Role of Myostatin, Activin A and Follistatin Cachexia of ENT Cancers
Condition: Cachexia; Squamous Cell Carcinoma; Head and Neck Cancer
MeSH terms: Carcinoma, Squamous Cell; Wasting Syndrome; Cachexia
Study type: Observational

Summary: 
      The main objective of our study was to determine the modifications of blood myostatin and
      activin A concentrations associated with head and neck cancers. Secondary objectives
      consisted in studying their influence on the occurrence of cachexia, bringing the proof of a
      tumoral secretion of these factors, and then determining the effect of tumor removal.
    

Detailed description: 
      Myostatin and activin A, two members of the superfamily TGF-β, have been shown to play a role
      on skeletal muscle mass regulation. In Humans, high plasma concentrations of activin A were
      observed in cancer patients, especially in cachectic subpopulations, suggesting their
      involvement in the development of cachexia.

      55 patients were included in the study : 32 in the cancer group (only squamous cell
      carcinoma) and 23 in the control group. The patients underwent a complete nutritional
      assessment and multiple samples : blood before and 7 days after surgery, skeletal muscle
      biopsies, tumor biopsies. Plasma concentrations of myostatin, activin and follistatin were
      measured before and after tumor removal surgery. Concentrations of myostatin, activin and
      follistatin were also measured in an incubation medium of a tumor biopsy. Activin A and
      follistatin plasma concentrations were significantly increased in the cancer group (320 vs.
      203 pg/ml ; p <0.001) (3593 vs 2148 pg/ml ; p <0.001), while myostatin plasma concentration
      was significantly decreased in this group (1542 vs. 2100 pg/ml ; p = 0.010). Surprisingly,
      data of the 7th postoperative day showed an increase in plasma activin A concentration (379
      vs 320 pg /ml ; p <0.001) while concentrations of myostatin and follistatin were not
      modified. A high postoperative systemic inflammation is one hypothesis to explain these later
      results. Myostatin, activin A and follistatin proteins were systematically detected in the
      medium of tumor a 48 hour-incubation period, providing a strong proof of the tumor production
      of these factors by squamous cell carcinoma. The activin A/myostatin/follistatin is modified
      in the context of head and neck cancer. Activin A particularly seems to play a role in the
      occurrence of cachexia while follistatin could have a protective role for skeletal muscle
      mass. This system could aimed in therapeutic ways to reduce cachexia in a context of cancer
      in order to improve the quality of life and survival of patients.
    

Intervention name(s): Tumor removal
Intervention type(s): Procedure
Intervention description(s): Surgery
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        55 patients were included in the study : 32 in the cancer group (only squamous cell
        carcinoma) and 23 in the control group.
      
Keywords: Activin A; Myostatin; Follistatin; Cachexia; Squamous cell carcinoma