Early diagnosis of doxorubicin-induced cardiotoxicity:The miRNA way

Abstract

This short commentary focuses on the use of circulating microRNAs as biomarkers of doxorubicin-induced cardiotoxicity in cancer patients undergoing chemotherapy. Cancer is one of the leading causes of death worldwide and is usually treated following different approaches; among these, anticancer drugs have a very important role. One of the most effective molecules is Doxorubicin (DOX), a two-edged sword which combines several beneficial effects with the lack of cancer-cell specificity. DOX toxicity is known to be able to compromise the clinical effectiveness of chemotherapy, strongly impacting patients' quality of life and survival, even years after its administration. It is associated with progressive disruption of cardiac function, and can progressively develop into heart failure. Despite the availability of different cardiac biomarkers (i.e., troponins, B-type natriuretic peptide) presenting several positive features like high sensitivity, cardiac specificity and low invasivity, reliable and timely risk assessment in long-term cancer survivors is still difficult to achieve. Indeed, cardiotoxicity is usually detected late when heart impairment has already occurred and is quite evident. Evaluation of left ventricle ejection fraction (LVEF) by imaging techniques is still the only reliable and accepted diagnostic tool but does not allow early prevention. In the past years, several efforts were made to identify new biomarkers for early assessment and diagnosis of cardiovascular diseases. Lately, a new class of circulating molecules, microRNAs (miRNAs), emerged, and many groups evidenced their possible exploitation as biomarkers due to their stability in several body fluids and to the possibility to detect them even at small concentrations. Despite the clinical relevancy, only a handful of studies have focused their attention on investigating the role of microRNAs in DOX-induced cardiotoxicity, mostly relying on the use animal models. Very recently, a few groups started to examine whether circulating miRNAs could represent new and reliable early cardiotoxicity biomarkers.