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Laviano A, Rossi Fanelli F. Nutritional status is a predictor of outcome in cancer patients, irrespective of stage. Intern Emerg Med 2017; 12:135-136. [PMID: 27639876 DOI: 10.1007/s11739-016-1539-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Alessandro Laviano
- Department of Clinical Medicine, Sapienza University, viale dell'Università 37, 00185, Rome, Italy.
| | - Filippo Rossi Fanelli
- Department of Clinical Medicine, Sapienza University, viale dell'Università 37, 00185, Rome, Italy
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Molfino A, Iannace A, Colaiacomo MC, Farcomeni A, Emiliani A, Gualdi G, Laviano A, Rossi Fanelli F. Cancer anorexia: hypothalamic activity and its association with inflammation and appetite-regulating peptides in lung cancer. J Cachexia Sarcopenia Muscle 2017; 8:40-47. [PMID: 27897393 PMCID: PMC5326827 DOI: 10.1002/jcsm.12156] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 07/19/2016] [Accepted: 09/05/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Energy homeostasis is mediated by the hypothalamus, whose inflammation-induced functional derangements contribute to the onset of anorexia in cancer. By using functional magnetic resonance imaging (fMRI), we determined the patterns of hypothalamic activation after oral intake in anorexic (A), non-anorexic (NA) cancer patients, and in controls (C). METHODS Lung cancer patients were considered. Hypothalamic activation was recorded in A and NA patients and in C by fMRI, before (T0), immediately after (T1) the administration of an oral nutritional supplement, and after 15 min (T2). The grey of the hypothalamus and Blood Oxygen Level Dependent (BOLD) intensity were calculated and normalized for basal conditions. Interleukin (IL)-1, IL-6, tumour necrosis factor (TNF)-α, ghrelin, and leptin plasma levels were measured. A statistical parametric mapping was used. RESULTS Thirteen lung cancer patients (7 M, 6 F; 9A, 4NA) and 2 C (1 M, 1 F) were enrolled. Controls had the lowest BOLD intensity. At all-time points, anorexic patients showed lower hypothalamic activity compared with NA (P < 0.001) (T0: 585.57 ± 55.69 vs. 667.92 ± 33.18, respectively; T1: 536.50 ± 61.70 vs. 624.49 ± 55.51, respectively; T2: 556.44 ± 58.51 vs. 615.43 ± 71.50, respectively). Anorexic patients showed greater BOLD signal reduction during T0-T1 than NA (-8.5% vs. -6.80%, P < 0.001). Independently from the presence of anorexia, BOLD signals modification before and after oral challenge correlated with basal values of IL-1 and ghrelin (P < 0.001). CONCLUSIONS Hypothalamic activity in A cancer patients is reduced respect to NA and responds differently to oral challenges. This suggests a central control of appetite dysregulation during cancer anorexia, before, and after oral intake.
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Affiliation(s)
- Alessio Molfino
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandro Iannace
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Colaiacomo
- Department of Emergency, Radiology Unit, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alessio Farcomeni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Gianfranco Gualdi
- Department of Emergency, Radiology Unit, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alessandro Laviano
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
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Donini LM, Poggiogalle E, Molfino A, Rosano A, Lenzi A, Rossi Fanelli F, Muscaritoli M. Mini-Nutritional Assessment, Malnutrition Universal Screening Tool, and Nutrition Risk Screening Tool for the Nutritional Evaluation of Older Nursing Home Residents. J Am Med Dir Assoc 2016; 17:959.e11-8. [DOI: 10.1016/j.jamda.2016.06.028] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 12/15/2022]
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Aversa Z, Pin F, Lucia S, Penna F, Verzaro R, Fazi M, Colasante G, Tirone A, Fanelli FR, Ramaccini C, Costelli P, Muscaritoli M. Autophagy is induced in the skeletal muscle of cachectic cancer patients. Sci Rep 2016; 6:30340. [PMID: 27459917 PMCID: PMC4962093 DOI: 10.1038/srep30340] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 06/30/2016] [Indexed: 12/13/2022] Open
Abstract
Basal rates of autophagy can be markedly accelerated by environmental stresses. Recently, autophagy has been involved in cancer-induced muscle wasting. Aim of this study has been to evaluate if autophagy is induced in the skeletal muscle of cancer patients. The expression (mRNA and protein) of autophagic markers has been evaluated in intraoperative muscle biopsies. Beclin-1 protein levels were increased in cachectic cancer patients, suggesting autophagy induction. LC3B-I protein levels were not significantly modified. LC3B-II protein levels were significantly increased in cachectic cancer patients suggesting either increased autophagosome formation or reduced autophagosome turnover. Conversely, p62 protein levels were increased in cachectic and non-cachectic cancer patients, suggesting impaired autophagosome clearance. As for mitophagy, both Bnip3 and Nix/Bnip3L show a trend to increase in cachectic patients. In the same patients, Parkin levels significantly increased, while PINK1 was unchanged. At gene level, Beclin-1, p-62, BNIP3, NIX/BNIP3L and TFEB mRNAs were not significantly modulated, while LC3B and PINK1 mRNA levels were increased and decreased, respectively, in cachectic cancer patients. Autophagy is induced in the skeletal muscle of cachectic cancer patients, although autophagosome clearance appears to be impaired. Further studies should evaluate whether modulation of autophagy could represent a relevant therapeutic strategy in cancer cachexia.
