AimsChemotherapy-induced heart failure is increasingly recognized as a major clinical challenge.
Cardiotoxicity of imatinib mesylate, a highly selective and effective anticancer drug belonging to
the new class of tyrosine kinase inhibitors, is being reported in patients, some progressing to
congestive heart failure. This represents an unanticipated challenge that could limit effective drug
use. Understanding the mechanisms and risk factors of imatinib mesylate cardiotoxicity is crucial
for prevention of cardiovascular complications in cancer patients.Methods and resultsWe used genetically engineered mice and primary rat neonatal cardiomyocytes to analyse the action
of imatinib on the heart. We found that treatment with imatinib (200 mg/kg/day for 5 weeks) leads to
mitochondrial-dependent myocyte loss and cardiac dysfunction, as confirmed by electron microscopy,
RNA analysis, and echocardiography. Imatinib cardiotoxicity was more severe in older mice, in part
due to an age-dependent increase in oxidative stress. Mechanistically, depletion of the
transcription factor GATA4 resulting in decreased levels of its prosurvival targets Bcl-2 and
Bcl-XL was an underlying cause of imatinib toxicity. Consistent with this, GATA4
haploinsufficient mice were more susceptible to imatinib, and myocyte-specific up-regulation of
GATA4 or Bcl-2 protected against drug-induced cardiotoxicity.ConclusionThe results indicate that imatinib action on the heart targets cardiomyocytes and involves
mitochondrial impairment and cell death that can be further aggravated by oxidative stress. This in
turn offers a possible explanation for the current conflicting data regarding imatinib
cardiotoxicity in cancer patients and suggests that cardiac monitoring of older patients receiving
imatinib therapy may be especially warranted.