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Publication
Caquexia oncológica: como modular a sua progressão
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|---|---|---|---|---|
| TC_28300 | 893.67 KB | Adobe PDF |
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Advisor(s)
Abstract(s)
A fisiopatologia da caquexiaé bastante complexa, sendo necessário um consenso
sobre a definição e os critérios específicos para descrever adequadamente a caquexia
associada ao cancro. A melhor compreensão da fisiopatologia a nível pré-clínico é vital
para o desenvolvimento de estratégias terapêuticas, sendo os ensaios clínicos necessários
para a compreensão do verdadeiro papel dessas intervenções no doente oncológico. A
alimentação per se não reverte significativamente a perda ponderal e parece evidente que
as alterações metabólicas em doentes oncológicos contribuem para o desenvolvimento da
caquexia. Perante isto, o desenvolvimento de diferentes abordagens terapêuticas tem-se
focado na reversão do catabolismo e aumento do anabolismo no doente oncológico com
recurso a suplementação.
O metabolito da leucina, B-hidroxi-B-metilbutirato (HMB), exibe um potencial
efeito anti-catabólico e tem recebido a atenção da comunidade científica enquanto
suplemento aplicado em quadros de caquexia. Este composto tem sido proposto como
responsável pelos efeitos induzidos da leucina na síntese proteica a nível muscular.
Neste trabalho, pretendemos abordar a definição clínica e relevante da caquexia
no doente oncológico, os processos metabólicos inerentes à presença tumoral/estímulo
caquético e o seu impacto no turnover proteico muscular, e de que forma é que o HMB
poderá contribuir para a modulação da progressão da caquexia no doente oncológico.
Fez-se um revisão da literatura, com recurso à base de dados PUBMED e COCHRANE
LIBRARY, entre 2005 até 2018, utilizando as palavras chave “HMB ou beta-hidroxybeta-
methylbutyrate” AND “cancer cachexia” ou “cachexia” AND “wasting” AND
“metabolism”.
A fisiopatologia da caquexia oncológica é complexa, confirmando que se
caracteriza por uma síndrome multifatorial, influenciaa pela presença de citoquinas
inflamatórias, anorexia, aumento da proteólise, diminuição da capacidade de síntese
proteica, impulsionada por alterações nas vias de ação inerentes a cada processo. A
administração isolada de HMB ou a sua combinação com outros nutrientes pode
representar uma ação segura e eficaz na prevenção da perda de massa muscular na
caquexia oncológica. Estudos sugerem que o HMB reduz o crescimento tumoral, no
entanto, o mecanismo responsável por este efeito não é claro e merece mais investigação.
The pathophysiology of cachexia is quite complex, requiring a consensus on the definition and specific criteria to adequately describe cachexia associated with cancer. A better understanding of pre-clinical pathophysiology is vital for the development of therapeutic strategies, and clinical trials are necessary to understand the true role of these interventions in cancer patients. Feeding per se does not significantly reverse weight loss and it seems clear that metabolic changes in cancer patients contribute to the development of cachexia. In view of this, the development of different therapeutic approaches has focused on the reversal of catabolism and anabolism increase in cancer patients with supplementation. The leucine metabolite, B-hydroxy-B-methylbutyrate (HMB), exhibits a potential anti-catabolic effect and has received the attention of the scientific community as a supplement applied to cachexia. This compound has been proposed as responsible for the induced effects of leucine on muscle protein synthesis. In this work, we intend to address the clinical and relevant definition of cachexia in cancer patients, the metabolic processes inherent to tumor presence / cachectic stimulus and their impact on muscle protein turnover, and how HMB may contribute to the modulation of progression of cachexia in cancer patients. A review of the literature was made using the PUBMED and COCHRANE LIBRARY database between 2005 and 2018 using the keywords "HMB or beta-hydroxy-betamethylbutyrate" AND "cancer cachexia" and "cachexia" wasting "AND" metabolism ". The pathophysiology of oncologic cachexia is complex, confirming that it is characterized by a multifactorial syndrome, influenced by the presence of inflammatory cytokines, anorexia, increased proteolysis, decreased protein synthesis capacity, driven by changes in the pathways inherent to each process. Isolated administration of HMB or its combination with other nutrients may represent a safe and effective action in preventing loss of muscle mass in oncological cachexia. Studies suggest that HMB reduces tumor growth, however, the mechanism responsible for this effect is unclear and deserves further investigation.
The pathophysiology of cachexia is quite complex, requiring a consensus on the definition and specific criteria to adequately describe cachexia associated with cancer. A better understanding of pre-clinical pathophysiology is vital for the development of therapeutic strategies, and clinical trials are necessary to understand the true role of these interventions in cancer patients. Feeding per se does not significantly reverse weight loss and it seems clear that metabolic changes in cancer patients contribute to the development of cachexia. In view of this, the development of different therapeutic approaches has focused on the reversal of catabolism and anabolism increase in cancer patients with supplementation. The leucine metabolite, B-hydroxy-B-methylbutyrate (HMB), exhibits a potential anti-catabolic effect and has received the attention of the scientific community as a supplement applied to cachexia. This compound has been proposed as responsible for the induced effects of leucine on muscle protein synthesis. In this work, we intend to address the clinical and relevant definition of cachexia in cancer patients, the metabolic processes inherent to tumor presence / cachectic stimulus and their impact on muscle protein turnover, and how HMB may contribute to the modulation of progression of cachexia in cancer patients. A review of the literature was made using the PUBMED and COCHRANE LIBRARY database between 2005 and 2018 using the keywords "HMB or beta-hydroxy-betamethylbutyrate" AND "cancer cachexia" and "cachexia" wasting "AND" metabolism ". The pathophysiology of oncologic cachexia is complex, confirming that it is characterized by a multifactorial syndrome, influenced by the presence of inflammatory cytokines, anorexia, increased proteolysis, decreased protein synthesis capacity, driven by changes in the pathways inherent to each process. Isolated administration of HMB or its combination with other nutrients may represent a safe and effective action in preventing loss of muscle mass in oncological cachexia. Studies suggest that HMB reduces tumor growth, however, the mechanism responsible for this effect is unclear and deserves further investigation.
Description
Trabalho Complementar apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciado em Ciências da Nutrição
Keywords
Beta-hidroxi-beta-metilbutirato Caquexia oncológica Perda ponderal Metabolismo Beta-hydroxy-beta-methylbutyrate Oncological cachexia Weight loss Metabolism