Cardiac radiation improves ventricular function in mice and humans with cardiomyopathy

Lauren N. Pedersen, Carla Valenzuela Ripoll, Mualla Ozcan, Zhen Guo, Aynaz Lotfinaghsh, Shiyang Zhang, Sherwin Ng, Carla Weinheimer, Jessica Nigro, Attila Kovacs, Ahmed Diab, Amanda Klaas, Felicia Grogan, Yoonje Cho, Anahita Ataran, Hannah Luehmann, Abigail Heck, Kollin Kolb, Lori Strong, Rachita NavaraGerard M. Walls, Geoff Hugo, Pamela Samson, Daniel Cooper, Francisco J. Reynoso, Julie K. Schwarz, Kaitlin Moore, Kory Lavine, Stacey L. Rentschler, Yongjian Liu, Pamela K. Woodard, Clifford Robinson, Phillip S. Cuculich, Carmen Bergom, Ali Javaheri

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Rapidly dividing cells are more sensitive to radiation therapy (RT) than quiescent cells. In the failing myocardium, macrophages and fibroblasts mediate collateral tissue injury, leading to progressive myocardial remodeling, fibrosis, and pump failure. Because these cells divide more rapidly than cardiomyocytes, we hypothesized that macrophages and fibroblasts would be more susceptible to lower doses of radiation and that cardiac radiation could therefore attenuate myocardial remodeling. Methods: In three independent murine heart failure models, including models of metabolic stress, ischemia, and pressure overload, mice underwent 5 Gy cardiac radiation or sham treatment followed by echocardiography. Immunofluorescence, flow cytometry, and non-invasive PET imaging were employed to evaluate cardiac macrophages and fibroblasts. Serial cardiac magnetic resonance imaging (cMRI) from patients with cardiomyopathy treated with 25 Gy cardiac RT for ventricular tachycardia (VT) was evaluated to determine changes in cardiac function. Findings: In murine heart failure models, cardiac radiation significantly increased LV ejection fraction and reduced end-diastolic volume vs. sham. Radiation resulted in reduced mRNA abundance of B-type natriuretic peptide and fibrotic genes, and histological assessment of the LV showed reduced fibrosis. PET and flow cytometry demonstrated reductions in pro-inflammatory macrophages, and immunofluorescence demonstrated reduced proliferation of macrophages and fibroblasts with RT. In patients who were treated with RT for VT, cMRI demonstrated decreases in LV end-diastolic volume and improvements in LV ejection fraction early after treatment. Conclusions: These results suggest that 5 Gy cardiac radiation attenuates cardiac remodeling in mice and humans with heart failure. Funding: NIH, ASTRO, AHA, Longer Life Foundation.

Original languageEnglish
Pages (from-to)928-943.e5
JournalMed
Volume4
Issue number12
DOIs
StatePublished - Dec 8 2023

Keywords

  • cardiomyopathy
  • fibrosis
  • heart failure
  • inflammation
  • macrophages
  • Pre-clinical research
  • proliferation
  • radiation
  • remodeling
  • X-ray

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