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Gutierrez-Leal I, Caballero-Hernández D, Orozco-Flores AA, Gomez-Flores R, Quistián-Martínez D, Tamez-Guerra P, Tamez-Guerra R, Rodríguez-Padilla C. Role of the sympathetic nervous system in cancer-associated cachexia and tumor progression in tumor-bearing BALB/c mice. BMC Neurosci 2024; 25:37. [PMID: 39174899 PMCID: PMC11342617 DOI: 10.1186/s12868-024-00887-8] [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: 04/18/2024] [Accepted: 08/14/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Adipose and muscle tissue wasting outlines the cachectic process during tumor progression. The sympathetic nervous system (SNS) is known to promote tumor progression and research suggests that it might also contribute to cancer-associated cachexia (CAC) energetic expenditure through fat wasting. METHODS We sympathectomized L5178Y-R tumor-bearing male BALB/c mice by intraperitoneally administering 6-hydroxydopamine to evaluate morphometric, inflammatory, and molecular indicators of CAC and tumor progression. RESULTS Tumor burden was associated with cachexia indicators, including a 10.5% body mass index (BMI) decrease, 40.19% interscapular, 54% inguinal, and 37.17% visceral adipose tissue loss, a 12% food intake decrease, and significant (p = 0.038 and p = 0.0037) increases in the plasmatic inflammatory cytokines IL-6 and IFN-γ respectively. Sympathectomy of tumor-bearing mice was associated with attenuated BMI and visceral adipose tissue loss, decreased interscapular Ucp-1 gene expression to basal levels, and 2.6-fold reduction in Mmp-9 relative gene expression, as compared with the unsympathectomized mice control group. CONCLUSION The SNS contributes to CAC-associated morphometric and adipose tissue alterations and promotes tumor progression in a murine model.
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Affiliation(s)
- Isaias Gutierrez-Leal
- Facultad de Ciencias Biológicas, Laboratorio de Inmunología y Virología, Universidad Autónoma de Nuevo León, Apartado postal 46 F, San Nicolás de los Garza, NL, 66451, Mexico
| | - Diana Caballero-Hernández
- Facultad de Ciencias Biológicas, Laboratorio de Inmunología y Virología, Universidad Autónoma de Nuevo León, Apartado postal 46 F, San Nicolás de los Garza, NL, 66451, Mexico.
| | - Alonso A Orozco-Flores
- Facultad de Ciencias Biológicas, Laboratorio de Inmunología y Virología, Universidad Autónoma de Nuevo León, Apartado postal 46 F, San Nicolás de los Garza, NL, 66451, Mexico
| | - Ricardo Gomez-Flores
- Facultad de Ciencias Biológicas, Laboratorio de Inmunología y Virología, Universidad Autónoma de Nuevo León, Apartado postal 46 F, San Nicolás de los Garza, NL, 66451, Mexico
| | - Deyanira Quistián-Martínez
- Facultad de Ciencias Biológicas, Departamento de Botánica, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, NL, 66451, Mexico
| | - Patricia Tamez-Guerra
- Facultad de Ciencias Biológicas, Laboratorio de Inmunología y Virología, Universidad Autónoma de Nuevo León, Apartado postal 46 F, San Nicolás de los Garza, NL, 66451, Mexico
| | - Reyes Tamez-Guerra
- Facultad de Ciencias Biológicas, Laboratorio de Inmunología y Virología, Universidad Autónoma de Nuevo León, Apartado postal 46 F, San Nicolás de los Garza, NL, 66451, Mexico
| | - Cristina Rodríguez-Padilla
- Facultad de Ciencias Biológicas, Laboratorio de Inmunología y Virología, Universidad Autónoma de Nuevo León, Apartado postal 46 F, San Nicolás de los Garza, NL, 66451, Mexico
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Life after acute pandysautonomia: a 40-year journey. Clin Auton Res 2023; 33:77-78. [PMID: 36574076 DOI: 10.1007/s10286-022-00916-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/11/2022] [Indexed: 12/28/2022]
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Noor B, Akhavan S, Leuchter M, Yang EH, Ajijola OA. Quantitative assessment of cardiovascular autonomic impairment in cancer survivors: a single center case series. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2020; 6:11. [PMID: 32742722 PMCID: PMC7388471 DOI: 10.1186/s40959-020-00065-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cardiovascular autonomic dysfunction in cancer survivors is poorly understood. OBJECTIVES To better characterize the clinical characteristics and types of autonomic dysfunction in this population. METHODS A retrospective analysis of cancer survivors within an academic cardio-oncology program referred for suspected autonomic dysfunction was performed. Autonomic reflex testing of adrenergic, cardiovagal, and sudomotor function was done. Autonomic impairment was graded on severity based on the Composite Autonomic Severity Score system. Patients with pre-existing autonomic dysfunction prior to their cancer diagnosis were excluded. RESULTS Of approximately 282 total patients in the UCLA Cardio-Oncology program, 24 were referred for suspected autonomic dysfunction and met the inclusion criteria. 