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In a population of cancer survivors with cancer therapy-related cardiac dysfunction (CTRCD) circulating SERPINA3 was elevated compared to age-matched controls. We aimed to assess the longitudinal dynamics of circulating SERPINA3 levels in patients with cancer treated with anthracycline chemotherapy (AnC) and its relation to CTRCD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>In this single centre cohort study, 55 patients with cancer scheduled for AnC were\u00a0prospectively enrolled. Cardiac evaluation (echocardiography, high-sensitive cardiac troponin I and NT-proBNP) was performed and SERPINA3 levels in plasma were assessed at 4 timepoints: before chemotherapy, directly after the end of chemotherapy, three months and twelve months after the end of chemotherapy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Forty-two out of 55 patients (76.4%) developed CTRCD within 1\u00a0year after end of\u00a0treatment. CTRCD was mild in 32 and moderate in 10 patients, defined as a change in cardiac biomarkers or GLS and LVEF decline\u2009&lt;\u200950% respectively. Overall, median SERPINA3 levels decreased from baseline to three months after AnC (215.7 [62.0\u2013984.0] to 176.9 [94.7\u2013678.0] \u00b5g\/ml, <jats:italic>p<\/jats:italic>\u2009=\u20090.031). This decrease was most prominent in patients without CTRCD (30.8% decrease, <jats:italic>p<\/jats:italic>\u2009=\u20090.007), followed by mild CTRCD (9.0% decrease, <jats:italic>p<\/jats:italic>\u2009=\u20090.022), while patients with moderate CTRCD did not show a reduction in SERPINA3 (5.1% increase, <jats:italic>p<\/jats:italic>\u2009=\u20090.987). SERPINA3 values at three months after AnC were positively correlated with NT-proBNP (r\u2009=\u20090.47, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). Several malignancy, treatment and patient characteristics were associated with higher SERPINA3 values.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Circulating SERPINA3 levels show dynamic changes in a population of patients with cancer, with an overall decrease following AnC. However, in patients that developed moderate CTRCD, SERPINA3 levels remained elevated. The potential of SERPINA3 dynamics as a biomarker for CTRCD, deserves validation in larger cohorts.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n            <jats:p>Overview of study protocol CTRCD development and SERPINA3 evolution in the study population. Created using Biorender.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s40959-025-00324-7","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T05:56:44Z","timestamp":1741931804000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dynamics of SERPINA3 in response to anthracycline treatment and cardiovascular dysfunction"],"prefix":"10.1186","volume":"11","author":[{"given":"Hanne M.","family":"Boen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lobke L.","family":"Pype","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Papadimitriou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sevilay","family":"Altintas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laure-Anne","family":"Teuwen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Anguille","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Saevels","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anke","family":"Verlinden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leen","family":"Delrue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ward A.","family":"Heggermont","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Bosman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter-Jan","family":"Guns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hein","family":"Heidbuchel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline M.","family":"Van De Heyning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emeline M.","family":"Van Craenenbroeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantijn","family":"Franssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,14]]},"reference":[{"issue":"1","key":"324_CR1","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1002\/ejhf.654","volume":"19","author":"JL Zamorano","year":"2017","unstructured":"Zamorano JL, Lancellotti P, Rodriguez Mu\u00f1oz D, Aboyans V, Asteggiano R, Galderisi M, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. 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