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Zhang Y, Gan C, Xu J, Pang L, Li W, Cheng H. Psychological distress as a risk factor for the efficacy of chemotherapy in advanced gastric cancer patients. Support Care Cancer 2023; 31:669. [PMID: 37922088 DOI: 10.1007/s00520-023-08143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/24/2023] [Indexed: 11/05/2023]
Abstract
AIM To assess the relationship between psychological distress and quality of life (QoL), cancer-related fatigue (CRF), and chemotherapy efficacy in advanced gastric cancer patients. METHODS Advanced gastric cancer patients (39 with psychological distress and 35 without psychological distress) completed the Distress Thermometer (DT), QoL, and CRF test before receiving chemotherapy and assessed the efficacy after completing 2 courses of chemotherapy. RESULTS Psychological distress was a significant factor in the efficacy of chemotherapy in advanced gastric cancer patients (χ2 = 6.324; p = 0.042). Compared to advanced gastric cancer patients with no psychological distress, advanced gastric cancer patients with psychological distress had a poorer QoL (50.41 ± 6.17 vs. 60.01 ± 7.94, t = - 5.882, p < 0.01) and more pronounced CRF (5.75 ± 1.16 vs. 3.22 ± 0.75, t = 11.231, p < 0.01) while receiving chemotherapy. FACT-G (p = 0.0035, r = - 0.4568), as well as PFS (p < 0.0001, r = 0.6599), correlated significantly with efficacy for patients in the psychological distress group. The FACT-G (p = 0.0134, r = - 0.4139) of patients in the no psychological distress group correlated significantly with efficacy. CONCLUSION Psychological distress has a negative impact on QoL, CRF, and efficacy and may be a potential risk for the efficacy of palliative chemotherapy in advanced gastric cancer patients.
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Affiliation(s)
- Yongkang Zhang
- Department of Oncology, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, 230088, China
| | - Chen Gan
- Department of Oncology, Anhui Medical University, Hefei, 230601, China
| | - Jian Xu
- Department of Oncology, Anhui Medical University, Hefei, 230601, China
| | - Lulian Pang
- Department of Oncology, Anhui Medical University, Hefei, 230601, China
| | - Wen Li
- Department of Oncology, Anhui Medical University, Hefei, 230601, China
| | - Huaidong Cheng
- Department of Oncology, Anhui Medical University, Hefei, 230601, China.
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, China.
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Alzhrani AA, Alsuhail AI, Rababah AA. Fatigue Prevalence Among Palliative Care Cancer Patients in Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia: A Cross-Sectional Study. J Palliat Care 2023; 38:424-431. [PMID: 37501537 DOI: 10.1177/08258597231191615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Objective: The aims of the current study are to assess the prevalence of cancer-related fatigue, to examine the difference in cancer-related fatigue severity in relation to patients' characteristics (age, gender, type of cancer, and palliative performance status), and to explore the correlation between cancer-related fatigue and pain, dyspnea, insomnia, and depression among palliative care patients. Methods: A cross-sectional descriptive observational study conducted at Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia. The study included cancer patients who received palliative care services from January 2016 to December 2021. Clinical data of study participants were retrospectively collected from Palliative Care department patient registry. Symptoms were assessed and scored using Edmonton Symptom Assessment Scale. Data analysis was performed using SPSS statistical software. Results: A total of 2616 patients were included in the study, 52.3% were females and 47.7% were males. The median age of study participants was 56 years (range: 2-101 years). Among all study population, the highest reported cancer type was gastrointestinal malignancy (33.5%), while the least was unknown primary malignancy (1.4%). With regards to Edmonton Symptom Assessment Scale, pain (86.4%) and fatigue (83%) were the highest reported symptom in comparison to constipation (17.3%) and insomnia (7.1%). Conclusion: Cancer-related fatigue is a prevalent and concerning issue among palliative care patients. It is essential that healthcare providers recognize the prevalence of fatigue among patients with life-limiting illnesses, assess patients for fatigue routinely, incorporate strategies for managing fatigue, work closely with affected individuals and their families in order to guide the establishment of a personalized care plan that addresses the patient's unique needs and preferences.
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Affiliation(s)
- Abdulaziz A Alzhrani
- Department of Palliative Care, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah I Alsuhail
- Department of Palliative Care, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmad A Rababah
- Department of Palliative Care, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Tezenas-du-Montcel C, Tolle V. La régulation de la prise alimentaire au travers des actions antagonistes de la ghréline et du LEAP-2. CAHIERS DE NUTRITION ET DE DIÉTÉTIQUE 2023. [DOI: 10.1016/j.cnd.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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4
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Muacevic A, Adler JR, Torres R, Maita K, Garcia J, Serrano L, Ho O, Forte AJ. Modulation of Burn Hypermetabolism in Preclinical Models. Cureus 2023; 15:e33518. [PMID: 36779088 PMCID: PMC9904913 DOI: 10.7759/cureus.33518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/11/2023] Open
Abstract
Severe burns elicit a state of physiological stress and increased metabolism to help the body compensate for the changes associated with the traumatic injury. However, this hypermetabolic state is associated with increased insulin resistance, cardiovascular dysfunction, skeletal muscle catabolism, impaired wound healing, and delayed recovery. Several interventions were attempted to modulate burn hypermetabolism, including nutritional support, early excision and grafting, and growth hormone application. However, burn hypermetabolism still imposes significant morbidity and mortality in burn patients. Due to the limitations of in vitro models, animal models are indispensable in burn research. Animal models provide researchers with invaluable tools to test the safety and efficacy of novel treatments or advance our knowledge of previously utilized agents. Several animal studies evaluated novel therapies to modulate burn hypermetabolism in the last few years, including recombinant human growth hormone, erythropoietin, acipimox, apelin, anti-interleukin-6 monoclonal antibody, and ghrelin therapies. Results from these studies are promising and may be effectively translated into human studies. In addition, other studies revisited drugs previously used in clinical practice, such as insulin and metformin, to further investigate their underlying mechanisms as modulators of burn hypermetabolism. This review aims to update burn experts with the novel therapies under investigation in burn hypermetabolism with a focus on applicability and translation. Furthermore, we aim to guide researchers in selecting the correct animal model for their experiments by providing a summary of the methodology and the rationale of the latest studies.
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Spiridon IA, Ciobanu DGA, Giușcă SE, Căruntu ID. Ghrelin and its role in gastrointestinal tract tumors (Review). Mol Med Rep 2021; 24:663. [PMID: 34296307 PMCID: PMC8335721 DOI: 10.3892/mmr.2021.12302] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/23/2021] [Indexed: 12/13/2022] Open
Abstract
Ghrelin, an orexigenic hormone, is a peptide that binds to the growth hormone secretagogue receptor; it is secreted mainly by enteroendocrine cells in the oxyntic glands of the stomach. Ghrelin serves a role in both local and systemic physiological processes, and is implicated in various pathologies, including neoplasia, with tissue expression in several types of malignancies in both in vitro and in vivo studies. However, the precise implications of the ghrelin axis in metastasis, invasion and cancer progression regulation has yet to be established. In the case of gastrointestinal (GI) tract malignancies, ghrelin has shown potential to become a prognostic factor or even a therapeutic target, although data in the literature are inconsistent and unsystematic, with reports untailored to a specific histological subtype of cancer or a particular localization. The evaluation of immunohistochemical expression shows a limited outlook owing to the low number of cases analyzed, and in vivo analyses have conflicting data regarding differences in ghrelin serum levels in patients with cancer. The aim of this review was to examine the relationship between ghrelin and GI tract malignancies to demonstrate the inconsistencies in current results and to highlight its clinical significance in the outcome of these patients.
