ABSTRACT
BACKGROUND: A significant number of patients treated with anthracyclines develop cardiotoxicity (anthracycline-induced cardiotoxicity [ACT]), mainly presenting as arrhythmias (acute ACT) or congestive heart failure (chronic ACT). There are no data on pharmacogenomic predictors of ACT. METHODS AND RESULTS: We genotyped participants of the German non-Hodgkin lymphoma study (NHL-B) who were followed up for the development of heart failure for a median of >3 years. Single-nucleotide polymorphisms (SNPs) were selected from 82 genes with conceivable relevance to ACT. Of 1697 patients, 55 developed acute and 54 developed chronic ACT (cumulative incidence of either form, 3.2%). We detected 5 significant associations with polymorphisms of the NAD(P)H oxidase and doxorubicin efflux transporters. Chronic ACT was associated with a variant of the NAD(P)H oxidase subunit NCF4 (rs1883112, -212A-->G; symbols with right-pointing arrows, as edited?' odds ratio [OR], 2.5; 95% CI, 1.3 to 5.0). Acute ACT was associated with the His72Tyr polymorphism in the p22phox subunit (rs4673; OR, 2.0; 95% CI, 1.0 to 3.9) and with the variant 7508T-->A (rs13058338; OR, 2.6; 95% CI, 1.3 to 5.1) of the RAC2 subunit of the same enzyme. In agreement with these results, mice deficient in NAD(P)H oxidase activity, unlike wild-type mice, were resistant to chronic doxorubicin treatment. In addition, acute ACT was associated with the Gly671Val variant of the doxorubicin efflux transporter multidrug resistance protein 1 (MRP1) (OR, 3.6; 95% CI, 1.6 to 8.4) and with the Val1188Glu-Cys1515Tyr (rs8187694-rs8187710) haplotype of the functionally similar MRP2 (OR, 2.3; 95% CI, 1.0 to 5.4). Polymorphisms in adrenergic receptors previously demonstrated to be predictive of heart failure were not associated with ACT. CONCLUSIONS: Genetic variants in doxorubicin transport and free radical metabolism may modulate the individual risk to develop ACT.
Subject(s)
ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics , Doxorubicin/toxicity , Heart Diseases/chemically induced , NADPH Oxidases/genetics , Polymorphism, Genetic , Adolescent , Adult , Aged , Animals , Anthracyclines/metabolism , Anthracyclines/toxicity , Biological Transport/genetics , Case-Control Studies , Doxorubicin/metabolism , Drug-Related Side Effects and Adverse Reactions/genetics , Female , Free Radicals/metabolism , Humans , Male , Membrane Glycoproteins/genetics , Mice , Mice, Knockout , Middle Aged , NADPH Oxidase 2 , Pharmacogenetics/methods , Ventricular Function, Left/drug effectsABSTRACT
The dermorphin-derived, MOP receptor-selective tetrapeptide Tyr-D-Arg2-Phe-Sar4 (TAPS) exhibits a high antinociceptive potency and stimulates respiration in rats. The receptor binding kinetics of [3H]TAPS were investigated using crude calf thalamic membrane preparations. Saturation studies showed binding of [3H]TAPS at two binding sites (0.4 and 3.2 nM). In the presence of MgSO4, [3H]TAPS binding occurred with high affinity at a single site only. The high-affinity binding component was reduced following the addition of K2-EDTA. The increase of the apparent dissociation constant was due to an enhanced dissociation rate (P<0.05), while association rates remained unchanged. Addition of 5'-guanylylimidodiphosphate (Gpp(NH)p) resulted in a reduction of affinity which was augmented in the presence of Na+. Thus, [3H]TAPS, depending on the presence of divalent cations, serves as ligand at two MOP receptor binding sites in the calf thalamus, which may represent distinct affinity states of the same receptor or receptor subtypes thereof.
Subject(s)
Oligopeptides/metabolism , Receptors, Opioid/metabolism , Animals , Binding Sites , Cattle , Hydrogen-Ion Concentration , Kinetics , Radioligand Assay , Rats , Temperature , Thalamus/cytology , Thalamus/metabolism , Time FactorsABSTRACT
The dermorphin-derived tetrapeptide Tyr-D-Arg(2)-Phe-Sar(4) (TAPS) was tested for its ability to induce tolerance, cross-tolerance, withdrawal and its substitution properties in rats subjected to chronic intracerebroventricular (i.c.v.) infusions of mu-opiate receptor agonists. Tolerance and cross-tolerance were assessed by quantification of the thermally induced tail-flick response. Chronic intracerebroventricular infusion of TAPS resulted in antinociception at almost 1000-fold lower doses compared to morphine sulphate and [D-Ala(2), MePhe(4)Gly(ol)(5)]enkephalin (DAMGO). Tolerance to the antinociceptive effect of TAPS developed similar to DAMGO and morphine sulphate. Cross-tolerance to intracerebroventricular bolus injections of DAMGO, but not of TAPS, was evident in rats rendered tolerant to morphine sulphate and TAPS. Naloxone-induced withdrawal was equally pronounced in animals treated with morphine sulphate, DAMGO or TAPS. TAPS substituted for morphine sulphate and vice versa regarding the withdrawal syndrome in a cross-over experimental design. In contrast to DAMGO, TAPS retains its antinociceptive effect following bolus administration in rats rendered tolerant to mu-opioid receptor agonists.