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PubMed1985

Macronutrient requirements in the malnourished cancer patient. How much of what and why?

Malnutrition is a prevalent problem in the hospitalized cancer population. Although the pathophysiology of cancer cachexia is incompletely understood, it assumes considerable clinical relevance because malnutrition is a potentially treatable problem associated with poor outcome. Once the clinician has made a decision to initiate enteral or parenteral nutritional support, the practical issue of macronutrient prescription necessitates review of existing animal and human data in order to formulate guidelines for nonprotein energy and nitrogen requirements for efficacious nutritional support in the malnourished cancer patient.

Amino Acids↗
PubMed1994

Chemohormone therapy of metastatic melanoma with megestrol acetate plus dacarbazine, carmustine, and cisplatin.

BACKGROUND: Chemotherapy with dacarbazine, carmustine, and cisplatin produces a modest objective response rate in melanoma. Megestrol acetate may ameliorate cachexia, abrogate drug resistance, and increase survival time in melanoma. METHODS: Nineteen patients with metastatic melanoma (16 evaluable) treated with dacarbazine (220 mg/m2/day for 3 days, intravenously [IV]), cisplatin (25 mg/m2/day for 3 days IV) every 3 weeks, and carmustine (150 mg/m2 IV single dose every 6 weeks) together with megestrol acetate (160 mg/day by mouth continuously) starting 2 days before chemotherapy. RESULTS: This regimen was well tolerated and resulted in a mean net weight gain of 1.45 kg. A 47% objective response rate was observed in all patients, including visceral sites of response, with a 39+ week median duration of response and median survival time of 16.7+ months in all evaluable patients. CONCLUSIONS: In this small Phase II study, the authors showed that megestrol acetate may contribute to a high objective response rate and prolonged median survival when used with a chemotherapy regimen of dacarbazine, carmustine, and cisplatin.

Adult↗
PubMed1990

Metabolic effects of cancer.

The potential causes of deranged metabolism in cancer are discussed with emphasis on changes in energy metabolism of glucose, fat and protein. The implications of these changes for the treatment of cachexia are then considered.

Cachexia↗
PubMed2002

Walker 256 tumour growth causes marked changes of glutamine metabolism in rat small intestine.

The effect of Walker 256 tumour growth on the metabolism of glucose and glutamine in the small intestine of rats was examined. Walker 256 tumour has been extensively used as an experimental model to induce cancer cachexia in rats. Walker 256 tumour growth decreased body weight and small intestine weight and length. The activities of glucose-6-phosphate dehydrogenase and phosphate-dependent glutaminase were reduced in the proximal, median and distal portions of the intestine. Glutamine oxidation was reduced in the proximal portion only. The decrease in glutaminase activity was not due to a low synthesis of the protein as indicated by Western blotting analysis. Hexokinase and citrate synthase activities were not changed by the tumour. These findings led us to postulate that tumour growth impairs glutamine metabolism of small intestine but the mechanism involved remains to be elucidated.

Animals↗
PubMed2006

Interleukin-13 receptor alpha2 chain: a potential biomarker and molecular target for ovarian cancer therapy.

BACKGROUND: Epithelial ovarian cancer demonstrates high mortality due to diagnosis at an advanced stage. In the search for a biomarker for early diagnosis and a target for therapy, the issue of whether interleukin-13 receptor (IL-13R), shown to be expressed on a variety of human cancers, is expressed in ovarian tumor samples was explored. In addition, whether this receptor serves as a biomarker and can be targeted by IL-13 cytotoxin was examined. METHODS: IL-13R expression in 15 normal and 68 ovarian tumor tissue samples was determined by immunohistochemistry. Correlation between clinicopathologic features and IL-13R expression was analyzed. The efficacy of IL-13R-directed cytotoxin was determined in mice with subcutaneous, orthotopic, and peritoneal metastatic ovarian cancer. RESULTS: Immunohistochemical analyses revealed that 83% of ovarian cancer specimens express IL-13Ralpha2, a high-affinity IL-13R subunit chain, whereas normal ovary samples expressed none or very low levels. The majority of clear cell ovarian carcinomas with the worst prognosis showed strong staining for IL-13Ralpha2. IL-13 cytotoxin was highly cytotoxic to the IGROV-1 ovarian cancer cell line in vitro, and it mediated significant antitumor activity against a xenografted tumor model. The antitumor effects were confirmed by treating orthotopically implanted or peritoneal metastatic ovarian tumors, which showed significant extension of survival in immunodeficient mice. IL-13 cytotoxin also prevented cachexia in treated mice. The soluble form of IL-13Ralpha2 was detected in the serum of mice with peritoneal metastasis, and the level decreased to baseline in the treated group. CONCLUSIONS: IL-13Ralpha2 is a promising target for ovarian cancer therapy, and the soluble form of IL-13R may be a possible surrogate marker for disease monitoring.

