Cardiac Cachexia - A Window to the Wasting Disorders

Keywords:
Cachexia; Wasting Syndrome; Exercise; Nutritional Physiological Phenomena

To The Editor

I read with interest the recent review by Okoshi and colleagues in the journal.¹ This was a thoroughly enjoyable read that reviewed the main areas of focus. I would like, however, to reinforce some of the arguments. In the section on neurohormonal blockade there has also been a successful phase 2 trial of the fourth generation beta-blocker espindolol in cancer cachexia.^2,3 Clearly beta-blockers can be helpful also in cardiac cachexia given their crucial role in heart failure in general. Other cardiovascular drugs are also being explored for their beneficial or protective effects on skeletal muscle. These include, as the authors point out, the ACE inhibitor Imidapril. Others including trimetazidine are also being studied.⁴ One issue of difficulty is that we are starting from the point of no effective therapies and testing therapies one by one. The true multi-system complexity of cachexia and yet its similarity across different organ failure syndromes implies it will be a multi-barrelled approach that may be needed to solve it. We may need to combine neurohormonal blockade, immune modulation, nutritional and exercise support with pro-anabolic agents to get real clinical benefits. Perhaps as the authors point out Cardiac Cachexia where several of these agents are already on board may be a good place to start. The time for a much greater focus on all cachexias, including of course cardiac cachexia, is truly here and now.⁵

References

• ¹
  Okoshi MP, Capalbo RV, Romeiro FG, Okoshi K. Cardiac cachexia: perspectives for prevention and treatment. Arq Bras Cardiol. 2017;108(1):74-80. doi: 10.5935/abc.20160142.
  » https://doi.org/10.5935/abc.20160142
• ²
  Stewart Coats AJ, Ho GF, Prabhash K, von Haehling S, Tilson J, Brown R, Beadle J, Anker SD; for and on behalf of the ACT-ONE study group. Espindolol for the treatment and prevention of cachexia in patients with stage III/IV non-small cell lung cancer or colorectal cancer: a randomized, double-blind, placebo-controlled, international multicentre phase II study (the ACT-ONE trial). J Cachexia Sarcopenia Muscle. 2016;7(3):355-65. doi: 10.1002/jcsm.12126.
  » https://doi.org/10.1002/jcsm.12126
• ³
  Lainscak M, Laviano A. ACT-ONE - ACTION at last on cancer cachexia by adapting a novel action beta-blocker. J Cachexia Sarcopenia Muscle. 2016;7(4):400-2. doi: 10.1002/jcsm.12136.
  » https://doi.org/10.1002/jcsm.12136
• ⁴
  Ferraro E, Pin F, Gorini S, Pontecorvo L, Ferri A, Mollace V, et al. Improvement of skeletal muscle performance in ageing by the metabolic modulator Trimetazidine. J Cachexia Sarcopenia Muscle. 2016;7(4):449-57. doi:10.1002/jcsm.12097.
  » https://doi.org/10.1002/jcsm.12097
• ⁵
  Loncar G, Springer J, Anker M, Doehner W, Lainscak M. Cardiac cachexia: hic et nunc. J Cachexia Sarcopenia Muscle. 2016;7(3):246-60. doi: 10.1002/jcsm.12118.
  » https://doi.org/10.1002/jcsm.12118

We truly appreciate the comments on our review manuscript published in the journal.¹ The authors reinforced our point of view by citing some papers published after the submission of our manuscript. We agree that we should immediately initiate a greater focus on cachexia of all causes aiming its prevention and treatment. While nutritional support has been long recommended for cachexia management, only more recently was exercise highlighted as a tool to manage muscle wasting and sarcopenia.^2-4 As correctly pointed out, due the capacity to prevent body weight loss in heart failure patients with reduced ejection fraction, neurohormonal blockade has also been evaluated in non-cardiac cachexia. However, concerning other therapies such as immune modulation and pro-anabolic agents, there is no convincingly evidence for a positive response^3,5,6 suggesting that additional studies are needed before we can effectively prevent and treat cachexia associated with different diseases including chronic heart and renal failure, cancer, and chronic obstructive pulmonary disease.

Marina P. Okoshi
Rafael V. Capalbo
Fernando G. Romeiro
Katashi Okoshi

References

• ¹
  Okoshi MP, Capalbo RV, Romeiro FG, Okoshi K. Cardiac cachexia: perspectives for prevention and treatment. Arq Bras Cardiol. 2017;108(1):74-80. doi: 10.5935/abc.20160142.
  » https://doi.org/10.5935/abc.20160142
• ²
  Gomes MJ, Martinez PF, Pagan LU, Damatto RL, Cezar MD, Lima AR, et al. Skeletal muscle aging: influence of oxidative stress and physical exercise. Oncotarget. 2017;8(12):20428-40. doi: 10.18632/oncotarget.14670.
  » https://doi.org/10.18632/oncotarget.14670
• ³
  Aversa Z, Costelli P, Muscaritoli M. Cancer-induced muscle wasting: latest findings in prevention and treatment. Ther Adv Med Oncol. 2017;9(5):369- 82. doi: 10.1177/1758834017698643.
  » https://doi.org/10.1177/1758834017698643
• ⁴
  Belloum Y, Rannou-Bekono F, Favier FB. Cancer-induced cardiac cachexia: pathogenesis and impact of physical activity (Review). Oncol Rep. 2017;37(5):2543-52. doi: 10.3892/or.2017.5542.
  » https://doi.org/10.3892/or.2017.5542
• ⁵
  von Haehling S, Ebner N, dos Santos MR, Springer J, Anker SD. Muscle wasting and cachexia in heart failure: mechanisms and therapies. Nat Rev Cardiol. 2017;14(6):323-41. doi: 10.1038/nrcardio.2017.51.
  » https://doi.org/10.1038/nrcardio.2017.51
• ⁶
  Lima AR, Pagan LU, Damatto RL, Cezar MD, Bonomo C, Gomes MJ. Effects of growth hormone on cardiac remodeling and soleus muscle in rats with aortic stenosis-induced heart failure. Oncotarget. 2017;8(47):83009-21. doi: https://doi.org/10.18632/oncotarget.20583
  » https://doi.org/10.18632/oncotarget.20583

Publication Dates

• Publication in this collection
  Jan 2018

History

• Received
  13 Aug 2017
• Reviewed
  28 Sept 2017
• Accepted
  28 Sept 2017