A systematic review of the protective effects of silymarin/silibinin against doxorubicin-induced cardiotoxicity.

2023-05-10
Cancer cell international 23(1)
- Mandeep Singh
- Mustafa M Kadhim
- Abduladheem Turki Jalil
- Shamam Kareem Oudah
- Zafar Aminov
- Fahad Alsaikhan
- Zanko Hassan Jawhar
- Andrés Alexis Ramírez-Coronel
- Bagher Farhood

PubMed: 37165384
DOI: 10.1186/s12935-023-02936-4

Study Design

Type: Review
Methods: Systematic search in accordance with PRISMA guideline; studies on silymarin/silibinin against doxorubicin-induced cardiotoxicity up to June 2022; 61 articles screened, 13 eligible papers included

Purpose

Although doxorubicin chemotherapy is commonly applied for treating different malignant tumors, cardiotoxicity induced by this chemotherapeutic agent restricts its clinical use. The use of silymarin/silibinin may mitigate the doxorubicin-induced cardiac adverse effects. For this aim, the potential cardioprotective effects of silymarin/silibinin against the doxorubicin-induced cardiotoxicity were systematically reviewed.

Methods

In this study, we performed a systematic search in accordance with PRISMA guideline for identifying all relevant studies on "the role of silymarin/silibinin against doxorubicin-induced cardiotoxicity" in different electronic databases up to June 2022. Sixty-one articles were obtained and screened based on the predefined inclusion and exclusion criteria. Thirteen eligible papers were finally included in this review.

Results

According to the echocardiographic and electrocardiographic findings, the doxorubicin-treated groups presented a significant reduction in ejection fraction, tissue Doppler peak mitral annulus systolic velocity, and fractional shortening as well as bradycardia, prolongation of QT and QRS interval. However, these echocardiographic abnormalities were obviously improved in the silymarin plus doxorubicin groups. As well, the doxorubicin administration led to induce histopathological and biochemical changes in the cardiac cells/tissue; in contrast, the silymarin/silibinin co-administration could mitigate these induced alterations (for most of the cases).

Conclusion

According to the findings, it was found that the co-administration of silymarin/silibinin alleviates the doxorubicin-induced cardiac adverse effects. Silymarin/silibinin exerts its cardioprotective effects via antioxidant, anti-inflammatory, anti-apoptotic activities, and other mechanisms.

Research Insights

Thistle→Improved Cardiac Histopathology
the doxorubicin administration led to induce histopathological changes in the cardiac cells/tissue; in contrast, the silymarin/silibinin co-administration could mitigate these induced alterations
Effect
Beneficial
Effect size
Moderate
Thistle→Improved Ejection Fraction
the doxorubicin-treated groups presented a significant reduction in ejection fraction... However, these echocardiographic abnormalities were obviously improved in the silymarin plus doxorubicin groups.
Effect
Beneficial
Effect size
Moderate
Thistle→Improved Fractional Shortening
the doxorubicin-treated groups presented a significant reduction in... fractional shortening... these echocardiographic abnormalities were obviously improved in the silymarin plus doxorubicin groups.
Effect
Beneficial
Effect size
Moderate
Thistle→Improved Heart Rate
bradycardia... these echocardiographic abnormalities were obviously improved in the silymarin plus doxorubicin groups.
Effect
Beneficial
Effect size
Moderate
Thistle→Improved Systolic Myocardial Velocity
the doxorubicin-treated groups presented a significant reduction in... tissue Doppler peak mitral annulus systolic velocity... these echocardiographic abnormalities were obviously improved in the silymarin plus doxorubicin groups.
Effect
Beneficial
Effect size
Moderate
Thistle→Reduced Cardiac Biochemical Marker
the doxorubicin administration led to induce biochemical changes in the cardiac cells/tissue; in contrast, the silymarin/silibinin co-administration could mitigate these induced alterations
Effect
Beneficial
Effect size
Moderate
Thistle→Reduced QRS Interval
prolongation of QRS interval... these echocardiographic abnormalities were obviously improved in the silymarin plus doxorubicin groups.
Effect
Beneficial
Effect size
Moderate
Thistle→Reduced QT Interval
prolongation of QT... these echocardiographic abnormalities were obviously improved in the silymarin plus doxorubicin groups.
Effect
Beneficial
Effect size
Moderate

Adverse Events Reported

Thistle→Overall tolerability
the silymarin/silibinin co-administration could mitigate these induced alterations (for most of the cases)
Finding
Reported