The anti-cancer drug trametinib suppresses angiotensin-induced cardiac remodelling in mice but is detrimental to function
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Background
The anti-cancer MEK inhibitor trametinib (alone or with the RAF inhibitor dabrafenib) causes cardiac dysfunction or heart failure in some patients. Our hypothesis is that cardiotoxicity is exacerbated by an underlying co-morbidity such as hypertension causing early cardiac dysfunction detectable on echocardiograms.
Objectives
The objectives were to assess the effects of trametinib on cardiac function in a mouse model of hypertension-induced cardiac hypertrophy and determine if this was moderated by dabrafenib.
Methods
Male mice were treated with vehicle, trametinib or dabrafenib/trametinib in the absence/presence of angiotensin II (AngII; 0.8 mg/kg/d to increase blood pressure over 7 d). Hearts were imaged using echocardiography.
Results
Inhibitors alone had a limited effect on mouse hearts over 28 d. Trametinib or trametinib/dabrafenib inhibited cardiac hypertrophy induced by AngII over 7 d, reducing left ventricular (LV) wall thickness and mass. AngII did not significantly affect cardiac function, but the inhibitors caused significant functional deterioration. Segmental analysis revealed variation of contraction around the LV, with selective effects of AngII and trametinib or dabrafenib/trametinib in basal/mid-regional segments. Frame-by-frame analysis of radial (not longitudinal) displacement of the LV endocardial wall demonstrated variation between consecutive cardiac cycles that enabled a high degree of classification according to treatment.
Conclusions
Trametinib inhibits AngII-induced cardiac hypertrophy in mice but is detrimental to cardiac function, responses that are not moderated by dabrafenib. AngII and MEK/RAF inhibition have regional effects around the LV with greater effects on radial displacement in basal/mid-regional segments. Assessment of such changes may facilitate early identification of developing cardiotoxicity.
Clinical perspectives
Competencies in Medical knowledge
The anti-cancer drugs trametinib and dabrafenib are cardiotoxic in some patients. These drugs had limited effects themselves on mouse hearts, but suppressed cardiac hypertrophy in a mouse model of hypertension whilst proving detrimental to cardiac function. Segments around the left ventricle were differentially affected by hypertension and inhibitors,with variation between consecutive cardiac cycles.
Translational outlook
Further research is needed to establish the relationship between hypertension and cardiotoxicity of trametinib in patients, and determine if regional effects in the ventricle wall can predict cardiac dysfunction. If so, a diagnostic algorithm may be a useful tool in identifying developing cardiotoxicity.
Abstract Figure
Summary Figure.Effects of dabrafenib/trametinib on the cardiac response to angiotensin II in mice.
Inhibiting ERK1/2 suppresses cardiac fibrosis and cardiomyocyte hypertrophy induced by angiotensin II. This results in a decline in cardiac function, with particular effects on radial wall movement and in different segments of the left ventricle.
