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Multidrug resistance (MDR) is frequently found in haematologic malignancies. It has been shown that MDR is often related to the expression of a membrane glycoprotein (P-170) which actively pumps many hydrophobic agents out of the cells. Previous electron microscopic investigations revealed morphological differences between P-388 resistant and P-388 sensible cell membranes, but the modulation of the membrane morphology seems to be related to the tumor-cell environment. In order to establish if morphological differences exist between sensitive and resistant cells, both sensitive and resistant strains from three different cell lines were studied by scanning electron microscopy: human leukaemia CEM and vinblastine resistant cells (CEM/VBL100), human breast cancer MCF-7 and mice leukaemia P-388 with the doxorubicin resistant strains (MCF-7/DX and P-388/DX, respectively). The surface of the membranes of the sensitive cells was regular, unlike the resistant ones which proved to be irregular, endowed with long villus-like processes or numerous folds and ruffles. The addition of albumin to the culture medium induced a shift from the resistant to the sensitive phenotype, thus suggesting that the P-388/DX morphology may be linked to the concentration of protein in the culture medium. Exposure to DX, verapamil (VRP) or monoclonal antibody against P-170 (mAb-57) did not modify the surface of the resistant strains, demonstrating that surface irregularities are probably not linked to P-glycoprotein function. Blasts from four P-170 positive leukaemic patients were also analyzed: an irregular shape was always found.

In order to determine the involvement of the atrial natriuretic factor (ANF) in a model of drug-induced cardiomyopathy, the effects of a single or repeated doses of doxorubicin on plasma ANF levels were examined. Female Wistar rats were treated with doxorubicin at two different schedules: a single 10 mg/kg iv dose or multiple 3 mg/kg iv doses once a week for 3 weeks; control groups were given vehicle (isotonic saline, 0.9% NaCl) intravenously. ANF was assayed in plasma by a specific and sensitive radioimmunoassay method and cardiac function was evaluated by monitoring of ECG and hemodynamic parameters. In the doxorubicin single-dose study plasma ANF values were measured during a period of 6 hours after dosing and were found to be significantly decreased at the 180th (12.5 +/- 2.9 pg/ml) and 360th minute (19.4 +/- 1.2 pg/ml) after dosing, compared to vehicle-treated animals (35.1 +/- 5.7 and 37.9 +/- 4.1 pg/ml, 180 and 360th minute, respectively). Rats treated with multiple doses of doxorubicin showed a significant increase in plasma ANF levels at the 21st (88.3 +/- 7.7 pg/ml) and 31st day (61.0 +/- 14.3 pg/ml) of the study compared to vehicle-treated animals at the same time points (41.8 +/- 8.0 and 26.5 +/- 7.2 pg/ml, respectively). At the 42nd day plasma ANF concentration in doxorubicin-treated rats was not significantly different from vehicle-treated rats. In both studies ANF level changes occurred in the setting of acute or chronic doxorubicin-induced cardiac damage, as evidenced by alterations of hemodynamic and ECG parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

The acute and chronic cardiotoxicity and cytotoxicity of the novel doxorubicin (DXR) derivative 4'-amino-3'-hydroxy-DXR were compared with those of 4'-deoxy-DXR and DXR. In the acute cardiotoxicity study, the ECG and hemodynamic changes recorded in anesthetized rats that had been treated i.v. with 10 mg/kg 4'-amino-3'-hydroxy-DXR or 8.6 mg/kg 4'-deoxy-DXR were significantly less severe than those caused by 13 mg/kg DXR. In the chronic cardiotoxicity study, rats received 3 weekly i.v. injections of 3 mg/kg DXR, 3 mg/kg 4'-amino-3'-hydroxy-DXR, or 2 mg/kg 4'-deoxy-DXR during the first 14 days of the study and were observed for an additional 35-day period. DXR induced severe cardiomyopathy that was characterized by ECG changes in vivo (S alpha T-segment widening and T-wave flattening) and by impairment of the contractile responses (Fmax, +/- dF/dtmax) to adrenaline of hearts isolated from treated animals. 4'-Deoxy-DXR caused a progressive enlargement of the S alpha T segment in vivo and a significant impairment of the -dF/dtmax value in vitro, which were less severe than those produced by DXR. The least cardiotoxic drug was 4'-amino-3'-hydroxy-DXR, which induced minor ECG changes without causing significant alterations in the contractile responses of isolated hearts to adrenaline. On the basis of the drug concentration required to inhibit 50% of the colony formation (IC50) of cell lines in vitro, 4'-amino-3'-hydroxy-DXR was less active than 4'-deoxy-DXR but at least twice as active as DXR against human cancer and murine transformed cell lines. These data indicate that 4'-amino-3'-hydroxy-DXR is significantly less cardiotoxic and more cytotoxic than DXR.