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Affiliation(s)
- Irene Alexandra Spiridon
- Department of Pathology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iași 700115, Romania
| | | | - Simona Eliza Giușcă
- Department of Pathology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iași 700115, Romania
| | - Irina Draga Căruntu
- Department of Histology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iași 700115, Romania
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6
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Cancer cachexia: molecular mechanism and pharmacological management. Biochem J 2021; 478:1663-1688. [PMID: 33970218 DOI: 10.1042/bcj20201009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 12/15/2022]
Abstract
Cancer cachexia often occurs in malignant tumors and is a multifactorial and complex symptom characterized by wasting of skeletal muscle and adipose tissue, resulting in weight loss, poor life quality and shorter survival. The pathogenic mechanism of cancer cachexia is complex, involving a variety of molecular substrates and signal pathways. Advancements in understanding the molecular mechanisms of cancer cachexia have provided a platform for the development of new targeted therapies. Although recent outcomes of early-phase trials have showed that several drugs presented an ideal curative effect, monotherapy cannot be entirely satisfactory in the treatment of cachexia-associated symptoms due to its complex and multifactorial pathogenesis. Therefore, the lack of definitive therapeutic strategies for cancer cachexia emphasizes the need to develop a better understanding of the underlying mechanisms. Increasing evidences show that the progression of cachexia is associated with metabolic alternations, which mainly include excessive energy expenditure, increased proteolysis and mitochondrial dysfunction. In this review, we provided an overview of the key mechanisms of cancer cachexia, with a major focus on muscle atrophy, adipose tissue wasting, anorexia and fatigue and updated the latest progress of pharmacological management of cancer cachexia, thereby further advancing the interventions that can counteract cancer cachexia.
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de Barros C, Aranha N, Severino P, Souto EB, Zielińska A, Lopes A, Rios A, Batain F, Crescencio K, Chaud M, Alves T. Quality by Design Approach for the Development of Liposome Carrying Ghrelin for Intranasal Administration. Pharmaceutics 2021; 13:pharmaceutics13050686. [PMID: 34068793 PMCID: PMC8151022 DOI: 10.3390/pharmaceutics13050686] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 02/06/2023] Open
Abstract
The therapeutic use of peptides has increasingly recognized in the development of new therapies. However, the susceptible enzymatic cleavage is a barrier that needs to overcome. Nose-to-brain delivery associated with liposomes can protect peptides against biodegradation and improve the accessibility to brain targets. The aim was to develop a liposomal formulation as ghrelin carrier. The quality by design (QbD) approach was used as a strategy for method development. The initial risk assessments were carried out using a fishbone diagram. A screening design study was performed for the critical material attributes/critical process parameters (CMAs/CPPs) on critical quality attributes (CQAs). Liposomes were obtained by hydrating phospholipid films, followed by extrusion or homogenization, and coated with chitosan. The optimized liposome formulation was produced by high-pressure homogenization coated with chitosan, and the resulted were liposomes size 72.25 ± 1.46 nm, PDI of 0.300 ± 0.027, the zeta potential of 50.3 ± 1.46 mV, and encapsulation efficiency of 53.2%. Moreover, chitosan coating improved performance in ex vivo permeation and mucoadhesion analyzes when compared to the uncoated liposome. In this context, chitosan coating is essential for the performance of the formulations in the ex vivo permeation and mucoadhesion analyzes. The intranasal administration of ghrelin liposomes coated with chitosan offers an innovative opportunity to treat cachexia.
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Affiliation(s)
- Cecília de Barros
- Laboratory of Biomaterials and Nanotechnology (LaBNUS), University of Sorocaba, Sorocaba 18078-005, São Paulo, Brazil; (C.d.B.); (A.R.); (F.B.); (K.C.)
| | - Norberto Aranha
- Technological and Environmental Processes, University of Sorocaba, Sorocaba 18078-005, São Paulo, Brazil;
| | - Patrícia Severino
- Nanomedicine and Nanotechnology Laboratory (LNMed), Institute of Technology and Research (ITP), Av. Murilo Dantas, 300, Aracaju 49010-390, Sergipe, Brazil;
| | - Eliana B. Souto
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, Ciências da Saúde, 3000-548 Coimbra, Portugal;
| | - Aleksandra Zielińska
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszynska 32, 60-479 Poznan, Poland;
| | - André Lopes
- Faculty of Pharmaceutical Science, University of Campinas, Campinas 13083-871, São Paulo, Brazil;
| | - Alessandra Rios
- Laboratory of Biomaterials and Nanotechnology (LaBNUS), University of Sorocaba, Sorocaba 18078-005, São Paulo, Brazil; (C.d.B.); (A.R.); (F.B.); (K.C.)
| | - Fernando Batain
- Laboratory of Biomaterials and Nanotechnology (LaBNUS), University of Sorocaba, Sorocaba 18078-005, São Paulo, Brazil; (C.d.B.); (A.R.); (F.B.); (K.C.)
| | - Kessi Crescencio
- Laboratory of Biomaterials and Nanotechnology (LaBNUS), University of Sorocaba, Sorocaba 18078-005, São Paulo, Brazil; (C.d.B.); (A.R.); (F.B.); (K.C.)
| | - Marco Chaud
- Laboratory of Biomaterials and Nanotechnology (LaBNUS), University of Sorocaba, Sorocaba 18078-005, São Paulo, Brazil; (C.d.B.); (A.R.); (F.B.); (K.C.)
- Technological and Environmental Processes, University of Sorocaba, Sorocaba 18078-005, São Paulo, Brazil;
- College of Bioprocess and Biotechnology Engineering, University of Sorocaba, Sorocaba 18023-000, Sâo Paulo, Brazil
- Correspondence: (M.C.); (T.A.)
| | - Thais Alves
- Laboratory of Biomaterials and Nanotechnology (LaBNUS), University of Sorocaba, Sorocaba 18078-005, São Paulo, Brazil; (C.d.B.); (A.R.); (F.B.); (K.C.)
- Technological Innovation Agency of Sorocaba, Sorocaba Technology Park, Itavuvu Avenue, Sorocaba 18078-005, São Paulo, Brazil
- Correspondence: (M.C.); (T.A.)
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8
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Zeng X, Chen P, Zhao L, Chen S. Acylated and unacylated ghrelin relieve cancer cachexia in mice through multiple mechanisms. CHINESE J PHYSIOL 2020; 63:195-203. [PMID: 33109785 DOI: 10.4103/cjp.cjp_59_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cancer cachexia is a wasting syndrome resulting from decreased protein synthesis and increased protein degradation. Calpain-dependent cleavage of myofilament is the initial step of myofilament degradation and plays a critical role in muscle atrophy. Ghrelin is a multifunctional hormone known to improve protein synthesis and inhibit protein degradation. However, its mechanism of action is not fully understood. Here we investigated whether acylated ghrelin (AG) and unacylated ghrelin (UnAG) could protect against cancer cachexia in mice bearing CT26 colorectal adenocarcinoma. We found for the first time that both AG and UnAG could inhibit calpain activity in skeletal muscle of cancer cachectic mice. AG and UnAG also improved tumor-free body weight, grip strength, muscle mass, epididymal fat mass, and nutritional state in tumor-bearing (TB) mice. Moreover, AG and UnAG reduced serum tumor necrosis factor-± concentration, increased Akt activity, and downregulated atrogin-1 expression in TB mice. Our results may contribute to the development of an AG/UnAG-based therapy for cancer cachexia.
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Affiliation(s)
- Xianliang Zeng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Ping Chen
- Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Li Zhao
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Sizeng Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
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Bielecka-Dabrowa A, Ebner N, Dos Santos MR, Ishida J, Hasenfuss G, von Haehling S. Cachexia, muscle wasting, and frailty in cardiovascular disease. Eur J Heart Fail 2020; 22:2314-2326. [PMID: 32949422 DOI: 10.1002/ejhf.2011] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/16/2022] Open
Abstract
The last several years have seen increasing interest in understanding cachexia, muscle wasting, and physical frailty across the broad spectrum of patients with cardiovascular illnesses. This interest originally started in the field of heart failure, but has recently been extended to other areas such as atrial fibrillation, coronary artery disease, peripheral artery disease as well as to patients after cardiac surgery or transcatheter aortic valve implantation. Tissue wasting and frailty are prevalent among many of the affected patients. The ageing process itself and concomitant cardiovascular illness decrease lean mass while fat mass is relatively preserved, making elderly patients particularly prone to develop wasting syndromes and frailty. The aim of this review is to provide an overview of the available knowledge of body wasting and physical frailty in patients with cardiovascular illness, particularly focussing on patients with heart failure in whom most of the available data have been gathered. In addition, mechanisms of wasting and possible therapeutic targets are discussed.