Adult↗
PubMed2001

An adult with Prader-Willi syndrome and anorexia nervosa: a case report.

A 39-year-old man with Prader-Willi syndrome presents for evaluation of uncontrolled weight loss. Past history was significant for gastric bypass and prior episodes of intentional dieting. Family history was significant for an alcoholic father and two siblings with anorexia nervosa. The patient was unconcerned about his weight loss despite cachexia and did not want to stop dieting. This presentation of a restrictive eating pattern in a man with a syndrome usually associated with compulsive hyperphagia is the first known report

Adult↗
PubMed2002

Anticachectic effects of the natural herb Coptidis rhizoma and berberine on mice bearing colon 26/clone 20 adenocarcinoma.

We previously showed that the natural herb Coptidis rhizoma has an anticachectic effect in nude mice bearing human esophageal cancer cells. We further investigated this phenomenon by examining the anticachectic effect of C. rhizoma in syngeneic mice bearing colon 26/clone 20 carcinoma cells, which cause IL-6-related cachexia after cell injection. We evaluated nutritional parameters such as serum glucose level and wasting of adipose tissue and muscle in tumor-bearing and non-tumor-bearing mice treated with C. rhizoma (CR) supplement or a normal diet. IL-6 levels in those mice were quantified by ELISA and real-time RT-PCR. CR supplementation significantly attenuated weight loss in tumor-bearing mice without changing food intake or tumor growth. Furthermore, these mice maintained good nutritional status. IL-6 mRNA levels in tumors and spleens and IL-6 protein levels in tumors and sera were significantly lower in tumor-bearing mice treated with CR supplement than in those treated with a normal diet. CR supplementation did not affect food intake, body weight, nutritional parameters and IL-6 levels in non-tumor-bearing mice. An in vitro study showed that C. rhizoma and its major component, berberine, inhibited IL-1-induced IL-6 mRNA expression in a dose-dependent manner in colon 26/clone 20 cells. Our results showed that C. rhizoma exerts an anticachectic effect on colon 26/clone 20-transplanted mice and that its effect is associated with tumor IL-6 production. We also suggest that its effect might be due to berberine.

Adenocarcinoma↗
PubMed2003

Skeletal muscle metabolism in physiology and in cancer disease.

Skeletal muscle is a tissue of high demand and it accounts for most of daily energy consumption. The classical concept of energy metabolism in skeletal muscle has been profoundly modified on the basis of studies showing the influence of additional factors (i.e., uncoupling proteins (UCPs) and peroxisome proliferator activated receptors (PPARs)) controlling parameters, such as substrate availability, cellular enzymes, carrier proteins, and proton leak, able to affect glycolysis, nutrient oxidation, and protein degradation. This extremely balanced system is greatly altered by cancer disease that can induce muscle cachexia with significant deleterious consequences and results in muscle wasting and weakness, delaying or preventing ambulation, and rehabilitation in catabolic patients.

Animals↗
PubMed1994

Tumor-derived components were responsible for suppression of ornithine decarboxylase activity in the rat wounded skin.

To elucidate the principal cause of delayed wound healing in a tumor-bearing host, the effect of Yoshida sarcoma-derived components on dermal wound healing was investigated in rats with the aid of ornithine decarboxylase (ODC) activity and in vivo bromodeoxyuridine (BrdU) labeling index. The ODC activity in the wounded skin decreased 3 and 7 days after intraperitoneal inoculation of Yoshida sarcoma cells (378.0 +/- 37.3 on Day 3, 280.0 +/- 140.0 on Day 7 vs. 809.3 +/- 109.5 pmol/mg protein/hour on Day 0). When administered 24 hours before and immediately after wounding, the crude nuclear component of the tumor cells significantly decreased the ODC activity in the wounded skin as compared with the control (185.9 +/- 159.8 vs. 534.0 +/- 59.1), but the non-nuclear component was not effective. When nuclear extracts of Yoshida sarcoma cells were intraperitoneally administered immediately after wounding, the 0.15 M or 0.35 M NaCl extract significantly suppressed ODC activity in the wounded skin (233.5 +/- 14.5 and 352.3 +/- 63.2 pmol/mg protein/hour, respectively) in comparison to the control (445.9 +/- 73.6). The BrdU labeling index of epidermal basal cells adjacent to the edge of the wound decreased up to 52% of the control by injection of the 0.15 M extract. It seems that tumor-derived nuclear components may be responsible for delayed wound healing which is commonly observed in cancer cachexia.

