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Sharma PS, Nandimath KR, Hiremath S, Burde K. Alteration of plasma free amino acids’ level in oral squamous cell carcinoma patients using High Performance Liquid Chromatography. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2020. [DOI: 10.1016/j.ajoms.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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2
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van der Meij BS, Teleni L, Engelen MPKJ, Deutz NEP. Amino acid kinetics and the response to nutrition in patients with cancer. Int J Radiat Biol 2018; 95:480-492. [PMID: 29667485 DOI: 10.1080/09553002.2018.1466209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE Amino acids are involved in many physiological processes in the body and serve as building blocks of proteins which are the main component of muscle mass. Often patients with cancer experience muscle wasting, which is associated with poor outcomes. The purpose of this paper is to discuss amino acid kinetics in cancer, review the evidence on the response to nutrition in patients with cancer, and to give recommendations on the appropriate level of amino acid or protein intake in cancer. Current evidence shows that amino acid kinetics in patients with cancer are disturbed, as reflected by increased and decreased levels of plasma amino acids, an increased whole body turnover of protein and muscle protein breakdown. A few studies show beneficial effects of acute and short-term supplementation of high protein meals or essential amino acid mixtures on muscle protein synthesis. CONCLUSIONS Cancer is associated with disturbances in amino acid kinetics. A high protein intake or supplementation of amino acids may improve muscle protein synthesis. Future research needs to identify the optimal level and amino acid mixtures for patients with cancer, in particular for those who are malnourished.
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Affiliation(s)
- Barbara S van der Meij
- a Faculty of Health Sciences and Medicine , Bond University , Gold Coast , Australia.,b Nutrition and Dietetics , Mater Group , Brisbane , Australia
| | - Laisa Teleni
- a Faculty of Health Sciences and Medicine , Bond University , Gold Coast , Australia
| | - Marielle P K J Engelen
- c Department Health and Kinesiology , Center for Translational Research in Aging & Longevity, Texas A&M University , College Station , TX , USA
| | - Nicolaas E P Deutz
- c Department Health and Kinesiology , Center for Translational Research in Aging & Longevity, Texas A&M University , College Station , TX , USA
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3
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Signatures of protein expression revealed by secretome analyses of cancer associated fibroblasts and melanoma cell lines. J Proteomics 2018; 174:1-8. [DOI: 10.1016/j.jprot.2017.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/11/2017] [Accepted: 12/18/2017] [Indexed: 02/07/2023]
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4
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Dodesini AR, Benedini S, Terruzzi I, Sereni LP, Luzi L. Protein, glucose and lipid metabolism in the cancer cachexia: A preliminary report. Acta Oncol 2009; 46:118-20. [PMID: 17438714 DOI: 10.1080/02841860600791491] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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5
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Holdsworth JD, Dionigi P, Clague MB, James OF, Wright PD. Body protein metabolism and plasma amino acids in cirrhosis of the liver. The effect of varying the branched chain amino acid content of intravenous amino acid solutions. Clin Nutr 2008; 3:153-62. [PMID: 16829451 DOI: 10.1016/s0261-5614(84)80032-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Body protein metabolism and plasma amino acids were measured in 37 patients with stable cirrhosis of the liver to assess the effect of disease severity (Child's classification). Thirty two patients underwent a second series of measurements while nutrition was administered intravenously as one of five different infusions. Four infusions were formulations of amino acids with dextrose of varying branched chain amino acid content (100%, 53%, 35% and 16% branched chain to total amino acids). The fifth infusion was dextrose alone. No differences were detected in body protein synthesis and breakdown between patients on the basis of disease severity although some small differences were noted in the plasma amino acids. Infusion of dextrose alone and the 16% BCAA solution led to negative protein balance and a lowering of the plasma branched chain amino acid concentrations. Improved protein balance was observed with 35% BCAA, this solution also lowered the levels of methionine and aromatic amino acids. In those patients given 53% BCAA protein balance was achieved and the plasma branched chain amino acids elevated. Protein balance also occurred with 100% BCAA, in association with marked increases in underlying protein synthesis and breakdown and with this infusion there were marked elevations in the plasma branched chain amino acids and depression of the other plasma amino acids. The increase in protein breakdown with this last formulation was unexpected and may be harmful. On the basis of these findings it is suggested that the composition of the 53% and 35% solutions may be optimal to protein metabolism and manipulation of plasma amino acids in this group of patients.
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Affiliation(s)
- J D Holdsworth
- Department of Medicine and Surgery, University of Newcastle upon Tyne, UK
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6
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Smith HJ, Greenberg NA, Tisdale MJ. Effect of eicosapentaenoic acid, protein and amino acids on protein synthesis and degradation in skeletal muscle of cachectic mice. Br J Cancer 2004; 91:408-12. [PMID: 15213711 PMCID: PMC2409806 DOI: 10.1038/sj.bjc.6601981] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Atrophy of skeletal muscle reduces both the quality and quantity of life of patients with cancer cachexia. Loss of muscle mass is thought to arise from a reduction in protein synthesis combined with an enhanced rate of protein degradation, and few treatments are available to counteract this process. Eicosapentaenoic acid (EPA) has been shown to attenuate the enhanced protein degradation, but to have no effect on protein synthesis. This study examines the effect of EPA combined with a protein and amino-acid supplementation on protein synthesis and degradation in gastrocnemius muscle of mice bearing the cachexia-inducing MAC16 tumour. Muscles from cachectic mice showed an 80% reduction in protein synthesis and about a 50-fold increase in protein degradation compared with muscles from nontumour-bearing mice of the same age and weight. Treatment with EPA (1 g kg−1) daily reduced protein degradation by 88%, but had no effect on protein synthesis. Combination of EPA with casein (5.35 g kg−1) also had no effect on protein synthesis, but when combined with the amino acids leucine, arginine and methionine there was almost a doubling of protein synthesis. The addition of carbohydrate (10.7 g kg−1) to stimulate insulin release had no additional effect. The combination involving the amino acids produced almost a doubling of the ratio of protein synthesis to protein degradation in gastrocnemius muscle over that of EPA alone. No treatment had a significant effect on tumour growth rate, but the inclusion of amino acids had a more significant effect on weight loss induced by the MAC16 tumour than that of EPA alone. The results suggest that combination therapy of cancer cachexia involving both inhibition of the enhanced protein degradation and stimulation of the reduced protein synthesis may be more effective than either treatment alone.