The purpose of this study was to evaluate the optimal timing of ADR-529 administration to protect rats treated with doxorubicin (DXR) against drug-induced cardiotoxicity. Complete electrocardiographic monitoring (QRS complex, S alpha T segment and T wave) and the histopathological analysis of cardiac tissue were used to assess the degree of heart damage produced in female rats treated with ten i.v. doses of 1 mg/kg DXR over a period of 15 weeks; body-weight increase and survival were also analyzed to evaluate the toxicity of treatments. Cardiac alterations induced by DXR were compared with those occurring in animals receiving 20 mg/kg i.v. ADR-529 at 30 min prior to DXR administration, starting at the first, third, or sixth DXR dose and given until the end of the study (15th week). Rats treated with DXR were severely cardiomyopathic, showing progressive and irreversible ECG alterations (QRS-complex and S alpha T-segment widening and T-wave flattening) and marked degeneration of the myocardium (myocyte vacuolation, myofibrillar loss, and endomyocardial fibrosis). The most effective cardiac protection was provided by the administration of ADR-529 beginning with the first or third DXR dose. Delaying treatment with ADR-529 until the sixth DXR dose resulted in a significant reduction in its therapeutic action on heart damage. A significant difference in body-weight increase and survival was observed between the treatment groups: ADR-529 injected prior to the first DXR dose significantly protected animals from DXR toxicity, but this schedule was significantly more toxic than the administration of ADR-529 beginning with the third or sixth DXR dose. Taking into account the degree of cardiac protection and the toxicity of combination treatments, the results of the present study demonstrate the superiority of ADR-529 given prior to the third DXR dose over the other schedules tested. This finding suggests that significant protection against DXR-induced chronic cardiotoxicity in the rat can be obtained using deferred treatment with ADR-529.

Doxorubicin (DXR), an anthracycline antineoplastic drug, is mainly metabolized to the C-13 dihydroderivative doxorubicinol (DXR-ol), which displays cytotoxic activity on various cell lines. To better characterize the cytotoxic activity of this metabolite, we have studied the effect of DXR (0.1-10 micrograms/ml) or DXR-ol (1-100 micrograms/ml) on the transformed fibroblast cell line V79/AP4 by means of the clonogenic assay, cytofluorescence, and light and electron microscopy. Both DXR and DXR-ol displayed a dose-dependent inhibition of colony formation with an IC50 factor DXR-ol/DXR of 19.5. A striking nuclear fluorescence was observed after DXR but not after DXR-ol. A low number of mitoses and a decrease in nucleoli staining affinity were the most evident alterations induced by DXR. Electron microscopy showed both nuclear and cytoplasmic changes in DXR treated cells: nucleolar segregation, cytoplasmic vacuoles, and mitochondrial swelling with dense needle-shaped material were observed. Exposure to formic acid confirmed the calcific nature of the mitochondrial bodies. Only the highest dose of DXR-ol brought about nuclear and cytoplasmic ultrastructural changes similar to those induced by DXR. Our data describe new in vitro findings on the cytotoxicity and morphological alterations induced by both DXR and DXR-ol, with a lower activity of DXR-ol against V79/AP4 fibroblasts.

The cardiotoxicity and cytotoxicity of the novel doxorubicin (DXR) derivative 4'-deoxy-4'-iodo-DXR were evaluated and compared to DXR. A single dose of DXR 10 mg/kg i.v. in anesthetized rats induced a significant widening of S alpha T segment of the electrocardiogram, an increase in both mean arterial blood pressure and heart rate and a fall in systemic arterial dP/dtmax, while 4'-deoxy-4'-iodo-DXR 4 mg/kg i.v. induced a significant widening of S alpha T segment and an increase in mean arterial blood pressure. A chronic cardiomyopathy was induced over a 6-week period by three injections of DXR 3 mg/kg per week i.v. and was characterized by a progressive enlargement of S alpha T segment, a flattening of T wave, the occurrence of arrhythmias and histological alterations of myocardium. The contractile responses to adrenaline of isolated hearts from DXR-treated animals were significantly reduced compared to controls. 4'-Deoxy-4'-iodo-DXR (1.2 mg/kg per week three times) induced minor ECG alterations and sporadic episodes of arrhythmias. The contractile responses of isolated hearts were not significantly different from those of controls and microscopic examination of hearts revealed only minor changes. Cytotoxicity in vitro was evaluated by the colony formation assay; based on IC50, 4'-deoxy-4'-iodo-DXR was up to six times more cytotoxic than DXR on four human cancer cell lines. These results suggest that 4'-deoxy-4'-iodo-DXR is significantly less cardiotoxic and more cytotoxic than DXR.

