阿霉素引起的小鼠心电异常(ni=3;x±s)
分组 心率/(次/分) QT间期/s 对照组 431.00±21.92 0.020±0.001 DOX组 290.70±17.20** 0.035±0.001** DOX+AST Ⅳ 80 mg/kg组 410.30±23.55## 0.026±0.001**## F 38.79 171.00 P <0.01 <0.01 MS组内 443.640 0.000 q检验:与对照组比较**P<0.01;与DOX组比较##P<0.01 表 2 3组小鼠心脏超声心动图检查结果(ni=3;x±s)
分组 EF/% FS/% 对照组 61.37±0.80 31.64±0.86 DOX组 48.56±0.34** 25.38±0.41** DOX+AST Ⅳ组 57.08±0.54**## 29.32±0.58**## F 365.39 72.45 P < 0.01 <0.01 MS组内 0.349 0.415 q检验:与对照组比较**P<0.01;与DOX组比较##P<0.01 表 3 AST Ⅳ改善阿霉素引起的心肌酶改变(ni=3;x±s)
分组 LDH/(U/L) CK-MB/(U/L) 对照组 546.20±15.61 168.10±6.81 DOX组 3 368.00±55.46** 289.30±5.80** DOX+AST Ⅳ 80mg/kg组 1 406.00±71.98**## 201.10±6.39**## F 2 214.77 292.40 P <0.01 <0.01 MS组内 2 833.535 40.283 q检验:与对照组比较**P<0.01;与DOX组比较##P<0.01 表 4 各组p-MerTK蛋白表达比较(ni=3;x±s)
分组 p-MerTK F P MS组内 对照组 1.00±0.00 6 337.57 <0.01 0.001 DOX组 3.47±0.04** DOX+AST Ⅳ 80 mg/kg组 1.93±0.02## q检验:与对照组比较**P<0.01;与DOX组比较##<0.01 表 5 各组炎症指标水平比较(ni=3;x±s)
分组 IL-1β/(ng/L) IL-6/(ng/L) TNF-α/(ng/L) 对照组 908.70±23.90 178.30±3.34 41.03±0.91 DOX组 1 949.00±52.34** 284.20±7.58** 145.80±3.33** DOX+AST Ⅳ 80 mg/kg组 1 650.00±35.71**## 243.00±4.76**## 123.00±4.83**## F 562.97 281.01 775.23 P < 0.01 < 0.01 <0.01 MS组内 1 528.630 30.423 11.749 q检验:与对照组比较**P<0.01;与DOX组比较##P<0.01 -
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