Drug-induced mitochondrial dysfunction and cardiotoxicity

Am J Physiol Heart Circ Physiol. 2015 Nov;309(9):H1453-67. doi: 10.1152/ajpheart.00554.2015. Epub 2015 Sep 18.


Mitochondria has an essential role in myocardial tissue homeostasis; thus deterioration in mitochondrial function eventually leads to cardiomyocyte and endothelial cell death and consequent cardiovascular dysfunction. Several chemical compounds and drugs have been known to directly or indirectly modulate cardiac mitochondrial function, which can account both for the toxicological and pharmacological properties of these substances. In many cases, toxicity problems appear only in the presence of additional cardiovascular disease conditions or develop months/years following the exposure, making the diagnosis difficult. Cardiotoxic agents affecting mitochondria include several widely used anticancer drugs [anthracyclines (Doxorubicin/Adriamycin), cisplatin, trastuzumab (Herceptin), arsenic trioxide (Trisenox), mitoxantrone (Novantrone), imatinib (Gleevec), bevacizumab (Avastin), sunitinib (Sutent), and sorafenib (Nevaxar)], antiviral compound azidothymidine (AZT, Zidovudine) and several oral antidiabetics [e.g., rosiglitazone (Avandia)]. Illicit drugs such as alcohol, cocaine, methamphetamine, ecstasy, and synthetic cannabinoids (spice, K2) may also induce mitochondria-related cardiotoxicity. Mitochondrial toxicity develops due to various mechanisms involving interference with the mitochondrial respiratory chain (e.g., uncoupling) or inhibition of the important mitochondrial enzymes (oxidative phosphorylation, Szent-Györgyi-Krebs cycle, mitochondrial DNA replication, ADP/ATP translocator). The final phase of mitochondrial dysfunction induces loss of mitochondrial membrane potential and an increase in mitochondrial oxidative/nitrative stress, eventually culminating into cell death. This review aims to discuss the mechanisms of mitochondrion-mediated cardiotoxicity of commonly used drugs and some potential cardioprotective strategies to prevent these toxicities.

Keywords: cardiomyopathy; drug development; heart; heart failure; reactive oxygen species; toxicology.

Publication types

  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antineoplastic Agents / adverse effects*
  • Antiviral Agents / adverse effects*
  • Cardiomyopathies / chemically induced*
  • Cardiomyopathies / metabolism
  • Cardiotoxicity / etiology
  • Cardiotoxicity / metabolism
  • Humans
  • Hypoglycemic Agents / adverse effects*
  • Illicit Drugs / adverse effects*
  • Mitochondria, Heart / metabolism*
  • Mitochondrial Diseases / etiology*
  • Mitochondrial Diseases / metabolism
  • Oxidative Stress


  • Antineoplastic Agents
  • Antiviral Agents
  • Hypoglycemic Agents
  • Illicit Drugs