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Affiliation(s)
- H J Smith
- Pharmaceutical Sciences Research Institute, Aston University, Birmingham B4 7ET, UK
| | - N A Greenberg
- Novartis Nutrition, 1541 Park Place Blvd., Minneapolis, MN 55416, USA
| | - M J Tisdale
- Pharmaceutical Sciences Research Institute, Aston University, Birmingham B4 7ET, UK
- Pharmaceutical Sciences Research Institute, Aston University, Birmingham B4 7ET, UK. E-mail:
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7
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Minet-Quinard R, Van Praagh I, Kwiatkowski F, Beaujon G, Feillel V, Beaufrère B, Bargnoux PJ, Cynober L, Vasson MP. Pre- and postoperative aminoacidemia in breast cancer: a study vs. matched healthy subjects. Cancer Invest 2004; 22:203-10. [PMID: 15199602 DOI: 10.1081/cnv-120030208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Various alterations of aminoacidemia have been described during breast cancer. The aim of this study was first to establish the specific modifications of plasma-free amino acid concentrations by a comparative study of 19 patients with mammary tumors and 18 healthy volunteers, and, second, to determine the evolution of aminoacidemia after surgical tumor removal. Aminoacidemia was determined the day before (D0), and then five days, one month (M1), and six months after surgical removal of the tumor, and a single determination was performed in control subjects. Plasma levels (mumol/L) of serine and glutamate were higher in cancer-bearing women at D0 (respectively, 124 +/- 3 and 68 +/- 7) than in healthy volunteers (respectively, 110 +/- 6 and 48 +/- 5). Surgical tumor removal induced a normalization of aminoacidemia (in mumol/L at D5: serine: 114 +/- 4; at M1: glutamate: 55 +/- 6 Non Significant (NS) from values of healthy subjects). Among the various patterns reported for breast cancer, we confirm one of those described by Cascino in 1995, and we show that these levels revert to normal after tumor surgical removal.
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Affiliation(s)
- Régine Minet-Quinard
- Laboratoire de Biochimie, Biologie Moléculaire et Nutrition, Faculté de Pharmacie, Clermont-Ferrand, France.
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8
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Biolo G, Antonione R, Barazzoni R, Zanetti M, Guarnieri G. Mechanisms of altered protein turnover in chronic diseases: a review of human kinetic studies. Curr Opin Clin Nutr Metab Care 2003; 6:55-63. [PMID: 12496681 DOI: 10.1097/00075197-200301000-00009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Changes in hormone secretion, tissue perfusion, oxygen availability, energy-protein intake, free amino acid pattern, hydration state, acid-base balance as well as activation of the systemic inflammatory response may affect protein synthesis and degradation. The overall purpose of this review is to describe how these factors may interact to change protein turnover in the different directions seen in kinetic studies in humans. RECENT FINDINGS Evidence indicates that, in vivo, changes of protein synthesis and degradation are strictly related. When protein synthesis is primarily suppressed, protein degradation is found to be unchanged or even slightly decreased. When protein degradation is primarily accelerated, the rate of synthesis is unchanged or even increased. Chronic disease states can, therefore, be characterized either by decreased or accelerated protein turnover. Apparent discrepancies among various studies in chronic uraemia, liver cirrhosis, chronic obstructive pulmonary disease and cancer may stem from the fact that the pathogenesis of protein metabolism abnormalities is multifactorial. When the effects of inflammatory mediators and stress hormones start overwhelming factors that tend to decrease protein synthesis and turnover (decreased protein-energy intake, physical activity, tissue oxygen delivery, leucine levels, etc.), the rate of protein degradation and turnover may increase. SUMMARY Low-protein turnover conditions are usually associated with the adequate sparing of body proteins, whereas in high-protein turnover conditions protein loss may proceed at a faster rate. Nonetheless, impaired recovery from acute complications and the reduced renewal of damaged and toxic proteins are potential undesired consequences of low-protein turnover.
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Abstract
Cancer cachexia is a frequent complication observed in patients with malignant tumors. Although several decades have passed since the first focus on the metabolic dysfunction's associated with cancer, few effective therapeutic interventions have been successfully introduced into the medical armamentarium. The present study thoroughly reviews the basic pathophysiology of cancer cachexia and the treatment options already investigated in that field. Experimental and clinical studies were evaluated individually in order to clarify the intricate alterations observed in tumor-bearing patients. The difficulties in introducing sound and effective nutritional support or metabolic manipulation to reverse cancer cachexia are outlined in this review.
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Affiliation(s)
- R N Younes
- Department of Surgery, Hospital das Clínicas, Faculty of Medicine, University of São Paulo
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10
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Abstract
Cachexia is a common cause of morbidity and mortality in patients with advanced cancer. It is characterised by numerous metabolic abnormalities including inefficient substrate utilisation, alterations in the balance of energy intake and expenditure and the acute-phase protein response. These changes seem to be driven by pro-inflammatory cytokines, alterations of the neuro-endocrine axis and tumour-derived catabolic factors. This results in the loss of both fat and lean tissue. Trials of conventional nutritional supplements in patients with cancer cachexia have failed to show any benefit in terms of weight gain or quality of life and this may be because the ongoing metabolic abnormalities prevent the efficient use of additional calories supplied. A variety of pharmacological agents have been studied in an attempt to normalise these metabolic changes with only limited success. However, it is possible that the combination of an agent to normalise the metabolic milieu along with the provision of additional nutritional support may have the potential to reverse cachexia in advanced cancer.
