The NADPH oxidase inhibitor Vas2870 prevents myocyte ferroptosis and improves cardiac remodelling and function in doxorubicin‐induced cardiomyopathy

Background and Purpose Doxorubicin has been used widely for the treatment of human cancer but its clinical use is limited by cardiotoxicity. We examined the effect of the pan‐NADPH oxidase inhibitor Vas2780 on myocyte ferroptosis and cardiac remodelling and function in a clinically relevant mouse model of chronic doxorubicin‐induced cardiomyopathy and the underlying mechanisms. Experimental Approach Sixty‐five mice were randomized to receive saline, Vas2870 (2 mg·kg −1 , i.p., once a day for 40 days), doxorubicin (3 mg·kg −1 , i.p., every other day, six times) or doxorubicin plus Vas2870 ( n = 10–22). Key Results Doxorubicin‐treated mice exhibited a decrease in left ventricular (LV) fractional shortening and an increase in the ratio of lung wet‐to‐dry weight, indicating LV systolic dysfunction and lung congestion, and these alterations were prevented by the Vas2870 treatment. In doxorubicin‐treated mice, myocardial levels of gp91phox, malondialdehyde and 4‐hydroxynonenal were increased; SLC7A11, GPX4, FTH1 and FPN proteins were decreased; TfR1 (CD71) protein and myocardial iron levels were elevated and ALAS1 was reduced. Vas2870 inhibited myocardial lipid peroxidation, prevented decreased SLC7A11 and GPX4 proteins, normalized dysregulated iron metabolism‐related proteins, increased ALAS1 protein and upregulated mitochondrial genes, resulting in the prevention of iron overload and ferroptosis in doxorubicin‐induced cardiomyopathy. Similarly, Vas2870 prevented doxorubicin‐induced ferroptosis in H9C2 cardiomyocytes. Conclusion and Implications Vas2870 prevents myocyte ferroptosis through inhibition of lipid peroxidation, GPX4/SLC7A11 downregulation and disruptions in iron metabolism, leading to the amelioration of doxorubicin‐induced heart failure. Therapies directed at inhibiting NADPH oxidase and/or ferroptosis may be of value in the treatment of heart failure.