Contribution of anorexia to tissue wasting in cachexia.
Contribution of anorexia to tissue wasting in cachexia.
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DOI：
10.1097/spc.0b013e32833e4aa5
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发表时间：
2010-12-01
影响因子：
2.1
通讯作者：
Rossi Fanelli, Filippo
中科院分区：
文献类型：
--
作者：
Molfino, Alessio;Laviano, Alessandro;Rossi Fanelli, Filippo
综述目的：厌食症是一种严重的衰弱症状，是几种慢性疾病临床病程的特征。它会导致体重减轻、瘦体重分解代谢和脂肪组织消耗，从而对患者的治疗结果产生负面影响。尽管与疾病相关的厌食症可能单独作为一种临床相关症状，但它现在被认为是恶病质综合征的一个组成部分。本综述讨论了实验和临床数据，表明厌食症的致病机制也可能表明恶病质中组织消耗的神经控制。最近的发现：一致的数据表明，在慢性疾病的实验模型中，选择性黑皮质素受体拮抗剂可调节食物摄入并减少消耗。因此，生长素释放肽的给药作用与黑皮质素拮抗作用有关，已在动物研究和人体试验中进行了测试，尽管尚未实现瘦体重的恢复，但效果良好。人们对选择性拮抗下丘脑黑皮质素受体的小分子的使用引起了更多的兴趣。总结：由下丘脑协调的“脑肌肉轴”似乎不仅介导厌食症的发作，而且通过集中影响能量稳态以及合成代谢和分解代谢之间的平衡，介导恶病质中的组织消耗。
PURPOSE OF REVIEW: Anorexia is a severe debilitating symptom characterizing the clinical course of several chronic diseases. It negatively impacts on patient outcome by contributing to weight loss, lean body mass catabolism and adipose tissue wasting. Although disease-associated anorexia may stand alone as a clinically relevant symptom, it is now considered as a component of the cachexia syndrome. The present review discusses experimental and clinical data indicating that the pathogenic mechanisms of anorexia may also suggest a neural control of tissue wasting in cachexia.RECENT FINDINGS: Consistent data show that selective melanocortin receptor antagonism modulates food intake and reduces wasting in experimental models of chronic disease. Consequently, ghrelin administration, whose prophagic effects are related to melanocortin antagonism, has been tested both in animal studies and human trials, with promising effects, although restoration of lean body mass has been not achieved. More interest is driven by the use of small molecules selectively antagonising hypothalamic melanocortin receptors.SUMMARY: The 'brain-muscle axis' coordinated by the hypothalamus seems to mediate the onset of not only anorexia but also tissue wasting in cachexia, by centrally influencing energy homeostasis and the balance between anabolism and catabolism.