Selenium in the Prevention of Anthracycline-Induced Cardiac Toxicity in Children with Cancer

Abstract

High cumulative doses of anthracyclines (300–500 mg/m2) used in the treatment of children with cancer may result in cardiotoxicity, a major long-term adverse effect that limits clinical usefulness of this class of chemotherapeutic agents. We assessed anthracycline-induced cardiotoxicity by measuring Pro-BNP levels and echocardiographic (ECHO) findings and investigated potential protective effect of selenium (Se) supplementation in a group of pediatric cancer patients. Plasma level of Pro-BNP was measured, and ECHO was performed in 67 patients (45 boys, 22 girls; ages 2–18 years; median age 12 years) after they completed anthracycline-containing chemotherapy. Serum Se level was measured in 37 patients. Eleven patients had high Pro-BNP levels and/or cardiac failure with Pro-BNP levels of 10–8,022 pg/mL (median 226.3 pg/mL; laboratory normal level is less than 120 pg/mL). Serum Se levels were low (20–129 mcg/L, median 62 mcg/L) in ten of these eleven patients. Eight of 10 patients with low Se and high Pro-BNP levels were supplemented with Se 100 mcg/day for a period of 4–33 months (median 6 months) which resulted in improvement in Pro-BNP and/or ECHO findings. These results suggest that Se supplementation may have a role in protection against anthracycline-induced cardiac toxicity.

Cardiotoxicity of anthracycline therapy: current perspectives

“…Most of the studies have been done in experimental animal models. For example, N-acetylcysteine and selenium (Se) did not significantly reduce the activity of xanthine oxidase (XOD) in a mouse model [ 77 ], although, according to a small clinical study in nine children with a high pro-BNP level and/or cardiac failure, Se supplementation proved to prevent AIC [ 78 ].…”

Successful recovery and allogeneic stem cell transplant following chemotherapy-induced severe cardiomyopathy: literature review of management and prognostic factors

“…Selenium acts as a cofactor for the enzyme glutathione peroxidase and catalyses the reaction of hydrogen peroxide reduction by using glutathione. In children with cardiac failure and raised Pro-BNP levels, selenium has shown cardioprotective effects 30. In animal studies conducted by Walker et al , mice prophylactically managed with probucol after treatment with DOX and TRZ showed preserved systolic function.…”

Kemoterapi ve Radyoterapiye Bağlı Kardiyovasküler Toksisite

“…Anjiyotensin dönüştürücü enzim (ACE) inhibitörü, anjiyotensin reseptör blokeri (ARB) veya β-bloker ajanlar tedaviye eklendiğinde kısalma fraksiyonunda ve sol ventrikül boyutlarında düzelme olmakta, ancak uzun dönemde etkileri sınırlı kalmaktadır. Radyoterapinin toksik etkisi ise "3-boyutlu", "intensity modulated", "stereotactic" ve "proton terapisi" gibi yeni geliştirilen teknikler sayesinde hem verilen doz ayarlanarak hem de uygulanan alan sınırları net olarak belirlenerek azaltılabilmektedir (2,5,(8)(9)(10)(11).…”