Abstract
Chemotherapy-related anemia is a major obstacle in anticancer therapy. Tamoxifen (TAM) is an antiestrogen prescribed for breast cancer patients with hemolytic potential and apoptotic properties in nucleated cells. However, the eryptotic activity of TAM has hitherto escaped the efforts of investigators. RBCs from apparently healthy volunteers were treated with 1–50 μM of TAM for 24 h at 37 °C. Hemoglobin leakage and LDH, AST, and AChE activities were photometrically determined while K+, Na+, and Mg2+ were detected by ion-selective electrode. Flow cytometry was used to identify eryptotic cells by annexin-V-FITC, intracellular Ca2+ by Fluo4/AM, sell size and morphology by FSC and SSC signals, respectively, and oxidative stress by H2DCFDA. Whole blood was also exposed to 30 μM of TAM for 24 h at 37 °C to examine the toxicity of TAM to WBCs and platelets. TAM caused Ca2+-independent, dose-responsive hemolysis accompanied by K+, LDH, and AST leakage without improving the mechanical stability of RBCs in hypotonic environments. TAM treatment also increased the proportion of cells positive for annexin-V-FITC, Fluo4, and DCF, along with diminished FSC and SSC signals and AChE activity. Notably, TAM toxicity was aggravated by sucrose but abrogated by vitamin C, PEG 8000, and urea. Moreover, TAM exhibited distinct cytotoxic profiles against leukocytes and platelets. TAM-induced eryptosis is characterized by breakdown of membrane asymmetry, inhibition of AChE activity, Ca2+ accumulation, cell shrinkage, and oxidative stress. Vitamin C, PEG 8000, and urea may hold promise to subvert the undesirable toxic effects of TAM on RBCs.
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The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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The authors extend their appreciation to the Deputyship for Research and Innovation, Ministry of Education, Saudi Arabia for funding this work through grant number IFKSURC-1-4407.
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This work was financially supported by the Deputyship for Research and Innovation, Ministry of Education, Saudi Arabia through grant number IFKSURC-1-4407.
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Conceptualization, MAA; methodology, all authors; software, JA; validation, all authors; formal analysis, AMA; investigation, all authors; resources, MAA and JA; data curation, all authors; writing—original draft preparation, all authors; writing—review and editing, all authors; visualization, all authors; supervision, MAA; project administration, MAA; funding acquisition, MAA. All authors have read and agreed to the published version of the manuscript.
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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of King Saud University Medical City (approval date: July 17, 2023/No. E-23-7706).
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Alfhili, M.A., Alyousef, A.M. & Alsughayyir, J. Tamoxifen induces eryptosis through calcium accumulation and oxidative stress. Med Oncol 40, 333 (2023). https://doi.org/10.1007/s12032-023-02205-4
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DOI: https://doi.org/10.1007/s12032-023-02205-4