Animals↗
PubMed2006

Conjugated linoleic acid preserves muscle mass in mice bearing the Lewis lung carcinoma, but not the B16 melanoma.

Conjugated linoleic acid (CLA), which is found in dairy products, reduces synthesis of tumor necrosis factor-alpha (TNFa), a pro-inflammatory cytokine that plays a major role in tumor-induced skeletal muscle wasting (SMW). The B16 melanoma expresses TNFa mRNA, and induced SMW with no change in muscle levels of TNFa type 1 receptor (TNFR1) protein. A diet containing .5% CLA had no effect on SMW or TNFR1 in mice bearing B16 tumors. In contrast, the Lewis lung carcinoma expresses low levels of TNFa mRNA, induced SMW, and increased muscle levels of TNFR1. A diet containing .5% CLA reduced SMW, but had no effect on muscle levels of TNFR1. We conclude that that tumor-induced SMW can occur independent of muscle levels of TNFR1. Further study is needed before CLA can be tested in persons with cancer cachexia.

Analysis of Variance↗
PubMed1997

IL-6: insights into novel biological activities.

IL-6 has many novel activities both within the adaptive immune system and without. It has therapeutic potential in acute inflammation, such as toxic or septic shock, and it is a potential target for cachexia, multiple myeloma, and osteoporosis. Further work on these aspects of IL-6 biology should yield new insight into the possibility of IL-6 both as a therapeutic agent and as a target for antagonists.

Animals↗
PubMed2002

Leptin role in advanced lung cancer. A mediator of the acute phase response or a marker of the status of nutrition?

Leptin is an anorexia inductor peptide produced by adipocytes and related to fat mass. Leptin is also produced by fat under proinflammatory cytokine action. Our objective is to study serum leptin levels in relation to nutritional status and acute phase response in advanced-stage non-small cell lung cancer.Seventy-six patients newly diagnosed of non surgical non-small cell lung cancer before chemotherapy treatment and 30 healthy controls were included. BMI, serum leptin and cholesterol levels and lymphocyte count were decreased in lung cancer patients. Cytokine IL-6, TNF-alpha, sTNF-RII, sIL-2R, IL-12, IL-10 and IFN-gamma, and other acute phase reactants as alpha1 antitrypsin, ferritin, CRP and platelets were all raised in patients, whereas the IL-2 was decreased. We found a direct relationship between leptin and other indicators of the status of nutrition, especially total fat mass. We also found a close relationship between the status of nutrition and the performance status (Karnofsky index). However, serum leptin and nutritional status were inversely correlated with acute phase proteins and proinflammatory cytokines, suggesting a stress-type malnutrition. Although serum leptin levels, nutritional status and Karnofsky index are related to survival, at multivariate analysis they all were displaced by the acute phase reaction markers. These results suggest that cancer anorexia and cachexia are not due to a dysregulation of leptin production. Circulating leptin concentrations are not elevated in weight-losing cancer patients and are inversely related to the intensity of the inflammatory response. In advanced lung cancer patients serum leptin concentrations only depend on the total amount of fat.

Acute-Phase Reaction↗
PubMed1993

Extremity metabolism in the cachectic, VX-2 carcinoma-bearing rabbit.

The pathophysiology of skeletal muscle loss in cancer cachexia is poorly understood. Immature, male, New Zealand White rabbits (TBs; n = 11) were implanted with VX-2 carcinoma and various indices of systemic and limb metabolism were examined in comparison with pair-fed controls (PFCs; n = 9) and normal controls (NCs; n = 22) fed ad lib. The TBs became hypophagic and experienced reduced growth relative to both control groups (P << 0.001). At 7 weeks (tumor burden 3-6% of body weight; no metastasis) the TBs had the following statistically significant differences from NCs: anemia, neutrophilic granulocytosis and thrombocytosis, hypercalcemia, hypoinsulinemia, elevated plasma triglycerides and altered plasma amino acids, increased hind limb effluxes of lactate and most amino acids. These alterations were not caused by hypophagia, since the PFCs were normal at 7 weeks with regard to all measured parameters except body weight and limb flow, both of which were reduced. The decrease in flow (P < 0.05) apparently contributed to conservation of skeletal muscle amino acids in the PFCs. Young New Zealand White rabbits implanted with VX-2 carcinoma manifest tumor burden, wasting, and metabolic alterations qualitatively similar to those seen with many human cancers.

