Uncoupling DNA damage from chromatin damage to detoxify doxorubicin

Xiaohang, Qiao, Sabina Y., van der Zanden, Dennis P. A., Wander, Daniel M., Borràs, Ji-Ying, Song, Xiaoyang, Li, Suzanne, van Duikeren, Noortje, van Gils, Arjo, Rutten, Tessa, van Herwaarden, Olaf, van Tellingen, Elisa, Giacomelli, Milena, Bellin, Valeria, Orlova, Leon G. J., Tertoolen, Sophie, Gerhardt, Jimmy J., Akkermans, Jeroen M., Bakker, Charlotte L., Zuur, Baoxu, Pang, Anke M., Smits, Christine L., Mummery, Linda, Smit, Ramon, Arens, Junmin, Li, Hermen S., Overkleeft, Jacques, Neefjes

Proceedings of the National Academy of Sciences |

Anthracyclines like doxorubicin are anticancer drugs, used by over 1 million cancer patients annually. However, they cause severe side effects, most notably, cardiotoxicity and therapy-related malignancies. It is unclear whether these side effects are directly linked to their anticancer activity. Doxorubicin exerts two activities: DNA damage and chromatin damage. Here, we show that both activities conspire in the cardiotoxicity, while doxorubicin variants with only chromatin-damaging activity remain active anticancer drugs devoid of side effects. This challenges the concept that doxorubicin works primarily by inducing DNA double-strand breaks and reveals another major anticancer activity, chromatin damage. Translating these observations will yield anticancer drugs for patients that are currently excluded from doxorubicin treatment and improve the quality of life of cancer survivors.