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Affiliation(s)
- M D Barber
- University Department of Surgery, Royal Infirmary of Edinburgh, Scotland EH3 9YW, Edinburgh, UK
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11
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Muscaritoli M, Conversano L, Petti MC, Torelli GF, Cascino A, Mecarocci S, Annicchiarico MA, Rossi Fanelli F. Plasma amino acid concentrations in patients with acute myelogenous leukemia. Nutrition 1999; 15:195-9. [PMID: 10198913 DOI: 10.1016/s0899-9007(98)00179-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Changes in plasma-free amino acid (PFAA) concentrations in the presence of solid tumors have been widely described. Conversely, the PFAA profile in patients with acute leukemias is less well defined. The aim of the present study was to clarify whether the PFAA profile is altered in patients with acute myeloid leukemia (AML), whether the profile differs from the PFAA profile of solid tumors, and whether it may predict outcome of AML. Fasting PFAA were measured in 40 untreated, normally nourished patients with AML (17 males, 23 females), ages 22-78 y, with white blood cell (WBC) counts ranging from 1.08 to 276.5 x 10(3)/cm2, and in 24 healthy volunteers. Plasma concentrations (mu mol/L, mean +/- SE) of glutamic acid (GLU), free tryptophan (FTRP), ornithine (ORN), and glycine (GLY) were significantly higher in AML (GLU: 90.2 +/- 6.1 versus 37 +/- 8; FTRP: 7.0 +/- 0.6 versus 4.8 +/- 0.3, P < 0.005; ORN: 108.7 +/- 5.8 versus 78 +/- 6, P < 0.001; GLY: 295.0 +/- 14.8 versus 239 +/- 9, P < 0.01), whereas serine (SER), methionine (MET), and taurine (TAU) were significantly lower in AML than in controls (SER: 109.0 +/- 5.8 versus 130 +/- 4, P < 0.03; MET: 25.5 +/- 1.3 versus 33 +/- 3, P < 0.03; TAU: 46.5 +/- 3.5 versus 81 +/- 2, P < 0.001), and tended to be even lower in patients who had not responded to chemotherapy or had relapsed within 18 mo of enrollment. Such changes were unrelated to age, sex, and WBC count. Changes in PFAA that occur in AML are only in part similar to those observed in solid tumors. The reduction of TAU appears to be a typical feature of AML and might be secondary to the deficiency of its precursors SER and MET. Further studies are under way aimed at clarifying whether PFAA might predict prognosis in AML, whether PFAA is normalized by remission induction, and if its correction may be of any benefit for patients with hematologic malignancies.
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Affiliation(s)
- M Muscaritoli
- Department of Clinical Medicine, University La Sapienza, Rome, Italy.
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12
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Forchielli ML, Paolucci G, Lo CW. Total parenteral nutrition and home parenteral nutrition: an effective combination to sustain malnourished children with cancer. Nutr Rev 1999; 57:15-20. [PMID: 10047701 DOI: 10.1111/j.1753-4887.1999.tb01771.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A patient with Wilms' tumor and severe failure to thrive required total parenteral nutrition (TPN) for "catch-up" growth. This case underscores how TPN might be useful in the management of a child with cancer. Cancer cachexia, chemotherapy, radiation, and infections caused by immune suppression can lead to potentially serious macro- and micronutrient deficiencies.
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13
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Lorite MJ, Thompson MG, Drake JL, Carling G, Tisdale MJ. Mechanism of muscle protein degradation induced by a cancer cachectic factor. Br J Cancer 1998; 78:850-6. [PMID: 9764574 PMCID: PMC2063122 DOI: 10.1038/bjc.1998.592] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A proteolysis-inducing factor (PIF) isolated from a cachexia-inducing murine tumour (MAC16) produced a decrease in body weight (1.6 g, P < or = 0.01 compared with control subjects) within 24 h after i.v. administration to non-tumour-bearing mice. Weight loss was associated with significant decreases in the weight of the spleen and soleus and gastrocnemius muscles, with no effect on the weight of the heart or kidney and with an increase in weight of the liver. Protein degradation in isolated soleus muscle was significantly increased in mice bearing the MAC16 tumour. To define which proteolytic pathways contribute to this increase, soleus muscles from mice bearing the MAC16 tumour and non-tumour-bearing animals administered PIF were incubated under conditions that modify different proteolytic systems. In mice bearing the MAC16 tumour, there were increases in both cathepsin B and L, and the Ca2+-dependent lysosomal and ATP-dependent pathways were found to contribute to the increased proteolysis; whereas, in PIF-injected animals, there was activation only of the ATP-dependent pathway. Further studies in mice bearing the MAC16 tumour have provided evidence for increased levels of ubiquitin-conjugated proteins and increased mRNA levels for the 14 kDa ubiquitin carrier protein E2 and the C9 proteasome subunit in gastrocnemius muscle, suggesting activation of the ATP-ubiquitin-dependent proteolytic pathway. A monoclonal antibody to PIF attenuated the enhanced protein degradation in soleus muscle from mice bearing the MAC16 tumour, confirming that PIF is responsible for the loss of skeletal muscle in cachectic mice.
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Affiliation(s)
- M J Lorite
- Pharmaceutical Sciences Institute, Aston University, Birmingham, UK
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14
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Daley SE, Pearson AD, Craft AW, Kernahan J, Wyllie RA, Price L, Brock C, Hetherington C, Halliday D, Bartlett K. Whole body protein metabolism in children with cancer. Arch Dis Child 1996; 75:273-81. [PMID: 8984910 PMCID: PMC1511724 DOI: 10.1136/adc.75.4.273] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Whole body protein synthesis and catabolism were measured using the [ring-2H5]phenylalanine and [1-13C]leucine primed constant infusion technique in 32 paediatric patients with cancer at different stages of treatment. Rates of synthesis (S) and catabolism (C) derived from the [ring-2H5]phenylalanine and [1-13C]leucine models were 4.7 (SD 1.3) (S) and 6.0 (1.5) (C) g/d/kg, and 5.5 (0.8) (S) and 6.8 (1.2) (C) g/d/kg, respectively. These results show that these two tracer techniques give similar results in this study population. Comparison of these values with results previously reported for groups of control children using the [ring-2H5]phenylalanine model (S = 3.69 and 3.93; C = 4.09 and 4.28 g/d/kg) and the [1-13C]leucine model (S = 4.32; C = 4.85 g/d/kg) show that rates of synthesis and catabolism were higher in cancer patients than in controls. Thus whole body protein turnover is increased in children under treatment for cancer. Other indices of metabolism such as plasma amino acids and intermediary metabolites were also measured and showed that, although subjects were in isotopic steady state, there were significant metabolic changes during the course of the primed constant infusions used to measure protein turnover.
