What is the clinical evidence from this study?

Study design: Other. Population: doxorubicin/trastuzumab-induced cardiotoxicity. Intervention: Qizaobaoxin Decoction (QZBXD). Primary outcome: cardiac function and biomarkers of myocardial injury.

What question did this study set out to answer?

The study aims to explore how Qizaobaoxin Decoction (QZBXD) can counteract the cardiotoxic effects of doxorubicin and trastuzumab in patients with breast cancer.

February 28, 2026

Qizaobaoxin Decoction ameliorates doxorubicin/trastuzumab-induced cardiotoxicity by modulating gut microbiota and associated metabolites

Key Result

Qizaobaoxin Decoction improved cardiac function and reduced myocardial injury biomarkers in a doxorubicin/trastuzumab-induced cardiotoxicity model by modulating gut microbiota and metabolism.

Key Points

The study aims to explore how Qizaobaoxin Decoction (QZBXD) can counteract the cardiotoxic effects of doxorubicin and trastuzumab in patients with breast cancer.
Investigated chemical composition of QZBXD using UPLC-Q-TOF-MS/MS to identify 83 compounds.
Utilized a DOX/TRZ-induced cardiotoxicity model to assess the effects of QZBXD on cardiac function and biomarkers.
Employed 16S rDNA sequencing and untargeted metabolomics to analyze gut microbiota composition and metabolites influenced by QZBXD.
QZBXD treatment increased left ventricular ejection fraction and improved left ventricular fractional shortening.
Reduced myocardial injury biomarkers, including cTnI, BNP, LDH, CK-MB, and α-HBDH, indicating less heart damage.
Restored gut microbiota diversity by decreasing harmful bacteria and enhancing beneficial bacteria, impacting metabolite levels.

Structured PICO

Does Qizaobaoxin Decoction mitigate cardiotoxicity in a doxorubicin/trastuzumab-induced cardiotoxicity model?

Population

DOX/TRZ-induced cardiotoxicity model

Intervention

Qizaobaoxin Decoction (QZBXD)

Outcome

Cardiac function (left ventricular ejection fraction and left ventricular fractional shortening), biomarkers of myocardial injury (cTnI, BNP, LDH, CK-MB, α-HBDH), and histopathological damagesurrogate

Qizaobaoxin Decoction demonstrates cardioprotective effects against doxorubicin/trastuzumab-induced cardiotoxicity in a preclinical model via modulation of gut microbiota and metabolism.

Abstract

Sequential treatment with anthracyclines and trastuzumab is highly effective for HER-2 positive breast cancer but poses a significant risk of cardiotoxicity. Qizaobaoxin Decoction (QZBXD), a modified Chinese herbal formula, has shown promise in protecting against antineoplastic drug-induced cardiotoxicity. This study aimed to investigate the chemical composition, efficacy, and mechanisms of QZBXD in mitigating doxorubicin/trastuzumab (DOX/TRZ)-induced cardiotoxicity. Using UPLC-Q-TOF-MS/MS, 83 compounds in QZBXD were identified, including flavonoids, organic acids, and phthalides. In DOX/TRZ-induced cardiotoxicity model, QZBXD treatment improved cardiac function (increased left ventricular ejection fraction and left ventricular fractional shortening), reduced biomarkers of myocardial injury (cTnI, BNP, LDH, CK-MB, α-HBDH), and alleviated histopathological damage. Mechanistically, 16S rDNA sequencing revealed that QZBXD restored gut microbiota diversity, reducing harmful bacteria (Ruminococcus, Oscillibacter) and increasing beneficial bacteria (Bacteroides). Untargeted metabolomics showed that QZBXD modulated tryptophan and arachidonic acid metabolism, affecting key metabolites (e.g., decreasing tryptamine and 8,9-epoxyeicosatrienoic acid, and increasing 4-hydroxy-L-tryptophan and L-formylkynurenine). Integrated analysis revealed that QZBXD confers cardioprotective effects against DOX/TRZ-induced cardiotoxicity by modulating gut microbiota composition, which subsequently influences tryptophan and arachidonic acid metabolism. This study provides a pharmacological basis for the clinical application of QZBXD in mitigating DOX/TRZ-induced cardiotoxicity.

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