22 had autonomic impairment on autonomic reflex testing. Eight patients were female, and the mean age at time of autonomic testing was 51.3 years. The average duration from cancer diagnosis to autonomic testing was 10.3 years. The reasons for referral included dizziness, tachycardia, palpitations, and syncope. The majority of patients (75%) had hematologic disorders. The most common chemotherapies administered were vinca alkaloids (54.2%), alkylating agents (66.7%), and anthracyclines (54.2%). Most patients received radiation to the thorax (66.7%) and neck (53.3%). Eleven patients had mild autonomic impairment, 7 had moderate, and 4 had severe autonomic impairment. Dysfunction was commonly present in the sympathetic and parasympathetic branches, but most pronounced in the sympathetic system. The majority of patients were diagnosed with orthostatic hypotension (50%), inappropriate sinus tachycardia (20.8%), and postural orthostatic tachycardia syndrome (12.5%) and had subjective improvement with treatment. CONCLUSION Cardiovascular autonomic dysfunction occurs in cancer survivors, and commonly affects both the sympathetic and parasympathetic systems. Symptom recognition in patients should prompt autonomic testing and treatment where appropriate.
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Affiliation(s)
- Benjamin Noor
- Division of Internal Medicine, Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
| | - Shannel Akhavan
- UCLA Cardio-Oncology Program and Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
| | - Michael Leuchter
- UCLA Cardiac Arrhythmia and Neurocardiology Research Center, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 100 Medical Plaza, Suite 660, Westwood Blvd, Los Angeles, CA 90095-1679 USA
| | - Eric H. Yang
- UCLA Cardio-Oncology Program and Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
| | - Olujimi A. Ajijola
- UCLA Cardio-Oncology Program and Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
- UCLA Cardiac Arrhythmia and Neurocardiology Research Center, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 100 Medical Plaza, Suite 660, Westwood Blvd, Los Angeles, CA 90095-1679 USA
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Classical Hodgkin Lymphoma Presenting with Severe, Recurrent Hypothermic Episodes. Case Rep Hematol 2018; 2018:3726593. [PMID: 30356349 PMCID: PMC6176302 DOI: 10.1155/2018/3726593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 08/30/2018] [Indexed: 11/17/2022] Open
Abstract
We report a case presenting with recurrent episodes of severe hypothermia preceding the diagnosis of Hodgkin lymphoma. The episodes of hypothermia were accompanied by other symptoms of autonomic dysfunction, mainly hypotension, which could be caused by autonomic neuropathy as part of a paraneoplastic syndrome. In comparison with previous reports describing an association between the presence of hypothermia and an adverse outcome, the present patient has responded well to lymphoma-specific treatment and is currently in an ongoing complete remission. Due to the peculiar cyclic pattern of the hypothermic episodes presented in this case, we hypothesize whether intermittent release of disease-related chemo- and cytokines could be a plausible pathogenetic explanation.
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Barbot M, Ceccato F, Zilio M, Albiger N, Sigon R, Rolma G, Boscaro M, Scaroni C, Bilora F. Cardiovascular autonomic dysfunction in patients with idiopathic diabetes insipidus. Pituitary 2018; 21:50-55. [PMID: 29081004 DOI: 10.1007/s11102-017-0846-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Central diabetes insipidus (DI) is a rare disease characterized by the excretion of excessive volumes of dilute urine due to reduced levels of the antidiuretic hormone arginine vasopressin (AVP), caused by an acquired or genetic defect in the neurohypophysis. The aim of this study was to identify any autonomic dysfunction (AD) in patients with DI as a possible cofactor responsible for their reportedly higher mortality. METHODS The study involved 12 patients (6 females) with central idiopathic DI and a well-controlled electrolyte balance, and 12 controls matched for age, sex and cardiovascular risk factors, who were assessed using the tilt, lying-to-standing, hand grip, deep breath, Valsalva maneuver and Stroop tests. RESULTS The tilt test showed a significantly more pronounced decrease in both systolic (- 20.67 ± 18 vs. - 1.92 ± 6.99 mmHg, p = 0.0009) and diastolic blood pressure (- 10.5 ± 14.29 vs. - 1.5 ± 5 mmHg, p = 0.012) in patients than in controls. Three patients with DI had to suspend the test due to the onset of syncope. The lying-to-standing test also revealed a marked reduction in blood pressure in patients with DI (1.05 ± 0.13 vs. 1.53 ± 0.14, p = 0.0001). Similar results emerged for the Valsalva maneuver (Valsalva ratio, 1.24 ± 0.19 vs. 1.79 ± 0.11, p < 0.0001) and deep breath test (1.08 ± 0.11 vs. 1.33 ± 0.08, p < 0.0001). CONCLUSIONS All the principal autonomic tests performed in the study were concordant in indicating that patients with central DI have an impaired autonomic nervous system function despite a normal hydroelectrolytic balance under desmopressin therapy. This impairment may reflect damage to the autonomic system per se and/or the absence of any vasoactive effect of AVP on vascular smooth muscle. In our opinion, patients with central DI should be educated on how to prevent orthostatic hypotension, and pharmacological treatment should be considered for patients with a more marked impairment.
