Effect of multimodal intervention care on cachexia in patients with advanced cancer compared to conventional management (MIRACLE): an open-label, parallel, randomized, phase 2 trial.

BACKGROUND: Cancer cachexia (CC) is a multifactorial process characterized by progressive weight loss, muscle mass, and fat tissue wasting, which adversely affects the quality of life and survival of patients with advanced stages of cancer. CC has a complex and multifactorial pathophysiology, and there is no established standard treatment. Therefore, it is often irreversible and a single treatment modality is unlikely to suppress its progression. We are conducting a randomized trial to investigate the efficacy and safety of a multimodal intervention compared to the best supportive care for patients who received palliative chemotherapy. METHODS: Patients with lung or gastrointestinal cancers undergoing palliative chemotherapy are eligible. Patients are randomized into a multimodal intervention care (MIC) arm versus a conventional palliative care (CPC) arm. MIC includes ibuprofen, omega-3-fatty acid, oral nutritional supplement, weekly physical, psychiatric assessment, nutritional counseling, and complementary and alternative medicine. CPC includes basic nutritional counseling and megestrol acetate as needed (i.e., anorexia ≥ grade 2). All interventions are performed for 12 weeks per subject. The co-primary outcomes are change (kg) in total lean body mass and handgrip strength (kg) from the baseline. A total of 112 patients will be assigned to the two arms (56 in each group). DISCUSSION: The purpose of this study is to evaluate the effect of MIC in preventing or alleviating CC in patients who underwent palliative chemotherapy. As there is no established single treatment for CC, it is expected that the results of this clinical trial will provide new insights to significantly improve the quality of life of patients with cancer. Considering the complex mechanisms of cachexia, the effect of MIC rather than a single specific drug is more promising. In this study, we did not overly restrict the type of cancer or chemotherapy. Therefore, we attempted to measure the effects of complex interventions while preserving clinical situations. Thus, it is expected that the results of this study can be applied effectively to real-world practice. TRIAL REGISTRATION: This clinical trial was registered in the Clinical Research Information Service (KCT0004967), Korean Clinical Trial Registry on April 27, 2020, and ClinicalTrial.gov (NCT04907864) on June 1, 2021.

Scutellariae radix extracts suppress ethanol-induced caspase-11 expression and cell death in N(2)a cells.

Scutellariae radix is a Chinese herbal medicine that has been used to treat disease conditions accompanying inflammation and oxidative stress. In the present study, we examined the effect of Scutellariae radix extracts during acute ethanol exposure in N(2)a neuroblastoma. The Scutellariae radix extracts effectively inhibited ethanol-induced apoptosis and caspase-3/-7 activation. Ethanol induced the expression of caspase-11 that has been known as a dual regulator of pathological apoptosis and inflammatory response. The ethanol-induced caspase-11 expression was suppressed by pretreatment of the Scutellariae radix extracts. Furthermore, the activation of caspase-3/-7 and apoptosis were significantly inhibited in caspase-11-/- mouse embryonic fibroblasts following ethanol treatment. These results suggest that caspase-11 has a regulatory role in ethanol-induced apoptosis, and the suppression of caspase-11 may be a mechanism by which Scutellariae radix exerts its cytoprotective effect.

The inhibition of nitric oxide synthase enhances PSA-NCAM expression and CREB phosphorylation in the rat hippocampus.

It is well known that nitric oxide (NO) acts downstream of NMDA receptor activation, which regulates the neural plasticity in the brain. In the present study, the effect of L-NAME, a non-selective nitric oxide synthase (NOS) inhibitor, on neural plasticity in the hippocampus was investigated. L-NAME increased the expression of PSA-NCAM and pCREB in the adult rat hippocampus. The co-localization of PSA-NCAM and pCREB indicates a possible relationship between the two in the granule cell layer in the dentate gyrus. Our results demonstrate that NO, as a subsignal of NMDA receptors, could be involved in the structural plasticity of the granule cell layer in the dentate gyrus by regulating the expression of PSA-NCAM and pCREB in the hippocampus.