CommentaryHuman and experimental data show that nutritional supplementation with a specific mixture of essential amino (EAA) improves both mitochondrial function and biogenesis and reduces either ROS formation or apoptotic drive in myocytes [1][2]. Supplementation with EAA is also effective in humans when tested in patients with cardiac dysfunction [3]. Doxorubicin (Doxo), an effective cancer chemotherapy agent, causes severe cardio-toxicity due to mitochondria damage, production of reactive oxygen species (ROS) and cell apoptosis with myofibrillar disarrangement, which in turn induces chronic heart failure. Pathogenesis of toxicity, as reported by Zhang et al. [4] is connected to the binding of Doxo to topoisomeraseIIb , which triggers a complex cascade of events, altering the DNA response and apoptosis pathways and triggering a marked alteration in the transcriptome, that selectively affects oxidative phosphorylation and mitochondrial biogenesis in cardiomyocytes. As a result, Doxoinduced cardiotoxicity limits optimal drug-dose use, reducing its potential therapeutic effects in cancer patients [5].Consequently, we hypothesized that supplementation with EAA would blunt Doxo cardio-toxicity, but we also tested if this would happen without interfering with the Doxo therapeutic effects on cancer cells. We used C57BL/6 mice fed on a normal diet and i.p. injected with a single saline or Doxo-HCl (15 mg/kg, from SigmaAldrich) injection to induce cardiomyopathy [6], with or without oral supplementation of EAA (1.5 g/kg). After 14 days, the heart was collected and morphologically evaluated by optical and electron microscopy. In addition, to test whether EAA supplementation negatively interferes with the Doxo anticancer action, we treated different cancer cell lines (3 × 10 5 cells/well in DMEM medium of HCT116 colon carcinoma; MCF7 mammary gland carcinoma; M14 melanoma), with Doxo (0.7 microg/ml) and with or without EAA (1% w/v). Untreated cancer cell lines (cultured in DMEM only) were used as controls. The osmolarity of the culture medium was the same for all groups. After 24 hours the cells were counted with the Trypan blue dye exclusion assay to distinguish live from dead cells.The in vivo experiments showed that Doxo significantly lowered body weight (22.59 ± 1.33 g vs 30.12 ± 1.4 g. p<0.05) and heart weight (0.12 ± 0.01 g vs 0.17 ± 0.01 g. p<0.05) compared to the control group. Furthermore, Doxo induced morphological alteration of cardiomyocytes with giant and irregularly shaped nuclei with condensed chromatin (Figure 1a A-C). In addition, Doxo impaired cellular distribution, morphology and the number of mitochondria (24 ± 2.8 vs 31.62 ± 5.5 Nmit/100µ2. p<0.05). Interestingly, EAA supplementation of Doxo-treated animals protected normal heart weight (0.16 ± 0.01 g vs 0.12 ± 0.01 g. p<0.05) and preserved cardiomyocytes architecture, mitochondrial morphology and number (28 ± 2.8 vs 24 ± 2.8 Nmit/100µ2. p<0.05) (Figure 1a The in vivo findings were partially surprising because previous studies had shown that EAA nu...