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Affiliation(s)
- Mattia Barbot
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy.
| | - Filippo Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy
| | - Marialuisa Zilio
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy
| | - Nora Albiger
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy
| | - Riccardo Sigon
- Endocrinology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Rolma
- Neuroradiology Institute, Hospital of Padova, Padova, Italy
| | - Marco Boscaro
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128, Padova, Italy
| | - Franca Bilora
- Coagulation Section, Department of Cardiovascular and Thoracic Sciences, University of Padova, Padova, Italy
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Cardiovascular effects of Hodgkin’s lymphoma: a review of literature. J Cancer Res Clin Oncol 2017; 144:99-107. [DOI: 10.1007/s00432-017-2560-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/11/2017] [Indexed: 01/09/2023]
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Mangla A, Dang G, Hamad H, Mohajer R, Catchatourian R, Kovarik P. Hypotension associated with advanced hodgkin lymphoma. Hematol Rep 2014; 6:5572. [PMID: 25317321 PMCID: PMC4194386 DOI: 10.4081/hr.2014.5572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 08/27/2014] [Accepted: 08/29/2014] [Indexed: 12/03/2022] Open
Abstract
Hypotension is an extremely rare manifestation of Hodgkin lymphoma. We report the case of a patient who presented with new onset hypotension and was diagnosed with urosepsis and septic shock requiring pressor support for maintaining his blood pressure. computed tomography (CT) scan of abdomen showed liver lesions, which were new on comparison with a CT abdomen done 3 weeks back. Biopsy of the liver lesions and subsequently a bone marrow biopsy showed large atypical Reed-Sternberg cells, positive for CD15 and CD 30 and negative for CD45, CD3 and CD20 on immuno-histochemical staining, hence establishing the diagnosis of Hodgkin lymphoma. The mechanism involved in Hodgkin lymphoma causing hypotension remains anecdotal, but since it is mostly seen in patients with advanced Hodgkin lymphoma, it is hypothetically related to a complex interaction between cytokines and mediators of vasodilatation. Here we review relevant literature pertaining to presentation and pathogenesis of this elusive and rare association.
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Affiliation(s)
- Ankit Mangla
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County , Chicago, IL, USA
| | - Geetanjali Dang
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County , Chicago, IL, USA
| | - Hussein Hamad
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County , Chicago, IL, USA
| | - Roozbeh Mohajer
- Division of Hematology and Oncology, John H. Stroger Jr. Hospital of Cook County , Chicago, IL, USA
| | - Rosalind Catchatourian
- Division of Hematology and Oncology, John H. Stroger Jr. Hospital of Cook County , Chicago, IL, USA
| | - Paula Kovarik
- Department of Pathology, John H. Stroger Jr. Hospital of Cook County , Chicago, IL, USA
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Shepshelovich D, Shpilberg O, Lahav M, Itchaki G, Yakimov M, Raanani P, Cohen A. Hodgkin lymphoma and hypothermia: case report and review of the literature. Acta Haematol 2013; 131:227-30. [PMID: 24335335 DOI: 10.1159/000355262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 08/22/2013] [Indexed: 11/19/2022]
Abstract
We report the development of hypothermia in a patient with Hodgkin lymphoma which resolved with chemotherapy administration. A review of the literature revealed 16 previous reports of hypothermia in patients with Hodgkin lymphoma. Overall prognosis seems to be unfavorable. To the best of our knowledge this is the first report of hypothermia in a patient with Hodgkin lymphoma transforming from chronic lymphocytic leukemia (Richter's syndrome). A possible pathophysiology could be paraneoplastic autonomic neuropathy. Physicians should be aware that Hodgkin lymphoma can present with hypothermia and should carefully monitor newly diagnosed patients with advanced disease for this complication. Likewise, patients with Hodgkin lymphoma who develop hypothermia should be screened for signs of autonomic neuropathy.
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Affiliation(s)
- Daniel Shepshelovich
- Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
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