Metformin protects against sunitinib-induced cardiotoxicity:
Investigating the role of AMPK
Abstract
Abstract BACKGROUND AND PURPOSE The multi-tyrosine kinase inhibitor
sunitinib malate is associated with cardiotoxicity through inhibition of
5’adenosine monophosphate protein kinase (AMPK) signalling. Here we
demonstrate the cardioprotective properties of metformin limiting the
adverse cardiotoxic effect of sunitinib. EXPERIMENTAL APPROACH Heart
rate (HR), left ventricular developed pressure (LVDP), coronary flow
(CF), infarct size, and phosphorylated-AMPKα levels were measured in the
rat Langendorff hearts perfused with 1 µM sunitinib ± 50 µM metformin ±
1 µM human equilibrative nucleoside transporter inhibitor
S-(4-Nitrobenzyl)-6-thionosine (NBTI). Isolated cardiac myocytes were
incubated with 1 µM sunitinib ± 50 µM metformin ± 1 µM NBTI to determine
the live cell population levels. Human hepatoma G2 (HepG2) and
promyelocytic leukemia (HL-60) cells were incubated with 0.1-100 µM
sunitinib ± 50 µM metformin to determine the cell viability. KEY RESULTS
Sunitinib significantly increased the infarct size and decreased the
LVDP, while the p-AMPKα level declined. In the cardiac myocytes study,
treatment with sunitinib decreased the cell viability. Co-administration
of metformin abolished these cardiotoxic effects of sunitinib.
Co-administration of NBTI (1 µM) inhibited the cardioprotective effects
of metformin. Anti-cancer properties of sunitinib and metformin was
recorded using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium
bromide (MTT) assay. MTT revealed that co-administration of metformin
with sunitinib decreased sunitinib’s antiproliferative properties,
evidenced by an increase in EC50 concentration value when compared to
sunitinib monotreatment in in-vitro HepG2 and HL60 cell lines. However,
metformin co-administration did not inhibit sunitinib’s properties
CONCLUSIONS AND IMPLICATIONS This study highlights the novel
cardioprotective properties of metformin via AMPK during
sunitinib-induced cardiotoxicity.