Anti-oxidant Effect of Bergamot Polyphenolic Fraction Counteracts Doxorubicin-Induced Cardiomyopathy: Role of Autophagy and C-Kit pos CD45 neg CD31 neg Cardiac Stem Cell Activation

J Mol Cell Cardiol. 2018 Jun;119:10-18. doi: 10.1016/j.yjmcc.2018.04.007. Epub 2018 Apr 12.


Doxorubicin (DOXO) is one of the most widely used antineoplastic drugs. Despite its highly beneficial effects against several malignancies, the clinical use of DOXO is often associated to cardiomyopathy that leads to congestive heart failure. Here we investigated the antioxidant and cardioprotective effects of a polyphenol-rich fraction of citrus bergamot (BPF), in DOXO-induced cardiac damage in rats. Moreover, we evaluated the effect of BPF on cardiomyocyte survival and resident endogenous cardiac stem/progenitor cell (eCSC) activation. Adult male Wistar rats were i.p. injected with saline (serving as controls, CTRL, n = 10), BPF (20 mg/kg daily for 14 consecutive days, n = 10), DOXO (6 doses of 2,5 mg/Kg from day 1 to day 14, n = 10), and DOXO + BPF (n = 10). Animals were then sacrificed 7 days later (i.e., at 21 days). DOXO administration reduced cardiac function at 21 days, an adverse effect significantly attenuated in animals receiving DOXO + BPF. No changes were detected in rats receiving just saline or BPF alone. The cardioprotective effect of BPF on DOXO acute toxicity was also associated with a significant antioxidant effect coupled with protective autophagy restoration, and attenuation of cardiomyocyte apoptosis and reactive hypertrophy. Finally, treatment of rats with BPF prevented eCSCs attrition by DOXO which was followed by a limited but significant increase of newly-formed BrdU+ cardiomyocytes. In conclusion, BPF reduces DOXO-induced cardiotoxicity by counteracting reactive oxygen species (ROS) overproduction, thereby restoring protective autophagy and attenuating cardiomyocyte apoptosis and pathologic remodeling. This beneficial effects on the early toxicity of DOXO is associated with enhanced CSCs survival and regenerative potential. Overall these data point to a potential clinical role by diet supplementation with polyphenol-rich fraction of citrus bergamot in counteracting antracycline-induced cardiomyopathy.

Keywords: Bergamot polyphenolic fraction; Cardiomiopathy; Doxorubicin; Oxidative stress; Stem cells.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antioxidants / administration & dosage
  • Antioxidants / chemistry
  • Autophagy / drug effects
  • Autophagy / genetics
  • Cardiomyopathies / chemically induced
  • Cardiomyopathies / drug therapy*
  • Cardiomyopathies / pathology
  • Cardiotonic Agents / administration & dosage
  • Cardiotonic Agents / chemistry
  • Cell Survival / drug effects
  • Citrus / chemistry*
  • Doxorubicin / administration & dosage
  • Doxorubicin / adverse effects
  • Humans
  • Leukocyte Common Antigens / genetics
  • Myocytes, Cardiac / drug effects*
  • Myocytes, Cardiac / metabolism
  • Neoplasms / complications
  • Neoplasms / drug therapy
  • Platelet Endothelial Cell Adhesion Molecule-1 / genetics
  • Polyphenols / administration & dosage*
  • Polyphenols / chemistry
  • Proto-Oncogene Proteins c-kit / genetics
  • Rats
  • Stem Cells / drug effects
  • Stem Cells / metabolism


  • Antioxidants
  • Cardiotonic Agents
  • Platelet Endothelial Cell Adhesion Molecule-1
  • Polyphenols
  • Doxorubicin
  • Proto-Oncogene Proteins c-kit
  • Leukocyte Common Antigens