Traditional Chinese medicine protects against doxorubicin cardiotoxicity via epigenetic modification and beyond

IF 6.7 1区医学 Q1 CHEMISTRY, MEDICINAL

Phytomedicine Pub Date : 2025-06-25 DOI:10.1016/j.phymed.2025.157020

Jingquan Zhou , Huan Liu , Feng Jiang , Xiyong Yu , Panxia Wang , Xiaoqian Wu

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引用次数: 0

Abstract

Background

Doxorubicin (DOX), a cornerstone chemotherapeutic agent, is plagued by dose-dependent cardiotoxicity that compromises its clinical utility. Despite advances in understanding DOX-induced cardiotoxicity (DIC), effective interventions remain limited. Emerging evidence highlights Traditional Chinese Medicine (TCM) – with its multi-target epigenetic modulatory potential – as a promising therapeutic strategy.

Purpose

This review systematically evaluates the epigenetic landscape of DIC pathogenesis and critically summarizes the cardioprotective effects of TCM through epigenetic reprogramming, aiming to bridge mechanistic insights with translational opportunities.

Study-design/methods

Data for this review were sourced from various scientific databases up to March 2025. Search terms include “Doxorubicin”, “Adriamycin”, “Cardiotoxicity”, “DOX-induced cardiotoxicity”, “Doxorubicin induced cardiomyopathy”, “epigenetic modifications”, “Histone Modification”, “DNA Methylation”, “Noncoding RNAs”, “long noncoding RNA”, “microRNA”, circular RNAs, “inflammation”, “ferroptosis”, “autophagy”, “apoptosis” and “Traditional Chinese Medicine” as well as several combinations thereof. Exclusions comprised non-TCM interventions, studies lacking mechanistic clarity, non-cardiotoxicity endpoints, case reports, or inaccessible data.

Results

By regulating various signaling pathways including oxidative stress, inflammation, autophagy and epigenetic modification, TCM has been positioned as a promising therapeutic strategy in alleviating DIC. We thoroughly review the pathological mechanism of DIC especially the epigenetic modification and further summarize the potential role of TCM. While preclinical data are compelling, clinical trials validating TCM's epigenetic effects (e.g., circulating miRNA biomarkers) are urgently needed.

Conclusion

This review synthesizes current evidence on TCM's cardioprotective effects via epigenetic modulation, providing a foundation for clinical translation.

Abstract Image

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传统中药通过表观遗传修饰和其他途径保护阿霉素免受心脏毒性

多柔比星（DOX）是一种基础化疗药物，其剂量依赖性心脏毒性影响了其临床应用。尽管对dox诱导的心脏毒性（DIC）的了解有所进展，但有效的干预措施仍然有限。越来越多的证据表明，具有多靶点表观遗传调节潜力的中药是一种很有前途的治疗策略。目的系统评价DIC发病机制的表观遗传格局，批判性地总结中医药通过表观遗传重编程对心脏的保护作用，旨在将机制认识与转化机会联系起来。研究设计/方法本综述的数据来源于截至2025年3月的各种科学数据库。搜索词包括“阿霉素”、“阿霉素”、“心脏毒性”、“dox诱导的心脏毒性”、“阿霉素诱导的心肌病”、“表观遗传修饰”、“组蛋白修饰”、“DNA甲基化”、“非编码RNA”、“长链非编码RNA”、“microRNA”、环状RNA、“炎症”、“铁死亡”、“自噬”、“细胞凋亡”和“中药”及其几种组合。排除包括非中医干预、缺乏机制清晰度的研究、非心脏毒性终点、病例报告或无法获得的数据。结果中药通过调节氧化应激、炎症、自噬和表观遗传修饰等多种信号通路，已被定位为缓解DIC的一种有前景的治疗策略。本文综述了DIC的病理机制，特别是表观遗传修饰，并进一步总结了中医药的潜在作用。虽然临床前数据令人信服，但迫切需要临床试验来验证中药的表观遗传效应（例如循环miRNA生物标志物）。结论本文综合了中药通过表观遗传调控对心脏保护作用的现有证据，为临床翻译提供依据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Phytomedicine 医学-药学

CiteScore

10.30

自引率

5.10%

发文量

670

审稿时长

91 days

期刊介绍： Phytomedicine is a therapy-oriented journal that publishes innovative studies on the efficacy, safety, quality, and mechanisms of action of specified plant extracts, phytopharmaceuticals, and their isolated constituents. This includes clinical, pharmacological, pharmacokinetic, and toxicological studies of herbal medicinal products, preparations, and purified compounds with defined and consistent quality, ensuring reproducible pharmacological activity. Founded in 1994, Phytomedicine aims to focus and stimulate research in this field and establish internationally accepted scientific standards for pharmacological studies, proof of clinical efficacy, and safety of phytomedicines.