Abstract GS.11: Exercise Therapy During Doxorubicin Treatment Provides Sex-specific Cardioprotection

Abstract

Moderate-intensity exercise is routinely prescribed to patients with cardiovascular diseases to improve cardiac function. It has also been recommended in patients undergoing anti-cancer chemotherapy to attenuate cardiotoxic effects. We recently identified that moderate endurance exercise in healthy mice causes the remodeling of cardiac physiology in a sex-specific manner. Therefore, we hypothesized that exercise therapy applied during doxorubicin chemotherapy would produce sex-specific cardioprotection. Male and female mice were divided into three groups, 1) sedentary control, 2) DOX - doxorubicin treated at 5 mg/kg/week for 6 weeks, and 3) EXDOX - 2 weeks of forced treadmill running for 2 weeks before DOX + exercise for an additional 6 weeks. Mouse health was tracked daily. Total body weight, echocardiography, and electrocardiography were assessed every 2 weeks. At the end of the protocol, triple parametric optical mapping was performed to determine the remodeling of cardiac metabolism-excitation-contraction coupling (MECC). DOX treatment increased morbidity and reduced total body weight in both males and females. DOX-induced action potential duration (APD) prolongation in both sexes and, additionally, in males alone, increased anisotropic ratio of conduction (index for arrhythmogenicity) and rise time of calcium transients (CaRT). In EXDOX mice, the onset of morbidity was delayed in both males and females compared to DOX mice. Total body weight in male EXDOX mice, but not females, was further reduced compared to DOX treatment alone. Echocardiography revealed increased LV wall thickness in male and female EXDOX mice vs DOX, while stroke volume was reduced in females alone. Next, DOX-induced APD prolongation was prevented in EXDOX females but not males. Furthermore, DOX-induced increase in CaRT was further increased in EXDOX males, in addition to increased calcium transient duration and reduced calcium decay constant. Taken together, these data suggest significant sex dimorphism in cardiac adaptation to DOX treatment and exercise therapy during DOX treatment. Female mice undergoing exercise therapy during DOX treatment demonstrated greater cardioprotection and attenuation of MECC remodeling.