image: Various emerging treatment strategies for AIC include cardioprotective agents, new nanotechnology, stem cell therapy, Chinese herbal formulas, distal ischemic preconditioning, physical exercise, monitoring and treatment, personalized therapy.
Credit: ©Science China Press
Scientific progress has deepened our comprehension of AIC mechanisms. Recent studies have explored emerging pathogenic mechanisms, including mitochondrial dysfunction, ferroptosis, myocardial senescence, genetic factors, epigenetic changes and gut microbiota dysregulation. Novel biomarkers, such as dysfunctional miRNAs (e.g., miRNA-34a), are closely linked to anthracycline-treated patients. Additionally, human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) can model cancer patients' AIC susceptibility, creating a promising experimental platform for high-risk patients.
Traditional AIC treatment strategies, such as limiting the cumulative dose of anthracyclines, changing the drug formulation (e.g., using liposomal doxorubicin), and using the cardioprotective agent dexrazoxane, have reduced cardiotoxicity to some extent, yet their limitations are also evident. With the rapid development of medical science and technology, new therapeutic strategies are emerging, bringing hope for AIC prevention and treatment. Nanotechnology, with its precise positioning and efficient drug delivery, can minimize damage to normal tissues. Stem cell therapy activates the body's repair mechanisms, offering potential for regenerating damaged heart muscle cells. Traditional Chinese medicine (TCM) plays a role through multi-target regulation; formulas like Huangqi Shengmaiyin, Qiliqiangxin Capsule, and Shenmai Injection improve symptoms and quality of life using TCM's holistic and syndrome-differentiation approaches. Distal ischemic preconditioning, a non-pharmacological treatment, provides new ideas by activating the body's protective mechanisms.
This review systematically reviews the novel pathogenesis of cardiotoxicity caused by anthracyclines and the limitations of traditional therapeutic strategies, and provides cutting-edge insights for emerging treatment strategies. While new mechanisms and therapies offer hope for cancer survivors, there are still challenges such as high costs, ethical concerns and safety concerns in clinical translation. Future improvements in patient outcomes require multidisciplinary collaboration and ongoing research.
Journal
Medicine Plus