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Affiliation(s)
- Zaira Aversa
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Pin
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Interuniversity Institute of Myology, Italy
| | - Simone Lucia
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabio Penna
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Interuniversity Institute of Myology, Italy
| | | | - Maurizio Fazi
- Department of Surgery, M.G. Vannini Hospital, Rome, Italy
| | - Giuseppina Colasante
- UOSA Chirurgia Bariatrica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Andrea Tirone
- UOSA Chirurgia Bariatrica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Cesarina Ramaccini
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Paola Costelli
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Interuniversity Institute of Myology, Italy
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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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Penna F, Bonetto A, Aversa Z, Minero VG, Rossi Fanelli F, Costelli P, Muscaritoli M. Effect of the specific proteasome inhibitor bortezomib on cancer-related muscle wasting. J Cachexia Sarcopenia Muscle 2016; 7:345-54. [PMID: 27239411 PMCID: PMC4864285 DOI: 10.1002/jcsm.12050] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/04/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Muscle wasting, a prominent feature of cancer cachexia, is mainly caused by sustained protein hypercatabolism. The enhanced muscle protein degradation rates rely on the activity of different proteolytic systems, although the Adenosine triphosphate (ATP)-ubiquitin-proteasome-dependent pathway and autophagy have been shown to play a pivotal role. Bortezomib is a potent reversible and selective proteasome and NF-κB inhibitor approved for the clinical use, which has been shown to be effective in preventing muscle wasting in different catabolic conditions. The aim of the present study has been to investigate whether pharmacological inhibition of proteasome by bortezomib may prevent skeletal muscle wasting in experimental cancer cachexia. METHODS Cancer cachexia was induced in rats by intraperitoneal injection of Yoshida AH-130 ascites hepatoma cells and in mice by subcutaneous inoculation of C26 carcinoma cells. Animals were then further randomized to receive bortezomib. The AH-130 hosts were weighted and sacrificed under anaesthesia, on Days 3, 4, 5, and 7 after tumour inoculation, while C26-bearing mice were weighted and sacrificed under anaesthesia 12 days after tumour transplantation. NF-κB and proteasome activation, MuRF1 and atrogin-1 mRNA expression and beclin-1 protein levels were evaluated in the gastrocnemius of controls and AH-130 hosts. RESULTS Bortezomib administration in the AH-130 hosts, although able to reduce proteasome and NF-κB DNA-binding activity in the skeletal muscle on Day 7 after tumour transplantation, did not prevent body weight loss and muscle wasting. In addition, bortezomib exerted a transient toxicity, as evidenced by the reduced food intake and by the increase in NF-κB DNA-binding activity in the AH-130 hosts 3 days after tumour transplantation. Beclin-1 protein levels were increased by bortezomib treatment in Day 3 controls but were unchanged on both Days 3 and 7 in the AH-130 hosts, suggesting that an early compensatory induction of autophagy may exist in healthy but not in tumour-bearing animals. Regarding C26-bearing mice, bortezomib did not prevent as well body and muscle weight loss 12 days after tumour implantation. CONCLUSIONS The results obtained suggest that proteasome inhibition by bortezomib is not able to prevent muscle wasting in experimental cancer cachexia. Further studies are needed to address the issue whether a different dosage of bortezomib alone or in combination with other drugs modulating different molecular pathways may effectively prevent muscle wasting during cancer cachexia.
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Affiliation(s)
- Fabio Penna
- Department of Clinical and Biological SciencesUniversity of TurinTurinItaly
| | - Andrea Bonetto
- Department of SurgeryIndiana University School of Medicine, IUPUIIndianapolisINUSA
| | - Zaira Aversa
- Department of Clinical Medicine, SapienzaUniversity of RomeRomeItaly
| | - Valerio Giacomo Minero
- Center of Experimental Research and Medical Studies (CeRMS)Città della Salute e della ScienzaTurinItaly
- Department of Molecular Biotechnology and Health SciencesUniversity of TurinTurinItaly
| | | | - Paola Costelli
- Department of Clinical and Biological SciencesUniversity of TurinTurinItaly
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Gigante A, Rossi Fanelli F, Lucci S, Barilaro G, Quarta S, Barbano B, Giovannetti A, Amoroso A, Rosato E. Lung ultrasound in systemic sclerosis: correlation with high-resolution computed tomography, pulmonary function tests and clinical variables of disease. Intern Emerg Med 2016; 11:213-7. [PMID: 26494471 DOI: 10.1007/s11739-015-1329-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/29/2015] [Indexed: 11/26/2022]
Abstract
Interstitial lung disease (ILD) is a hallmark of systemic sclerosis (SSc). Although high-resolution computed tomography (HRCT) is the gold standard to diagnose ILD, recently lung ultrasound (LUS) has emerged in SSc patients as a new promising technique for the ILD evaluation, noninvasive and radiation-free. The aim of this study was to evaluate if there is a correlation between LUS, chest HRCT, pulmonary function tests findings and clinical variables of the disease. Thirty-nine patients (33 women and 6 men; mean age 51 ± 15.2 years) underwent clinical examination, HRCT, pulmonary function tests and LUS for detection of B-lines. A positive correlation exists between the number of B-lines and the HRCT score (r = 0.81, p < 0.0001), conversely a negative correlation exists between the number of B-lines and diffusing capacity of the lung for carbon monoxide (DLCO) (r = -0.63, p < 0.0001). The number of B-lines increases along with the progression of the capillaroscopic damage. A statistically significant difference in the number of B-lines was found between patients with and without digital ulcers [42 (3-84) vs 16 (4-55)]. We found that the number of B-lines increased with the progression of both HRCT score and digital vascular damage. LUS may therefore, be a useful tool to determine the best timing for HRCT execution, thus, preventing for many patients a continuous and useless exposure to ionizing radiation.
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Affiliation(s)
- Antonietta Gigante
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy.
| | - Filippo Rossi Fanelli
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
| | - Silvio Lucci
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
| | - Giuseppe Barilaro
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
| | - Silvia Quarta
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
| | - Biagio Barbano
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
| | - Antonello Giovannetti
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
| | - Antonio Amoroso
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
| | - Edoardo Rosato
- Clinical Immunology Unit, Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
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Molfino A, Amabile MI, Monti M, Rossi Fanelli F, Muscaritoli M. Carnitine for the treatment of cachexia: Lights and shadows. Int J Cardiol 2015; 198:180-1. [DOI: 10.1016/j.ijcard.2015.06.156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/27/2015] [Indexed: 01/07/2023]
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Molfino A, Kaysen GA, Chertow GM, Doyle J, Delgado C, Dwyer T, Laviano A, Rossi Fanelli F, Johansen KL. Validating Appetite Assessment Tools Among Patients Receiving Hemodialysis. J Ren Nutr 2015; 26:103-10. [PMID: 26522141 DOI: 10.1053/j.jrn.2015.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/10/2015] [Accepted: 09/13/2015] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To test the performance of appetite assessment tools among patients receiving hemodialysis (HD). DESIGN Cross-sectional. SUBJECTS Two hundred twenty-one patients receiving HD enrolled in seven dialysis facilities in Northern California. INTERVENTION We assessed 5 appetite assessment tools (self-assessment of appetite, subjective assessment of appetite, visual analog scale [VAS], Functional Assessment of Anorexia/Cachexia Therapy [FAACT] score, and the Anorexia Questionnaire [AQ]). MAIN OUTCOME MEASURES Reported food intake, normalized protein catabolic rate, and change in body weight were used as criterion measures, and we assessed associations among the appetite tools and biomarkers associated with nutrition and inflammation. Patients were asked to report their appetite and the percentage of food eaten (from 0% to 100%) during the last meal compared to usual intake. RESULTS Fifty-eight (26%) patients reported food intake ≤ 50% (defined as poor appetite). The prevalence of anorexia was 12% by self-assessment of appetite, 6% by subjective assessment of appetite, 24% by VAS, 17% by FAACT score, and 12% by AQ. All the tools were significantly associated with food intake ≤ 50% (P < .001), except self-assessment of appetite. The FAACT score and the VAS had the strongest association with food intake ≤ 50% (C-statistic 0.80 and 0.76). Patients with food intake ≤ 50% reported weight loss more frequently than patients without low intake (36% vs 22%) and weight gain less frequently (19% vs 35%; P = .03). Normalized protein catabolic rate was lower among anorexic patients based on the VAS (1.1 ± 0.3 vs 1.2 ± 0.3, P = .03). Ln interleukin-6 correlated inversely with food intake (P = .03), but neither interleukin-6 nor C-reactive protein correlated with any of the appetite tools. Furthermore, only the self-assessment of appetite was significantly associated with serum albumin (P = .02), prealbumin (P = .02) and adiponectin concentrations (P = .03). CONCLUSIONS Alternative appetite assessment tools yielded widely different estimates of the prevalence of anorexia in HD. When considering self-reported food intake as the criterion standard for anorexia, the FAACT score and VAS discriminated patients reasonably well.
