Chronic Inflammation in Cancer Cachexia: History
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Cachexia, a type of metabolic syndrome linked to the disease, is associated with a dysregulation of metabolic pathways. Cancer Cachexia is a subtle condition that reduces patients’ quality of life by impairing their response to therapy and survival. Inflammatory mediators that may play a role in the pathogenesis of neoplastic cachexia, for example, overlap with those that may play a role in the pathogenesis of obesity. Cachexia is a complication of cancer-related malnutrition associated with catabolic/hypermetabolic changes.

  • chronic inflammation
  • cachexia

1. Malnutrition and Cancer

A change in nutritional status is common during the natural history of a neoplastic disease [121,122]. Even with adequate nutritional support, neoplasia has a limited reversibility, which distinguishes malnutrition from “regular” malnourishment [123]. Because of this characteristic, this condition is referred to as neoplastic cachexia rather than malnutrition associated with neoplasia [124]. Cachexia may be caused by a tumor–host interaction [125]. Tumors may produce pro-inflammatory cytokines (TNF-, IL-6, and so on), lipid mobilization factors (LMF), and catabolic-inducing protides (CIP) [126,127,128]. If a tumor is present, the host’s inflammatory and neuroendocrine stress responses will be activated [129,130]. In this case, changes in body composition (and their functional consequences) as well as anomalies in the humoral system would emerge. Neoplastic cachexia is defined by weight loss and metabolic abnormalities across multiple substrates, as follows:
  • Improved glucose metabolism (from lactate and amino acids in the muscles), increased lactic acid synthesis, peripheral insulin resistance, and increased lactate excretion [131,132].
  • Increased protein metabolism is defined by an increase in blood levels of a factor that stimulates proteolysis (PIF), an increase in muscle tissue protein catabolism, and a decrease in lean mass and liver protein synthesis [133,134].
  • LMF (lipid mobilizing factor) is an enzyme that increases lipid metabolism, beta-oxidation, and turnover-free fatty acid synthesis to promote lipolysis [135,136].

2. Dysregulation of Metabolic Pathways during Cachexia

The long-term release of tumor cytokines into the bloodstream may disrupt the neuroendocrine control of metabolism in multiple organs [137,138]. If metabolites were difficult to obtain or were used incorrectly, cachexia would worsen [139,140]. As a result of the activation of the brown adipose tissue (BAT), which causes a fever, patients with anorexia and cachexia are committed to energy-intensive, maladaptive reactions to anorexia. Obesity and cachexia are associated with increased lipolysis, elevated free fatty acid (FFA), ceramides, and insulin resistance [141,142]. Other metabolic pathways also changing in an unusual way [143,144,145]. Insulin resistance is important in the context of pathogenic bacteria because it diverts nutrients away from anabolic and antimetabolic pathways, and toward immune system energy supplies. This lays the groundwork for understanding insulin resistance caused by inflammation [146]. Immune cells that have been stimulated can receive nutrients via an energy recourse reaction using this adaptive technique [147]. Once the infection has been cleared and equilibrium has been restored, anti-inflammatory chemicals are typically used to counteract this response [148]. Chronic inflammatory disorders such as inflammatory arthritis and chronic obstructive pulmonary disease (COPD) share molecular recognition sensors and mediators with cancer and obesity [149].

3. Cancer Cytokines and Inflammation

Proinflammatory cytokines, which play a role in the development and progression of cancer, play a critical role in survival rates, quality of life, and therapy response [150,151]. Many types of cancer patients have elevated levels of cytokines and soluble receptors in their blood. IL-6 and IL-8 concentrations appear to be strongly predictive of prognosis and outcome in a number of studies [152,153,154,155]. When cancer cells interact with other cells in the tumor microenvironment, such as endothelial and immune cells, as well as necrotic tissue, they can process cytokines [156]. The release of cytokines into the bloodstream by tumors has the potential to affect organs located far from the tumor’s location. In contrast to their well-known normal biological roles, these tumor cytokines have the potential to subvert physiological systems when produced chronically by tumors in the absence of sufficient negative feedback regulatory signals [157,158]. Some of these cancer cytokines may be difficult to identify because they are produced by a diverse mix of malignant and normal cells in the tumors of different patients. Because tumors produce and express them in high quantities, their function differs from those of cytokines and myokines, which are also produced and expressed in high quantities by tumors [159,160]. Tumors produce IL-6 continuously, in contrast to immune cells’ precise circadian regulation of IL-6 and other cytokines, and skeletal muscle’s transitory spikes in plasma IL-6 production during exercise. IL-6 concentrations, on the other hand, can increase up to 100-fold during physical activity but quickly return to pre-exercise levels once the activity is completed [108,161,162]. Cachexia has a negative impact on the health and well-being of cancer patients. Individuals with cachexia’s clinical and nutritional care will be improved if the metabolic anomalies and treatment options are better understood [162]. A tumor’s overproduction of cytokines alters the energy balance in many organ systems and reveals treatment options. Researchers can investigate cancer cytokines’ normal and malignant functions, as well as their interactions with inflammatory signals and metabolic abnormalities, to identify cancer cytokines. [163]. Researchers now have new insights into both obesity and neoplastic cachexia, which share many of the same molecular recognition sensors and process mediators [164,165].

4. Chronic Inflammation in Obesity and Cancer Cachexia

Researchers now have a new avenue for studying inflammation and how it affects metabolic pathways after discovering that metabolic illnesses are frequently accompanied by a low-grade inflammatory condition. The primary cause of metabolic homeostasis disruption appears to be intercellular communication between immunological and metabolic cells. When a person overeats, immune sensors such as TLRs or inflammasomes detect high levels of lipid in the diet or their metabolic products, resulting in the production of inflammatory cytokines in various metabolic organs. Furthermore, dietary lipids can alter gut bacteria, resulting in an increase in proinflammatory molecules, which can result in an incorrect immunological response. Saturated fatty acids, inflammatory cytokines, and bacterial lipopolysaccharides, LPS, all influence insulin signaling, altering cellular metabolism. As a result, in addition to the obvious strategy of reducing caloric intake, saturated fats, and a low glycemic index, which has been shown to lower insulin levels and reduce systemic inflammation and relapse, new therapeutic strategies aimed at targeting immune sensors and different protein kinase can also be used to improve obesity-related complications. Despite growing scientific attention, this nutritional problem requires a better understanding and a more precise formal description by the health care industry in order to implement numerous therapies that must be tailored to each patient’s needs. The “diet” (in the broadest and most original sense of “lifestyle”) retains its extraordinary importance and merits careful consideration, according to the most recent scientific evidence, given the positive effect demonstrated in numerous studies of physical activity on the associated symptomatology of cachexia.

This entry is adapted from the peer-reviewed paper 10.3390/jcm11082191

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