Amino Acids↗
PubMed1995

Anticatabolic effect of the beta 2-agonist cimaterol in vivo in tumor-bearing animals.

Loss of lean body mass occurs in cancer and may adversely affect outcome. The beta 2-agonist cimaterol increases muscle mass and protein content in tumor-bearing animals, in part by decreasing protein degradation, but the effect of the drug on protein synthesis remains uncertain. To determine the influence of cimaterol on protein synthesis, a methylcholanthrene sarcoma was transplanted sc into the dorsum of male Fischer-344 rats. After 3 weeks of tumor growth, tumor-bearing and control animals received daily sc injections of the beta 2-agonist cimaterol (0.15 mg/kg) for 5 days. Rate of protein synthesis was measured using iv [3H]-phenylalanine (25 microCi/100 g body wt) and cold phenylalanine (150 mumole/100 g body wt) in a flooding dose. Extensor digitorum longus muscles were harvested 10 min later, homogenized, and assayed for [3H]-phenylalanine uptake (bound) (dpm/mg muscle) and tissue-specific (free) radioactivity to determine protein synthesis rate (Ks: %/24 hr). There was a significant increase in protein synthesis rate in control and tumor-bearing animals receiving cimaterol compared to that in freely feeding, food-deprived, or matched-carcass-weight nontumor-bearing controls, as well as compared to that in tumor-bearing controls. We conclude that the anabolic effects of cimaterol are due to both decreased protein degradation and increased muscle protein synthesis. Therefore, beta 2-agonists may prove useful in prevention and/or treatment of cancer cachexia.

Adrenergic beta-Agonists↗
PubMed1996

Protein metabolism in cachectic tumor-bearing rats: effect of tumor excision.

The effect of tumor resection on protein metabolism in cancer-bearing subjects is poorly documented. We explored changes in nitrogen (N) and protein metabolism after excision of tumors both at the whole body level (N balance) and at the tissue level, including skeletal muscle, small intestine, and liver. Sixteen male Sprague-Dawley rats (approximately 375 g) bearing subcutaneous Morris hepatoma 7777 for 6 weeks were either operated for tumor excision and studied for 10 days postoperatively (n = 10) or sacrificed on the day of surgery as tumor-bearing controls; operated and unoperated tumor-bearing rats were compared with healthy rats (n = 16). Tumors, which grew to a mass of 74 +/- 7 g (mean +/- SEM), induced significant loss of body mass (-27 +/- 13 g) and protein depletion in epitrochlearis muscle (EPI) (-38%) and small intestine (-42%) vs healthy rats. Tumor significantly decreased muscle protein synthesis vs healthy rats (7.14 +/- 0.5 vs 10.7 +/- 0.5 nmol phenylalanine (Phe)/EPI/3 hr), net degradation (21.7 +/- 2.9 vs 30.6 +/- 2.5 nmol Phe/EPI/3 hr) and degradation (28.8 +/- 2.7 vs 41.4 +/- 2.5 nmol Phe/EPI/3 hr). In 50% of operated rats, tumor removal was followed immediately by increased food intake, body weight, and N balance; in other rats, this was delayed by 2-4 days. By 6 days postoperative, all rats were gaining weight and had normal food intake; wasting was abolished in small intestine, but not in skeletal muscle (protein mass -43% vs healthy rats, P < 0.05). Postoperative rats maintained lower muscle protein degradation (28.2 +/- 2.0 vs 41.4 +/- 2.5 nmol Phe/EPI/3 hr, P < 0.05) than healthy rats; protein synthesis was no longer reduced. In skeletal muscle, protein synthesis and protein deposition were related to levels of postoperative food intake (r = 0.91 and 0.98, respectively; P < 0.05). Following tumor excision, reversal of cancer cachexia appeared to be highly dependent on the level of postoperative food intake.

Animals↗
PubMed1998

Sepsis increases lung glutamine synthetase expression in the tumor-bearing host.