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Affiliation(s)
- Alessio Molfino
- Division of Nephrology, Department of Internal Medicine, University of California, Davis, California; Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
| | - George A Kaysen
- Division of Nephrology, Department of Internal Medicine, University of California, Davis, California
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Julie Doyle
- Division of Nephrology, University of California, San Francisco, San Francisco, California; Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Cynthia Delgado
- Division of Nephrology, University of California, San Francisco, San Francisco, California; Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Tjien Dwyer
- Division of Nephrology, Department of Internal Medicine, University of California, Davis, California
| | - Alessandro Laviano
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Kirsten L Johansen
- Division of Nephrology, University of California, San Francisco, San Francisco, California; Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California
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Molfino A, Gioia G, Fanelli FR, Laviano A. Contribution of Neuroinflammation to the Pathogenesis of Cancer Cachexia. Mediators Inflamm 2015; 2015:801685. [PMID: 26504362 PMCID: PMC4609516 DOI: 10.1155/2015/801685] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/10/2015] [Indexed: 11/18/2022] Open
Abstract
Inflammation characterizes the course of acute and chronic diseases and is largely responsible for the metabolic and behavioral changes occurring during the clinical journey of patients. Robust data indicate that, during cancer, functional modifications within brain areas regulating energy homeostasis contribute to the onset of anorexia, reduced food intake, and increased catabolism of muscle mass and adipose tissue. In particular, functional changes are associated with increased hypothalamic concentration of proinflammatory cytokines, which suggests that neuroinflammation may represent the adaptive response of the brain to peripheral challenges, including tumor growth. Within this conceptual framework, the vagus nerve appears to be involved in conveying alert signals to the hypothalamus, whereas hypothalamic serotonin appears to contribute to triggering catabolic signals.
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Affiliation(s)
- Alessio Molfino
- Department of Clinical Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Gianfranco Gioia
- Department of Clinical Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Filippo Rossi Fanelli
- Department of Clinical Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Alessandro Laviano
- Department of Clinical Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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Afeltra A, Gigante A, Margiotta DPE, Taffon C, Cianci R, Barbano B, Liberatori M, Amoroso A, Rossi Fanelli F. The involvement of T regulatory lymphocytes in a cohort of lupus nephritis patients: a pilot study. Intern Emerg Med 2015; 10:677-83. [PMID: 25720575 DOI: 10.1007/s11739-015-1212-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/30/2015] [Indexed: 12/22/2022]
Abstract
T regulator lymphocytes (Tregs) play a key role in the maintenance of immune tolerance and in the development of autoimmune diseases. Expression of Foxp3 is specific for Tregs, and can be used for the identification of these cells. This study investigated the variations of Tregs Foxp3+ in the kidney biopsies inflammatory infiltrate of different lupus nephritis classes compared to that of ANCA glomerulonephritis, acute tubulointerstitial nephritis and nephroangiosclerosis. Sections of paraffin-embedded tissue have been stained by immunohistochemistry with anti-CD3 and anti-FoxP3 antibodies. We find that the ratio of FoxP3+/CD3+ cells is significantly lower in patients with lupus nephritis class IV and in patients with vasculitides than in the course of nephroangiosclerosis, tubulointerstitial nephritis and lupus nephritis class V. The data presented herein demonstrate a decrease of FoxP3+ Treg cells in the inflammatory infiltrate of lupus nephritis, particularly during the most active phases of lupus nephritis, as observed in the course of a IV class nephritis.
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Affiliation(s)
- Antonella Afeltra
- Clinical Medicine and Rheumatology, Integrated Research Center, Campus Bio-Medico University, Rome, Italy
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Muscaritoli M, Capria S, Iori AP, Fanelli FR. Nutritional and Metabolic Support in Haematological Malignancies and Haematopoietic Stem-Cell Transplantation. Clin Nutr 2015. [DOI: 10.1002/9781119211945.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lai S, Molfino A, Russo GE, Testorio M, Galani A, Innico G, Frassetti N, Pistolesi V, Morabito S, Rossi Fanelli F. Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis. Cardiorenal Med 2014; 5:20-30. [PMID: 25759697 DOI: 10.1159/000369588] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 11/04/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Mortality in dialysis patients is higher than in the general population, and cardiovascular disease represents the leading cause of death. Hypertension and volume overload are important risk factors for the development of left ventricular hypertrophy (LVH) in hemodialysis (HD) and peritoneal dialysis (PD) patients. Other factors are mainly represented by hyperparathyroidism, vascular calcification, arterial stiffness and inflammation. The aim of this study was to compare blood pressure (BP) and metabolic parameters with cardiovascular changes [cardiothoracic ratio (CTR), aortic arch calcification (AAC) and LV mass index (LVMI)] between PD and HD patients. MATERIALS AND METHODS 45 patients (23 HD and 22 PD patients) were enrolled. BP measurements, echocardiography and chest X-ray were performed in each patient to determine the LVMI and to evaluate the CTR and AAC. Inflammatory indexes, intact parathyroid hormone (iPTH) and arterial blood gas analysis were also evaluated. RESULTS LVMI was higher in PD than HD patients (139 ŷ 19 vs. 104 ŷ 22; p = 0.04). In PD patients, a significant correlation between iPTH, C-reactive protein and the presence of LVH was observed (r = 0.70, p = 0.04; r = 0.70, p = 0.03, respectively). The CTR was increased in PD patients as compared to HD patients, while no significant differences in cardiac calcifications were determined. CONCLUSIONS Our data indicate that HD patients present more effective BP control than PD patients. Adequate fluid and metabolic control are necessary to assess the adequacy of BP, which is strongly correlated with the increase in LVMI and with the increased CTR in dialysis patients. PD is a home therapy and allows a better quality of life, but PD patients may present a further increased cardiovascular risk if not adequately monitored.
