Cardioprotective potential of botanical agents against anthracycline-induced cardiotoxicity

Abstract

Background: Cancer is a major public health problem imposing the largest worldwide disease burden and chemotherapy is still its mainstay treatment used alone or in combination with surgery or radiotherapy. Anthracyclines are one of the chemotherapeutic agents effective against solid tumors, hematologic malignancies, and sarcomas. Despite their effective role in improving survival rates, their widespread use has been limited due to their cardiotoxic effects. It is hypothesized that botanical agents rich in vitamins and antioxidants could help to overcome the chemotherapy's side effects associated with oxidative stress. In this review, we aimed to investigate the cardioprotective properties of a number of these agents and summarize strategies for reducing the risk of anthracycline-induced cardiotoxicity. Methods: Scientific databases including Pubmed and Medline were searched using the Mesh term and entry terms of eleven botanical agents, including citrus, blueberry, peanut, soybean, carrot, aloe vera, green tea, rosemary, flaxseed, cocoa, and propolis to find relevant articles regarding the cardioprotective potential of these agents. Clinical, preclinical, animal studies, and in vitro experiments in the English language and with available full texts that evaluated the cardioprotective potential of these botanical agents against anthracycline-induced cardiotoxicity were included, (full search strategy - supplementary file1). Results and Conclusion: Besides the ability of these botanical agents to attenuate anthracycline-induced cardiotoxicity, they also tend to show some synergistic effects with antineoplastic agents and can be used as potential adjuvant therapy. Further clinical investigations are required to evaluate the cardioprotective potential of these products in cancer patients.

Keywords

• Cardiotoxicity
• Cardioprotective
• Anthracyclines
• Doxorubicin
• Antioxidants
• Plants