This study investigates the effects of daunorubicin, 4-demethoxy-daunorubicin, 11-deoxydaunorubicin, 5-imino-daunorubicin, doxorubicin, 4'-epidoxorubicin and the new derivative 4'-iodo-4'-deoxydoxorubicin, on superoxide anion production in heart sarcosomes and by mitochondrial NADH dehydrogenase. In cardiac sarcosomes all the anthracyclines tested enhanced NADPH-dependent superoxide formation which followed Michaelis-Menten kinetics and their Vmax were similar to that of doxorubicin except 5-iminodaunorubicin which did not affect superoxide production and 4'-iodo-4'-deoxydoxorubicin which showed significantly lower Vmax and Km. The superoxide formation by NADH dehydrogenase in the presence of anthracyclines appeared to follow saturation kinetics, depending by NADH. 4-Demethoxydaunorubicin and 4'-epidoxorubicin showed Vmax higher than that of doxorubicin although the Km values were similar. By contrast 5-iminodaunorubicin failed to increase superoxide production over control levels and 4'-Iodo-4'-deoxydoxorubicin hardly enhanced superoxide production by NADH dehydrogenase. A marked difference of superoxide formation rate was shown for the molecules tested in our in vitro system. The behaviour displayed in vitro by the imino- and iodo-derivatives well correlate to their moderate cardiotoxicity in vivo. For the other molecules tested, the poor correlation between the in vitro production of superoxides and the in vivo cardiotoxicity degree might depend on the pharmacokinetic steps which may modify the cardiac effects of these anthracyclines.

The effects of fructose-1,6-diphosphate, an intermediate metabolite of glycolysis, on acute and chronic cardiotoxicity of doxorubicin were investigated in rats. In the acute study, urethane-anaesthetized Wistar female rats treated with 10 mg/kg i.v. doxorubicin developed a widening of the S alpha T segment, an impairment of +dP/dtmax, and tachycardia. Pretreatment with 375 and 750 mg/kg i.p. fructose-1,6-diphosphate prevented the S alpha T segment from widening, whereas only 750 mg/kg i.p. significantly attenuated the heart rate increase. Chronic cardiomyopathy was induced over a 6-week period by weekly doses of 3 mg/kg i.v. doxorubicin, being characterized in vivo by the progressive enlargement of the S alpha T segment and the occurrence of histological alterations and in vitro by a marked impairment of the inotropic response elicited by adrenaline in isolated hearts from treated rats. Concurrent treatment with 150 and 300 mg/kg i.p. fructose-1,6-diphosphate thrice a week for 6 weeks did not lessen the chronic heart damage, whereas 600 mg/kg given i.p. significantly reduced the widening of the S alpha T segment and the severity of histological damage in vivo, as well as significantly improving the contractile responses of hearts in vitro. These findings suggest that the administration of fructose-1,6-diphosphate plays a protective role in the acute and chronic cardiotoxicity of doxorubicin in the rat.

The acute and chronic cardiotoxicity as well as the cytotoxicity of 4'-deoxy-4'-iodo-doxorubicinol (I-DXRol), the major metabolite of the doxorubicin (DXR) derivative 4'-deoxy-4'-iodo-DXR (I-DXR), were compared with those of I-DXR and DXR. In the acute study, anesthetized rats received i.v. DXR (10 mg/kg), I-DXR (4 mg/kg), or I-DXRol (4 mg/kg) and were monitored for ECG (S alpha T segment and T wave), systolic (SBP) and diastolic (DBP) blood pressure, the first derivative of the systemic arterial pressure (SA dP/dtmax), and heart rate. Treatments induced a significant widening of the S alpha T segment, but I-DXRol was significantly less toxic than I-DXR or DXR. As compared with control values, DXR induced a marked increase in SBP and DBP and a decrease in SA dP/dtmax, whereas I-DXR and I-DXRol induced modest changes in hemodynamic parameters. In the chronic study, 3 mg/kg DXR given to rats by i.v. bolus once a week for 3 weeks resulted in severe chronic cardiotoxicity that lasted 6 weeks and was characterized by S alpha T-segment widening, T-wave flattening, and severe cardiac histological damage. Doses of 1.2 mg/kg I-DXR and 1.2 and 2.4 mg/kg I-DXRol, given i.v. once a week for 3 weeks, and 3.6 mg/kg I-DXRol given as a single dose were associated with a significant T-wave voltage reduction; I-DXR and 2.4 mg/kg I-DXRol induced significant histological alterations of cardiac tissue as compared with control values, whereas modest alterations of heart tissue were observed after injections of 1.2 and 3.6 mg/kg I-DXRol in three doses and in a single dose, respectively. The cytotoxicity of the three anthracyclines against one glioblastoma cell line and two human small-cell lung cancer lines was similar. Results indicate that the acute cardiotoxicity of I-DXRol is lower than that of I-DXR and DXR, whereas the chronic heart damage is similar to that induced by I-DXR and significantly lower compared than that caused by DXR. Moreover, the cytotoxicity of the metabolite appears to be similar to that of I-DXR and DXR. The lack of additional cardiac toxicity due to I-DXRol further supports the lower overall cardiac toxicity of I-DXR, which retains a cytotoxic activity similar to that of the parent drug.

