Pediatric and adult
cancer patients, following the use of the
antitumor drug Doxorubicin develop
cardiotoxicity. Pharmacological protection of microvascular endothelium might produce a double benefit: (i) reduction of myocardial toxicity (the primary target of
Doxorubicin action) and (ii) maintenance of the vascular functionality for the adequate delivery of chemotherapeutics to
tumor cells. This study was aimed to evaluate the mechanisms responsible of the protective effects of the
angiotensin converting enzyme inhibitor (ACEI)
Zofenoprilat against the toxic effects exerted by
Doxorubicin on coronary microvascular endothelium. We found that exposure of endothelial cells to
Doxorubicin (0.1-1μM range) impaired cell survival by promoting their apoptosis. ERK1/2 related p53 activation, but not
reactive oxygen species, was responsible for
Doxorubicin induced
caspase-3 cleavage. P53 mediated-apoptosis and impairment of survival were reverted by treatment with
Zofenoprilat. The previously described PI-3K/eNOS/endogenous
fibroblast growth factor signaling was not involved in the protective effect, which, instead, could be ascribed to
cystathionine gamma lyase dependent availability of H2S from
Zofenoprilat. Furthermore, considering the
tumor environment, the treatment of endothelial/
tumor co-cultures with
Zofenoprilat did not affect the antitumor efficacy of
Doxorubicin. In conclusion the ACEI
Zofenoprilat exerts a protective effect on
Doxorubicin induced endothelial damage, without affecting its antitumor efficacy. Thus, sulfhydryl containing ACEI may be a useful
therapy for
Doxorubicin-induced
cardiotoxicity.