Immunology and cachexia: a review
Many types of conditions and diseases are associated with wasting syndromes such as cachexia. However, despite its prevalence, there is limited knowledge regarding the diagnosis and treatment of cachexia due to our lack of understanding of the causative molecular mechanisms. Cachexia must be viewed through an immunological context to understand its full consequences on patient prognosis. For example, it is known that cytokines such as tumour necrosis factor, IL-1β, IL-6 and IFNγ are consistently upregulated in cases of cachexia in both immune and non-immune cells. This appears to lead to the changes in transcriptional regulation, inducing catabolic pathways in muscles and adipose tissue. Yet, despite this understanding, targeting such cytokines has not shown successful in clinical settings. Further research has also been done to identify the involvement of immune cells such as macrophages, neutrophils, myeloid-derived suppressor cells and T cells in cachexia. Yet, their full involvement in the condition is not yet understood. Hence, many questions remain about this interplay between cachexia and immune system. It is vital to discover the common and unique properties of cancer cachexia and infection-associated cachexia to develop effective therapeutic strategies for cachexia.
This review by Baazim H et al. aimed to highlight the relationship between the immune system and cachexia, as well as our current lack of knowledge surrounding this syndrome.
Cachexia staging score predicts survival: a review
The guidelines most commonly used to diagnose cachexia are the European Palliative Care Research Collaborative (EPCRC) guidelines. Here, cachexia is classified according to weight loss. However, for patients in palliative care with advanced cancer, there are often cases of oedema and ascites. This hampers the ability to detect weight loss, affecting the likelihood to be diagnosed with cachexia. Therefore, this study wished to examine the validity of diagnosing cachexia based upon other items. Alongside weight loss, this includes factors such as fatigue, decreasing muscle mass in the mid-upper arm, abnormal levels of white blood cells, reduced food intake and others. This study validated the CSS, Cachexia Staging Score, which demonstrated that patients without cachexia had a higher survival rate, and that the risk of mortality was higher with more severe cachexia. They also validated that cachexia prevalence was not significantly different compared to previous studies. Hence, such a multidimensional assessment helps to evaluate disorders including cachexia.
This review by Ueshima J et al. aimed to validate the Cachexia Staging Score for patients with advanced cancer who are under palliative care.
Tumour derived exosomes and cancer cachexia: a review
Exosomes are extracellular vesicles that contain cargo such as proteins, lipids, nucleic acids and more. Their function is to alter cell signalling in the cell it releases its cargo into. For example, exosomes have been seen to alter muscle and adipose tissue metabolism. This has led to the thought that they may be involved in cancer cachexia. Inhibiting tumour derived exosome release therefore may improve survival and cancer cachexia in patients. Specifically, tumour derived exosome micro-RNAs have been associated with muscle wasting and tumour presence. Furthermore, they may package inflammatory cytokines. This could play a causal role in cancer cachexia as increase cytokine circulation is thought to precede the loss of appetite in cachexia, holding a causal role in the disease progression.
This review by Pitzer CR et al. aimed to summarise the potential involvement of tumour derived exosomes in cancer cachexia.
Sarcopenia, unpreparedness, and the developing world: an urgent concern?
Muscle strength has recently been defined as sarcopenia’s main component by the revised European Working Group in Sarcopenia for Older People (EWGSOP2). This shift from muscle mass to strength has had transformative implications within clinical practice and has greatly facilitated sarcopenia’s diagnostic process. Despite this trailblazing consensus, sarcopenia remains an issue of growing concern throughout high-income countries (HICs). Although low- and middle-income countries (LMICs) are disproportionately affected by the threat of sarcopenia, their care providers and healthcare systems seem to be the least prepared to tackle it.
The aim of this article is to expose the state of sarcopenia awareness and management in LMICs. It further proposes solutions to prepare the developing world for this growing concern.
PIH and sarcopenia in COPD: a causal relationship?
Nocturnal hypoxia commonly occurs in patients with chronic obstructive pulmonary disease (COPD), and in this context may be referred to as prolonged intermittent hypoxia (PIH). It is estimated that 1 in 5 COPD patients also suffer from sarcopenia, which may affect both respiratory and non-respiratory skeletal muscles and be causally linked to PIH. The presentation of sarcopenia alongside COPD is known to reduce quality of life and increase both hospitalisation and mortality rates in affected patients. Despite this, the adaptive cellular responses to PIH in skeletal muscle have not yet been adequately investigated.
The aim of this article was to discuss findings from a 2022 paper by Attaway and colleagues, which itself aimed to explore adaptive cellular responses to PIH.
Latest treatments for cancer cachexia: a review
Currently, there are many interventions and treatments for cancer cachexia. Early nutritional intervention and care are essential to ensure that sufficient nutritional requirements are met for the patients. This includes oral nutrition where possible, as well as nutrition and exercise therapy. Furthermore, preventive care to minimise loss of skeletal muscle mass is vital. Pharmacological options are also available. These include many options, such as non-steroidal anti-inflammatory drugs, anti-cytokine therapy and eicosapentaenoic acid. Furthermore, steroids are often used for cachexia. However, they have limited effects are limited, so recently, anamorelin hydrochloride, a ligand with a similar action to that of ghrelin, was developed. It is used to treat weight loss by increasing appetite and has been approved for use in cachexia. Anamorelin hydrochloride holds great promise to function as an effective therapeutic drug for cancer cachexia.
This review by Watanabe H & Oshima T aimed to review the current treatments of cancer cachexia, as well as anamorelin hydrochloride, a new and promising treatment.