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Affiliation(s)
- S E Daley
- Department of Child Health, University of Newcastle upon Tyne
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15
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Chesnin V, Adunsky A, Waller A. The effect of intravenous fluid infusion on blood and urine parameters of hydration and on state of consciousness in terminal cancer patients. Am J Hosp Palliat Care 1996; 13:3. [PMID: 8716319 DOI: 10.1177/104990919601300201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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16
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Tayek JA, Sutter L, Manglik S, Lillington LB, Grosvenor M, Chlebowski RT. Altered metabolism and mortality in patients with colon cancer receiving chemotherapy. Am J Med Sci 1995; 310:48-55. [PMID: 7631642 DOI: 10.1097/00000441-199508000-00002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To identify the metabolic effects of 5-fluorouracil and hydrazine sulfate therapy, 22 patients with colon cancer were admitted prospectively to a Clinical Research Center for serial measurement of counter-regulatory hormones, fasting hepatic glucose production (HGP), intravenous glucose tolerance test, plasma leucine appearance (LA) and leucine oxidation. Combined therapy was associated with a significant reduction in fasting glucose level (98 +/- 2 mg/dL to 94 +/- 2, P < 0.025) without a significant fall in fasting HGP (2.09 +/- 0.11 mg/kg/min versus 2.03 +/- 0.13; P > 0.05). The decreased fasting glucose value was associated with a mild but not statistically improved glucose disposal rate in response to the intravenous glucose tolerance test (1.34 +/- 0.07 %/min vs 1.47 +/- 0.11, P = 0.15). Plasma leucine appearance was significantly reduced after 2 months of therapy (63.3 +/- 3.0 mumol/kg/hr vs 57.1 +/- 3.9 mumol/kg/hr; P < 0.025), but leucine oxidation (11.5 +/- 1.1 mumol/kg/hr vs 11.2 +/- 1.1 mumol/kg/hr) was not altered. Despite the fact that plasma triiodothyronine concentrations significantly increased with therapy, it was not associated with plasma LA. Half of the patients with cancer died 14 +/- 4 months after the study, and the other half were alive 58 +/- 2 months later. Survival time can be estimated with 59% accuracy using plasma LA, HGP, carcino-embryonic antigen, and insulin concentration. Multiple regression analysis identified that plasma LA was related directly to length of survival time, and baseline HGP, carcino-embryonic antigen, and insulin concentration were related inversely to length of survival.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J A Tayek
- Department of Medicine, UCLA School of Medicine, Harbor-UCLA Medical Center, Torrance, USA
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17
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Abstract
Patients with advanced cancer and cachexia typically demonstrate modestly increased rates of energy expenditure in the presence of diminished food intake due to anorexia and to gastrointestinal disturbances. Rates of glucose production by the liver, gluconeogenesis and glycolysis to lactate (Cori cycle) are increased, fat mobilisation and oxidation are accelerated. There is a redistribution of body proteins away from muscle towards visceral proteins, resulting in marked muscle protein loss. Cancer cachexia differs from simple starvation and demonstrates metabolic similarities to sepsis or polytrauma. The metabolic response in the patient with cancer is largely due to mediators released by the tumour or by the host; recently the role of cytokines such as tumour necrosis factor alpha (TNF alpha), interleukin-1 (IL-1) and -6 (IL-6) and interferon gamma (INF gamma) has been emphasized. Catabolic hormones such as glucocorticoids and adrenaline have also been implicated. Cytokines have the potential to reproduce experimentally the clinical syndrome of cancer cachexia. There is evidence of increased production of several of them in certain types of cancer. There are overlapping activities of the cytokines TNF alpha, IL-1, IFN gamma and IL-6. The contribution of each of them to cancer cachexia remains unclear. Inhibition of cytokine activity using specific antibodies in cancer-bearing experimental animals demonstrated partial prevention of cachexia. A positive feedback between macrophage-derived IL-1 and tumour-derived IL-6 has been demonstrated recently in experimental cancer cachexia. Cytokines may support tumour growth by acting as growth factors.
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Affiliation(s)
- U Keller
- Department of Internal Medicine, University Hospital, Basel, Switzerland
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18
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Richards EW, Long CL, Nelson KM, Tohver OK, Pinkston JA, Navari RM, Blakemore WS. Protein turnover in advanced lung cancer patients. Metabolism 1993; 42:291-6. [PMID: 8487646 DOI: 10.1016/0026-0495(93)90076-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Understanding the extent to which changes in whole-body protein kinetics contribute to the commonly observed weight loss and decrease in lean body mass (LBM) in patients with cancer is currently obscured by conflicting reports in the literature. While several studies have reported significant increases in whole-body protein turnover (WBPT), synthesis (WBPS), and catabolism (WBPC) in patients with cancer, others have failed to confirm these observations. We have measured whole-body protein kinetics using a primed constant infusion of 15N-glycine in a homogenous group of 32 newly diagnosed advanced lung cancer patients with comparable staging and before any antineoplastic treatment, and in 19 normal healthy volunteer controls. Urinary urea and ammonia 15N enrichment was determined in individually collected urine samples obtained during the 24-hour study period and averaged for the determination of protein kinetics. During the last 6 hours of urine collection, samples were obtained hourly for determination of 15N plateau enrichment. Twenty-four-hour urinary nitrogen and creatinine excretion was determined from 24-hour pooled urine samples. Resting metabolic expenditure (RME) was determined by indirect calorimetry and LBM was estimated from deuterium oxide dilution. Age body weight, LBM, RME, and 24-hour urinary nitrogen excretion did not differ between cancer and control subjects. WBPT, WBPC, and WBPS (g/kg/d) were significantly increased in lung cancer patients. However, when the same results were expressed either per kilogram LBM or per gram 24-hour urinary creatinine excretion, WBPT, WBPC, and WBPS rates were not statistically different from those of the controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- E W Richards
- Department of Research, Baptist Medical Centers, Birmingham, AL 35211
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19
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Pisters PW, Pearlstone DB. Protein and amino acid metabolism in cancer cachexia: investigative techniques and therapeutic interventions. Crit Rev Clin Lab Sci 1993; 30:223-72. [PMID: 8260072 DOI: 10.3109/10408369309084669] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cancer cachexia is a complex syndrome characterized primarily by diminished nutrient intake and progressive tissue depletion that is manifest clinically as anorexia and host weight loss. The gradual loss of host protein stores is central to this process. This review outlines the techniques that have been used to evaluate human amino acid metabolism, their application in patients with cancer cachexia, and possible therapeutic interventions designed to overcome alterations in host protein and amino acid metabolism associated with malignant cachexia. The techniques of nitrogen balance and 3-methylhistidine excretion provide indirect estimates of overall nitrogen metabolism and skeletal muscle myofibrillar protein breakdown. Measurement of circulating amino acid concentrations, particularly when combined with assessment of arterial-venous differences and regional amino acid balance allows for investigation of interorgan amino acid metabolism. One of the most significant advances in in vivo amino acid metabolic research has been the development of labeled amino acid tracer studies to evaluate whole body and regional amino acid kinetics. The use of stable and unstable amino acid isotopes in these techniques is reviewed in detail. Virtually all of these techniques have now been employed in the evaluation of human cancer cachexia. The results of studies evaluating amino acid concentrations, regional amino acid balance, and 3-methylhistidine excretion are summarized. The use of regional and whole body kinetic studies in cancer cachexia are reviewed extensively. Most investigators have observed increased rates of whole body protein turnover, synthesis, and catabolism in both weight-stable and weight-losing cancer patients. Some studies have suggested a relationship between the extent of disease and the degree of aberration in amino acid kinetic parameters. Investigators have attempted to reverse some of these alterations by provision of substrate (nutritional support) or administration of specific pharmacologic or anabolic agents such as hydrazine sulfate, insulin, growth hormone, and beta-2 agonists. The role of total parenteral nutrition (TPN) in cancer and its effects on protein and amino acid kinetics and tumor growth are addressed. The possible benefits of specific amino acid nutritional formulations with increased branched chain amino acids, arginine, and glutamine are reviewed. Although many of these approaches appear promising, significant impact on clinically definable parameters remains to be demonstrated. A better understanding of the underlying protein catabolic mechanisms of cancer cachexia will likely lead to more effective therapies to reverse the protein calorie malnutrition associated with cancer cachexia.
