Acute effects of adriamycin on the macromolecular organization of the cardiac muscle cell plasma membrane.

Adriamycin is a potent chemotherapeutic agent used in the treatment of human neoplastic disease. A major side effect limiting the use of this drug is its toxic effect on the heart, and congestive heart failure becomes an increasingly common complication as the cumulative dose of the drug rises. To learn more about the mechanism of adriamycin cardiotoxicity and, in particular, to investigate its initial effects on the cardiac muscle cell plasma membrane, isolated guinea pig myocytes were exposed to the drug in vitro. Plasma membrane macromolecular structure was examined by freeze-fracture electron microscopy of myocytes exposed to 0.1, 1 and 2 mM adriamycin for periods up to 105 minutes. The principal effect of adriamycin was rapid induction of smooth (protein-poor) domains in the membrane, with displacement and clustering of intramembrane particles (the structures representing integral membrane proteins). These effects, which are time-dependent and dose-dependent, culminate in the formation of saucer-shaped lesions in the membrane, which broadly resemble deformations of the membrane induced by polymyxin B. Both adriamycin and polymyxin are known to have the ability to interact selectively with anionic phospholipids. It is concluded that an important initial effect of adriamycin on cardiac muscle cells is alteration of the macromolecular architecture of the plasma membrane, probably through interaction with anionic phospholipids, and that this may represent the underlying cause of a range of sarcolemmal dysfunctions associated with exposure to the drug.