BACKGROUND
Impaired cardiac function in doxorubicin-treated childhood cancer survivors is partly mediated by disruption of mitochondrial energy production. Doxorubicin intercalates into mitochondrial DNA (mtDNA) disrupting genes encoding for polypeptides that make ATP.
METHODS
This cross-sectional study examined mtDNA copy numbers/cell and oxidative phosphorylation (OXPHOS) in peripheral blood mononuclear cells (PBMCs) in 64 childhood survivors of high-risk acute lymphoblastic leukemia (ALL) treated on Dana-Farber Cancer Institute Childhood ALL protocols who had received doxorubicin alone (42%) or with dexrazoxane (58%), a cardioprotectant. Mitochondrial DNA copies per cell and OXPHOS enzyme activities of nicotinamide adenine dinucleotide (NADH) dehydrogenase (Complex I, CI) and cytochrome c oxidase (Complex IV, CIV) were measured by quantitative real time-polymerase chain reaction (qRT-PCR) immunoassay and thin layer chromatography, respectively.
RESULTS
At a median follow-up of 7.8 years after treatment, the median number of mtDNA copies per cell for patients treated with doxorubicin alone was significantly higher than for those who also received dexrazoxane (medians, 1106.3 and 310.5; P=0.001). No significant differences were detected between groups for CI or CIV activities.
CONCLUSIONS
Doxorubicin-treated survivors had increased PBMC mtDNA copies/cell and concomitant use of dexrazoxane was associated with lower mtDNA copies/cell. Due to a possible compensatory increase in mtDNA copies/cell to maintain mitochondrial function in the setting of mitochondrial dysfunction, overall OXPHOS activity was not different between groups. The long-term sustainability of this compensatory response in these survivors at risk for cardiac dysfunction over their lifespan is concerning.