Acute stresses such as trauma or endotoxemia augment GLN demand and are associated with increased release of this amino acid from skeletal muscle and lung as well as increased expression of glutamine synthetase (GS, the principal enzyme of GLN synthesis) in these tissues. Muscle GLN release is also increased during chronic catabolic states which are associated with depletion of lean body mass, such as starvation or malignancy. We hypothesized that the expression of GS in response to an acute stress would be altered in tumor-bearing rats (TBR) experiencing severe cachexia and therefore a previously heightened GLN demand. Male Fischer 344 rats were implanted with methylcholanthrene-induced fibrosarcoma tumors or underwent sham operations and pair-feeding (sham) with TBR partners. When tumor burden reached approximately 15% of carcass weight, animals received injections of either Escherichia coli lipopolysaccharide (LPS, 1 mg/kg body wt) or saline vehicle. Rats were sacrificed 8 h after injection and lung and muscle tissue were analyzed for GS mRNA and protein via Northern and Western blot techniques, respectively. LPS injection caused an equivalent 4- to 6-fold increase in lung and muscle GS mRNA in both TBR and sham rats (P < 0.01). LPS did not produce a significant increase in GS protein level in muscle tissue of either group or in lung tissue of sham rats. In contrast, endotoxin did lead to a 3.5-fold increase in GS protein levels in lung tissue of TBRs (P < 0.05). This increase in lung GS protein may signify the importance of the lung in maintaining GLN homeostasis during chronic catabolic states where muscle mass is diminished.

Animals↗
PubMed2001

Plasma nitrate accumulation during the development of pacing-induced dilated cardiac myopathy in conscious dogs is due to renal impairment.

Heart failure is associated with an increase in plasma nitrate and nitrite (NOx). To date there is still some controversy regarding the causes of nitrate accumulation during the development of heart failure. The goal of this study was to analyze the underlying mechanisms that cause accumulation of plasma nitrates during the development of heart failure in dogs. Dogs were chronically instrumented for measurement of hemodynamics and renal function. Hearts were paced initially at 210 bpm for 3 weeks and then at 240 until the development of heart failure. Hemodynamics, renal function, renal blood flow, arterial blood gases, hemoglobin, plasma and urine NOx levels, and creatinine levels were measured weekly. Heart failure was assessed by hemodynamic alterations, physical signs such as lethargy, ascites, cachexia, and postmortem evidence of cardiac hypertrophy. LVSP (from 127 +/- 3 to 106 +/- 3 mmHg), LV dP/dt (from 2658 +/- 173 to 1439 +/- 217 mmHg/s), MAP (from 101 +/- 1.9 to 83 +/- 1.8 mmHg) fell, whereas LVEDP tripled (from 6.4 +/- 0.9 to 20 +/- 2.6 mmHg), and heart rate rose (from 101 +/- 4.2 to 117 +/- 6.3 bpm), all changes P < 0.05. RBF (from 146 +/- 10 to 96 +/- 9.9 ml/min), urine output (V) (from 0.26 +/- 0.02 to 0.16 +/- 0.02 ml/min), GFR (from 63 +/- 1.8 to 49 +/- 2 ml/min), and Na excretion (from 45 +/- 4.5 to 14 +/- 4.6 microEq/min) all decreased (P < 0.05), whereas RVR increased (from 0.68 +/- 0.05 to 0.94 +/- 0.1 mmHg/ml/min). These changes took place during a rise in plasma NOx (from 3.7 +/- 0.5 to 16+/-3.3 microM), a decrease in urine NOx (from 33 +/- 9.9 to 8.1 +/- 4.9 microM), and a concurrent increase in NOx reabsorption (from 221 +/- 31 to 818 +/- 166 nmol/min). There was a direct correlation between the increase in plasma NOx levels and an increase in filtered load (r(2) = 0.97, P = 0.02), a negative correlation between NOx levels and NOx excretion (r(2) = 0.65 P < 0.09), and a direct correlation between plasma NOx levels and NOx reabsorption (r(2) = 0.97, P = 0.02). These results indicate that elevated plasma NOx during heart failure are most likely the result of an impairment of the renal function and not increased NOx production. Furthermore, without knowing changes in renal function the measurement of plasma NOx in and of itself is a meaningless index of NO formation.

Animals↗
PubMed2003

Role of brain tryptophan and serotonin in secondary anorexia.

Anorexia and reduced energy intake contribute to worsen the prognosis of patients suffering from a number of chronic diseases, by promoting skeletal muscle wasting, leading to the development of malnutrition and eventually cachexia. The pathogenesis of cancer anorexia is still matter of debate. Many possible mediators, including hormones, peptides, and neurotransmitters, appear to be involved. However, consistent animal and clinical data suggest that brain tryptophan and serotonin may represent a common final pathway shared by many contributing factors. Supporting this hypothesis, recent data showed that the manipulation of brain tryptophan availability ameliorates anorexia and food intake in cancer patients.

Anorexia↗