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Affiliation(s)
- P W Pisters
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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20
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Tayek JA, Chlebowski RT. Metabolic response to chemotherapy in colon cancer patients. JPEN J Parenter Enteral Nutr 1992; 16:65S-71S. [PMID: 1287227 DOI: 10.1177/014860719201600606] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The goal of this investigation was to identify the metabolic abnormalities in a group of colon cancer patients before and during 5-fluorouracil chemotherapy. Twenty-two colon cancer patients were prospectively enrolled into a Clinical Research Center for measurement of counter regulatory hormones, fasting hepatic glucose production (HGP), intravenous glucose tolerance test, plasma leucine appearance (LA), and leucine oxidation (LO). Both the cancer group and the normal volunteers were matched for nutrition status (109 +/- 5% of ideal body weight vs 104 +/- 4%, mean +/- SEM, respectively) and history of weight loss (6.3 +/- 2.6 kg vs 4.4 +/- 4.8). Plasma growth hormone was significantly elevated in the colon cancer patients (3.22 +/- 0.62 ng/mL vs 0.73 +/- 0.18, p < .05) despite the fact that insulin-like growth factor-1 levels were not different. Plasma glucose, insulin, cortisol, glucagon, epinephrine, and norepinephrine levels were not significantly different than those of the normal volunteers. Fasting HGP rates were slightly but not significantly elevated in the group of colon cancer patients compared with the normal volunteers (2.09 +/- 0.11 mg/kg per minute vs 1.79 +/- 0.10, p = .10). Plasma LA was not significantly elevated in the colon cancer group (63.3 +/- 3.0 mumol/kg per hour vs 57.7 +/- 4.2; p = .25). Five days of continuous 5-fluorouracil chemotherapy was associated with a significant elevation in both the fasting glucose level (97 +/- 3 mg/dL vs 106 +/- 5, p < .05), and HGP (2.09 +/- 0.11 mg/kg per minute vs 2.27 +/- 0.10; p < .05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J A Tayek
- UCLA School of Medicine Department of Medicine
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21
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Heys SD, Park KG, Garlick PJ, Eremin O. Nutrition and malignant disease: implications for surgical practice. Br J Surg 1992; 79:614-23. [PMID: 1643468 DOI: 10.1002/bjs.1800790707] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Malignant disease is often associated with weight loss and malnutrition. Nutritional support is frequently provided to patients with cancer in an attempt to improve nutritional status and reverse weight loss, with the aim of reducing morbidity and mortality rates. This review evaluates the effect of supplemental nutrition on morbidity and mortality in patients with malignancy undergoing treatment with surgery, chemotherapy or radiotherapy. It also assesses the effect nutritional supplementation has on host defence mechanisms and how nutrients affect tumour cell growth. The evidence suggests that perioperative nutritional support, if given for at least 10 days, reduces morbidity and mortality in patients with biochemical evidence of severe malnutrition, manifest as a low serum albumin concentration and excessive weight loss. In contrast, there is no evidence that parenteral nutritional support benefits patients undergoing chemotherapy or radiotherapy, in terms of either an increased tumour response rate or prolongation of survival. Current research on malignant disease is highlighting the role of specific nutrients (amino acids, essential fatty acids and polyribonucleotides) as key regulators of both anticancer host defence mechanisms and the control of nitrogen metabolism and tumour growth. Arginine, essential fatty acids and ribonucleotides have all been demonstrated to stimulate antitumour host defence mechanisms and some also modulate tumour cell metabolism. Dietary manipulation offers exciting possibilities for the innovative management of malignant disease.
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Affiliation(s)
- S D Heys
- Department of Surgery, University of Aberdeen, UK
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22
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Abstract
The hypothesis that tumors arising in a particular organ site impose a characteristic plasma free amino acid (PFAA) pattern was tested by analyzing PFAA in fasting venous blood of preoperative patients with breast cancer, gastrointestinal tract cancer, and head and neck cancer. Healthy volunteers served as control subjects. Levels of 28 PFAA were determined in blood samples using an amino acid analyzer, and the data were compared using discriminant analysis and chi-square testing. Compared with control subjects, the concentrations of seven amino acids (glutamine, threonine, histidine, cysteine, alanine, arginine, and ornithine) in patients with tumors correlated closely with the known diagnoses. By means of discriminant analysis, these seven amino acids had the highest correlation with the specific diagnoses, indicating that PFAA profiles correlate diagnostically with the organ-site origin of three different kinds of malignant tumors.
