Morphology, metabolism, microcirculation, and strength of skeletal muscles in cancer-related cachexia.
OBJECTIVE
Cancer-related cachexia is an obscure syndrome leading to muscle wasting, reduced physical fitness and quality of life. The aim of this study was to assess morphology, metabolism, and microcirculation in skeletal muscles of patients with cancer-related cachexia and to compare these data with matched healthy volunteers.


METHODS
In 19 patients with cancer-induced cachexia and 19 age-, gender-, and body-height-matched healthy volunteers body composition and aerobic capacity (VO(2max)) were analyzed. Skeletal muscle fiber size and capillarization were evaluated in biopsies of the vastus lateralis muscle. The cross-sectional area (CSA) of the quadriceps femoris muscle was measured by magnetic resonance imaging as well as its isokinetic and isometric force. The energy and lipid metabolism of the vastus lateralis muscle was quantified by (31)P and (1)H spectroscopy and parameters of its microcirculation by contrast-enhanced ultrasonography (CEUS).


RESULTS
Morphologic parameters were about 30% lower in cachexia than in volunteers (body mass index: 20 +/- 3 vs. 27 +/- 4 kg m(-2), CSA: 45 +/- 13 vs. 67 +/- 14 cm(2), total fiber size: 2854 +/- 1112 vs. 4181 +/- 1461 microm(2)). VO(2max) was reduced in cachexia (23 +/- 9 vs. 32 +/- 7 ml min(-1) kg(-1), p=0.03), whereas histologically determined capillary density and microcirculation in vivo were not different. Both concentrations of muscular energy metabolites, pH, and trimethyl-ammonium-containing compounds were comparable in both groups. Absolute strength of quadriceps muscle was reduced in cachexia (isometric: 107 +/- 40 vs. 160 +/- 40 Nm, isokinetic: 101 +/- 46 vs. 167 +/- 50 Nm; p=0.03), but identical when normalized on CSA (isometric: 2.4 +/- 0.5 vs. 2.4 +/- 0.4 Nm cm(-2), isokinetic: 2.2 +/- 0.4 vs. 2.5 +/- 0.5 Nm cm(-2)).


CONCLUSIONS
Cancer-related cachexia is associated with a loss of muscle volume but not of functionality, which can be a rationale for muscle training.
Weber
Marc-André
MA
Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany. MarcAndre.Weber@med.uni-heidelberg.de
Krakowski-Roosen
Holger
H
Schröder
Leif
L
Kinscherf
Ralf
R
Krix
Martin
M
Kopp-Schneider
Annette
A
Essig
Marco
M
Bachert
Peter
P
Kauczor
Hans-Ulrich
HU
Hildebrandt
Wulf
W
D000255:Adenosine Triphosphate / Q000378:metabolism; D002100:Cachexia / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D016022:Case-Control Studies; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D019906:Nuclear Magnetic Resonance, Biomolecular / Q000379:methods; D010100:Oxygen / Q000378:metabolism; D010725:Phosphocreatine / Q000378:metabolism
D010725:Phosphocreatine; D000255:Adenosine Triphosphate; D010100:Oxygen