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Affiliation(s)
- Agata Bielecka-Dabrowa
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | | | - Junishi Ishida
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
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10
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T. de Barros C, Rios AC, Alves TFR, Batain F, Crescencio KMM, Lopes LJ, Zielińska A, Severino P, G. Mazzola P, Souto EB, Chaud MV. Cachexia: Pathophysiology and Ghrelin Liposomes for Nose-to-Brain Delivery. Int J Mol Sci 2020; 21:ijms21175974. [PMID: 32825177 PMCID: PMC7503373 DOI: 10.3390/ijms21175974] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 12/17/2022] Open
Abstract
Cachexia, a severe multifactorial condition that is underestimated and unrecognized in patients, is characterized by continuous muscle mass loss that leads to progressive functional impairment, while nutritional support cannot completely reverse this clinical condition. There is a strong need for more effective and targeted therapies for cachexia patients. There is a need for drugs that act on cachexia as a distinct and treatable condition to prevent or reverse excess catabolism and inflammation. Due to ghrelin properties, it has been studied in the cachexia and other treatments in a growing number of works. However, in the body, exogenous ghrelin is subject to very rapid degradation. In this context, the intranasal release of ghrelin-loaded liposomes to cross the blood-brain barrier and the release of the drug into the central nervous system may be a promising alternative to improve its bioavailability. The administration of nose-to-brain liposomes for the management of cachexia was addressed only in a limited number of published works. This review focuses on the discussion of the pathophysiology of cachexia, synthesis and physiological effects of ghrelin and the potential treatment of the diseased using ghrelin-loaded liposomes through the nose-to-brain route.
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Affiliation(s)
- Cecilia T. de Barros
- Laboratory of Biomaterials and Nanotechnology (LaBNUS), University of Sorocaba, Sorocaba, 18078-005 São Paulo, Brazil; (C.T.d.B.); (A.C.R.); (T.F.R.A.); (F.B.); (K.M.M.C.); (L.J.L.)
| | - Alessandra C. Rios
- Laboratory of Biomaterials and Nanotechnology (LaBNUS), University of Sorocaba, Sorocaba, 18078-005 São Paulo, Brazil; (C.T.d.B.); (A.C.R.); (T.F.R.A.); (F.B.); (K.M.M.C.); (L.J.L.)
| | - Thaís F. R. Alves
- Laboratory of Biomaterials and Nanotechnology (LaBNUS), University of Sorocaba, Sorocaba, 18078-005 São Paulo, Brazil; (C.T.d.B.); (A.C.R.); (T.F.R.A.); (F.B.); (K.M.M.C.); (L.J.L.)
| | - Fernando Batain
- Laboratory of Biomaterials and Nanotechnology (LaBNUS), University of Sorocaba, Sorocaba, 18078-005 São Paulo, Brazil; (C.T.d.B.); (A.C.R.); (T.F.R.A.); (F.B.); (K.M.M.C.); (L.J.L.)
| | - Kessi M. M. Crescencio
- Laboratory of Biomaterials and Nanotechnology (LaBNUS), University of Sorocaba, Sorocaba, 18078-005 São Paulo, Brazil; (C.T.d.B.); (A.C.R.); (T.F.R.A.); (F.B.); (K.M.M.C.); (L.J.L.)
| | - Laura J. Lopes
- Laboratory of Biomaterials and Nanotechnology (LaBNUS), University of Sorocaba, Sorocaba, 18078-005 São Paulo, Brazil; (C.T.d.B.); (A.C.R.); (T.F.R.A.); (F.B.); (K.M.M.C.); (L.J.L.)
| | - Aleksandra Zielińska
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; (A.Z.); (E.B.S.)
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszyńska 32, 60-479 Poznań, Poland
| | - Patricia Severino
- Institute of Technology and Research, University of Tiradentes (UNIT), 49032-490 Aracaju, Sergipe, Brazil;
- Tiradentes Institute, 150 Mt Vernon St, Dorchester, MA 02125, USA
- Center for Biomedical Engineering, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA 02139, USA
| | - Priscila G. Mazzola
- Faculty of Pharmaceutical Science, University of Campinas (UNICAMP), Candido Portinari Street, Campinas, 13083-871 São Paulo, Brazil;
| | - Eliana B. Souto
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; (A.Z.); (E.B.S.)
- CEB—Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Marco V. Chaud
- Laboratory of Biomaterials and Nanotechnology (LaBNUS), University of Sorocaba, Sorocaba, 18078-005 São Paulo, Brazil; (C.T.d.B.); (A.C.R.); (T.F.R.A.); (F.B.); (K.M.M.C.); (L.J.L.)
- Bioprocess and Biotechnology College, University of Sorocaba, Sorocaba, 18078-005 São Paulo, Brazil
- Correspondence: ; Tel.: +55-15-98172-4431
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Akalu Y, Molla MD, Dessie G, Ayelign B. Physiological Effect of Ghrelin on Body Systems. Int J Endocrinol 2020; 2020:1385138. [PMID: 32565790 PMCID: PMC7267865 DOI: 10.1155/2020/1385138] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/08/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023] Open
Abstract
Ghrelin is a relatively novel multifaceted hormone that has been found to exert a plethora of physiological effects. In this review, we found/confirmed that ghrelin has effect on all body systems. It induces appetite; promotes the use of carbohydrates as a source of fuel while sparing fat; inhibits lipid oxidation and promotes lipogenesis; stimulates the gastric acid secretion and motility; improves cardiac performance; decreases blood pressure; and protects the kidneys, heart, and brain. Ghrelin is important for learning, memory, cognition, reward, sleep, taste sensation, olfaction, and sniffing. It has sympatholytic, analgesic, antimicrobial, antifibrotic, and osteogenic effects. Moreover, ghrelin makes the skeletal muscle more excitable and stimulates its regeneration following injury; delays puberty; promotes fetal lung development; decreases thyroid hormone and testosterone; stimulates release of growth hormone, prolactin, glucagon, adrenocorticotropic hormone, cortisol, vasopressin, and oxytocin; inhibits insulin release; and promotes wound healing. Ghrelin protects the body by different mechanisms including inhibition of unwanted inflammation and induction of autophagy. Having a clear understanding of the ghrelin effect in each system has therapeutic implications. Future studies are necessary to elucidate the molecular mechanisms of ghrelin actions as well as its application as a GHSR agonist to treat most common diseases in each system without any paradoxical outcomes on the other systems.
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Affiliation(s)
- Yonas Akalu
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Meseret Derbew Molla
- Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Dessie
- Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Birhanu Ayelign
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Science, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Lima JD, Simoes E, de Castro G, Morais MRP, de Matos‐Neto EM, Alves MJ, Pinto NI, Figueredo RG, Zorn TM, Felipe‐Silva AS, Tokeshi F, Otoch JP, Alcantara P, Cabral FJ, Ferro ES, Laviano A, Seelaender M. Tumour-derived transforming growth factor-β signalling contributes to fibrosis in patients with cancer cachexia. J Cachexia Sarcopenia Muscle 2019; 10:1045-1059. [PMID: 31273954 PMCID: PMC6818454 DOI: 10.1002/jcsm.12441] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 04/05/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cachexia is a paraneoplastic syndrome related with poor prognosis. The tumour micro-environment contributes to systemic inflammation and increased oxidative stress as well as to fibrosis. The aim of the present study was to characterise the inflammatory circulating factors and tumour micro-environment profile, as potentially contributing to tumour fibrosis in cachectic cancer patients. METHODS 74 patients (weight stable cancer n = 31; cachectic cancer n = 43) diagnosed with colorectal cancer were recruited, and tumour biopsies were collected during surgery. Multiplex assay was performed to study inflammatory cytokines and growth factors. Immunohistochemistry analysis was carried out to study extracellular matrix components. RESULTS Higher protein expression of inflammatory cytokines and growth factors such as epidermal growth factor, granulocyte-macrophage colony-stimulating factor, interferon-α, and interleukin (IL)-8 was observed in the tumour and serum of cachectic cancer patients in comparison with weight-stable counterparts. Also, IL-8 was positively correlated with weight loss in cachectic patients (P = 0.04; r = 0.627). Immunohistochemistry staining showed intense collagen deposition (P = 0.0006) and increased presence of α-smooth muscle actin (P < 0.0001) in tumours of cachectic cancer patients, characterizing fibrosis. In addition, higher transforming growth factor (TGF)-β1, TGF-β2, and TGF-β3 expression (P = 0.003, P = 0.05, and P = 0.047, respectively) was found in the tumour of cachectic patients, parallel to p38 mitogen-activated protein kinase alteration. Hypoxia-inducible factor-1α mRNA content was significantly increased in the tumour of cachectic patients, when compared with weight-stable group (P = 0.005). CONCLUSIONS Our results demonstrate TGF-β pathway activation in the tumour in cachexia, through the (non-canonical) mitogen-activated protein kinase pathway. The results show that during cachexia, intratumoural inflammatory response contributes to the onset of fibrosis. Tumour remodelling, probably by TGF-β-induced transdifferentiation of fibroblasts to myofibroblasts, induces unbalanced inflammatory cytokine profile, angiogenesis, and elevation of extracellular matrix components (EMC). We speculate that these changes may affect tumour aggressiveness and present consequences in peripheral organs.