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Affiliation(s)
- A Kubota
- Department of Surgery, University Hospital, State University of New York Health Science Center, Syracuse, New York 13210
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23
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Abstract
The potential causes of deranged metabolism in cancer are discussed with emphasis on changes in energy metabolism of glucose, fat and protein. The implications of these changes for the treatment of cachexia are then considered.
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Affiliation(s)
- R G Douglas
- Department of Surgery, Auckland Hospital, New Zealand
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24
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Harrison RA, Lewin MR, Halliday D, Clark CG. Leucine kinetics in surgical patients. II: A study of the effect of malignant disease and tumour burden. Br J Surg 1989; 76:509-11. [PMID: 2736366 DOI: 10.1002/bjs.1800760525] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Isotope studies of protein turnover have given conflicting evidence about the effects of a malignant tumour on the protein metabolism of the host. Leucine kinetics have been studied, as an index of protein turnover, using a well established methodology. Twenty patients were studied, five with benign disease of the colon, ten with localized malignant tumours of the large bowel, and five in whom there was evidence of metastatic disease from a colonic primary. No effect was observed on the leucine turnover of the patients that might be attributable to the presence or size of the tumour burden. It is suggested that some of the previously conflicting results may be attributable to variability in the experimental design, the heterogeneous patient groups studied and the methods used to express the results obtained.
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Affiliation(s)
- R A Harrison
- Department of Surgery, University College London, UK
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25
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McNurlan MA, Garlick PJ. Influence of nutrient intake on protein turnover. DIABETES/METABOLISM REVIEWS 1989; 5:165-89. [PMID: 2647434 DOI: 10.1002/dmr.5610050206] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- M A McNurlan
- Rowett Research Institute, Bucksburn, Aberdeen, Scotland, United Kingdom
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26
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Borzotta AP, Clague MB, Johnston ID. The effects of gastrointestinal malignancy on whole body protein metabolism. J Surg Res 1987; 43:505-12. [PMID: 3695451 DOI: 10.1016/0022-4804(87)90123-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
To study whether primary site or advancing stage of disease influenced whole body protein metabolism, [1-14C]leucine was used in five gastric and nine colorectal cancer patients and ten with benign disease. No differences were found by primary site or by comparing cancerous to benign patients. No differences were found between TNM stages 1, 2, or 3. Flux, synthesis and breakdown rates (2.30 +/- 0.29, 1.88 +/- 0.33, and 1.66 +/- 0.26 mmole leucine kg-1 day-1, respectively) were significantly greater in disseminated (stage 4) disease than in localized (stages 1-3) disease (1.71 +/- 0.32, 1.44 +/- 0.23, and 1.09 +/- 0.23 mmole leucine kg-1 day-1). Advanced cancer stage is marked by accelerated leucine metabolism, with flux and synthesis rates influenced primarily by feeding and secondarily by stage of disease. Protein breakdown rates correlated most closely to the stage of cancer. Cancer cachexia is the result of appetite suppression, decreased nutrient intake, and altered metabolism of endogenous substrates. Protein metabolism probably changes as a consequence, not a cause, of altered intake and energy metabolism in the tumor-bearing host.
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Affiliation(s)
- A P Borzotta
- Department of Surgery, Case Western Reserve University, Cleveland, Ohio
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28
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Starnes HF, Warren RS, Brennan MF. Protein synthesis in hepatocytes isolated from patients with gastrointestinal malignancy. J Clin Invest 1987; 80:1384-90. [PMID: 3680502 PMCID: PMC442394 DOI: 10.1172/jci113216] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
To investigate the effect of remote and proximate cancer on hepatic protein metabolism, we determined rates of total protein synthesis by hepatocytes (HPS) isolated from 31 patients undergoing liver wedge biopsy: 7 patients with benign disease, 14 with gastric cancer, and 10 with colorectal cancer (5 of whom had liver metastases). Patients with malignant disease without weight loss had a threefold higher rate of total HPS (4,980 +/- 814 pmol/h per 10(5) viable cells) than patients with benign disease without weight loss (1,278 +/- 318 pmol/h per 10(5) viable cells, P less than 0.001). Among the patients with gastric cancer, eight with preoperative weight loss had lower rates of HPS (380 +/- 90 pmol/h per 10(5) viable cells) than those without weight loss (4,061 +/- 401 pmol/h per 10(5) viable cells, P less than 0.002). The highest rates of HPS were seen in patients with colorectal cancer with liver metastases (8,005 +/- 1,975 pmol/h per 10(5) viable cells) vs. colorectal cancer patients without liver metastases (3,060 +/- 575 pmol/h per 10(5) viable cells, P less than 0.03). These data indicate that modulation of hepatic protein synthesis occurs in malignancy in man. However, the stimulatory influence of the tumor-bearing state may be overridden by the inhibitory effects of cachexia.
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Affiliation(s)
- H F Starnes
- Memorial Sloan-Kettering Cancer Center, New York, New York 10021
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Kurzer M, Meguid MM. Cancer et métabolisme protéique. NUTR CLIN METAB 1987. [DOI: 10.1016/s0985-0562(87)80048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Wright PD, Holdsworth JD, Dionigi P, Clague MB, James OF. Effect of branched chain amino acid infusions on body protein metabolism in cirrhosis of liver. Gut 1986; 27 Suppl 1:96-102. [PMID: 3539714 PMCID: PMC1434605 DOI: 10.1136/gut.27.suppl_1.96] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Thirty seven patients with established cirrhosis of the liver were subjected to measurement of body protein metabolism using L-(1-14C) labelled leucine as a tracer. The effects of disease severity and those of solutions containing 0%, 16%, 35%, 53%, and 100% branched chain amino acids were evaluated. Significant increases in protein synthesis were noted with solutions containing 35%, 53%, and 100% branched chain amino acids, but in patients receiving 100% branched chain amino acids without additional essential amino acid supplement the increase in synthesis was matched by a significant increase in protein breakdown. Protein balance was thus improved only in patients receiving 35% and 53% branched chain amino acids. It was concluded that the high increase in protein breakdown in patients receiving 100% branched chain amino acids was undesirable, and such a solution should not be recommended for clinical use.