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Affiliation(s)
- Silvia Lai
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Alessio Molfino
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Gaspare Elios Russo
- Department of Gynecology, Obstetrics and Urological Sciences, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Massimo Testorio
- Department of Gynecology, Obstetrics and Urological Sciences, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Alessandro Galani
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Georgie Innico
- Department of Gynecology, Obstetrics and Urological Sciences, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Nicla Frassetti
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Valentina Pistolesi
- Department of Nephrology and Urology, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Santo Morabito
- Department of Nephrology and Urology, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Filippo Rossi Fanelli
- Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
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Molfino A, Gioia G, Rossi Fanelli F, Muscaritoli M. The role for dietary omega-3 fatty acids supplementation in older adults. Nutrients 2014; 6:4058-73. [PMID: 25285409 PMCID: PMC4210907 DOI: 10.3390/nu6104058] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 08/28/2014] [Accepted: 09/17/2014] [Indexed: 12/21/2022] Open
Abstract
Optimal nutrition is one of the most important determinants of healthier ageing, reducing the risk of disability, maintaining mental and physical functions, and thus preserving and ensuring a better quality of life. Dietary intake and nutrient absorption decline with age, thus increasing the risk of malnutrition, morbidity and mortality. Specific nutrients, particularly long-chain omega-3 polyunsaturated fatty acids (PUFAs), might have the potential of preventing and reducing co-morbidities in older adults. Omega-3 PUFAs are able to modulate inflammation, hyperlipidemia, platelet aggregation, and hypertension. Different mechanisms contribute to these effects, including conditioning cell membrane function and composition, eicosanoid production, and gene expression. The present review analyzes the influence of omega-3 PUFAs status and intake on brain function, cardiovascular system, immune function, muscle performance and bone health in older adults. Omega-3 FAs may have substantial benefits in reducing the risk of cognitive decline in older people. The available data encourage higher intakes of omega-3 PUFAs in the diet or via specific supplements. More studies are needed to confirm the role of omega-3 FAs in maintaining bone health and preventing the loss of muscle mass and function associated with ageing. In summary, omega-3 PUFAs are now identified as potential key nutrients, safe and effective in the treatment and prevention of several negative consequences of ageing.
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Affiliation(s)
- Alessio Molfino
- Department of Clinical Medicine Sapienza, University of Rome, Viale dell'Università 37, 00185 Rome, Italy.
| | - Gianfranco Gioia
- Department of Clinical Medicine Sapienza, University of Rome, Viale dell'Università 37, 00185 Rome, Italy.
| | - Filippo Rossi Fanelli
- Department of Clinical Medicine Sapienza, University of Rome, Viale dell'Università 37, 00185 Rome, Italy.
| | - Maurizio Muscaritoli
- Department of Clinical Medicine Sapienza, University of Rome, Viale dell'Università 37, 00185 Rome, Italy.
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Abstract
PURPOSE OF REVIEW Despite the high prevalence of cancer cachexia, a condition that negatively impacts patients' prognosis and quality of life, effective therapies are still lacking. Ghrelin is a peptide hormone involved in anabolic and homeostatic functions, whose mechanisms of action are still only partially clarified, but with promising positive effects in cancer cachexia. Recently, the therapeutic administration of ghrelin in cancer has been shown to counteract loss of body mass and function, including muscle, and we specifically focus on this novel evidence. RECENT FINDINGS Recent research aimed at developing new pharmacological therapies to prevent muscle wasting has used ghrelin and molecules acting as synthetic ghrelin receptor agonists with different modalities of administration and with high selectivity for specific targeted tissues. Positive effects of these therapies were described in cancer cachexia and chemotherapy-induced muscle wasting. New insights into the mechanisms of action of ghrelin revealed how its pleiotropic effects should be ascribed both to systemic anti-inflammation effect and to muscle-specific action through the activation of the antiatrophic molecular cascade. SUMMARY Growing interest arises from the identification of ghrelin as a valid and well tolerated therapeutic option to counteract structural and functional wasting derived from tumour growth.
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Affiliation(s)
- Alessio Molfino
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
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Molfino A, Formiconi A, Leone PM, Rossi Fanelli F, Muscaritoli M. Towards improved awareness and earlier diagnosis of early onset colorectal neoplasms. Intern Emerg Med 2014; 9:615-6. [PMID: 24986080 DOI: 10.1007/s11739-014-1101-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/23/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Alessio Molfino
- Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
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Attalla El Halabieh N, Petrillo E, Laviano A, Delfino M, Rossi Fanelli F. A Case of Pneumocystis jirovecii Pneumonia in a Severely Malnourished, HIV-Negative Patient. JPEN J Parenter Enteral Nutr 2014; 40:722-4. [DOI: 10.1177/0148607114548072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/29/2014] [Indexed: 12/29/2022]
Affiliation(s)
| | - Enrico Petrillo
- Department of Clinical Medicine, Sapienza University, Rome, Italy
| | | | - Massimo Delfino
- Department of Clinical Medicine, Sapienza University, Rome, Italy
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Abstract
Biological treatments represent a novel approach to counteract cancer cachexia. Monoclonal antibodies targeting cytokines and molecules responsible for muscle wasting, with an anti-inflammatory effect, however, still have several limitations and need further clinical investigation. New research in this field will contribute to the better understanding of the multifactorial pathogenesis of cancer cachexia, while favoring the consolidation of multimodal preventive and therapeutic strategies encompassing nutritional and pharmacological treatments. New pharmacological therapies and conventional nutritional treatments will soon integrate in the 'parallel pathway', aimed at early recognition, prevention and treatment of the metabolic and nutritional derangements occurring in cancer. This will likely produce improvement in quality of life, tolerance to treatments and survival.
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Affiliation(s)
- Alessio Molfino
- Sapienza University of Rome, Department of Clinical Medicine , Viale dell'Università, 37, 00185 Roma , Italy +39 06 499 72016 ;
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Lucia S, Gemma D, Gori C, Rossi Fanelli F, Muscaritoli M. An Unusual Complication of Transthoracic Lung Biopsy. Eur J Case Rep Intern Med 2014. [DOI: 10.12890/2014_000021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Simone Lucia
- Department of Clinical Medicine - Sapienza University of Rome - Italy
| | - Daniele Gemma
- Department of Clinical Medicine - Sapienza – University of Rome, Italy
| | - Chiara Gori
- Department of Clinical Medicine - Sapienza University of Rome - Italy
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Gigante A, Liberatori M, Gasperini ML, Sardo L, Di Mario F, Dorelli B, Barbano B, Rosato E, Rossi Fanelli F, Amoroso A. Prevalence and clinical features of patients with the cardiorenal syndrome admitted to an internal medicine ward. Cardiorenal Med 2014; 4:88-94. [PMID: 25254030 DOI: 10.1159/000362566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/26/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Many patients admitted to a Department of Internal Medicine have different degrees of heart and kidney dysfunction. Mortality, morbidity and cost of care greatly increase when cardiac and renal diseases coexist. METHODS A retrospective cohort study was conducted on 1,087 patients admitted from December 2009 to December 2012 to evaluate the prevalence of the cardiorenal syndrome (CRS) and clinical features. RESULTS Out of 1,087 patients discharged from our unit during the study period, 190 (17.5%) were diagnosed as having CRS and classified into five types. CRS was more common in males (68.9%). CRS type 1 was associated with higher age (79.9 ± 8.9 years) and accounted for 61.5% of all deaths (p < 0.001), representing a risk factor for mortality (OR 4.23, 95% CI 1.8-10). Congestive heart failure was significantly different among the five CRS types (p < 0.0001) with a greater frequency in type 1 patients. Infectious diseases were more frequent in CRS types 1, 3 and 5 (p < 0.05). Pneumonia presented a statistically higher frequency in CRS types 1 and 5 compared to other classes (p < 0.01), and community-acquired infections were statistically more frequent in CRS types 1 and 5 (p < 0.05). The distribution of community-acquired pneumonia was different among the classes (p < 0.01) with a higher frequency in CRS types 1, 3 and 5. CONCLUSION CRS is a condition that is more frequently observed in the clinical practice. The identification of predisposing trigger factors, such as infectious diseases, particularly in the elderly, plays a key role in reducing morbidity and mortality. An early recognition can be useful to optimize therapy, encourage a multidisciplinary approach and prevent complications.
