title: Reversal of tumor-associated hyperglucagonemia as treatment for cancer cachexia.
abstract: BACKGROUND
  The tumor-bearing state is associated with increased circulating glucagon levels that may play an etiologic role in cancer cachexia. The secretion of glucagon can be inhibited with long-term somatostatin analogs, and, in combination with insulin, should maximally reverse the low insulin/glucagon ratio seen in cancer cachexia. The goal of this study is to examine the effect of somatostatin (octreotide) and insulin in a model of cancer cachexia and to determine whether inhibition of glucagon secretion will reverse some of the abnormalities in carbohydrate metabolism to selectively benefit host versus tumor metabolism.
  
  
  METHODS
  Sixty-seven female Lewis rats were subcutaneously inoculated with 1 x 10(6) metastasizing mammary adenocarcinoma tumor cells. On day 30 the animals were randomized into four groups to receive (1) tumor-bearing control (saline injections); (2) octreotide, 150 microgram/kg intraperitoneally twice a day; (3) neutral protamine Hagedorn insulin, 5 units/kg subcutaneously twice a day; or (4) both insulin and octreotide injections. A fifth group of non-tumor-bearing controls was included. The animals received treatment for 5 days and were then killed.
  
  
  RESULTS
  The tumor-bearing state was found to be associated with an increase in glucagon levels and a significant decrease in the insulin/glucagon ratio. The combination of somatostatin+insulin resulted in a 23-fold increase in the insulin/glucagon ratio without causing significant host morbidity from hypoglycemia. This increased insulin/glucagon ratio was associated with increased carcass weight, increased muscle weight, increased muscle protein, increased liver cellular protein, increased liver microsomal P-450 content, and decreased tumor protein content compared with the tumor-bearing controls. These results were not seen with insulin or somatostatin alone. Hepatic lactate dehydrogenase, glucose-6-phosphatase, and fructose-1, 6-diphosphatase activities were increased as a result of combination hormone treatment.
  
  
  CONCLUSIONS
  Combination hormone treatment with somatostatin and insulin results in a marked increase in the insulin/glucagon ratio and a selective nutritional benefit to the host. The inhibition of tumor-associated hyperglucagonemia should be considered in the treatment of cancer cachexia.
authors.affiliation: Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Bartlett
authors.forename: S L
authors.initials: SL
authors.lastname: Charland
authors.forename: M H
authors.initials: MH
authors.lastname: Torosian
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000503:physiopathology*; D000704:Analysis of Variance; D000818:Animals; D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight / Q000187:drug effects; D002100:Cachexia / Q000209:etiology / Q000517:prevention & control*; D003577:Cytochrome P-450 Enzyme System / Q000187:drug effects / Q000378:metabolism; D004359:Drug Therapy, Combination; D005260:Female; D005934:Glucagon / Q000097:blood / Q000378:metabolism*; D007328:Insulin / Q000097:blood / Q000627:therapeutic use*; D061389:Insulin, Regular, Pork; D008325:Mammary Neoplasms, Experimental / Q000473:pathology / Q000503:physiopathology*; D008862:Microsomes, Liver / Q000201:enzymology; D009362:Neoplasm Metastasis; D015282:Octreotide / Q000627:therapeutic use*; D009929:Organ Size / Q000187:drug effects; D011897:Random Allocation; D051381:Rats; D011917:Rats, Inbred Lew; D013004:Somatostatin / Q000494:pharmacology
chemical_list: D001786:Blood Glucose; D007328:Insulin; D061389:Insulin, Regular, Pork; D013004:Somatostatin; D005934:Glucagon; D003577:Cytochrome P-450 Enzyme System; C000006:insulin, neutral; D015282:Octreotide