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Patent Pending Anthracyclines can cause cardiotoxicity. This cardiotoxicity may be caused by many factors, which may include inhibition and/or poisoning of topoisomerase-IIB in cardiomyocytes,[12] interference with the ryanodine receptors of the sarcoplasmic reticulum, free radical formation in the heart, or from buildup of metabolic products of the anthracycline in the heart.