Vitamin C mitigates oxidative/nitrosative stress and inflammation in doxorubicin-induced cardiomyopathy

Am J Physiol Heart Circ Physiol. 2017 Oct 1;313(4):H795-H809. doi: 10.1152/ajpheart.00253.2017. Epub 2017 Jul 14.


Increase in oxidative/nitrosative stress is one of the mechanisms associated with the development of cardiotoxicity due to doxorubicin (Dox), a potent chemotherapy drug. Previously, we reported mitigation of Dox-induced oxidative/nitrosative stress and apoptosis by vitamin C (Vit C) in isolated cardiomyocytes. In the present in vivo study in rats, we investigated the effect of prophylactic treatment with Vit C on Dox-induced apoptosis, inflammation, oxidative/nitrosative stress, cardiac dysfunction, and Vit C transporter proteins. Dox (cumulative dose: 15 mg/kg) in rats reduced systolic and diastolic cardiac function and caused structural damage. These changes were associated with a myocardial increase in reactive oxygen species, reduction in antioxidant enzyme activities, increased expression of apoptotic proteins, and inflammation. Dox also caused an increase in the expression of proapoptotic proteins Bax, Bnip-3, Bak, and caspase-3. An increase in oxidative/nitrosative stress attributable to Dox was indicated by an increase in superoxide, protein carbonyl formation, lipid peroxidation, nitric oxide (NO), NO synthase (NOS) activity, protein nitrosylation, and inducible NOS protein expression. Dox increased the levels of cardiac proinflammatory cytokines TNF-α, IL-1β, and IL-6, whereas the expression of Vit C transporter proteins (sodium-ascorbate cotransporter 2 and glucose transporter 4) was reduced. Prophylactic and concurrent treatment with Vit C prevented all these changes and improved survival in the Vit C + Dox group. Vit C also improved Dox-mediated systolic and diastolic dysfunctions and structural damage. These results suggest a cardioprotective role of Vit C in Dox-induced cardiomyopathy by reducing oxidative/nitrosative stress, inflammation, and apoptosis, as well as improving Vit C transporter proteins.NEW & NOTEWORTHY This in vivo study provides novel data that vitamin C improves cardiac structure and function in doxorubicin-induced cardiomyopathy by reducing oxidative/nitrosative stress, apoptosis, and inflammation along with upregulation of cardiac vitamin C transporter proteins. The latter may have a crucial role in improving antioxidant status in this cardiomyopathy.

Keywords: antioxidant; doxorubicin; nitrosative stress; oxidative stress; vitamin C transporter proteins.

MeSH terms

  • Animals
  • Anti-Inflammatory Agents, Non-Steroidal / pharmacology*
  • Antibiotics, Antineoplastic*
  • Antioxidants / pharmacology*
  • Ascorbic Acid / pharmacology*
  • Cardiomyopathies / chemically induced*
  • Cardiomyopathies / drug therapy*
  • Cardiotonic Agents / pharmacology*
  • Cytokines / biosynthesis
  • Doxorubicin*
  • Electrocardiography / drug effects
  • Male
  • Nitric Oxide Synthase / biosynthesis
  • Nitric Oxide Synthase / metabolism
  • Oxidative Stress / drug effects*
  • Oxygen Consumption / drug effects
  • Rats
  • Rats, Wistar
  • Reactive Nitrogen Species
  • Stress, Physiological / drug effects*
  • Survival Analysis


  • Anti-Inflammatory Agents, Non-Steroidal
  • Antibiotics, Antineoplastic
  • Antioxidants
  • Cardiotonic Agents
  • Cytokines
  • Reactive Nitrogen Species
  • Doxorubicin
  • Nitric Oxide Synthase
  • Ascorbic Acid