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Affiliation(s)
- Joanna D.C.C. Lima
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | - Estefania Simoes
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | - Gabriela de Castro
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | - Mychel Raony P.T. Morais
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | | | - Michele J. Alves
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
- Department of PathologyOhio State UniversityColumbusOHUSA
| | - Nelson I. Pinto
- Department of PhysiologyFederal University of São PauloSão PauloBrazil
| | - Raquel G. Figueredo
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | - Telma M.T. Zorn
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | | | - Flavio Tokeshi
- Department of Clinical SurgeryUniversity of São PauloSão PauloBrazil
| | - José P. Otoch
- Department of Clinical SurgeryUniversity of São PauloSão PauloBrazil
| | - Paulo Alcantara
- Department of Clinical SurgeryUniversity of São PauloSão PauloBrazil
| | | | - Emer S. Ferro
- Department of PharmacologyUniversity of São PauloSão PauloBrazil
| | | | - Marilia Seelaender
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
- Department of Clinical SurgeryUniversity of São PauloSão PauloBrazil
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Yang S, Chu S, Gao Y, Ai Q, Liu Y, Li X, Chen N. A Narrative Review of Cancer-Related Fatigue (CRF) and Its Possible Pathogenesis. Cells 2019; 8:cells8070738. [PMID: 31323874 PMCID: PMC6679212 DOI: 10.3390/cells8070738] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 12/16/2022] Open
Abstract
Many cancer patients suffer from severe fatigue when treated with chemotherapy or radiotherapy; however, the etiology and pathogenesis of this kind of fatigue remains unknown. Fatigue is associated with cancer itself, as well as adjuvant therapies and can persist for a long time. Cancer patients present a high degree of fatigue, which dramatically affects the quality of their everyday life. There are various clinical research studies and reviews that aimed to explore the mechanisms of cancer-related fatigue (CRF). However, there are certain limitations in these studies: For example, some studies have only blood biochemical texts without histopathological examination, and there has been insufficient systemic evaluation of the dynamic changes in relevant indexes. Thus, we present this narrative review to summarize previous studies on CRF and explore promising research directions. Plenty of evidence suggests a possible association between CRF and physiological dysfunction, including skeletal muscular and mitochondrial dysfunction, peripheral immune activation and inflammation dysfunction, as well as central nervous system (CNS) disorder. Mitochondrial DNA (mtDNA), mitochondrial structure, oxidative pressure, and some active factors such as ATP play significant roles that lead to the induction of CRF. Meanwhile, several pro-inflammatory and anti-inflammatory cytokines in the peripheral system, even in the CNS, significantly contribute to the occurrence of CRF. Moreover, CNS function disorders, such as neuropeptide, neurotransmitter, and hypothalamic-pituitary-adrenal (HPA) axis dysfunction, tend to amplify the sense of fatigue in cancer patients through various signaling pathways. There have been few accurate animal models established to further explore the molecular mechanisms of CRF due to different types of cancer, adjuvant therapy schedules, living environments, and physical status. It is imperative to develop appropriate animal models that can mimic human CRF and to explore additional mechanisms using histopathological and biochemical methods. Therefore, the main purpose of this review is to analyze the possible pathogenesis of CRF and recommend future research that will clarify CRF pathogenesis and facilitate the formulation of new treatment options.
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Affiliation(s)
- Songwei Yang
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, Hunan, China
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces, Changsha 410208, Hunan, China
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medical, Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Shifeng Chu
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, Hunan, China
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces, Changsha 410208, Hunan, China
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medical, Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Yan Gao
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medical, Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Qidi Ai
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, Hunan, China
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces, Changsha 410208, Hunan, China
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medical, Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Yingjiao Liu
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, Hunan, China
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces, Changsha 410208, Hunan, China
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medical, Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Xun Li
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, Hunan, China
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces, Changsha 410208, Hunan, China
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medical, Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Naihong Chen
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, Hunan, China.
- Hunan Engineering Technology Center of Standardization and Function of Chinese Herbal Decoction Pieces, Changsha 410208, Hunan, China.
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medical, Neuroscience Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China.
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14
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Argyrou C, Hatziagapiou K, Theodorakidou M, Nikola OA, Vlahopoulos S, Lambrou GI. The role of adiponectin, LEPTIN, and ghrelin in the progress and prognosis of childhood acute lymphoblastic leukemia. Leuk Lymphoma 2019; 60:2158-2169. [PMID: 30696312 DOI: 10.1080/10428194.2019.1569230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Dysregulation of adipokine pathways is implicated in the carcinogenesis and ALL. The aim of this study is to present the most recent data available regarding the role of leptin, adiponectin and ghrelin in the pathogenesis and prognosis of ALL. The PubMed database was searched using 'Leptin', 'Adiponectin', 'Ghrelin', 'Cancer', 'Children' and 'Acute Lymphoblastic Leukemia' as keywords. The majority of the studies indicated that leptin levels are increased and adiponectin levels are decreased in ALL children at diagnosis, as well as in ALL survivors. Ghrelin levels were found to be lower at diagnosis and progressively increased during treatment. Further research is warranted, as the heterogeneity of the current studies, various treatment protocols and differences in sample sizes make it difficult to deduce solid conclusions regarding the role of adipokines in ALL.
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Affiliation(s)
- Chrysa Argyrou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Choremeio Research Laboratory , Athens , Greece
| | - Kyriaki Hatziagapiou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Choremeio Research Laboratory , Athens , Greece
| | - Margarita Theodorakidou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Choremeio Research Laboratory , Athens , Greece
| | - Olti Alexandra Nikola
- First Department of Pediatrics, National and Kapodistrian University of Athens, Choremeio Research Laboratory , Athens , Greece
| | - Spiros Vlahopoulos
- First Department of Pediatrics, National and Kapodistrian University of Athens, Choremeio Research Laboratory , Athens , Greece
| | - George I Lambrou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Choremeio Research Laboratory , Athens , Greece
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15
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Karlsson S, Gardelli C, Lindhagen M, Nikitidis G, Svensson T. Route Optimization and Manufacture of Multihundred Grams of a Ghrelin Receptor Agonist. Org Process Res Dev 2018. [DOI: 10.1021/acs.oprd.8b00179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Staffan Karlsson
- Early Chemical Development, Pharmaceutical Sciences, IMED Biotech Unit, AstraZeneca Gothenburg, SE-431 83 Mölndal, Sweden
| | - Cristina Gardelli
- Medicinal Chemistry, Respiratory, Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca Gothenburg, SE-431 83 Mölndal, Sweden
| | - Marika Lindhagen
- Early Chemical Development, Pharmaceutical Sciences, IMED Biotech Unit, AstraZeneca Gothenburg, SE-431 83 Mölndal, Sweden
| | - Grigorios Nikitidis
- Early Chemical Development, Pharmaceutical Sciences, IMED Biotech Unit, AstraZeneca Gothenburg, SE-431 83 Mölndal, Sweden
| | - Tor Svensson
- Medicinal Chemistry, Respiratory, Inflammation and Autoimmunity, IMED Biotech Unit, AstraZeneca Gothenburg, SE-431 83 Mölndal, Sweden
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16
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Asprosin: Possible target in connection with ghrelin and cytokine network expression in the post-burn treatment. Med Hypotheses 2018; 118:163-168. [DOI: 10.1016/j.mehy.2018.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/29/2018] [Accepted: 07/05/2018] [Indexed: 12/14/2022]
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17
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Holubová M, Blechová M, Kákonová A, Kuneš J, Železná B, Maletínská L. In Vitro and In Vivo Characterization of Novel Stable Peptidic Ghrelin Analogs: Beneficial Effects in the Settings of Lipopolysaccharide-Induced Anorexia in Mice. J Pharmacol Exp Ther 2018; 366:422-432. [PMID: 29914876 DOI: 10.1124/jpet.118.249086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/08/2018] [Indexed: 01/08/2023] Open
Abstract
Ghrelin, the only known orexigenic gut hormone produced primarily in the stomach, has lately gained attention as a potential treatment of anorexia and cachexia. However, its biologic stability is highly limited; therefore, a number of both peptide and nonpeptide ghrelin analogs have been synthesized. In this study, we provide in vitro and in vivo characterization of a series of novel peptide growth hormone secretagogue receptor (GHS-R1a) agonists, both under nonpathologic conditions and in the context of lipopolysaccharide (LPS)-induced anorexia. These analogs were based on our previous series modified by replacing the Ser3 with diaminopropionic acid (Dpr), the N-terminal Gly with sarcosine, and Phe4 with various noncoded amino acids. New analogs were further modified by replacing the n-octanoyl bound to Dpr3 with longer or unsaturated fatty acid residues, by incorporation of the second fatty acid residue into the molecule, or by shortening the peptide chain. These modifications preserved the ability of ghrelin analogs to bind to the membranes of cells transfected with GHS-R1a, as well as the GHS-R1a signaling activation. The selected analogs exhibited long-lasting and potent orexigenic effects after a single s.c. administration in mice. The stability of new ghrelin analogs in mice after s.c. administration was significantly higher when compared with ghrelin and [Dpr3]ghrelin, with half-lives of approximately 2 hours. A single s.c. injection of the selected ghrelin analogs in mice with LPS-induced anorexia significantly increased food intake via the activation of orexigenic pathways and normalized blood levels of proinflammatory cytokines, demonstrating the anti-inflammatory potential of the analogs.
