Abstract Body: Introduction: Psychosocial stress is a significant cardiovascular risk factor and an enormous burden on cancer patients. However, limited knowledge is available on the underlying mechanisms at least in part because of lack of translationally relevant animal models. Previous work from our lab established that adult exposure to social stress can exacerbate the cardiovascular effect of juvenile doxorubicin (DOX) exposure. However, the effect of concomitant DOX and stress exposure in adult mice is unknown.
Methods: In this study, a ‘two-hit’ mouse model was established, in which chronic subordination stress (CSS) and DOX treatment were given simultaneously. Twelve-week-old male C57BL/6N (6N) and C57BL/6J (6J) mice were subjected to daily episodes of social defeat by dominant CD1 mice with whom they remained in continuous sensory contact with for 28 days, thus establishing social subordination. One week after the start of CSS, mice were administered DOX (8 mg/kg/week) for 3 weeks. Thereafter, cardiac function was assessed by echocardiography and gene expression of inflammatory and pro-fibrotic markers were determined by real-time PCR. Cardiac fibrosis and inflammation were assessed by histopathologic analysis.
Results: Cardiac dysfunction and significant cardiac fibrosis were observed in 6N but not in 6J mice that were exposed to both DOX and CSS, as evidenced by reduced ejection fraction, cardiac output, and increased trichrome staining, respectively. Additionally, gene expression analysis demonstrated significant upregulation of atrial natriuretic peptide and interleukin-6 in 6N mice exposed to both DOX and CSS compared to 6J mice. Finally, DOX caused cardiac atrophy and abrogated CSS-induced cardiac hypertrophy in 6N but not in 6J mice, as evidenced by measuring left ventricular mass and heart weight/tibia length.
Conclusion: Exposure to CSS exacerbated the cardiotoxic effects of DOX in a sub-strain dependent manner. These findings highlight psychosocial stress as a risk factor for worse cardiovascular outcome in cancer patients receiving cardiotoxic regimens. The study underscores sub-strain differences in the cardiac responses of 6N and 6J mouse to CSS alone and CSS/DOX treatment that may serve as a discovery platform for the identification of genetic biomarkers of resilience.