MTN is one of the most broadly used organophosphate compounds applied in agriculture as a pesticide, as an ectoparasiticide in veterinary practice, control of public health programs, and food preparation and processing areas (
45,
46). In the present study, MTN (100 mg/kg) exhibited cardiac toxicity in subacute exposure (14 days) by inducing morphological damages and elevating the cardiac marker CK-MB level in serum. It has been shown that chronic exposure to OPs introduces oxidative stress damage and free radical production in different organs, such as the cardiovascular system (
28,
47 and
48). Oxidative stress in cardiac tissues appeared to be responsible for these morphological and biochemical changes since co-administration with crocin in all doses of vitamin E was protective against MTN-induced cardiac toxicity by decreasing oxidative stress. Several studies reported that subacute exposure to Ops, such as MTN, inhibited cholinesterase enzyme activity and caused oxidative stress. Moreover, MTN was shown to produce free radicals in different organs, such as the cardiovascular system (
29,
49-
51). Our data revealed that the cardiac level of MDA was significantly enhanced after exposure to MTN. MDA as the common product of lipid peroxidation is widely used to assess the presence of free radicals and lipid peroxidation in different toxicity and disease studies, including in cardiovascular toxicity (
52-
54). Another biochemical marker we also measured in this work was GSH. GSH is an antioxidant marker, significantly reduced in MTN-treated group compared to the control group. In the present study, vitamin E or α-tocopherol, the biologically most active antioxidants, were utilized as positive controls. Our histopathological findings indicated that sub-chronic exposure to MTN could induce congestion, infiltration of inflammatory cells and multifocal necrosis in cardiac tissue. Crocin as a potent antioxidant agent showed cardioprotective effects (
29,
55). Co-administration of Crocin and MTN as compared to MTN alone decreased the cardiac MDA level and the serum CK-MB concentration and increased the GSH content in the heart tissue. Crocin also protected the heart from histological changes induced by MTN, probably via its antioxidative and anti-inflammatory properties (
56,
57). The protective effect of crocin may also be related to its inhibitory effect on lipid peroxidation leading to stabilization of membranes thereby blocking the release of cardiac enzymes (
56). A proteomics approach was employed in the present study to identify if protein expression was changed in response to subacute exposure to MTN (
Table 1). Seven proteins were found to be differentially regulated following MTN exposure compared to the control group. Our results confirmed a good agreement between well-known biomarkers of human cardiac disease and cellular response to MTN. Besides, using the proteomic approach, we revealed that mitochondrial proteins showing differential expression in response to MTN. ATP synthase, aconitate hydratase, malate dehydrogenase, and L-lactate dehydrogenase (LDH) as mitochondrial enzymes changed significantly in the MTN-exposed group. Involvement of mitochondrial injuries following exposure to OPs has been reported by many researchers (
27,
58). Multiple lines of evidence have demonstrated that OPs could alter mitochondrial respiration and respiratory chain enzyme activity (
59,
60). Mitochondria have a vital role in ATP production and the ROS, so dysfunction of mitochondria in the OPs toxicity involved in multisystem disorders in different organs including liver, heart and neurons (
61,
62). Indeed, changes in the levels of these mitochondrial enzymes may the most relevant signal of heart toxicity of MTN (
36). LDH, as an important glycolytic enzyme, is a potential biomarker in toxicology and clinical chemistry if detected extracellularly as a sign of cell, tissue and organ damage (
63). Previously, it has been demonstrated that the LDH activity altered after exposure to toxic compounds or oxygen stress (
64-
67). Venkatesan
et al. have also reported that malathion treatment enhanced LDH release in a dose-dependent manner and induced neurotoxicity in N2a neuroblastoma cells (
68). Elevated LDH also entirely consistent with that observed by Kalender
et al. (
69). Increased LDH in the malathion-treated group in the present study may indicate toxic effects of MTN in the heart. Multiple studies have reported an association between ATP synthase and exposure to the OPs pesticide (
31,
33 and
34). Decreases in ATP synthase level in OPs treated groups compared to control supported by several studies (
70,
71). Acute exposure to MTN in a rat model induced cardiac failure, diminished ATP production and affected ADP/ATP ratio in heart tissue cell line (
32). Decreased ATP synthase as observed in response to MTN may reflect the inability of the cells to maintain a normal energy level (
72). Down-regulation of aconitate hydratase suggesting overproduction of superoxide anion and hydrogen peroxide in rat heart mitochondria in subacute intoxication with MTN (
58).
Upon exposure to MTN, the level of malate dehydrogenase- a key enzyme in the Krebs cycle- in rat heart tissue was significantly reduced. In the present study, this reduction in malate dehydrogenase indicates a decrease in the respiration rate due to toxicity induced by MTN (
73). Decreased level of malate dehydrogenase results in lesser production of ATP in the mitochondria which may prevent numerous important metabolic functions in the animals (
74). Calreticulin, a Ca
2+-binding chaperone in the endoplasmic reticulum (ER), is a regulator of calcium homeostasis through modulation of ER Ca
2+ storage and transport (
75). Furthermore, calreticulin affects many aspects of cellular processes, including cardiac development, muscle contraction, cell adhesion, adipocyte differentiation, innate immunity, steroid-sensitive gene expression, apoptosis, and stress responses (
76,
77). It is possible that decreased calreticulin in the heart tissue following MTN treatment could be responsible for lipid production, previously proposed (
69). In our proteomic study, reduced-expression of calreticulin was detected after exposure to MTN. Tropomyosin and desmin were found to decrease in the heart after MTN administration. Tropomyosins are actin filament binding proteins, possessing significant roles in regulating cardiovascular homeostasis and modulation of endothelial cell function (
78). Desmin, as a muscle-specific protein and a crucial intermediate filament in the heart, involves inhibition of cardiac conduction, cell architecture, arrhythmias, mitochondrial function and behavior and restrictive heart failure (
70,
79). It has been reported a heart without desmin is characterized by cardiomyocyte degeneration and a dilated cardiomyopathy (
71).