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Affiliation(s)
- Martina Holubová
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Prague, Czech Republic (M.H., M.B., A.K., J.K., B.Ž., L.M.) and Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic (J.K.)
| | - Miroslava Blechová
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Prague, Czech Republic (M.H., M.B., A.K., J.K., B.Ž., L.M.) and Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic (J.K.)
| | - Anna Kákonová
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Prague, Czech Republic (M.H., M.B., A.K., J.K., B.Ž., L.M.) and Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic (J.K.)
| | - Jaroslav Kuneš
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Prague, Czech Republic (M.H., M.B., A.K., J.K., B.Ž., L.M.) and Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic (J.K.)
| | - Blanka Železná
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Prague, Czech Republic (M.H., M.B., A.K., J.K., B.Ž., L.M.) and Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic (J.K.)
| | - Lenka Maletínská
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Prague, Czech Republic (M.H., M.B., A.K., J.K., B.Ž., L.M.) and Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic (J.K.)
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18
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Khatib MN, Shankar AH, Kirubakaran R, Gaidhane A, Gaidhane S, Simkhada P, Quazi Syed Z. Ghrelin for the management of cachexia associated with cancer. Cochrane Database Syst Rev 2018; 2:CD012229. [PMID: 29489032 PMCID: PMC6491219 DOI: 10.1002/14651858.cd012229.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cancer sufferers are amongst the most malnourished of all the patient groups. Studies have shown that ghrelin, a gut hormone can be a potential therapeutic agent for cachexia (wasting syndrome) associated with cancer. A variety of mechanisms of action of ghrelin in people with cancer cachexia have been proposed. However, safety and efficacy of ghrelin for cancer-associated cachexia have not been systematically reviewed. The aim of this review was to assess whether ghrelin is associated with better food intake, body composition and survival than other options for adults with cancer cachexia. OBJECTIVES To assess the efficacy and safety of ghrelin in improving food intake, body composition and survival in people with cachexia associated with cancer. SEARCH METHODS We searched CENTRAL, MEDLINE and Embase without language restrictions up to July 2017. We also searched for ongoing studies in trials registers, performed handsearching, checked bibliographic references of relevant articles and contacted authors and experts in the field to seek potentially relevant research. We applied no restrictions on language, date, or publication status. SELECTION CRITERIA We included randomised controlled (parallel-group or cross-over) trials comparing ghrelin (any formulation or route of administration) with placebo or an active comparator in adults (aged 18 years and over) who met any of the international criteria for cancer cachexia. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for eligibility. Two review authors then extracted data and assessed the risk of bias for individual studies using standard Cochrane methodology. For dichotomous variables, we planned to calculate risk ratio with 95% confidence intervals (CI) and for continuous data, we planned to calculate mean differences (MD) with 95% CI. We assessed the evidence using GRADE and created 'Summary of findings' tables. MAIN RESULTS We screened 926 individual references and identified three studies that satisfied the inclusion criteria. Fifty-nine participants (37 men and 22 women) aged between 54 and 78 years were randomised initially, 47 participants completed the treatment. One study had a parallel design and two had a cross-over design. The studies included people with a variety of cancers and also differed in the dosage, route of administration, frequency and duration of treatment.One trial, which compared ghrelin with placebo, found that ghrelin improved food intake (very low-quality evidence) and had no adverse events (very low-quality evidence). Due to unavailability of data we were unable to report on comparisons for ghrelin versus no treatment or alternative experimental treatment modalities, or ghrelin in combination with other treatments or ghrelin analogues/ghrelin mimetics/ghrelin potentiators. Two studies compared a higher dose of ghrelin with a lower dose of ghrelin, however due to differences in study designs and great diversity in the treatment provided we did not pool the results. In both trials, food intake did not differ between participants on higher-dose and lower-dose ghrelin. None of the included studies assessed data on body weight. One study reported higher adverse events with a higher dose as compared to a lower dose of ghrelin.All studies were at high risk of attrition bias and bias for size of the study. Risk of bias in other domains was unclear or low.We rated the overall quality of the evidence for primary outcomes (food intake, body weight, adverse events) as very low. We downgraded the quality of the evidence due to lack of data, high or unclear risk of bias of the studies and small study size. AUTHORS' CONCLUSIONS There is insufficient evidence to be able to support or refute the use of ghrelin in people with cancer cachexia. Adequately powered randomised controlled trials focusing on evaluation of safety and efficacy of ghrelin in people with cancer cachexia is warranted.
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Affiliation(s)
- Mahalaqua Nazli Khatib
- Division of Evidence Synthesis; School of Epidemiology and Public Health & Department of Physiology, Datta Meghe Institute of Medical Sciences, Sawangi Meghe, Wardha, Maharashtra, India, 442004
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19
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Muscular Dystrophies and Cancer Cachexia: Similarities in Chronic Skeletal Muscle Degeneration. J Funct Morphol Kinesiol 2017. [DOI: 10.3390/jfmk2040039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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20
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Zeng X, Chen S, Yang Y, Ke Z. Acylated and unacylated ghrelin inhibit atrophy in myotubes co-cultured with colon carcinoma cells. Oncotarget 2017; 8:72872-72885. [PMID: 29069832 PMCID: PMC5641175 DOI: 10.18632/oncotarget.20531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/30/2017] [Indexed: 01/06/2023] Open
Abstract
Cancer cachexia is a result of increased protein degradation and decreased protein synthesis. The multifunctional circulating hormone ghrelin promotes synthesis and inhibits degradation of muscle protein, but its mechanism of action is not fully understood. Here, we investigated whether co-culturing C2C12 myotubes with CT26 colon carcinoma cells induces myotube atrophy, and whether acylated ghrelin (AG) and unacylated ghrelin (UnAG) had anti-atrophic effects. We found that co-culture induced myotube atrophy and increased tumor necrosis factor-alpha (TNF-α) and myostatin concentrations in the culture medium. Moreover, co-culture down-regulated myogenin and MyoD expression, inhibited the Akt signaling, up-regulated ubiquitin E3 ligase expression, and activated the calpain system and autophagy in myotubes. Both AG and UnAG inhibited these changes. Our study describes a novel in vitro model that can be employed to investigate cancer cachexia, and our findings suggest a possible use for AG and UnAG in treating cancer cachexia.
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Affiliation(s)
- Xianliang Zeng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Sizeng Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Yang Yang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Zhao Ke
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
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21
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Aversa Z, Costelli P, Muscaritoli M. Cancer-induced muscle wasting: latest findings in prevention and treatment. Ther Adv Med Oncol 2017; 9:369-382. [PMID: 28529552 PMCID: PMC5424865 DOI: 10.1177/1758834017698643] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 02/14/2017] [Indexed: 12/17/2022] Open
Abstract
Cancer cachexia is a severe and disabling clinical condition that frequently accompanies the development of many types of cancer. Muscle wasting is the hallmark of cancer cachexia and is associated with serious clinical consequences such as physical impairment, poor quality of life, reduced tolerance to treatments and shorter survival. Cancer cachexia may evolve through different stages of clinical relevance, namely pre-cachexia, cachexia and refractory cachexia. Given its detrimental clinical consequences, it appears mandatory to prevent and/or delay the progression of cancer cachexia to its refractory stage by implementing the early recognition and treatment of the nutritional and metabolic alterations occurring during cancer. Research on the molecular mechanisms underlying muscle wasting during cancer cachexia has expanded in the last few years, allowing the identification of several potential therapeutic targets and the development of many promising drugs. Several of these agents have already reached the clinical evaluation, but it is becoming increasingly evident that a single therapy may not be completely successful in the treatment of cancer-related muscle wasting, given its multifactorial and complex pathogenesis. This suggests that early and structured multimodal interventions (including targeted nutritional supplementation, physical exercise and pharmacological interventions) are necessary to prevent and/or treat the devastating consequences of this cancer comorbidity, and future research should focus on this approach.
