Cardio-oncology was centered around the cardiotoxic effects of cancer therapy on the heart. Being able to identify patients prone to cardiotoxic adverse events and monitoring their cardiac health throughout treatment is paramount. Biomarkers are crucial for identifying and monitoring cardiac complications in cancer patients undergoing various treatment modalities. For example, cardiac troponins and NT-proBNP can serve as valuable biomarkers in detecting early signs of cardiotoxicity, enabling timely intervention to minimize cardiac damage while allowing for the continuation of cancer treatment. Additionally, research in Cardio-Oncology is focused on the identification of novel biomarkers that can predict individual susceptibility to cardiotoxicity, facilitating personalized treatment plans.

Furthermore, we use state-of-the art in vitro models to study the effect of cancer treatment on various cardiac cell types. Though commonly cardiomyocytes are the main focus of research, we also assess cardiotoxic effects on cardiac fibroblasts and endothelial cells using induced pluripotent stem cell-like cells (2D model) as well as cardiac organoids including all three cell-types of interest (3D model). This provides more information on the cell-types which are more in contact with other factors, such as the immune system and secreted factors in the circulation.

The immune system plays an essential role in both cardiovascular disease and cancer. Immune checkpoints are an example of this which have taken off since their use as cancer treatment. Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment by enhancing the body’s immune response against cancer cells. However, their use has been associated with various immune-related adverse events, including cardiovascular complications such as myocarditis. Myocarditis is a rare but potentially life-threatening side effect of ICIs, which involves inflammation of the heart muscle.

We are targeting ICI-mediated myocarditis on different levels of research.
We are exploring biomarkers and early detection methods to identify patients at higher risk. For example, we have evaluated the diagnostic and prognostic value of cardiac troponin T and are using large cohort studies to validate our findings. Furthermore, we are investigating the potential role of corticosteroids or other immunomodulatory agents in managing these cardiovascular complications.

While ICIs continue to offer significant benefits in cancer treatment, ongoing pre-clinical research is essential to better understand and manage their potential cardiovascular side effects, ensuring the safety and efficacy of these groundbreaking therapies. Pre-clinical research in this area has focused on elucidating the underlying mechanisms of ICI-related myocarditis and developing strategies to mitigate its risks.

On a new frontier, in learning from oncology, we are studying the role of immune checkpoints in cardiac disease. We found that they can be indicative of cardiac outcome, and are currently investigating their behavior in various etiologies using pre-clinical models as well as bioinformatics. Pre-clinical models will allow us to identify immune checkpoints of interest and study the effect of modulating their action, while bioinformatics provide transcriptional information on disease-specific subpopulation of cell-types and predict which cell-cell interaction might be of interest to target.

The field of Cardio-Oncology originated from patients presenting with cardiac adverse events after cancer treatment. However, given the tremendous amount of shared risk factors between cardiovascular diseases and cancer, our group pioneered the investigation of the effect of heart failure on cancer. Both Cardio-Oncology and Reversed Cardio-Oncology epidemiological research play crucial roles in improving the overall care and quality of life for cancer patients and survivors. Epidemiological studies in the field of Reverse Cardio-Oncology explore the cancer outcome in long-term cardiovascular disease. This includes evaluating the use known cardiovascular diseases biomarkers for to predict cancer. Additionally, they examine the impact of various pre-existing cardiovascular conditions on cancer treatment decisions and outcomes, ultimately guiding clinical practice to minimize risk of developing one after the other.

Pre-clinical Reverse Cardio-Oncology research includes studying the effect of cardiac injury on tumor growth and elucidating which factors (secreted proteins, the reprogrammed immune system, dysbiosis of the gut microbiome, etc.) drive this.