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Affiliation(s)
- Antonietta Gigante
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Marta Liberatori
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Liborio Sardo
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesca Di Mario
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Barbara Dorelli
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Biagio Barbano
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Edoardo Rosato
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Antonio Amoroso
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
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Affiliation(s)
- Alessandro Laviano
- Department of Clinical Medicine, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
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Muscaritoli M, Lucia S, Molfino A, Cederholm T, Rossi Fanelli F. Muscle atrophy in aging and chronic diseases: is it sarcopenia or cachexia? Intern Emerg Med 2013; 8:553-60. [PMID: 22773188 DOI: 10.1007/s11739-012-0807-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 06/18/2012] [Indexed: 12/24/2022]
Abstract
Cachexia and sarcopenia present several analogies in both the pathogenic mechanisms and the clinical picture. The loss of muscle mass and strength is a hallmark of these two clinical conditions. Although frequently overlapping and often indistinguishable, especially in old individuals, these two conditions should be considered distinct clinical entities. A prompt and accurate patient evaluation, guiding the physician through a proper differential diagnostic procedure and providing the best therapeutic options, is recommended. Given the several commonalities between cachexia and sarcopenia, it is likely that the therapeutic approaches may prove effective in both conditions. This review focuses on the most recent available literature and aims at providing physicians with the correct tools that are available to aid in diagnosing these two different entities that often clinically overlap. Currently available or proposed therapeutic strategies for pre-cachexia, cachexia and sarcopenia are also briefly described.
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Affiliation(s)
- Maurizio Muscaritoli
- Department of Clinical Medicine, Sapienza, University of Rome, Viale dell'Università, 37, 00185, Rome, Italy,
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Affiliation(s)
- Maurizio Muscaritoli
- Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, Rome, Italy.
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26
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Arezzo di Trifiletti A, Misino P, Giannantoni P, Giannantoni B, Cascino A, Fazi L, Rossi Fanelli F, Laviano A. Comparison of the performance of four different tools in diagnosing disease-associated anorexia and their relationship with nutritional, functional and clinical outcome measures in hospitalized patients. Clin Nutr 2013; 32:527-32. [DOI: 10.1016/j.clnu.2012.11.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 10/09/2012] [Accepted: 11/11/2012] [Indexed: 11/24/2022]
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Bonetto A, Penna F, Aversa Z, Mercantini P, Baccino FM, Costelli P, Ziparo V, Lucia S, Fanelli FR, Muscaritoli M. Early changes of muscle insulin-like growth factor-1 and myostatin gene expression in gastric cancer patients. Muscle Nerve 2013; 48:387-92. [DOI: 10.1002/mus.23798] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Andrea Bonetto
- Department of Experimental Medicine and Oncology; University of Turin; Turin; Italy
| | - Fabio Penna
- Department of Experimental Medicine and Oncology; University of Turin; Turin; Italy
| | - Zaira Aversa
- Department of Clinical Medicine, Sapienza; University of Rome; Rome; Italy
| | - Paolo Mercantini
- Department of Surgery, S. Andrea Hospital, Sapienza; University of Rome; Rome; Italy
| | - Francesco M. Baccino
- Department of Experimental Medicine and Oncology; University of Turin; Turin; Italy
| | - Paola Costelli
- Department of Experimental Medicine and Oncology; University of Turin; Turin; Italy
| | - Vincenzo Ziparo
- Department of Surgery, S. Andrea Hospital, Sapienza; University of Rome; Rome; Italy
| | - Simone Lucia
- Department of Clinical Medicine, Sapienza; University of Rome; Rome; Italy
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Rianda S, Rossi Fanelli F, Laviano A. Malnutrition, cachexia and nutritional intervention: when much becomes too much. CMI 2013. [DOI: 10.7175/cmi.v7i2.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Disease-associated malnutrition, also defined as cachexia, is a complex syndrome characterised by the progressive deterioration of nutritional status resulting from the combined effects of reduced appetite and food intake, and profound changes in host metabolism. Cachexia has been repeatedly demonstrated to represent a negative prognostic factor for patients suffering from acute and chronic diseases, including cancer. In oncology patients, early diagnosis of cachexia and timely nutritional intervention have been demonstrated not only to prevent further deterioration of nutritional status, but also to increase quality of life and survival when integrated in a multiprofessional and multidisciplinary approach. However, nutritional therapy is associated to the possible development of complications, which may be fatal. Therefore, nutritional therapy in severely malnourished patients should be cautiously prescribed by experts in the field, who should develop a monitoring program to early detect complications and to maximise the clinical efficacy.Here we describe a cancer patient affected by refeeding syndrome, who was fortunately early diagnosed and properly treated.
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Laviano A, Molfino A, Rianda S, Rossi Fanelli F. The growth hormone secretagogue receptor (Ghs-R). Curr Pharm Des 2013; 18:4749-54. [PMID: 22632856 DOI: 10.2174/138161212803216906] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 04/05/2012] [Indexed: 11/22/2022]
Abstract
The growth hormone secretagogue receptor (GHS-R) is a component of the ghrelin signaling pathway and is involved in mediating the pleiotropic effects of ghrelin. Two isoforms have been identified, but only GHS-R1a binds with acyl ghrelin and transduces its message. However, the inactive variant of GHS-R, GHS-R1b, appears to play a critical role in modulating the activity of GHS-R1a by forming heterodimeric complexes which attenuates trafficking of the active variant to the cell surface. The molecular mechanisms of signal transduction are complex and are specific of the tissues where GHS-R1a is expressed. The potent induction of GH secretion and the stimulation of appetite are the most intensively studied functions of GHS-R1a. However, the tissue distribution of GHS-R1a extends beyond the pituitary and the hypothalamus, and reflects the different biological functions of the ghrelin/GHS-R system. GHS-R1a is also expressed in other brain areas, in the pancreas, adipose tissue, immune cells and cardiovascular system, and modulates learning and memory, glucose and lipid metabolism, inflammatory response and cardiac performance. The pleiotropic effects of the ghrelin/GHS-R system suggest their exploitation to prevent and treat a number of clinical conditions. Among many other syndromes and diseases, cancer cachexia, aging related cognitive decline, obesity and diabetes may significantly benefit from the use of GHS-R1a agonists or antagonists.
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Affiliation(s)
- Alessandro Laviano
- Department of Clinical Medicine, Sapienza University, viale dell'Università 37, 00185 Rome, Italy.