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Affiliation(s)
- Zaira Aversa
- Department of Clinical Medicine, Sapienza University of Rome, Italy
| | - Paola Costelli
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | - Maurizio Muscaritoli
- Department of Clinical Medicine, Sapienza, University of Rome, Viale dell’Università 37, 00185 Rome, Italy
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22
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Els-Heindl S, Bellmann-Sickert K, Beck-Sickinger AG. C-terminus of a hexapeptidic ghrelin receptor inverse agonist can switch peptide behavior from inverse agonism to agonism. Biopolymers 2017; 106:101-8. [PMID: 26566778 DOI: 10.1002/bip.22768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/05/2015] [Accepted: 11/09/2015] [Indexed: 11/10/2022]
Abstract
Subtle changes in the sequence at the N-terminus and in the aromatic core of hexapeptidic ghrelin receptor inverse agonists can switch behavior from inverse agonism to agonism, but the C-terminal role of the sequence is unclear. Thus, analogs of the ghrelin receptor inverse agonist KbFwLL-NH2 (b = β-(3-benzothienyl)-d-alanine) were synthesized by solid phase peptide synthesis in order to identify the influence of aromaticity, charge, and hydrophobicity. Potency and efficacy of the hexapeptides were evaluated in inositol triphosphate turnover assays. Notably, modifications directly at the C-terminal Leu(6) could influence peptide efficacy leading to decreased constitutive activity. High hydrophobicity at the C-terminal position was of importance for elevated inverse agonist activity, the introduction of charged amino acids led to decreased potency. In contrast, structure-activity relationship studies of Leu(5) located closer to the aromatic core revealed an agonism-inducing position. These findings imply that amino acids with possible cation-π or π-π interactions and a suitable orientation at the C-terminus of the aromatic core induce agonism. Receptor binding studies showed that most peptides bind to the receptor at a concentration of 1 µM and modification directly at the C-terminus is generally more accepted than Leu(5) substitution. Interestingly, this observation is not dependent on the type of modification. These studies reveal another switch region of the short ghrelin receptor ligand pointing out the sensitivity of the ghrelin receptor binding pocket.
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Affiliation(s)
- Sylvia Els-Heindl
- Faculty of Biosciences, Pharmacy and Psychology, Institute of Biochemistry, Universität Leipzig, Brüderstraße 34, Leipzig, 04103, Germany
| | - Kathrin Bellmann-Sickert
- Faculty of Biosciences, Pharmacy and Psychology, Institute of Biochemistry, Universität Leipzig, Brüderstraße 34, Leipzig, 04103, Germany
| | - Annette G Beck-Sickinger
- Faculty of Biosciences, Pharmacy and Psychology, Institute of Biochemistry, Universität Leipzig, Brüderstraße 34, Leipzig, 04103, Germany
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23
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Vanhoutte G, van de Wiel M, Wouters K, Sels M, Bartolomeeussen L, De Keersmaecker S, Verschueren C, De Vroey V, De Wilde A, Smits E, Cheung KJ, De Clerck L, Aerts P, Baert D, Vandoninck C, Kindt S, Schelfhaut S, Vankerkhoven M, Troch A, Ceulemans L, Vandenbergh H, Leys S, Rondou T, Dewitte E, Maes K, Pauwels P, De Winter B, Van Gaal L, Ysebaert D, Peeters M. Cachexia in cancer: what is in the definition? BMJ Open Gastroenterol 2016; 3:e000097. [PMID: 27843571 PMCID: PMC5093365 DOI: 10.1136/bmjgast-2016-000097] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/14/2016] [Accepted: 07/18/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE This study aimed to provide evidence-based results on differences in overall survival (OS) rate to guide the diagnosis of cancer cachexia. DESIGN Data collection and clinical assessment was performed every 3 months (5 visits): baseline data, muscle strength, nutritional and psychosocial status. 2 definitions on cachexia using different diagnostic criteria were applied for the same patient population. Fearon et al's definition is based on weight loss, body mass index (BMI) and sarcopenia. Evans et al nuances the contribution of sarcopenia and attaches additional attention to abnormal biochemistry parameters, fatigue and anorexia. The mean OS rates were compared between patients with and without cachexia for both definitions. RESULTS Based on the population of 167 patients who enrolled, 70% developed cachexia according to Fearon et al's definition and 40% according to Evans et al's definition. The OS in the cachectic population is 0.97 and 0.55 years, respectively. The difference in OS between patients with and without cachexia is more significant using the diagnostic criteria of Evans et al. The focus of Fearon et al on weight loss and sarcopenia over-rates the assignment of patients to the cachectic group and OS rates have less prognostic value. CONCLUSION This study presents a correlation with prognosis in favour of Evans et al' definition as a tool for cachexia diagnosis. This means that weight loss and BMI decline are both key factors in patients with cancer leading to cachexia but less decisive as stated by Fearon et al. Instead, extra factors gain importance in order to predict survival, such as chronic inflammation, anaemia, protein depletion, reduced food intake, fatigue, decreased muscle strength and lean tissue depletion. TRIAL REGISTRATION NUMBER B300201112334.
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Affiliation(s)
- Greetje Vanhoutte
- Universitair Ziekenhuis Antwerpen (UZA) Wilrijkstraat , Edegem , Belgium
| | - Mick van de Wiel
- Department of Oncology (MOCA) , University Hospital Antwerp (UZA) , Edegem , Belgium
| | - Kristin Wouters
- Scientific Coordination and Biostatistics , University Hospital Antwerp (UZA) , Edegem , Belgium
| | - Michaël Sels
- Department of Dietetics , University Hospital Antwerp (UZA) Oncology (MOCA) , Edegem , Belgium
| | - Linda Bartolomeeussen
- Department of Dietetics , University Hospital Antwerp (UZA) Oncology (MOCA) , Edegem , Belgium
| | - Sven De Keersmaecker
- Department of Oncology (MOCA) , University Hospital Antwerp (UZA) , Edegem , Belgium
| | - Caroline Verschueren
- Department of Oncology (MOCA) , University Hospital Antwerp (UZA) , Edegem , Belgium
| | - Veronique De Vroey
- Department of Clinical Biology , University Hospital Antwerp (UZA) , Edegem , Belgium
| | - Annemieke De Wilde
- Department of Pathology , University Hospital Antwerp (UZA) , Edegem , Belgium
| | - Elke Smits
- Scientific Coordination and Biostatistics , University Hospital Antwerp (UZA) , Edegem , Belgium
| | - Kin Jip Cheung
- Department of Oncology (MOCA) , University Hospital Antwerp (UZA) , Edegem , Belgium
| | - Liesbeth De Clerck
- Department of Oncology (MOCA) , University Hospital Antwerp (UZA) , Edegem , Belgium
| | - Petra Aerts
- Laboratory of Experimental Medicine and Pediatrics (LEMP) , University of Antwerp (UA) , Wilrijk , Belgium
| | - Didier Baert
- Department of Gastroenterology , Maria Middelares Medical Centre, AZ Maria Middelares Hospital , Gent , Belgium
| | - Caroline Vandoninck
- Department of Gastroenterology , Maria Middelares Medical Centre, AZ Maria Middelares Hospital , Gent , Belgium
| | - Sofie Kindt
- Department of Gastroenterology , Maria Middelares Medical Centre, AZ Maria Middelares Hospital , Gent , Belgium
| | - Sofie Schelfhaut
- Department of Gastroenterology , Maria Middelares Medical Centre, AZ Maria Middelares Hospital , Gent , Belgium
| | - Marc Vankerkhoven
- Department of Gastroenterology , Maria Middelares Medical Centre, AZ Maria Middelares Hospital , Gent , Belgium
| | | | | | | | - Sven Leys
- Heilig Hart Hospital , Lier , Belgium
| | - Tim Rondou
- Department of Gastroenterology , Sint Jozef Kliniek , Bornem , Belgium
| | - Elke Dewitte
- Department of Gastroenterology , Sint Jozef Kliniek , Bornem , Belgium
| | - Kristel Maes
- Department of Gastroenterology , Sint Jozef Kliniek , Bornem , Belgium
| | - Patrick Pauwels
