Abstract
Objective: The use of trastuzumab (TZM) in the clinical management of human epidermal growth factor receptor 2 positive metastatic breast and gastric cancers, gastro-esophageal adenocarcinoma, and colorectal carcinoma has been limited by its off-target cardiac, hepatic, and renal toxicities which till date have no effective therapies in either their prevention or amelioration. Thus, the present study is designed at investigating the protective and therapeutic potentials of 400 mg/kg/day Clerodendrum volubile ethanol leaf extract (CVE) and Irvingia gabonensis ethanol seed extract (IGE) pretreatments in TZM-intoxicated Wistar rats based on their reported folkloric use in the local management of kidney and liver diseases and the previously reported therapeutic potential of these African vegetables in TZM cardiotoxicity.
 Methods: Forty-nine male Wistar rats were randomly allotted into seven groups of seven rats per group. Group I rats were treated with 10 ml/kg/day of 5% dimethyl sulfoxide (DMSO) sterile water p.o. and 1 ml/kg/day 5% DMSO sterile water i.p.; Groups II and III rats were orally pretreated with 400 mg/kg/day CVE and IGE, respectively, 3 h before 1 ml/kg/day/i.p. 5% DMSO sterile water; Group IV rats were orally pretreated with 10 ml/kg/day 5% DMSO sterile water 3 h before 2.25 mg/kg/day/i.p. TZM; and Groups V-VII rats were pretreated with 20 mg/kg/day Vit. C, 400 mg/kg/day CVE, and 400 mg/kg/day IGE all dissolved in 5% DMSO sterile water, respectively, 3 h before i.p. injections of 2.25 mg/kg/day TZM, all for 7 days. Liver function parameters, renal function parameters, oxidative stress markers, and histopathological investigations were the study measuring endpoints.
 Results: Oral pretreatment with 20 mg/kg/day Vit. C, 400 mg/kg/day CVE and IGE significantly ameliorated TZM-mediated hepatic and renal toxicities by effectively lowering the serum alanine transaminase, aspartate transaminase, alkaline phosphatase, creatinine, and urea levels. CVE and IGE pretreatments also significantly reversed TZM-induced decreases in the hepatic and renal tissue catalase, superoxide dismutase, and glutathione- S-transferase activities and reduced malondialdehyde levels. CVE and IGE pretreatments also improved TZM-induced hepatic and renal histological lesions.
 Conclusions: Overall, the chemotherapeutic/chemopreventive potentials of CVE and IGE in TZM-induced hepatorenal dysfunction were either wholly or partly mediated through free-radical scavenging and antioxidant activities.
Highlights
A number of cytotoxic agents that are metabolized and excreted from the body through the hepatic and renal routes may significantly alter the functional integrity of liver and kidney due to the toxic nature of either their primary or secondary metabolites, the severity and pattern of their toxicity vary according to their respective drug targets [1]
Trastuzumab (TZM) is a humanized mouse IgG kappa monoclonal antibody targeted against the subdomain IV of the extracellular region of human epidermal growth factor receptor 2 (HER2) [2,3,4] which is widely used in the clinical management of HER2 overexpressing metastatic solid tumors such as breast and gastric cancers [4,5], adenocarcinoma of gastroesophageal junction [2,3,6], and advanced HER2-positive salivary duct carcinoma and colorectal carcinoma [7]
There are reports that prolonged TZM administration is associated with renal dysfunctions [15,28,29] that may manifest as acute kidney injury (AKI) [5]
Summary
A number of cytotoxic agents that are metabolized and excreted from the body through the hepatic and renal routes may significantly alter the functional integrity of liver and kidney due to the toxic nature of either their primary or secondary metabolites, the severity and pattern of their toxicity vary according to their respective drug targets [1]. These anticancer agents include alkylating cytotoxic agents, antibiotic cytotoxics, molecular targeted therapies, radio-diagnostic contrast agents as well as bone targeted therapies depending on the cancer types and stages [1]. There are no known approved antidotes to these off-target toxicities
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More From: Asian Journal of Pharmaceutical and Clinical Research
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