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Abstract
Two patterns of response, that due to starvation or semistarvation and that due the stress, determine whether protein-calorie malnutrition of the adult marasmus variety or hypoalbuminemic malnutrition will occur in any particular nonmalignant disease. The latter condition can have two major components, the neuroendocrine response to injury, which is in large measure mediated by hormones of the hypothalamus and adrenal gland, and the panoply of responses to interleukin-1 production and release by macrophages and monocytes upon activation, usually by phagocytosis. In some cancer patients with weight loss there are many similarities to an interleukin-1 response including increases in resting energy expenditure, whole-body protein flux and synthesis and glucose flux and recycling, hypoalbuminemia and increased albumin catabolic rates, and an adaptive low T3 state that suggest a similar injury/infection response. Separation of cancer patients with malnutrition into those with an injury/infection response and those with simple starvation may explain the heterogeneous response to nutritional support among malnourished cancer patients and suggest new feeding regimens that may uniquely benefit the stress form of cancer malnutrition.
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Abstract
We have reviewed the data that indicate that protein depletion is an important problem in cancer patients. An incomplete, yet useful, idea of the underlying mechanisms emerges. Further, we have seen that the provision of nutritional support may have a beneficial effect on patients with cancer, and we have explored areas of recent advances in nutritional formulation as regards energy and nitrogen source. Finally, data regarding micronutrients affecting nitrogen metabolism were reviewed. The extent to which tumor metabolism and changes secondary to the tumor-bearing state are influenced by micronutrients is not known. Traditional regimens based on the requirements of normal subjects or noncancer patients may not be relevant to the metabolic needs of the cancer patient. This could explain in part the failure of nutritional intervention trials to demonstrate a consistent benefit of nutritional support to the cancer patient. Further information regarding micronutrient needs in normal humans and cancer-bearing patients and their utilization by malignant tumors will have to be obtained.
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Ota DM, Kleman G, Diamond K. Practical considerations in the nutritional management of the cancer patient. Curr Probl Cancer 1986; 10:345-98. [PMID: 3089692 DOI: 10.1016/s0147-0272(86)80013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Tessitore L, Bonelli G, Isidoro C, Kazakova OV, Baccino FM. Comparative studies on protein turnover regulations in tumor cells and host tissues: development and analysis of an experimental model. Toxicol Pathol 1986; 14:451-6. [PMID: 3544167 DOI: 10.1177/019262338601400411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The protein mass of cells and tissues is determined by the relative rates of protein synthesis (PS) and degradation (PD). A convergent modulation of both PS and PD is operated by many cell types to regulate protein accumulation and thus growth. Transformed and neoplastic cells may show markedly defective PD regulations. Yet even highly-deviated cells such as those of the transplantable Yoshida ascites hepatoma AH-130 cease growth when attaining a conspicuous population size, by operating a combined reduction of PS and acceleration of PD. As in normal cells, PD acceleration is effected through an activation of the acidic-vacuolar (lysosomal) mechanism. AH-130 tumor-bearing rats develop a markedly negative nitrogen balance early after transplantation. Tumor growth involves pronounced perturbations in host body and tissue protein metabolism. Apparently, these changes occur mostly at the level of PD rather than PS, at least in liver and skeletal muscle (gastrocnemius). These observations indicate that either tumor and host cells sense different signals for PD regulations or their thresholds for the same signals are poised differently. This model seems most suitable for further studies to elucidate which signals and mechanisms are involved in these protein metabolic perturbations and possibly, to develop the rationale for adequate corrective strategies.
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36
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Hardy C, Wallace C, Khansur T, Vance RB, Thigpen JT, Balducci L. Nutrition, cancer, and aging: an annotated review. II. Cancer cachexia and aging. J Am Geriatr Soc 1986; 34:219-28. [PMID: 3081618 DOI: 10.1111/j.1532-5415.1986.tb04207.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The interactions of cancer and malnutrition are discussed with the focus on aging. To establish whether the elderly are more likely to develop cancer cachexia and its complications, this review encompasses the pathogenesis of malnutrition in cancer; the age-related alterations of appetite, gastrointestinal function, energy expenditure, and protein turnover; the diagnosis of malnutrition; and the effectiveness of nutritional support in the elderly. Although metabolic and physiologic changes induced by cancer and age appear synergistic in causing cachexia, more frequent complications of malnutrition have not been observed in the geriatric cancer patients. This may be due to only a small proportion of the elderly with cancer being enrolled in clinical studies or to a reduced cachexia-inducing ability of tumors in these patients. A limited number of studies indicate nutritional replenishment is obtainable in malnourished elderly by hyperalimentation. As restoration of the lean body mass may be slower in older patients, early institution of nutritional support is recommended in malnourished elderly or elderly at risk for malnutrition during neoplastic treatment.
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37
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Ward HC, Johnson AW, Halliday D, Sim AJ. Elevated rates of whole body protein metabolism in patients with disseminated malignancy in the immediate postoperative period. Br J Surg 1985; 72:983-6. [PMID: 4084756 DOI: 10.1002/bjs.1800721216] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Protein metabolism after surgery in the presence of disseminated malignancy has been investigated and compared with results obtained from patients undergoing similar surgical procedures for benign disease and localized malignancy. Whole body nitrogen turnover, measured by primed continuous infusion of 15N glycine, was highest with disseminated malignancy. Similarly rates of whole body protein synthesis and breakdown, calculated from turnover and nitrogen excretion (nitrogen intake being zero), were elevated in the presence of disseminated malignant disease. The increased rates of protein metabolism may represent adaptation to the demands of inevitably growing malignant tissue.
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Edén E, Ekman L, Bennegård K, Lindmark L, Lundholm K. Whole-body tyrosine flux in relation to energy expenditure in weight-losing cancer patients. Metabolism 1984; 33:1020-7. [PMID: 6493045 DOI: 10.1016/0026-0495(84)90231-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Whole-body tyrosine flux was measured in seven weight-losing cancer patients and compared with that of seven noncancer patients with malnutrition. L[U-14C] tyrosine was infused intravenously (IV) after an overnight fast under resting conditions and flux rates, oxidation, and incorporation into proteins of tyrosine were calculated from plateau values of specific activity of tyrosine in plasma and of labeled expired carbon dioxide. Rates of protein synthesis were calculated from the flux rate of tyrosine after subtracting the proportion oxidized. Simultaneous measurements of whole-body carbon dioxide production and oxygen uptake were also performed in each subject. Cancer patients had elevated whole-body tyrosine flux, protein synthesis, and energy expenditure when expressed in relation to body weight and whole-body potassium while the differences in tyrosine kinetics became of borderline significance when expressed in relation to energy expenditure. Tyrosine incorporation into whole-body proteins corresponded to a synthesis rate of 2.70 +/- 0.17 protein/kg/d in cancer patients and 2.18 +/- 0.17 in control patients (P less than 0.025). The results show that elevated protein synthesis in weight-losing cancer patients may explain not more than one third of the elevated energy expenditure. Therefore, other systems that utilize energy must increase in activity.