- Department of Pathology , University Hospital Antwerp (UZA) , Edegem , Belgium
| | - Benedicte De Winter
- Laboratory of Experimental Medicine and Pediatrics (LEMP) , University of Antwerp (UA) , Wilrijk , Belgium
| | - Luc Van Gaal
- Endocrinology, Diabetology, Metabolic Diseases and Nutrition Pathology , University Hospital Antwerp (UZA) , Edegem , Belgium
| | - Dirk Ysebaert
- Hepatobiliary Surgery University Hospital Antwerp (UZA), Edegem, Belgium
| | - Marc Peeters
- Department of Oncology (MOCA) , University Hospital Antwerp (UZA) , Edegem , Belgium
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Paxton BE, Arepally A, Alley CL, Kim CY. Bariatric Embolization: Pilot Study on the Impact of Gastroprotective Agents and Arterial Distribution on Ulceration Risk and Efficacy in a Porcine Model. J Vasc Interv Radiol 2016; 27:1923-1928. [PMID: 27717647 DOI: 10.1016/j.jvir.2016.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/16/2016] [Accepted: 07/24/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To assess whether the number of fundal arteries embolized and use of gastroprotective agents have an impact on ghrelin suppression and gastric ulceration rates. MATERIALS AND METHODS Twenty-two healthy, growing swine (mean, 38.4 kg; range, 30.3-47.0 kg) were evaluated. Six control swine underwent a sham procedure. Gastric embolization was performed by the infusion of 40-µm microspheres selectively into some or all gastric arteries supplying the gastric fundus. In group 1, 6 swine underwent embolization of all 4 arteries to the gastric fundus. In group 2, 5 swine underwent embolization of 2 gastric fundal arteries. In group 3, 5 swine underwent embolization of 1 gastric fundal artery. Animals in groups 2 and 3 were treated with gastroprotective agents (sucralfate and omeprazole). Weight and fasting plasma ghrelin levels were analyzed at baseline and at week 4. Upon animal euthanasia, gross analysis was performed for identification of ulcers. RESULTS Only group 1 animals exhibited changes in serum ghrelin levels that rendered them significantly lower than those in control animals (P = .049). Group 3 animals exhibited marked elevations in serum ghrelin levels compared with control animals (P = .001). Gross pathologic evaluation revealed 0 ulcers in the control animals, 3 ulcers (50%) in group 1, 2 ulcers (40%) in group 2, and 2 ulcers (40%) in group 3. CONCLUSIONS Administration of gastroprotective agents and embolization of fewer arteries to the gastric fundus did not prevent gastric ulceration in treated animals. Only animals that underwent embolization of all gastric arteries exhibited significant decreases in serum ghrelin levels.
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Affiliation(s)
- Ben E Paxton
- Division of Interventional Radiology, Prescott Radiologists, Prescott, Arizona
| | - Aravind Arepally
- Division of Interventional Radiology, Piedmont Healthcare, Atlanta, Georgia
| | | | - Charles Y Kim
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, 2301 Erwin Rd., Durham, NC 27710
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Molfino A, Amabile MI, Rossi Fanelli F, Muscaritoli M. Novel therapeutic options for cachexia and sarcopenia. Expert Opin Biol Ther 2016; 16:1239-44. [DOI: 10.1080/14712598.2016.1208168] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Alessio Molfino
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Ida Amabile
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
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Khatib MN, Shankar A, Kirubakaran R, Gaidhane A, Gaidhane S, Simkhada P, Quazi Syed Z. Ghrelin for the management of cachexia associated with cancer. Hippokratia 2016. [DOI: 10.1002/14651858.cd012229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Mahalaqua Nazli Khatib
- Datta Meghe Institute of Medical Sciences; Department of Physiology; Sawangi Meghe Wardha Maharashtra India 442004
| | - Anuraj Shankar
- Harvard University; Department of Nutrition; 655 Huntington Avenue Building 2, Room 331A Boston Massachusetts USA 02115
| | - Richard Kirubakaran
- Christian Medical College; South Asian Cochrane Network & Center, Prof. BV Moses Center for Evidence-Informed Health Care and Health Policy; Carman Block II Floor CMC Campus, Bagayam Vellore Tamil Nadu India 632002
| | - Abhay Gaidhane
- Datta Meghe Institute of Medical Sciences; Department of Community Medicine; Sawangi Meghe Wardha Maharashtra State India 442004
| | - Shilpa Gaidhane
- Datta Meghe Institute of Medical Sciences; Department of Medicine; Sawangi Meghe Wardha Maharashtra State India 442004
| | - Padam Simkhada
- Liverpool John Moores University; Centre for Public Health; Henry Cotton Building 15-21 Webster Street Liverpool UK L3 2ET
| | - Zahiruddin Quazi Syed
- Datta Meghe Institute of Medical Sciences; Department of Community Medicine; Sawangi Meghe Wardha Maharashtra State India 442004
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27
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Loncar G, Springer J, Anker M, Doehner W, Lainscak M. Cardiac cachexia: hic et nunc. J Cachexia Sarcopenia Muscle 2016; 7:246-60. [PMID: 27386168 PMCID: PMC4929818 DOI: 10.1002/jcsm.12118] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/18/2016] [Indexed: 12/12/2022] Open
Abstract
Cardiac cachexia (CC) is the clinical entity at the end of the chronic natural course of heart failure (HF). Despite the efforts, even the most recent definition of cardiac cachexia has been challenged, more precisely, the addition of new criteria on top of obligatory weight loss. The pathophysiology of CC is complex and multifactorial. A better understanding of pathophysiological pathways in body wasting will contribute to establish potentially novel treatment strategies. The complex biochemical network related with CC and HF pathophysiology underlines that a single biomarker cannot reflect all of the features of the disease. Biomarkers that could pick up the changes in body composition before they convey into clinical manifestations of CC would be of great importance. The development of preventive and therapeutic strategies against cachexia, sarcopenia, and wasting disorders is perceived as an urgent need by healthcare professionals. The treatment of body wasting remains an unresolved challenge to this day. As CC is a multifactorial disorder, it is unlikely that any single agent will be completely effective in treating this condition. Among all investigated therapeutic strategies, aerobic exercise training in HF patients is the most proved to counteract skeletal muscle wasting and is recommended by treatment guidelines for HF.
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Affiliation(s)
- Goran Loncar
- Department of Cardiology Clinical Hospital Zvezdara Belgrade Serbia; School of Medicine University of Belgrade Belgrade Serbia
| | - Jochen Springer
- Innovative Clinical Trials, Department of Cardiology and Pneumology University Medical Center Göttingen (UMG) Göttingen Germany
| | - Markus Anker
- Department of Cardiology Charité - Universitätsmedizin Berlin Germany
| | - Wolfram Doehner
- Center for Stroke Research Berlin Charité Universitätsmedizin Berlin Germany
| | - Mitja Lainscak
- Department of Cardiology and Department of Research and Education General Hospital Celje Celje Slovenia; Faculty of Medicine University of Ljubljana Ljubljana Slovenia
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28
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Abstract
Cancer cachexia is defined as a multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass with or without loss of fat mass. The syndrome cannot be fully reversed by conventional nutritional support, and despite an increased number of studies related to cancer cachexia, the underlying mechanisms are still poorly defined, and therapeutic options are limited. This review focuses on recent studies investigating mechanisms and pathways in cancer cachexia. The role of molecular and functional imaging in identifying cachexia at an earlier stage, in identifying potential metabolic targets and pathways, and in assessing treatment efficacy is also reviewed.