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Merli M, Giusto M, Molfino A, Bonetto A, Rossi M, Ginanni Corradini S, Baccino FM, Rossi Fanelli F, Costelli P, Muscaritoli M. MuRF-1 and p-GSK3β expression in muscle atrophy of cirrhosis. Liver Int 2013; 33:714-21. [PMID: 23432902 DOI: 10.1111/liv.12128] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 01/19/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic diseases, including cirrhosis, are often accompanied by protein-energy malnutrition and muscle loss, which in turn negatively affect quality of life, morbidity and mortality. Unlike other chronic conditions, few data are available on the molecular mechanisms underlying muscle wasting in this clinical setting. AIMS To assess mechanisms of muscle atrophy in patients with cirrhosis. METHODS Nutritional [subjective global assessment (SGA) and anthropometry] and metabolic assessment was performed in 30 cirrhotic patients awaiting liver transplantation. Rectus abdominis biopsies were obtained intraoperatively in 22 cirrhotic patients and in 10 well-nourished subjects undergoing elective surgery for non-neoplastic disease, as a control group. Total RNA was extracted and mRNA for atrogenes (MuRF-1, Atrogin-1/MAFbx), myostatin (MSTN), GSK3β and IGF-1 was assayed. RESULTS A total of 50% of cirrhotic patients were malnourished based on SGA, while 53% were muscle-depleted according to mid-arm muscle area (MAMA<5th percentile). MuRF-1 RNA expression was significantly increased in malnourished cirrhotic patients (SGA-B/C) vs. well-nourished patients (SGA-A) (P = 0.01). The phosphorylation of GSK3β was up-regulated in cirrhotic patients with hepatocellular carcinoma (HCC) vs. patients without tumour (P < 0.05). CONCLUSIONS Muscle loss is frequently found in end-stage liver disease patients. Molecular factors pertaining to signalling pathways known to be involved in the regulation of muscle mass are altered during cirrhosis and HCC.
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Affiliation(s)
- Manuela Merli
- Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
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Aversa Z, Alamdari N, Castillero E, Muscaritoli M, Fanelli FR, Hasselgren PO. CaMKII activity is reduced in skeletal muscle during sepsis. J Cell Biochem 2013; 114:1294-305. [DOI: 10.1002/jcb.24469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 11/27/2012] [Indexed: 12/23/2022]
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Abstract
PURPOSE OF REVIEW Significant achievements have been obtained in cancer treatment, but the clinical relevance of drug approach in daily practice remains questionable due to the high costs, limited efficacy, and negligible influence on quality of life. A new concept is emerging which is based on the early combination of chemotherapy and nutrition therapy. RECENT FINDINGS Inflammation dictates tumour initiation, progression and growth. Omega-3 fatty acids exert anti-inflammatory effects, and therefore recent studies investigated their role in cancer prevention, in cancer cachexia treatment and in enhancement of antitumour therapies. Limited evidence suggests a role for omega-3 fatty acid supplementation in cancer prevention, but they have been shown to preserve muscle mass and function in cancer patients even during active treatment. During chemotherapy, omega-3 fatty acids may contribute to a reduced inflammatory response, but whether cancer treatment toxicity can be prevented remains to be assessed. Finally, small studies showed that omega-3 fatty acids increase response rate to chemotherapy. SUMMARY Combination of chemotherapy and omega-3 supplementation appears an effective strategy to enhance the clinical outcome of cancer patients in their curative and palliative clinical trajectory.
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Molfino A, De Luca S, Muscaritoli M, Citro G, Fazi L, Mari A, Ramaccini C, Rossi Fanelli F, Laviano A. Timing of antioxidant supplementation is critical in improving anorexia in an experimental model of cancer. Int J Food Sci Nutr 2013; 64:570-4. [PMID: 23301688 DOI: 10.3109/09637486.2012.759189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Increased oxidative stress may contribute to cancer anorexia, which could be ameliorated by antioxidant supplementation. methylcholanthrene (MCA) sarcoma-bearing Fisher rats were studied. After tumour inoculation, rats were randomly assigned to standard diet (CTR group, n = 6), or to an antioxidant-enriched diet (AOX group, n = 8). Eight more rats (STD-AOX group) switched from standard to antioxidant diet when anorexia developed. At the end of the study, food intake (FI, g/d), body weight and tumour weight (g) were recorded, and plasma samples were obtained. On day 16, anorexia has appeared only in CTR and STD-AOX animals. At the end of the study, FI in AOX animals was still higher than in the other groups (p = 0.08). No differences in body and tumour weights were observed among groups. However, hydrogen peroxide and interleukin-1β levels were significantly reduced only in AOX rats. Data obtained suggest that early antioxidant supplementation improves cancer anorexia, ameliorates oxidative stress and reduces inflammation.
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Affiliation(s)
- Alessio Molfino
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
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Laviano A, Seelaender M, Rianda S, Silverio R, Rossi Fanelli F. Neuroinflammation: a contributing factor to the pathogenesis of cancer cachexia. Crit Rev Oncog 2012; 17:247-51. [PMID: 22831155 DOI: 10.1615/critrevoncog.v17.i3.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The clinical journey of cancer patients is frequently complicated by the development of a complex and multifaceted syndrome, the main features of which are reduced appetite, decreased food intake, progressive weight loss, and wasting of muscle mass and adipose tissue, which is not prevented by the provision of calories and proteins. This syndrome, termed Cachexia, is responsible for increased morbidity, reduced survival, and impinged quality of life of cancer patients. The pathogenesis is complex and involves deranged metabolism of peripheral tissues and profound alterations of brain neurochemistry. Recent studies indicate that brain neurochemistry is perturbed during tumor growth by cancer-induced increased intrahypothalamic expression of proinflammatory cytokines. The attending neurochemical chaos mediates the anorexigenic behavioral responses associated to cancer cachexia, but recent data seem to suggest that neuronal output also may be involved in the metabolic changes occurring at the peripheral level.
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Abstract
Cancer cachexia is a disabling syndrome because of the complex interactions between the tumor, host metabolism, and proinflammatory cytokines that increases patients' morbidity and mortality. Considering the recent new definition and classification of cachexia, we aimed to review cancer cachexia from its underlying mechanisms to the clinical approach. Cancer cachexia is featured by a disruption in energy balance, metabolic changes, a decrease in fat mass, depletion of skeletal muscle mass, and perturbations in proinflammatory cytokines. Diagnostic effort should be focused on the recognition of precachexia to prevent or delay changes in body composition and nutritional complications secondary to cancer. From the point of disease diagnosis, every cancer patient needs continuous monitoring to receive effective, tailored nutritional and metabolic support. To date, practical guidelines to counteract cancer-related muscle wasting are lacking, mainly because of the multifactorial pathogenesis of the syndrome. A single therapy may not be effective; only a multimodal approach involving different treatment combinations is more likely to be successful in the prevention and treatment of cancer cachexia.
