Role and molecular mechanism of traditional Chinese medicine in preventing cardiotoxicity associated with chemoradiotherapy

Abstract

Cardiotoxicity is a serious complication of cancer therapy. It is the second leading cause of morbidity and mortality in cancer survivors and is associated with a variety of factors, including oxidative stress, inflammation, apoptosis, autophagy, endoplasmic reticulum stress, and abnormal myocardial energy metabolism. A number of studies have shown that traditional Chinese medicine (TCM) can mitigate chemoradiotherapy-associated cardiotoxicity via these pathways. Therefore, this study reviews the effects and molecular mechanisms of TCM on chemoradiotherapy-related cardiotoxicity. In this study, we searched PubMed for basic studies on the anti-cardiotoxicity of TCM in the past 5 years and summarized their results. Angelica Sinensis, Astragalus membranaceus Bunge, Danshinone IIA sulfonate sodium (STS), Astragaloside (AS), Resveratrol, Ginsenoside, Quercetin, Danggui Buxue Decoction (DBD), Shengxian decoction (SXT), Compound Danshen Dripping Pill (CDDP), Qishen Huanwu Capsule (QSHWC), Angelica Sinensis and Astragalus membranaceus Bunge Ultrafiltration Extract (AS-AM),Shenmai injection (SMI), Xinmailong (XML), and nearly 60 other herbs, herbal monomers, herbal soups and herbal compound preparations were found to be effective as complementary or alternative treatments. These preparations reduced chemoradiotherapy-induced cardiotoxicity through various pathways such as anti-oxidative stress, anti-inflammation, alleviating endoplasmic reticulum stress, regulation of apoptosis and autophagy, and improvement of myocardial energy metabolism. However, few clinical trials have been conducted on these therapies, and these trials can provide stronger evidence-based support for TCM.

A review of chemotherapeutic drugs-induced arrhythmia and potential intervention with traditional Chinese medicines

“…Ginsenosides are the most crucial active substances in ginseng, which have antioxidant, apoptosis inhibiting, autophagy regulating, and other cardiotoxicity-reducing effects ( Hou et al, 2022 ; Lv et al, 2022 ). It has been found that Dox can cause apoptosis and autophagy in H9c2 cardiomyocytes, and ginsenoside Rb1 can attenuate Dox-induced myocardial injury by a mechanism that may be realized by inhibiting Dox-induced autophagy ( Li et al, 2017 ; Zhang et al, 2017 ; Zhu et al, 2017 ).…”

A Review on Probable Causes of Cardiotoxicity Caused by Common Cancer Drugs and the Role of Traditional Chinese Medicine in Prevention and Treatment

“…Salvia miltiorrhiza and Ligusticum Chuanxiong are commonly employed to improve blood circulation and eliminate blood stasis, while sophora flavescens is often used to alleviate internal heat. 54 …”

“…Salvia miltiorrhiza and Ligusticum Chuanxiong are commonly employed to improve blood circulation and eliminate blood stasis, while sophora flavescens is often used to alleviate internal heat. 54 The management of cardiotoxicity involves addressing the development of TCM compound preparation, which is primarily characterized by a deficiency in Qi and Yin. The medications used in this treatment approach primarily aim to replenish Qi and Yin.…”