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Department of Clinical Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
Department of Pharmacology and Toxicology, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
Department of Natural Products, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
d
Department of Pathology and Forensic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
e
Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
f
Department of Clinical Biochemistry, Faculty of Medicine, Taibah University, Madinah, Saudi Arabia
b
c
a r t i c l e
i n f o
Article history:
Received 8 November 2009
Accepted 3 February 2010
Keywords:
Cranberry
Doxorubicin
Cardiotoxicity
Antioxidation
a b s t r a c t
Doxorubicin (DOX) is a widely used cancer chemotherapeutic agent. However, it generates free oxygen
radicals that result in serious dose-limiting cardiotoxicity. Supplementations with berries were proven
effective in reducing oxidative stress associated with several ailments. The aim of the current study
was to investigate the potential protective effect of cranberry extract (CRAN) against DOX-induced cardiotoxicity in rats. CRAN was given orally to rats (100 mg/kg/day for 10 consecutive days) and DOX
(15 mg/kg; i.p.) was administered on the seventh day. CRAN protected against DOX-induced increased
mortality and ECG changes. It signicantly inhibited DOX-provoked glutathione (GSH) depletion and
accumulation of oxidized glutathione (GSSG), malondialdehyde (MDA), and protein carbonyls in cardiac
tissues. The reductions of cardiac activities of catalase (CAT), superoxide dismutase (SOD), glutathione
peroxidase (GSH-Px) and glutathione reductase (GR) were signicantly mitigated. Elevation of cardiac
myeloperoxidase (MPO) activity in response to DOX treatment was signicantly hampered. Pretreatment
of CRAN signicantly guarded against DOX-induced rise of serum lactate dehydrogenase (LDH), creatine
phosphokinase (CK), creatine kinase-MB (CK-MB) as well as troponin I level. CRAN alleviated histopathological changes in rats hearts treated with DOX. In conclusion, CRAN protects against DOX-induced cardiotoxicity in rats. This can be attributed, at least in part, to CRANs antioxidant activity.
2010 Elsevier Ltd. All rights reserved.
1. Introduction
Cranberries are small, dark red fruits that are widely consumed
as juice and sauce. They come from a shrub, Vaccinium macrocarpon
Aiton [Ericaceae], native to eastern North America (Cunningham
et al., 2004). Active constituents of cranberries include several
avonols and avonoids as proanthocyanidins and anthocyanins
(Ariga, 2004). Cranberry juice has long been consumed for the prevention of urinary tract infections (Foo et al., 2000). Studies have
shown that supplementations with berries were effective in reducing oxidative stress associated with aging. Further, cranberries have
been reported to possess anti-inammatory and anti-mutagenic
properties and provide cardioprotection (Bagchi et al., 2004).
Doxorubicin (DOX) is one of the most effective antitumor antibiotics belonging to the class of anthracyclines. However, its use is
* Corresponding author. Tel.: +966 56 2134533; fax: +966 2 6951696.
E-mail address: ashour032000@yahoo.com (O.M. Ashour).
0278-6915/$ - see front matter 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.fct.2010.02.008
1179
1180
using Software GraphPad InStat, Version 4 (GraphPad Software Inc., La Jolla, CA,
USA). Statistical signicance was determined as p value below 0.05.
Table 2
The effect of cranberry extract (CRAN) on doxorubicin (DOX)-induced alterations in
heart rate, ST interval and QT interval.
3. Results
3.1. Evaluation of general toxicity
Four rats died in DOX-only-treated group (33.3%) two days after
DOX administration. However, no mortality was observed in all
other groups including the combined CRAN + DOX-treated group.
Rats in the DOX-only-treated group showed scruffy fur and developed a light yellow tinge. These animals showed, also, red exudates
around the eyes which appeared to sicker, weaker and lethargic as
compared to CRAN + DOX-treated group. Strikingly, these animals
developed ascites, as determined by a grossly distended abdomen
and later conrmed during necropsy. The hallmark gross pathologic changes in DOX-only-treated rats were excessive amounts
of pericardial, pleural and peritoneal uids. Effusion intensity score
was moderate in 25% and severe in 75% in DOX-only treated animals, compared with two rats only (16.7%) in the CRAN + DOX
group, where the intensity score was severe (Table 1).
Control
CRAN
DOX
CRAN + DOX
ST interval (ms)
QT interval (ms)
360 15.0
355 12.0
260 12.0a
360 14.0b
100 6.00
90.0 8.00
360 9.00a
110 4.00b
500 40.0
480 20.0
1280 104a
460 42.0b
CRAN was given orally to rats (100 mg/kg/day for 10 consecutive days) and DOX
(15 mg/kg; i.p.) was administered on the seventh day.
Data are the mean SEM of 12 rats.
a
p < 0.05 vs. corresponding control group.
b
p < 0.05 vs. corresponding DOX group.
Table 1
The effect of cranberry extract (CRAN) on doxorubicin (DOX)-induced pleural,
pericardial and peritoneal effusion intensity score in surviving rats.
Group
Control
CRAN
DOX
CRAN + DOX
No. of
animals
12
12
8
12
+1
+2
+3
No.
No.
No.