The localization of cardiac cytofluorescence and tissue levels of doxorubicin (DXR) and doxorubicinol (DXR-ol) were studied in rats treated with a single (9 mg/kg: 1-day study) or 3 weekly doses (3 mg/kg: 7-week study) of the compounds. A striking orange-red fluorescence was observed in cardiac cell nuclei from DXR 1-day rats, whilst heart cells from DXR-ol 1-day rats displayed a faint, diffuse fluorescence. Neither cardiac tissue from DXR nor from DXR-ol 7-week animals showed any drug-specific fluorescence. HPLC assay showed that in DXR 1-day rats the drug was concentrated in the heart, which also contained the endogenously produced DXR-ol. Plasma levels of DXR-ol were initially high in DXR-ol 1-day rats but rapidly decreased with time; cardiac levels of DXR-ol remained low. Hearts from DXR 7-week rats contained appreciable amounts of DXR and DXR-ol, while very low levels of DXR-ol were found in DXR-ol 7-week animals. The data correlated well with the ECG alterations recorded during the study, which were more severe in DXR- than in DXR-ol-treated rats. These results indicate that the lower tissue uptake of exogenously administered DXR-ol might explain its lower toxic cardiac potential compared with DXR.

A comparison was made of the sensitivity of ECG, ultrastructural heart pathology, and plasma enzymes CK-MB and alpha-HBDH as methods to assess doxorubicin cardiotoxicity in adult beagle dogs given doxorubicin 30 mg/m2 i.v. once a week for three times. A progressive increase in JT and QT intervals, in corrected JT (JTc) and QT (QTc) intervals as well as a reduction in both T wave amplitude and RR duration, were observed in doxorubicin-treated dogs; the electrocardiogram (ECG) abnormalities were associated with doxorubicin-induced ultrastructural changes in cardiac tissue, consisting of dilation of the sarcoplasmic reticulum, multiform, flasklike invaginations of T-tubules containing electrondense material, and interruption of the junctional sarcoplasmic reticulum, which became more severe as the observation period progressed. On the contrary, doxorubicin treatment was associated with transient changes in plasma CK-MB and alpha-HBDH, which were unrelated to the severity of chronic cardiotoxicity. Overall results suggest that the monitoring of the ECG parameters related to the repolarization of the cardiac muscle, and particularly JT and JTc, might be regarded as a noninvasive method for the study of doxorubicin cardiotoxocity in the dog.

A morphometric study was performed in dog atria to assess the effects of both single and repeated doses of doxorubicin on specific granules containing the natriuretic factor. Male beagle dogs were divided into 4 groups and treated i.v. as follows: groups A and B were controls and received isotonic saline; group C was given doxorubicin 2.4 mg/kg in a single injection; group D received doxorubicin 1.2 mg/kg once a week for 3 consecutive weeks. Samples of left atrium were taken 8 hours (groups A and C) or 28 days (groups B and D) after the last dose, and examined by the electron microscope. Compared with controls, the atrial tissue of group C dogs showed a significant increase in the number of specific granules; by contrast, the granularity was found to decrease significantly in the atria from group D dogs. These observations indicate a significant biphasic effect of doxorubicin on specific atrial granules of dog heart. The increase in granule density might be due to a block of the secretory process which is dependent on the metabolic energy supply. The reduction in cardiomyocyte granularity may be ascribed to the impairment of nucleic acid and protein synthesis induced by doxorubicin. Such alterations may play a significant role in doxorubicin-induced cardiovascular toxicity.

Doxorubicin (DXR) (0.17 x 10(-4) M) induces an acute cardiotoxicity in isolated rat heart; there is a progressive widening of the S alpha T segment, with a decrease in force derivatives and in the coronary flow. Concurrent perfusion with fructose-1,6-diphosphate (FDP) (10(-5)-10(-4) M) dose-dependently reduces the S alpha T enlargement but fails to affect the reduction in force derivatives and coronary flow. The target of cardiac protection by FDP might be the ionic mechanisms underlying the action potential configuration.