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40
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Abstract
Metabolic abnormalities arising from malnutrition and malignancy are seen in patients with cancer cachexia. To discriminate between the effects of pure malnutrition and tumour-specific metabolic alterations, the kinetics of whole-body metabolism were determined in 7 untreated, malnourished cancer patients and in 11 patients with benign disease, also malnourished, by means of primed constant infusion of 15N-glycine. Patients in both groups received 500 kcal/day as 5% glucose solution without any nitrogen. Whole-body protein turnover was 32% and 35% higher in the cancer patients than in the non-cancer patients and starved normal subjects respectively. Similarly, the rate of protein synthesis was 35% and 54% higher in the cancer patients than in the non-cancer patients and starved normal subjects respectively. Our study supports the view that aberrations of host metabolism in patients with cancer cachexia are different from those in non-cancer patients suffering equivalent weight loss.
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Abstract
There has been a rapid expansion of knowledge in the field of nutrition and metabolism with regard to the general surgical patient. However, only recently has there been greater appreciation of the benefits of adequate nutrition and appropriate metabolic care of the neurosurgical patient. In this review, the authors attempt to outline 1) the metabolic response to stress in general, and how it applies to the neurosurgical patient; 2) how best to provide adequate nutritional support for the neurosurgical patient; 3) the effects of nutrition on neurotransmitters; and 4) the effect of diet and nutrition on patients with malignant brain tumors.
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Stein TP, Ang SD, Schluter MD, Leskiw MJ, Nusbaum M. Whole-body protein turnover in metabolically stressed patients and patients with cancer as measured with [15N] glycine. BIOCHEMICAL MEDICINE 1983; 30:59-77. [PMID: 6626186 DOI: 10.1016/0006-2944(83)90009-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The whole-body protein synthesis rate (PSR) was measured in 5 control patients (group I) and 38 patients in various clinical states (group II). A single pulse of [15N]glycine was given and the PSR calculated from the 15N enrichment in the urinary ammonia excreted over the next 10 hr. The patients' results fell into three separate groups: group IIa patients were nonstressed and had uneventful recoveries (3.1 +/- 0.6 g prot./kg/day), their PSRs were the same as the control group I, (3.1 +/- 1.0 g prot./kg/day); group IIb patients were stressed, had higher PSRs (6.3 +/- 0.9 g prot./kg/day), one of whom died, and the rest had more complications than group IIa; group IIc patients had very high PSRs (15.4 +/- 6.1 g prot./kg/day), all of whom were seriously ill, and 8 out 12 died; Data are +/- 1 SD. The PSR correlated with the serum glutamate oxaloacetate transferase (SGOT, P less than 0.01). We concluded: (i) [15N]glycine cannot be used to measure the PSR in patients with evidence of liver disease; the results are best interpreted in terms of glycine metabolism; (ii) the "apparent" PSR correlated with clinical status; and (iii) an elevated PSR in a patient with a malignancy is not necessarily due to protein metabolism by the tumor.
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Macfie J, Burkinshaw L, Oxby C, Holmfield JH, Hill GL. The effect of gastrointestinal malignancy on resting metabolic expenditure. Br J Surg 1982; 69:443-6. [PMID: 7104629 DOI: 10.1002/bjs.1800690803] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Abstract
It is unclear whether or not the presence of a malignancy causes an increased energy demand in the patient. As energy expenditure is normally related to body cell mass, it might be expected that an alteration in the relationship between body cell mass and energy expenditure would be observed in patients with malignant disease. This study aimed to investigate this possibility and to attempt to quantify any change in order to determine its clinical relevance.
Three groups of patients were studied: a control group (group I), consisting of healthy volunteers and patients awaiting minor elective surgery for benign conditions, and two groups of patients with malignant disease the extent of which was assessed at laparotomy; group II comprised those with local disease and group III those with metastatic disease. Resting metabolic expenditure (RME) was measured by indirect calorimetry and the total body potassium (TBK) was measured as an indicator of body cell mass. The results show a close correlation between RME and TBK in all groups. The RME at a given potassium content was greatest in those patients with metastatic disease. The magnitude of the difference was small, however, amounting to a mean elevation of 289 kcal/d in this group compared to control subjects.
It is concluded that malignancy may result in an increased energy demand, particularly in patients with metastatic disease. The magnitude of the increase is small and probably of little consequence when planning nutritional support, although its cumulative effect over many months may be significant.
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47
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Clague MB, Carmichael MJ, Keir MJ, Rogaly E, Wright PD, Johnston ID. Increased incorporation of an infused labelled amino acid into plasma proteins as a means of assessing the severity of injury or activity of disease in surgical patients. Ann Surg 1982; 196:53-8. [PMID: 7092352 PMCID: PMC1352497 DOI: 10.1097/00000658-198207000-00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Following injury there is increased synthesis of several plasma proteins. During a constant rate infusion of 1-(1-14C) leucine some of the labeled amino acid became incorporated into plasma proteins, the amount being readily determined after precipitation with perchloric acid. This value was correlated with the clinical state of the patient to see if an index of severity of injury could be derived. Before operation 6.7 +/- 0.5% (mean +/- SD, n = 16) of the infused labeled amino acid was incorporated in asymptomatic patients, irrespective of their dietary intakes, while in the presence of symptomatology this value rose, correlating with tumor staging in patients with colorectal neoplasia (r = 0.988, p = 0.001). It returned to normal following tumor resection, but was elevated in the presence of recurrence or residual disease. After operation it also rose, being maximal in the early postoperative period and following the more major surgical procedures, the increase correlating with the change in cortisol level in patients following cholecystectomy (r = 0.84, p less than 0.01; n = 8). The pattern of distribution of the label among the plasma proteins did not change with increased incorporation. The increase in incorporation of 1-(1-14C) leucine into plasma proteins would appear to offer a good index for severity of injury of activity of a disease state.
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