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Affiliation(s)
- Simone Lucia
- Department of Clinical Medicine, Sapienza University, Rome, Italy
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Yoshino J, Conte C, Fontana L, Mittendorfer B, Imai SI, Schechtman KB, Gu C, Kunz I, Rossi Fanelli F, Patterson BW, Klein S. Resveratrol supplementation does not improve metabolic function in nonobese women with normal glucose tolerance. Cell Metab 2012; 16:658-64. [PMID: 23102619 PMCID: PMC3496026 DOI: 10.1016/j.cmet.2012.09.015] [Citation(s) in RCA: 292] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/07/2012] [Accepted: 09/27/2012] [Indexed: 12/12/2022]
Abstract
Resveratrol has been reported to improve metabolic function in metabolically abnormal rodents and humans, but it has not been studied in nonobese people with normal glucose tolerance. We conducted a randomized, double-blind, placebo-controlled trial to evaluate the metabolic effects of 12 weeks of resveratrol supplementation (75 mg/day) in nonobese, postmenopausal women with normal glucose tolerance. Although resveratrol supplementation increased plasma resveratrol concentration, it did not change body composition, resting metabolic rate, plasma lipids, or inflammatory markers. A two-stage hyperinsulinemic-euglycemic clamp procedure, in conjunction with stable isotopically labeled tracer infusions, demonstrated that resveratrol did not increase liver, skeletal muscle, or adipose tissue insulin sensitivity. Consistent with the absence of in vivo metabolic effects, resveratrol did not affect its putative molecular targets, including AMPK, SIRT1, NAMPT, and PPARGC1A, in either skeletal muscle or adipose tissue. These findings demonstrate that resveratrol supplementation does not have beneficial metabolic effects in nonobese, postmenopausal women with normal glucose tolerance.
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Affiliation(s)
- Jun Yoshino
- Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
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Muscaritoli M, Molfino A, Laviano A, Rasio D, Rossi Fanelli F. Parenteral nutrition in advanced cancer patients. Crit Rev Oncol Hematol 2012; 84:26-36. [DOI: 10.1016/j.critrevonc.2012.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 12/23/2011] [Accepted: 01/25/2012] [Indexed: 10/28/2022] Open
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Molfino A, Chiappini MG, Laviano A, Ammann T, Bollea MR, Alegiani F, Rossi Fanelli F, Muscaritoli M. Effect of intensive nutritional counseling and support on clinical outcomes of hemodialysis patients. Nutrition 2012; 28:1012-5. [DOI: 10.1016/j.nut.2012.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 01/17/2012] [Accepted: 01/17/2012] [Indexed: 11/29/2022]
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Muscaritoli M, Kushta I, Molfino A, Inghilleri M, Sabatelli M, Rossi Fanelli F. Nutritional and metabolic support in patients with amyotrophic lateral sclerosis. Nutrition 2012; 28:959-66. [DOI: 10.1016/j.nut.2012.01.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 01/10/2012] [Accepted: 01/18/2012] [Indexed: 12/12/2022]
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Muscaritoli M, Costelli P, Molfino A, Penna F, M. Baccino F, Gioia G, Rossi Fanelli F. New Strategies for Metabolic Support in Cancer. CNF 2012. [DOI: 10.2174/157340112800840826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Laviano A, Molfino A, Seelaender M, Frascaria T, Bertini G, Ramaccini C, Bollea MR, Citro G, Fanelli FR. Carnitine Administration Reduces Cytokine Levels, Improves Food Intake, and Ameliorates Body Composition in Tumor-Bearing Rats. Cancer Invest 2011; 29:696-700. [DOI: 10.3109/07357907.2011.626476] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Gigante A, Gasperini ML, Giannakakis K, Barbano B, Fanelli FR, Papa A, Cianci R, Amoroso A. Ask-Upmark Kidney and Tubulointerstitial Nephritis in a Woman with Severe Renal Failure. Ren Fail 2011; 33:726-9. [DOI: 10.3109/0886022x.2011.589939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Laviano A, Seelaender M, Sanchez-Lara K, Gioulbasanis I, Molfino A, Rossi Fanelli F. Beyond anorexia -cachexia. Nutrition and modulation of cancer patients' metabolism: supplementary, complementary or alternative anti-neoplastic therapy? Eur J Pharmacol 2011; 668 Suppl 1:S87-90. [PMID: 21810420 DOI: 10.1016/j.ejphar.2011.06.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 05/30/2011] [Accepted: 06/27/2011] [Indexed: 01/27/2023]
Abstract
Anorexia and muscle wasting are frequently observed in cancer patients and influence their clinical outcome. The better understanding of the mechanisms underlying behavioral changes and altered metabolism yielded to the development of specialized nutritional support, which enhances utilization of provided calories and proteins by counteracting some of the metabolic derangements occurring during tumor growth. Inflammation appears to be a key factor determining the cancer-associated biochemical abnormalities eventually leading to anorexia and cachexia. Interestingly, inflammation is also involved in carcinogenesis, cancer progression and metastasis by impairing immune surveillance, among other mechanisms. Therefore, nutritional interventions aiming at modulating inflammation to restore nutritional status may also result in improved response to pharmacological anti-cancer therapies. Recent clinical data show that supplementation with nutrients targeting inflammation and immune system increases response rate and survival in cancer patients. This suggests that nutrition therapy should be considered as an important adjuvant strategy in the multidimensional approach to cancer patients.
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Molfino A, Logorelli F, Citro G, Bertini G, Ramaccini C, Bollea MR, Rossi Fanelli F, Laviano A. Stimulation of the nicotine antiinflammatory pathway improves food intake and body composition in tumor-bearing rats. Nutr Cancer 2011; 63:295-9. [PMID: 21298590 DOI: 10.1080/01635581.2011.530736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Inflammation contributes to the pathogenesis of cancer anorexia-cachexia syndrome. Nicotine administration reduces cytokine levels and mortality during sepsis. Therefore, nicotine administration may result in improved anorexia-cachexia. Sixteen male Fischer rats inoculated with MCA sarcoma were assigned to random injections of nicotine (NIC; 200 mg/kg BW/d) or saline (C). Food intake (FI), body weight, body composition, interleukin (IL)-1, IL-6 levels were evaluated. Data were analyzed via Student's t-test for paired and unpaired data and ANOVA. FI started declining 12 days after tumor inoculation both in C and NIC rats, but the decline was significantly attenuated by nicotine administration. At the end of the study, lean body mass wasting was more severe in C rats than in NIC rats (P<0.05), whereas a trend toward attenuation of fat mass depletion was observed. IL-1 circulating levels were significantly lower in NIC rats than in C rats (114±21 pg/mL vs. 190±35 pg/mL, respectively; P<0.01), whereas the reduction of IL-6 levels in NIC rats was only marginally not significant when compared to C rats (555±174 pg/mL vs. 721±160 pg/mL, respectively; P=0.06). Our data suggest that the nicotinic antiinflammatory pathway may represent an interesting and possibly effective therapy for anorexia-cachexia syndrome.
