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Myocarditis associated with doxorubicin cardiotoxicity
P B Gaudin1, R H Hruban, W E Beschorner
1Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
American Journal of Clinical Pathology
|August 1, 1993
Summary
Anthracycline chemotherapy, like doxorubicin, can cause myocarditis. This study found T lymphocytes and Class II antigen expression in myocardial biopsy specimens, suggesting inflammation is a component of doxorubicin cardiotoxicity.
Area of Science:
- Cardiology
- Oncology
- Pathology
Background:
- Anthracyclines are widely used chemotherapy agents.
- Cardiotoxicity is a known side effect of anthracycline treatment.
- The precise mechanisms of anthracycline-induced cardiotoxicity are not fully understood.
Purpose of the Study:
- To investigate the frequency and characteristics of myocarditis in patients treated with anthracyclines.
- To examine the role of inflammatory infiltrates and endothelial cell activation in doxorubicin cardiotoxicity.
Main Methods:
- Review of histologic, electron microscopic, and immunoperoxidase stain results from endomyocardial biopsy specimens of 11 patients with doxorubicin cardiotoxicity.
- Use of monoclonal antibodies to identify lymphocytes, macrophages, and endothelial cells.
- Assessment for induced Class II antigen expression on arterial endothelial cells.
Main Results:
- Myocarditis was present in 4 of 11 biopsy specimens and borderline myocarditis in 2.
- Infiltrating lymphocytes were predominantly T lymphocytes.
- Induced Class II antigen expression was observed on arterial endothelial cells.
- Foci of replacement fibrosis suggested a chronic process.
Conclusions:
- Myocarditis can be a component of doxorubicin-induced myocardial injury.
- The findings suggest an inflammatory process involving T lymphocytes and endothelial cell activation in anthracycline cardiotoxicity.
- Further research is needed to establish a causal relationship.