CANCER chemotherapy with anthracyclines is highly effective against tumours but often comes at a cost: cardiotoxicity leading to cardiac dysfunction. New preclinical research suggested that remote ischaemic conditioning (RIC) could protect cardiac function during treatment without weakening the anticancer effects of chemotherapy.
Anthracyclines, such as doxorubicin, are widely used to treat a variety of malignancies. However, these drugs are also known to cause anthracycline-induced cardiotoxicity, a complication that can lead to long-term cardiac dysfunction, reduced quality of life, and increased cardiovascular risk among cancer survivors. Despite decades of investigation, effective strategies to prevent this complication have remained limited.
RIC is a non-pharmacological intervention in which short cycles of reduced blood flow and reperfusion are applied to a limb, typically using a cuff or similar device. This brief, controlled stress was thought to activate protective biological pathways that could shield distant organs such as the heart from injury.
Remote Ischaemic Conditioning Preserves Cardiac Function
To investigate whether RIC could safely protect the heart during chemotherapy, researchers conducted an experimental study using a tumour-bearing mouse model. Cutaneous tumours were first induced in CD1 mice before animals received five weekly injections of doxorubicin at a dose of 5 mg/kg.
The mice were then randomly assigned to receive doxorubicin alone or doxorubicin alongside weekly RIC. The conditioning protocol consisted of three cycles of 5-minute hindlimb ischaemia followed by reperfusion. Cardiac function was monitored with longitudinal echocardiography, while tumour growth, survival, and body weight were assessed throughout the experiment.
Doxorubicin treatment significantly reduced survival, inhibited tumour growth, and caused clear cardiac injury, including left ventricular systolic dysfunction and cardiac atrophy. In contrast, animals receiving RIC maintained significantly better cardiac function. The intervention preserved left ventricular ejection fraction and partially prevented early structural changes in the heart.
Remote Ischaemic Conditioning Does Not Reduce Antitumour Effects
A key concern surrounding cardioprotective strategies is the possibility that they might also shield tumours from chemotherapy. Importantly, the study found that RIC did not compromise the anticancer activity of doxorubicin.
Tumour growth inhibition remained comparable between mice treated with doxorubicin alone and those receiving the combined therapy. This indicated that the cardioprotective effects of RIC occurred without reducing chemotherapy efficacy.
The researchers also observed a trend toward improved overall survival among animals receiving RIC, although further studies are required to confirm this effect.
While the findings were limited to a preclinical model, they highlighted the potential of RIC as a simple, low-cost, and non-drug strategy to mitigate anthracycline-induced cardiotoxicity. Future clinical research will be needed to determine whether the approach can safely protect heart function in patients undergoing cancer treatment.
Reference
Díaz-Guerra A et al. Remote ischemic conditioning protects against anthracycline cardiotoxicity without impairing its antitumor activity. Basic Res Cardiol. 2026; DOI:10.1007/s00395-026-01160-1.
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