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29
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Cardiac cachexia: hic et nunc: "hic et nunc" - here and now. Int J Cardiol 2015; 201:e1-12. [PMID: 26545926 DOI: 10.1016/j.ijcard.2015.10.115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 02/07/2023]
Abstract
Cardiac cachexia (CC) is the clinical entity at the end of chronic natural course of heart failure (HF). Despite the efforts, even the most recent definition of cardiac cachexia has been challenged, more precisely the addition of new criteria on top of obligatory weight loss. The pathophysiology of CC is complex and multifactorial. Better understanding of pathophysiological pathways in body wasting will contribute to establish potentially novel treatment strategies. The complex biochemical network related with CC and HF pathophysiology underlines that a single biomarker cannot reflect all of the features of the disease. Biomarkers that could pick-up the changes in body composition before they convey into clinical manifestations of CC would be of great importance. The development of preventive and therapeutic strategies against cachexia, sarcopenia and wasting disorders is perceived as an urgent need by healthcare professionals. The treatment of body wasting remains an unresolved challenge to this day. As CC is a multifactorial disorder, it is unlikely that any single agent will be completely effective in treating this condition. Among all investigated therapeutic strategies, aerobic exercise training in HF patients is the most proved to counteract skeletal muscle wasting and is recommended by treatment guidelines for HF.
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30
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Vitorino R, Moreira-Gonçalves D, Ferreira R. Mitochondrial plasticity in cancer-related muscle wasting: potential approaches for its management. Curr Opin Clin Nutr Metab Care 2015; 18:226-33. [PMID: 25783794 DOI: 10.1097/mco.0000000000000161] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Cancer cachexia represents a critical problem in clinical oncology due to its negative impact on patients' quality of life, therapeutic tolerance and survival. This paraneoplasic condition is characterized by significant weight loss mainly from skeletal muscle wasting. Understanding the molecular mechanisms underlying cancer cachexia is urgent in order to develop and apply efficient therapeutic strategies. RECENT FINDINGS Mitochondrial dysfunction is an early event in cancer-induced muscle wasting. Decreased ability for ATP synthesis, impaired mitochondrial biogenesis, increased oxidative stress, impairment of protein quality control systems, increased susceptibility to mitophagy and to apoptosis were all shown to mediate contractile dysfunction and wasting in cancer cachexia. Anti-inflammatory therapies as well as exercise training seem to counteract muscle mass loss in part by improving mitochondrial functionality. SUMMARY Given its central role in muscle wasting, mitochondrial plasticity should be viewed as a key therapeutic target for the preservation of muscle mass in cancer cachexia. Few studies have addressed the mitochondrial events modulated by cancer cachexia and contradictory data were reported. Scarcer studies have focused on the mitochondrial adaptation to anticancer cachexia strategies.
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Affiliation(s)
- Rui Vitorino
- aQOPNA, Department of Chemistry bInstitute for Research in Biomedicine - iBiMED, Health Sciences Program, University of Aveiro, Aveiro cCIAFEL, Faculty of Sports dDepartment of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
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31
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Marini JC, Didelija IC. Arginine depletion by arginine deiminase does not affect whole protein metabolism or muscle fractional protein synthesis rate in mice. PLoS One 2015; 10:e0119801. [PMID: 25775142 PMCID: PMC4361593 DOI: 10.1371/journal.pone.0119801] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/20/2015] [Indexed: 01/23/2023] Open
Abstract
Due to the absolute need for arginine that certain cancer cells have, arginine depletion is a therapy in clinical trials to treat several types of cancers. Arginine is an amino acids utilized not only as a precursor for other important molecules, but also for protein synthesis. Because arginine depletion can potentially exacerbate the progressive loss of body weight, and especially lean body mass, in cancer patients we determined the effect of arginine depletion by pegylated arginine deiminase (ADI-PEG 20) on whole body protein synthesis and fractional protein synthesis rate in multiple tissues of mice. ADI-PEG 20 successfully depleted circulating arginine (<1 μmol/L), and increased citrulline concentration more than tenfold. Body weight and body composition, however, were not affected by ADI-PEG 20. Despite the depletion of arginine, whole body protein synthesis and breakdown were maintained in the ADI-PEG 20 treated mice. The fractional protein synthesis rate of muscle was also not affected by arginine depletion. Most tissues (liver, kidney, spleen, heart, lungs, stomach, small and large intestine, pancreas) were able to maintain their fractional protein synthesis rate; however, the fractional protein synthesis rate of brain, thymus and testicles was reduced due to the ADI-PEG 20 treatment. Furthermore, these results were confirmed by the incorporation of ureido [14C]citrulline, which indicate the local conversion into arginine, into protein. In conclusion, the intracellular recycling pathway of citrulline is able to provide enough arginine to maintain protein synthesis rate and prevent the loss of lean body mass and body weight.
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Affiliation(s)
- Juan C. Marini
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
- United States Department of Agriculture/Agricultural Research Service Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail:
| | - Inka Cajo Didelija
- United States Department of Agriculture/Agricultural Research Service Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
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Camilleri M, Acosta A. Emerging treatments in Neurogastroenterology: relamorelin: a novel gastrocolokinetic synthetic ghrelin agonist. Neurogastroenterol Motil 2015; 27:324-32. [PMID: 25545036 PMCID: PMC4424792 DOI: 10.1111/nmo.12490] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/20/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Synthetic ghrelin agonists, predominantly small molecules, are being developed as prokinetic agents that may prove useful in the treatment of gastrointestinal motility disorders. Relamorelin (RM-131) is a pentapeptide synthetic ghrelin analog that activates the growth hormone secretagogue (GHS)-1a (also called the ghrelin) receptor with approximately sixfold greater potency than natural ghrelin. The ability of relamorelin to stimulate growth hormone (GH) release is comparable to that of native ghrelin. Relamorelin has enhanced efficacy and plasma stability compared to native ghrelin. PURPOSE In this review, we discuss the pharmacokinetics, pharmacodynamics and potential indications for relamorelin. Relamorelin is administered subcutaneously, dosed daily or twice daily. Relamorelin is being studied for the treatment of patients with gastrointestinal motility disorders. Phase IIA pharmacodynamic studies have demonstrated acceleration of gastric emptying in patients with type 1 diabetes mellitus (T1DM) and type 2 DM (T2DM) and upper gastrointestinal symptoms. In a phase IIA study in patients with diabetic gastroparesis, relamorelin accelerated gastric emptying and significantly improved vomiting frequency compared to placebo and improved other symptoms of gastroparesis in a prespecified subgroup of patients with vomiting at baseline. In patients with chronic idiopathic constipation with defined transit profile at baseline, relamorelin relieved constipation and accelerated colonic transit compared to placebo. These characteristics suggest that this new ghrelin analog shows great promise to relieve patients with upper or lower gastrointestinal motility disorders.
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Affiliation(s)
- M. Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.); Mayo Clinic; Rochester MN USA
| | - A. Acosta
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.); Mayo Clinic; Rochester MN USA
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Fujitsuka N, Uezono Y. Rikkunshito, a ghrelin potentiator, ameliorates anorexia-cachexia syndrome. Front Pharmacol 2014; 5:271. [PMID: 25540621 PMCID: PMC4261902 DOI: 10.3389/fphar.2014.00271] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/20/2014] [Indexed: 12/24/2022] Open
Abstract
Anorexia–cachexia syndrome develops during the advanced stages of various chronic diseases in which patients exhibit a decreased food intake, weight loss, and muscle tissue wasting. For these patients, this syndrome is a critical problem leading to an increased rate of morbidity and mortality. The present pharmacological therapies for treating anorexia–cachexia have limited effectiveness. The Japanese herbal medicine rikkunshito is often prescribed for the treatment of anorexia and upper gastrointestinal (GI) disorders. Thus, rikkunshito is expected to be beneficial for the treatment of patients with anorexia–cachexia syndrome. In this review, we summarize the effects of rikkunshito and its mechanisms of action on anorexia–cachexia. Persistent loss of appetite leads to a progressive depletion of body energy stores, which is frequently associated with cachexia. Consequently, regulating appetite and energy homeostasis is critically important for treating cachexia. Ghrelin is mainly secreted from the stomach, and it plays an important role in initiating feeding, controlling GI motility, and regulating energy expenditure. Recent clinical and basic science studies have demonstrated that the critical mechanism of rikkunshito underlies endogenous ghrelin activity. Interestingly, several components of rikkunshito target multiple gastric and central sites, and regulate the secretion, receptor sensitization, and degradation of ghrelin. Rikkunshito is effective for the treatment of anorexia, body weight loss, muscle wasting, and anxiety-related behavior. Furthermore, treatment with rikkunshito was observed to prolong survival in an animal model of cachexia. The use of a potentiator of ghrelin signaling, such as rikkunshito, may represent a novel approach for the treatment of anorexia–cachexia syndrome.
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Affiliation(s)
| | - Yasuhito Uezono
- Division of Cancer Pathophysiology, National Cancer Center Research Institute Tokyo, Japan
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