Cancer drugs and the heart: importance and management

Progress in the detection and treatment of cancer has led to an impressive reduction in both mortality and morbidity. Due to their mechanism of action, however, conventional chemotherapeutics and some of the newer anti-cancer signaling inhibitors carry a substantial risk of cardiovascular side effects that include cardiac dysfunction and heart failure, arterial hypertension, vasospastic and thromboembolic ischaemia, dysrhythmia, and QT prolongation. While some of these side effects are irreversible and cause progressive cardiovascular disease, others induce only temporary dysfunction with no apparent long-term sequelae for the patient. The challenge for the cardiovascular specialist is to balance the need for life-saving cancer treatment with the assessment of risk from cancer drug-associated cardiovascular side effects to prevent long-term damage. This review discusses concepts for timely diagnosis, intervention, and surveillance of cancer patients undergoing treatment, and provides approaches to clinical uncertaintie

Pathophysiology and diagnosis of cancer drug induced cardiomyopathy

The clinical manifestations of anti-cancer drug associated cardiac side effects are diverse and can range from acutely induced cardiac arrhythmias to Q-T interval prolongation, changes in coronary vasomotion with consecutive myocardial ischemia, myocarditis, pericarditis, severe contractile dysfunction, and potentially fatal heart failure. The pathophysiology of these adverse effects is similarly heterogeneous and the identification of potential mechanisms is frequently difficult since the majority of cancer patients is not only treated with a multitude of cancer drugs but might also be exposed to potentially cardiotoxic radiation therapy. Some of the targets inhibited by new anti-cancer drugs also appear to be important for the maintenance of cellular homeostasis of normal tissue, in particular during exposure to cytotoxic chemotherapy. If acute chemotherapy-induced myocardial damage is only moderate, the process of myocardial remodeling can lead to progressive myocardial dysfunction over years and eventually induce myocardial dysfunction and heart failure. The tools for diagnosing anti-cancer drug associated cardiotoxicity and monitoring patients during chemotherapy include invasive and noninvasive techniques as well as laboratory investigations and are mostly only validated for anthracycline-induced cardiotoxicity and more recently for trastuzumab-associated cardiac dysfunctio

Characterisation of the tetrahalophosphonium cations PBrnI4 − n+ (0 ≤ n ≤ 4) by 31P MAS NMR, IR and Raman spectroscopy and the crystal structures of PI4+AlCl4−, PI4+AlBr4− and PI4+GaI4−

The novel tetrahalophosphonium salts PBr4+AsF6−, PI4+AlCl4− and PI4+EBr4− (E = Al, Ga) have been synthesised. A variety of solid complexes containing PBr4+ (e.g. PBr4+AsF6−, PBr4+AlBr4− PBr4+GaBr4−), PI4+ (e.g. PI4+AlCl4−, PI4+AlBr4−, PI4+GaBr4−) or the mixed species PBrnI4 − n+ (0 ≤ n ≤ 4, containing AlBr4−, GaBr4−, AsF6− or SbF6−) have been studied by solid-state 31P MAS NMR and vibrational spectroscopy. The influence of the counter-ion on the chemical shift and the vibrational frequencies are discussed. The crystal structures of PI4+AlCl4−, PI4+AlBr4− and PI4+GaI4− are reported. Evidence for the existence of the hitherto unknown mixed bromoiodophosphonium cations PBr3I+, PBr2I2+ and PBrI3+ has been confirmed by spin–orbit corrected density functional calculations of isotropic 31P chemical shifts for PBrnI4 − n+

A Sustained Dietary Change Increases Epigenetic Variation in Isogenic Mice

Epigenetic changes can be induced by adverse environmental exposures, such as nutritional imbalance, but little is known about the nature or extent of these changes. Here we have explored the epigenomic effects of a sustained nutritional change, excess dietary methyl donors, by assessing genomic CpG methylation patterns in isogenic mice exposed for one or six generations. We find stochastic variation in methylation levels at many loci; exposure to methyl donors increases the magnitude of this variation and the number of variable loci. Several gene ontology categories are significantly overrepresented in genes proximal to these methylation-variable loci, suggesting that certain pathways are susceptible to environmental influence on their epigenetic states. Long-term exposure to the diet (six generations) results in a larger number of loci exhibiting epigenetic variability, suggesting that some of the induced changes are heritable. This finding presents the possibility that epigenetic variation within populations can be induced by environmental change, providing a vehicle for disease predisposition and possibly a substrate for natural selection.This work was supported by the Australian Research Council (DP0771859) and the National Health and Medical Research Council (#459412, #635510)

Quantum tunnelling of magnetization in Mn12-ac studied by 55Mn NMR

We present an ultra-low temperature study (down to T = 20 mK) of the nuclear spin-lattice relaxation (SLR) in the 55Mn nuclei of the molecular magnet Mn12-ac. The nuclear spins act as local probes for the electronic spin fluctuations, due to thermal excitations and to tunnelling events. In the quantum regime (below T = 0.75 K), the nuclear SLR becomes temperature-independent and is driven by fluctuations of the cluster's electronic spin due to the quantum tunnelling of magnetization in the ground doublet. The quantitative analysis of the nuclear SLR shows that the presence of fast-tunnelling molecules, combined with nuclear intercluster spin diffusion, plays an important role in the relaxation process.Comment: RevTex, 5 pages, 3 eps figures; presented at the Internation Conference on Molecular Magnets (Valencia, 5 - 10 Oct. 2002); to be published in Polyhedro