Metformin and Dapagliflozin Attenuate Doxorubicin-Induced Acute Cardiotoxicity in Wistar Rats: An Electrocardiographic, Biochemical, and Histopathological Approach

Abstract

Doxorubicin is a widely used anticancer drug whose efficacy is limited due to its cardiotoxicity. There is no ideal cardioprotection available against doxorubicin-induced cardiotoxicity. This study aimed to investigate the anticipated cardioprotective potential of metformin and dapagliflozin against doxorubicin-induced acute cardiotoxicity in Wistar rats. At the beginning of the experiment, cardiac screening of experimental animals was done by recording an electrocardiogram (ECG) before allocating them into the groups. Thereafter, a total of thirty healthy adult Wistar rats (150-200 g) were randomly divided into five groups (n = 6) and treated for eight days as follows: group I (normal control), group II (doxorubicin control), group III (metformin 250 mg/kg/day), group IV (metformin 180 mg/kg/day), and group V (dapagliflozin 0.9 mg/kg/day). On the 7th day of the treatment phase, doxorubicin 20 mg/kg was administered intraperitoneal to groups II, III, IV, and V. On the 9th day (immediately after 48 h of doxorubicin administration), blood was collected from anesthetized animals for glucose, lipid profile, CK-MB & AST estimation, and ECG was recorded. Later, animals were sacrificed, and the heart was dissected for histopathological examination. We found that compared to normal control rats, CK-MB, AST, and glucose were significantly increased in doxorubicin control rats. There was a significant reversal of doxorubicin-induced hyperglycemia in the rats treated with metformin 250 mg/kg compared to doxorubicin control rats. Both metformin (180 mg/kg and 250 mg/kg) and dapagliflozin (0.9 mg/kg) significantly altered doxorubicin-induced ECG changes and reduced the levels of cardiac injury biomarkers CK-MB and AST compared to doxorubicin control rats. Metformin and dapagliflozin protected the cellular architecture of the myocardium from doxorubicin-induced myocardial injury. Current study revealed that both metformin and dapagliflozin at the FDA-recommended antidiabetic doses mitigated doxorubicin-induced acute cardiotoxicity in Wistar rats. The obtained data have opened the perspective to perform chronic studies and then to clinical studies to precisely consider metformin and dapagliflozin as potential chemoprotection in the combination of chemotherapy with doxorubicin to limit its cardiotoxicity, especially in patients with comorbid conditions like type II diabetes mellitus.

Keywords: Antidiabetic drugs; Cardio-oncology; Cardiotoxicity; Chemoprotectant; Chemotherapy; Electrocardiograph.

Fig. 1

Effect on fasting blood glucose level (Mean ± SD). a Compared to normal control, b compared to doxorubicin control; *** p ≤ 0.001

Fig. 2

Effect on cardiac injury biomarkers-CK-MB and AST (Mean ± SD). a Compared to normal control, b compared to doxorubicin control, d compared to doxorubicin + metformin 180 mg/kg; ***p ≤ 0.001 and *p ≤ 0.05

Fig. 3

Qualitative analysis of ECG. a prolongation of the QT interval, b reduced QRS complex amplitude, c increased PR interval

Fig. 4

Quantitative analysis of ECG (Mean ± SD). a compared to normal control, b compared to doxorubicin control; ***p ≤ 0.001, **p ≤ 0.01, and *p ≤ 0.05

Fig. 5

Histopathological examination of the heart (longitudinal Sect. 400X). a intermuscular edema, b- cardiomyocytes degeneration, c- infiltration with inflammatory cells, d- myofibrillar loss