No.
12
12
0
10
100
100
0
83.3
0
0
0
0
0
0
0
0
0
0
2
0
0
0
25
0
0
0
6
2
0
0
75a
16.7b
CRAN was given orally to rats (100 mg/kg/day for 10 consecutive days) and DOX
(15 mg/kg; i.p.) was administered on the seventh day.
Score: (0) non, (1) mild, (2) moderate, (3) severe. Statistical analysis was done using
X2 test.
a
p < 0.05 vs. corresponding control group.
b
p < 0.05 vs. corresponding DOX group.
group was signicantly lower than that of the DOX group and is
statistically non-signicant from the corresponding value of the
control group (Table 3).
Administration of DOX to rats signicantly reduced the cardiac
activities of CAT, SOD, GSH-Px and GR as compared to the control
activities. Catalase activity showed no alteration by pretreatment
with CRAN. Meanwhile, the activities of SOD and GR in the com-
1181
Table 3
The effect of cranberry extract (CRAN) on doxorubicin (DOX)-induced alterations in the cardiac reduced and oxidized glutathione (GSH and GSSG), malondialdehyde (MDA) and
protein carbonyl contents.
Control
CRAN
DOX
CRAN + DOX
4.61 0.21
4.85 0.11
2.01 0.08a
3.89 0.17a,b
0.87 0.10
0.92 0.08
1.61 0.07a
0.98 0.02b
60.6 3.20
55.2 2.40
129.3 6.20a
79.8 3.80a.b
0.182 0.03
0.179 0.04
0.386 0.05a
0.189 0.07b
CRAN was given orally to rats (100 mg/kg/day for 10 consecutive days) and DOX (15 mg/kg; i.p.) was administered on the seventh day.
Data are the mean SEM of 6 rats.
a
p < 0.05 vs. corresponding control group.
b
p < 0.05 vs. corresponding DOX group.
Table 4
The effect of cranberry extract (CRAN) on doxorubicin (DOX)-induced alterations in the cardiac activities of catalase (CAT), superoxide dismutase (SOD) glutathione peroxidase
(GSH-Px) and glutathione reductase (GR).
Control
CRAN
DOX
CRAN + DOX
GR (U/mg protein)
8.13 0.27
8.05 0.23
3.46 0.17a
3.92 0.26a
33.1 1.42
34.6 1.71
18.6 1.21a
29.1 1.16b
5.12 0.12
5.03 0.17
1.82 0.10a
4.86 0.18a,b
5.82 0.22
5.53 0.24
3.10 0.20a
5.36 0.32b
CRAN was given orally to rats (100 mg/kg/day for 10 consecutive days) and DOX (15 mg/kg; i.p.) was administered on the seventh day.
Data are the mean SEM of 6 rats.
a
p < 0.05 vs. corresponding control group.
b
p < 0.05 vs. corresponding DOX group.
4. Discussion
The serum markers indicating myocardial injury; LDH, CPK, CKMB and troponin I, were signicantly (p < 0.05) elevated in the
DOX-only-treated group compared with control and CRAN-onlytreated group. Pretreatment with CRAN in DOX + CRAN group signicantly reduced their levels as compared with DOX-only-treated
group. However, none of the assessed parameters was returned to
corresponding control values (Table 5).
4
3
a,b
Control
CRAN
DOX
CRAN+DOX
2
1
0
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Table 5
The effect of cranberry extract (CRAN) on doxorubicin (DOX)-induced alterations in serum biomarkers of cardiac injury; lactate dehydrogenase (LDH), creatine phosphokinase
(CPK), creatine phosphokinase isoenzyme-MB (CK-MB) and troponin I.
Control
CRAN
DOX
CRAN + DOX
LDH (IU/L)
CPK (IU/L)
CK-MB (IU/L)
Troponin I (ng/ml)
122 9.80
126 8.30
211 10.3a
166 9.80a,b
246 13.0
252 11.0
780 28.0a
363 15.0a,b
93.0 6.70
90.0 7.20
189 10.0a
127 9.20a,b
9.62 0.13
10.3 0.23
17.2 1.13a
13.9 0.30a,b
CRAN was given orally to rats (100 mg/kg/day for 10 consecutive days) and DOX (15 mg/kg; i.p.) was administered on the seventh day.
Data are the mean SEM of 12 rats.
a
p < 0.05 vs. corresponding control group.
b
p < 0.05 vs. corresponding DOX group.
Fig. 3. Effect of cranberry extract (CRAN) on doxorubicin (DOX)-induced histopathological alterations in cardiac tissues. CRAN was given orally to rats (100 mg/kg/day for 10
consecutive days) and DOX (15 mg/kg; i.p.) was administered on the seventh day. Cardiac tissues from control and cranberry extract (CRAN) groups show normal histological
pattern (a and b, respectively). Cardiac tissues from doxorubicin (DOX)-treated group show swollen vacuolated cardiomyocytes (V), interstitial edema (E) and brosed bands
(F) (c). Cardiac tissues from DOX + CRAN treated rats show some vacuolated cardiomyocytes (V) and minimal interstitial edema (E) with no brosed bands (d) (H&E X125).
1183
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