The triangle of death of neurons: Oxidative damage, mitochondrial dysfunction, and loss of choline-containing biomolecules in brains of mice treated with doxorubicin. Advanced insights into mechanisms of chemotherapy induced cognitive impairment (“chemobrain”) involving TNF-α
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Cancer treatments are developing fast and the number of cancer survivors could arise to 20 million in United State by 2025. However, a large fraction of cancer survivors demonstrate cognitive dysfunction and associated decreased quality of life both shortly, and often long-term, after chemotherapy treatment. The etiologies of chemotherapy induced cognitive impairment (CICI) are complicated, made more so by the fact that many anti-cancer drugs cannot cross the blood-brain barrier (BBB). Multiple related factors and confounders lead to difficulties in determining the underlying mechanisms. Chemotherapy induced, oxidative stress-mediated tumor necrosis factor-alpha (TNF-α) elevation was considered as one of the main candidate mechanisms underlying CICI. Doxorubicin (Dox) is a prototypical reactive oxygen species (ROS)-generating chemotherapeutic agent used to treat solid tumors and lymphomas as part of multi-drug chemotherapeutic regimens. We previously reported that peripheral Dox-administration leads to plasma protein damage and elevation of TNF-α in plasma and brain of mice. In the present study, we used TNF-α null (TNFKO) mice to investigate the role of TNF-α in Dox-induced, oxidative stress-mediated alterations in brain. We report that Dox-induced oxidative stress in brain is ameliorated and brain mitochondrial function assessed by the Seahorse-determined oxygen consumption rate (OCR) is preserved in brains of TNFKO mice. Further, we show that Dox-decreased the level of hippocampal choline-containing compounds and brain phospholipases activity are partially protected in TNFKO group in MRS study. Our results provide strong evidence that Dox-targeted mitochondrial damage and levels of brain choline-containing metabolites, as well as phospholipases changes decreased in the CNS are associated with oxidative stress mediated by TNF-α. These results are consistent with the notion that oxidative stress and elevated TNF-α in brain underlie the damage to mitochondria and other pathological changes that lead to CICI. The results are discussed with reference to our identifying a potential therapeutic target to protect against cognitive problems after chemotherapy.
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Mitochondria are the principal source of ATP, which is formed by oxidative phosphorylation following electron flow through highly integrated protein complexes.
“Mitochondria are the principal source of ATP, which is formed by oxidative phosphorylation following electron flow through highly integrated protein complexes; however, mitochondria are also involved in many other functions as well, which, among others, include apoptosis, protein synthesis, and fatty acid oxidation [14,15].”
From Mitochondrial Oxidative and Nitrosative Stress and Alzheimer Disease (2020) · cites this paper as [15]
The Discussion (page not provided) says mitochondria meet much of the brain’s energy demand and mentions Complex I of the electron transport chain. The Methods and Materials section on bioenergetic analysis (page not provided) links mitochondrial respiration to ATP production. Our copy does not describe ATP formation as oxidative phosphorylation following electron flow through integrated protein complexes. (LLM, conf=0.82)
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- [31]Keeney JT, Ren X, Warrier G, Noel T, Powell DK, Brelsfoard JM, Saatman KE, Sultana R, St Clair DK, Butterfield DA, Doxorubicin-induced elevated oxidative stress in brain and cognitive decline: protection by MESNA and insights into mechanisms of chemotherapy-induced cognitive impairment (“chemobrain”). In Press (2014). PMC6084398 30100992
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- Authors
- Ren, X., Keeney, J. T. R., Miriyala, S., Noel, T., Powell, D. K., Chaiswing, L., Bondada, S., St. Clair, D. K., & Butterfield, D. A.
- Affiliations
- University of Kentucky (US)
- Corresponding author
- Butterfield, D. Allan
- ORCID
- Venue
- Free Radical Biology and Medicine
- Publisher
- Elsevier BV
- Published
- 2019-04
- Volume
- 134
- Pages
- 1-8
- ISSN
- 0891-5849 (ISSN-L)
- PMC
- PMC6588453
- OpenAlex
- W2906426773
- Cited by
- 88
- References
- 59
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 11 · 2023: 18 · 2022: 11 · 2021: 15 · 2020: 10 · 2019: 3
- FWCI
- 5.27
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Free Radical Biology and Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NCI (2 P30 CA177558-06)
- Multiple PI R01 (R01 CA217934-02)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Chemotherapy-induced cardiotoxicity and mitigation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Mitochondrial Function and Pathology
- Keywords
- chemotherapy-induced cognitive impairment, doxorubicin, TNF-α, oxidative stress, mitochondrial dysfunction, phospholipase, hippocampus, oxygen consumption rate, neurotoxicity, TNF-alpha knockout mice, magnetic resonance spectroscopy, blood-brain barrier
- MeSH terms
- Animals, Antibiotics, Antineoplastic, Brain, Choline, Doxorubicin, Male, Mice, Inbred C57BL, Mitochondria, Neurons, Oxidation-Reduction, Tumor Necrosis Factor-alpha, Mice, Knockout, Oxidative Stress, Mice, Cognitive Dysfunction
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