Muscle NAD+ depletion and Serpina3n as molecular determinants of murine cancer cachexia-the effects of blocking myostatin and activins.

OBJECTIVE: Cancer cachexia and muscle loss are associated with increased morbidity and mortality. In preclinical animal models, blocking activin receptor (ACVR) ligands has improved survival and prevented muscle wasting in cancer cachexia without an effect on tumour growth. However, the underlying mechanisms are poorly understood. This study aimed to identify cancer cachexia and soluble ACVR (sACVR) administration-evoked changes in muscle proteome. METHODS: Healthy and C26 tumour-bearing (TB) mice were treated with recombinant sACVR. The sACVR or PBS control were administered either prior to the tumour formation or by continued administration before and after tumour formation. Muscles were analysed by quantitative proteomics with further examination of mitochondria and nicotinamide adenine dinucleotide (NAD+) metabolism. To complement the first prophylactic experiment, sACVR (or PBS) was injected as a treatment after tumour cell inoculation. RESULTS: Muscle proteomics in TB cachectic mice revealed downregulated signatures for mitochondrial oxidative phosphorylation (OXPHOS) and increased acute phase response (APR). These were accompanied by muscle NAD+ deficiency, alterations in NAD+ biosynthesis including downregulation of nicotinamide riboside kinase 2 (Nrk2), and decreased muscle protein synthesis. The disturbances in NAD+ metabolism and protein synthesis were rescued by treatment with sACVR. Across the whole proteome and APR, in particular, Serpina3n represented the most upregulated protein and the strongest predictor of cachexia. However, the increase in Serpina3n expression was associated with increased inflammation rather than decreased muscle mass and/or protein synthesis. CONCLUSIONS: We present evidence implicating disturbed muscle mitochondrial OXPHOS proteome and NAD+ homeostasis in experimental cancer cachexia. Treatment of TB mice with a blocker of activin receptor ligands restores depleted muscle NAD+ and Nrk2, as well as decreased muscle protein synthesis. These results indicate putative new treatment therapies for cachexia and that although acute phase protein Serpina3n may serve as a predictor of cachexia, it more likely reflects a condition of elevated inflammation.

Activin receptor ligand traps in chronic kidney disease.

PURPOSE OF REVIEW: Sotatercept and luspatercept are recombinant soluble activin type-II receptor-IgG-Fc fusion proteins that are tested in clinical trials for the treatment of various types of anemias, including renal anemia. The mechanism of the action of the novel drugs is incompletely understood, but it seems to be based on the inactivation of soluble proteins of the transforming growth factor-ß (TGFß) family. This review considers pros and cons of the clinical use of the drugs in reference to the current therapy with recombinant erythropoiesis-stimulating agents (ESAs). RECENT FINDINGS: One or more activin type-II receptor (ActRII) ligands appear to inhibit erythroid precursors, for example growth and differentiation factor 11. Trapping of these ligands by the recombinant ActRII fusion proteins, sotatercept and luspatercept increases red blood cell numbers and hemoglobin levels in humans. Reportedly, the novel compounds were well tolerated in trials on healthy volunteers and patients suffering from anemia due to chronic kidney disease or malignancies. On approval, the drugs may prove particularly useful in patients suffering from ineffective erythropoiesis, such as in myelodysplastic syndrome, multiple myeloma or ß-thalassemia, where ESAs are of little use. Independent of their effect on erythropoiesis, ActRII ligand traps were found to exert beneficial effects on renal tissue in experimental animals. SUMMARY: ESAs are likely to remain standard of care in renal anemia. There is a need for a better understanding of the effects of ActRII ligand traps on TGFß-like proteins. The novel drugs have not been approved for sale as therapeutics so far. Their long-term efficacy and safety still needs to be proven, particularly with respect to immunogenicity. Antifibrotic effects may be worthy to be investigated in humans.

Differential secretion of gonadotrophins: investigation of the role of secretogranin II and chromogranin A in the release of LH and FSH in LbetaT2 cells.

This study investigated the role of the secretory granule proteins, secretogranin II (SgII) and chromogranin A (CgA), in the differential secretion of FSH and LH from LbetaT2 mouse gonadotroph cells. Exogenous activin, which synergises with GnRH, is essential for the release of FSH from these cells, but also has stimulatory effects on LH and enhances GnRH-induced LH secretion. Two experiments are reported. In experiment 1, cultures were supplemented with activin (0-50 ng/ml), with and without a daily 1 h treatment of 10 nM GnRH, for 3 days. Protein secretion and mRNA levels were measured. In experiment 2, cells were treated with activin (50 ng/ml) alone, a daily 1 h treatment of 10 nM GnRH, or a combination of both for 6 days. In addition, cells exposed to activin+GnRH for 3 days were subsequently left untreated or given activin or GnRH alone for a further 3 days for comparison with cells maintained in activin+GnRH for 6 days. Protein secretion, intracellular protein and mRNA levels were measured. FSH secretion was stimulated, dose dependently, by activin and this effect increased synergistically in the presence of GnRH. The close correlation between secreted and intracellular FSH and FSHbeta mRNA levels was maintained in cells that had undergone treatment withdrawal after previous exposure to activin+GnRH, but there was no correlation between FSH and the granins. These results are consistent with the view that FSH released in response to activin/GnRH is constitutively secreted via a granin-independent pathway. SgII secretion mirrored the GnRH-induced secretion of LH, but was unaffected by activin, which stimulated LH secretion and had a detrimental effect on CgA mRNA transcription. This confirms previous observations that the LH released in response to GnRH is co-released with SgII via a regulated, granin-dependent pathway, and, in addition, suggests that activin may stimulate LH secretion through a constitutive, granin-independent pathway.