Pharmacological Inhibition of CB1 Cannabinoid Receptor Protects Against Doxorubicin-Induced Cardiotoxicity
Partha Mukhopadhyay, PhD*,1,
Sándor Bátkai, MD, PhD*,1,
Mohanraj Rajesh, PhD*,
Nora Czifra*,
Judith Harvey-White, MSc*,
György Haskó, MD, PhD ,
Zsuzsanna Zsengeller, MD, PhD ,
Norma P. Gerard, MD ,
Lucas Liaudet, MD ,
George Kunos, MD, PhD, FAHA* and
Pál Pacher, MD, PhD, FAPS, FAHA*,*
* Laboratory of Physiological Studies, NIH/NIAAA, Bethesda, Maryland
Department of Surgery, UMDNJ-New Jersey Medical School, Newark, New Jersey
Pulmonary Division, Department of Pediatrics, Childrens Hospital, Harvard Medical School, Boston, Massachusetts
Department of Intensive Care Medicine, University Hospital, Lausanne, Switzerland.

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Figure 1 Effects of CB1 Antagonists on DOX-Induced Cardiac Dysfunction
Effect of doxorubicin (DOX) on left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), LV maximum first derivative of ventricular pressure with respect to time (+dP/dt), LV –dP/dt, heart rate, stroke work, ejection fraction, and cardiac output and tau (Weiss and Glantz) in mice. Mice were pretreated either with vehicle, rimonabant, or AM281, and treated with either vehicle or DOX, as indicated in the Methods section. Hemodynamic parameters were measured 5 days after DOX administration. Results are mean ± standard error of the mean of 7 to 13 experiments in each group. *p < 0.05 versus vehicle; #p < 0.05 versus DOX. CB1 = cannabinoid-1.
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Figure 2 Effect of CB1 Antagonists on DOX-Induced Depression of Load-Independent Indexes of Cardiac Contractility
(A) Representative pressure–volume (P–V) loops obtained with a P–V conductance catheter system at different preloads after vena cava occlusion, showing differences in the end-systolic P–V relation (ESPVR) and between mice pretreated with vehicle, rimonabant, or AM281 and treated with vehicle or DOX. The less steep ESPVR in DOX-treated mice indicates decreased contractile function, which was improved by CB1 antagonists. (B) Effects of CB1 antagonists on DOX-induced depression of load-independent indexes of cardiac contractility. Results are mean ± standard error of the mean of 9 to 18 experiments in each group. *p < 0.05 versus vehicle; #p < 0.05 versus DOX. EDV = end-diastolic volume relation; ESPVR or Emax = end-systolic pressure–volume relation; PRSW = preload-recruitable stroke work; other abbreviations as in Figure 1.
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Figure 3 Effects of CB1 Antagonists on DOX-Induced Cell Death and Apoptosis In Vitro
(A) Effects of CB1 antagonists on cell viability measured by XTT assays. AM281 and rimonabant (1 µmol/l) prevent cell death induced by 1 or 5 µmol/l of DOX. *p < 0.05 versus control group; #p < 0.05 versus DOX (n = 4). (B) Effects of CB1 antagonists on the early apoptosis marker fluorescent annexin V conjugate (Annexin V-FITC) and cell death detection dye propidium iodide (PI) measured by flow cytometric analysis of H9c2. Representative data from 3 experiments analyzed. (C) Effects of CB1 antagonists on active caspase expression (green) and nuclear staining pattern by Hoechst 33342 dye (blue). Please also note that some of the nuclei are fragmented in DOX-treated cells (indicative of late apoptosis), but not in CB1 antagonist-treated or control cells. Representative data from at least 15 experiments analyzed. Abbreviations as in Figure 1.
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Figure 4 Effects of CB1 Agonist, CB2 Antagonists, and Agonists on DOX-Induced Apoptosis in H9c2 In Vitro
Effects of CB1 agonist, CB2 antagonists, and agonists on the early apoptosis marker Annexin V-FITC and cell death detection dye propidium iodide (PI) measured by flow cytometric analysis of H9c2. Representative data from 3 experiments analyzed. Abbreviations as in Figures 1 and 3.
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Figure 5 Effects of CB1 Antagonists on DOX-Induced Apoptosis In Vivo
(A) Effects of CB1 antagonists on DOX-induced caspase-3 activation analyzed by Western blot from heart tissue homogenates. Treatment with rimonabant or AM281 reduced myocardial caspase-3 activation in DOX-treated mice. The blot was also probed for beta-actin level for loading control. Representative blot from at least 5 experiments. (B) Effects of CB1 antagonists on DOX-induced caspase-3 activity analyzed by colorimetric method from heart tissue homogenates. Treatment with rimonabant or AM281 reduced caspase-3 activity in DOX-treated mice. *p < 0.05 versus vehicle; #p < 0.05 versus DOX (n = 4 per group). (C) Effects of CB1 antagonists on DOX-induced caspase-3 and caspase-9 gene expression. Data were analyzed with 2 housekeeping genes, and data presented here were normalized with beta-actin. Treatment with rimonabant or AM281 reduced myocardial caspase-3 and caspase-9 gene expression in DOX-treated mice. *p < 0.05 versus vehicle; #p < 0.05 versus DOX (n = 6 to 15 per group). Abbreviations as in Figure 1.
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Figure 6 Effects of Rimonabant and AM281 on DOX-Induced Myocardial Apoptosis In Vivo Determined by TUNEL and DNA Fragmentation Assay
(A) Note the increased myocardial terminal deoxynucleotidyltransferase-mediated nick-end labeling (TUNEL) staining from doxorubicin (DOX)-treated mice (brown). Treatment with cannabinoid-1 antagonist rimonabant and AM281 reduced myocardial TUNEL staining in DOX-treated mice. Similar immunohistochemical profiles were seen in n = 3 hearts per group. Quantitative measurements were carried out in 20 fields per group. *p < 0.05 versus vehicle (Veh); #p < 0.05 versus DOX. (B) Effects of rimonabant and AM281 on DOX-induced myocardial apoptosis in vivo by TUNEL assay. *p < 0.05 versus vehicle; #p < 0.05 versus DOX (n = 4 per group). (C) Effects of rimonabant and AM281 on DOX-induced deoxyribonucleic acid (DNA) fragmentation in vivo. Changes are expressed in % of myocardial DNA fragmentation in vehicle-treated mice (100%). *p < 0.05 versus vehicle; #p < 0.05 versus DOX (n = 4 per group). Eu = Europium.
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Figure 7 Effects of DOX on Myocardial Endocannabinoid Content and CB1/2 Receptor Expression
(A) Evidence of CB1 receptor protein expression in total lysate of DOX-treated mouse heart tissue homogenate by Western blot analysis. (B and D) Evidence of CB1 and CB2 receptor gene expression by semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) from complementary deoxyribonucleic acid of both untreated and DOX-treated mouse heart samples (B) and cardiomyocytes (D). (C) Evidence of CB1 receptor and CB2 receptor gene expression in heart tissue by quantitative real-time PCR after normalization to beta-actin (n = 6 to 15). (E) Effect of DOX on anandamide (AEA) and 2-arachidonylglycerol (2-AG) production in vivo by liquid chromatography mass spectrometry (LCMS) analysis of heart tissue samples. *p < 0.05 versus vehicle (n = 6). (F) Effect of DOX (1 µM for 2 h) on AEA and 2-AG production in vitro by LCMS analysis of H9c2 cells. Increased AEA levels were observed in doxorubicin treated samples. *p < 0.05 versus vehicle (n = 3). KO = knockout; other abbreviations as in Figure 1.
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