Research Papers:

Angiotensin-converting enzyme 2 overexpression protects against doxorubicin-induced cardiomyopathy by multiple mechanisms in rats

Hui Ma, Jing Kong, Yu-Lin Wang, Jun-Long Li, Nai-Hao Hei, Xin-Ran Cao, Jing-Jing Yang, Wen-Jiang Yan, Wen-Jing Liang, Hong-Yan Dai and Bo Dong _

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Oncotarget. 2017; 8:24548-24563. https://doi.org/10.18632/oncotarget.15595

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Hui Ma1,2, Jing Kong3, Yu-Lin Wang1,2, Jun-Long Li1,2, Nai-Hao Hei1,2, Xin-Ran Cao1,2, Jing-Jing Yang3, Wen-Jiang Yan3, Wen-Jing Liang3, Hong-Yan Dai4, Bo Dong1,2

1Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China

2Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China

3Key Laboratory of Cardiovascular Remodeling and Function Research, Qilu Hospital, Shandong University, Jinan, China

4Cardiovascular department, Qingdao Municipal Hospital, Qingdao, China

Correspondence to:

Bo Dong, email: [email protected]

Keywords: angiotensin-converting enzyme 2, cilazapril, doxorubicin-induced cardiomyopathy, gene therapy

Received: November 18, 2016     Accepted: February 13, 2017     Published: February 21, 2017


Angiotensin-converting enzyme 2 (ACE2) is considered a potential therapeutic target of the renin-angiotensin system (RAS) for the treatment of cardiovascular diseases. We aimed to explore the effects of ACE2 overexpression on doxorubicin-induced cardiomyopathy in rats. Rats were randomly divided into treatment and control groups. The rats of treatment group were injected intraperitoneally with 6 doses of doxorubicin (2.5 mg/kg) within a period of two weeks. Two weeks after the initial injection of doxorubicin, these rats were randomly divided into Mock, Ad-EGFP, Ad-ACE2, and Cilazapril groups. The rats of Ad-EGFP and Ad-ACE2 groups received intramyocardial injection of Ad-EGFP and Ad-ACE2, respectively. The rats of Cilazapril group received cilazapril (10 mg/kg/day) via intragastric intubation. Apoptosis, inflammation, oxidative stress, cardiac function, the extent of myocardial fibrosis, and levels of ACE2, ACE, angiotensin II (AngII), and angiotensin (1–7) were evaluated. Four weeks after ACE2 gene transfer, the Ad-ACE2 group showed not only reduced apoptosis, inflammatory response, oxidative stress, left ventricular (LV) volume, extent of myocardial fibrosis and mortality of rats, but also increased LV ejection fraction and ACE2 expression level compared with the Mock and Ad-EGFP groups. ACE2 overexpression was superior to cilazapril in improving doxorubicin-induced cardiomyopathy. The putative mechanisms may involve activation of the AMPK and PI3K-AKT pathways, inhibition of the ERK pathway, decrease of TGF-β1 expression, and interactions of shifting RAS components, such as decreased myocardium AngII levels, increased myocardium Ang (1–7) levels, and reduced ACE expression. Thus, ACE2 may be a novel therapeutic approach to prevent and treat doxorubicin-induced cardiomyopathy.

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