Novel Toll-like receptor-4 deficiency attenuates trastuzumab (Herceptin) induced cardiac injury in mice

Background: Cardiac inflammation and generation of oxidative stress are known to contribute to trastuzumab (herceptin) induced cardiac toxicity. Toll-like receptors (TLRs) are a part of the innate immune system and are involved in cardiac stress reactions. Since TLR4 might play a relevant role in cardiac inflammatory signaling, we investigated whether or not TLR4 is involved in trastuzumab induced cardiotoxicity. Methods: Seven days after a single injection of herceptin (2 mg/kg; i.p.), left ventricular pressure volume loops were measured in HeN compotent (TLR4(+/+)) and HeJ mutant (TLR4(-/-)) treated with trastuzumab and control mice. Immunofluorescent staining for monocyte infiltration and analyses of plasma by (ELISAs) for different chemokines including: MCP-1 and tumor necrosis factor-alpha (TNF-alpha), Western immunoblotting assay for ICAM-1, and used troponin I for cardiac injury marker. Results: Trastuzumab injection resulted in an impairment of left ventricular function in TLR-4 competent (HeN), in contrast TLR4(-/-) trastuzumab mice showed improved left ventricular function EF%, CO; p < 0.05, attenuation of mononuclear cell infiltration in TLR4(-/-); p < 0.05 vs. TLR-4 competent (HeN), reduced level of cytokines TNF-alpha, MCP-1 and ICAM-1 expression in TLR4(-/-), marked reduction of myocardial troponin-I levels in TLR4-deficient mice. Data are presented as means +/- SE; n = 8 in each group p < 0.05 vs. TLR-4 competent (HeN). Conclusions: Treatment with trastuzumab induces an inflammatory response that contributes to myocardial tissue TLR4 mediates chemokine expression (TNF-alpha, MCP-1and ICAM-1), so in experimental animals TLR4 deficiency improves left ventricular function and attenuates pathophysiological key mechanisms in trastuzumab induced cardiomyopathy.