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Affiliation(s)
- Alessio Molfino
- Department of Clinical Medicine, Sapienza University, Rome, Italy
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Laviano A, Aghilone F, Colagiovanni D, Fiandra F, Giambarresi R, Tordiglione P, Molfino A, Muscaritoli M, Rosa G, Rossi Fanelli F. Metabolic and clinical effects of the supplementation of a functional mixture of amino acids in cerebral hemorrhage. Neurocrit Care 2011; 14:44-9. [PMID: 20972646 DOI: 10.1007/s12028-010-9461-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oral supplementation of a specific mixture of essential and non-essential amino acids has been shown to modulate hypercatabolism in patients with chronic heart failure, leading to improved clinical outcome. The aim of this study was to test whether such effects could be replicated in an acute clinical model of hypercatabolism. METHODS After approval by the Ethics Committee, patients with acute brain hemorrhage admitted to the Neurosurgical ICU were randomly assigned to receive enterally for 14 days 20% of their estimated nitrogen requirements as a standard protein supplement (control group; n = 9) or as a functional amino acid mixture (Aminotrofic®, Errekappa Euroterapici; study group; n = 10). Metabolic and clinical outcome measures were monitored. RESULTS In the study group, insulin sensitivity and total lymphocyte count appeared to improve when compared with control patients. Less positive blood cultures were found in the study group against control patients (4 vs. 7, respectively; P = 0.05). Also, mortality in the study group was reduced than in control patients (60 vs. 77%; P = n.s.). CONCLUSIONS Supplementation with specific amino acids in critically ill patients may modulate metabolic response and improve clinical outcome.
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Aversa Z, Bonetto A, Penna F, Costelli P, Di Rienzo G, Lacitignola A, Baccino FM, Ziparo V, Mercantini P, Rossi Fanelli F, Muscaritoli M. Changes in myostatin signaling in non-weight-losing cancer patients. Ann Surg Oncol 2011; 19:1350-6. [PMID: 21519918 DOI: 10.1245/s10434-011-1720-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Myostatin is a negative regulator of skeletal muscle mass. We recently demonstrated that myostatin expression is upregulated in an experimental model of cancer cachexia, suggesting that modulations of this pathway might play a pathogenic role in cancer-related muscle wasting. The present study was designed to investigate whether myostatin signaling is modulated in the muscle of non-weight-losing (nWL) patients with lung and gastric cancer. METHODS Myostatin signaling was studied in muscle biopsies obtained during surgical procedure from nWL patients affected by gastric (n=16) or lung (n=17) cancer. Western blotting was applied to test both the total expression of myostatin and the expression of phosphorylated form of GSK-3beta and Smad2/3. RESULTS In patients with gastric cancer, the expression of both myostatin and phosphorylated GSK-3beta (p-GSK3β) were significantly increased. By contrast, in patients with lung cancer, myostatin levels were comparable to controls, whereas the expression of p-GSK3β significantly decreased in patients with disease stage III/IV. CONCLUSIONS Myostatin signaling is altered in nWL cancer patients. Different tumor types may give rise to different patterns of molecular changes within the muscle, which occur even before cachexia becomes clinically apparent.
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Affiliation(s)
- Zaira Aversa
- Department of Clinical Medicine, Sapienza, University of Rome, Rome, Italy
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Silvério R, Laviano A, Rossi Fanelli F, Seelaender M. L-Carnitine induces recovery of liver lipid metabolism in cancer cachexia. Amino Acids 2011; 42:1783-92. [PMID: 21465256 DOI: 10.1007/s00726-011-0898-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 03/22/2011] [Indexed: 11/30/2022]
Abstract
Cancer cachexia causes metabolic alterations with a marked effect on hepatic lipid metabolism. L-Carnitine modulates lipid metabolism and its supplementation has been proposed as a therapeutic strategy in many diseases. In the present study, the effects of L-carnitine supplementation on gene expression and on liver lipid metabolism-related proteins was investigated in cachectic tumour-bearing rats. Wistar rats were assigned to receive 1 g/kg of L-carnitine or saline. After 14 days, supplemented and control animals were assigned to a control (N), control supplemented with L-carnitine (CN), tumour-bearing Walker 256 carcinosarcoma (TB) and tumour-bearing supplemented with L-carnitine (CTB) group. The mRNA expression of carnitine palmitoyltransferase I and II (CPT I and II), microsomal triglyceride transfer protein (MTP), liver fatty acid-binding protein (L-FABP), fatty acid translocase (FAT/CD36), peroxisome proliferator-activated receptor-alpha (PPAR-alpha) and organic cation transporter 2 (OCTN2) was assessed, and the maximal activity of CPT I and II in the liver measured, along with plasma and liver triacylglycerol content. The gene expression of MTP, and CPT I catalytic activity were reduced in TB, who also showed increased liver (150%) and plasma (3.3-fold) triacylglycerol content. L-Carnitine supplementation was able to restore these parameters back to control values (p<0.05). These data show that L-carnitine preserves hepatic lipid metabolism in tumour-bearing animals, suggesting its supplementation to be of potential interest in cachexia.
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Affiliation(s)
- Renata Silvério
- Cancer Metabolism Research Group, Institute of Biomedical Sciences, University of São Paulo, Av. Prof. Lineu Prestes, 1524, CEP 05508-900, Butantã, São Paulo, SP, Brazil
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Muscaritoli M, Molfino A, Gioia G, Laviano A, Rossi Fanelli F. The "parallel pathway": a novel nutritional and metabolic approach to cancer patients. Intern Emerg Med 2011; 6:105-12. [PMID: 20596799 DOI: 10.1007/s11739-010-0426-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 06/16/2010] [Indexed: 12/14/2022]
Abstract
Cancer-associated malnutrition results from a deadly combination of anorexia, which leads to reduced food intake, and derangements of host metabolism inducing body weight loss, and hindering its reversal with nutrient supplementation. Cancer patients often experience both anorexia and weight loss, contributing to the onset of the clinical feature named as anorexia-cachexia syndrome. This condition has a negative impact upon patients' nutritional status. The pathogenesis of the anorexia-cachexia syndrome is multifactorial, and is related to: tumour-derived factors, host-derived factors inducing metabolic derangements, and side effects of anticancer therapies. In addition, the lack of awareness of cancer patients' nutritional issues and status by many oncologists, frequently results in progressive weight loss going undiagnosed until it becomes severe. The critical involvement of host inflammatory response in the development of weight loss, and, in particular, lean body mass depletion, limits the response to the provision of standard nutrition support. A novel nutritional and metabolic approach, named "parallel pathway", has been devised that may help maintain or improve nutritional status, and prevent or delay the onset of cancer cachexia. Such an approach may improve tolerance to aggressive anticancer therapies, and ameliorate the functional capacity and quality of life even in advanced disease stages. The "parallel pathway" implies a multiprofessional and multimodal approach aimed at ensuring early, appropriate and continuous nutritional and metabolic support to cancer patients in any phase of their cancer journey.
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Affiliation(s)
- Maurizio Muscaritoli
- Department of Clinical Medicine, Sapienza University of Rome, viale dell'Università, 37, 00185, Rome, Italy.
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