Chemotherapy Drugs Induce Cachexia and Alter Muscle Protein Metabolism
Authors: Mora Stephen 
Published: May 2022

Chemotherapy is the main regimen to treat neoplastic tumours. Maintenance of muscle mass during treatment is associated with greater patient prognosis and reduces toxicity and severe side effects. However, chemotherapy induces cachexia, a wasting disorder characterized by muscle weakness and a loss of muscle mass. Although cancer, a disease treated with chemotherapy, is often diagnosed in older individuals, studies investigating chemotherapy‐induced cachexia are done exclusively in young animals at an age equivalent to a 20‐year‐old human. Therefore, studies investigating the effects of chemotherapy‐induced cachexia at an age range relevant to humans is needed. The objective of this study is to compare the severity and mechanisms of chemotherapy‐induced cachexia in 3‐month‐old adult (equivalent to a 20‐year‐old human) and 18‐month‐old (equivalent to a 56‐year‐old human) mice. Three‐month‐old adult CD2F1 male mice were treated with either folfiri (50mg/kg 5‐fluorouracil (5FU), 90mg/kg Leucovorin and 24mg/kg CPT11) (drug) or vehicle (10% DMSO in saline) for 6‐weeks. Male mice aged to 18‐months will undergo similar treatments. Adult mice treated with the drug cocktail exhibited significant body weight loss (~10%, n=4, p=0.0117) with no differences in food intake. Decreases in body weight were associated with a loss of muscle mass in the gastrocnemius (~25%, n=4, p=0.006), quadriceps (~30%, n=4, p=0.019) and tibialis anterior (~40%, n=4, p<0.0001). Insulin tolerance tests at weeks 3 and 6 of treatment were also performed and glucose levels were found to be non‐significantly higher in drug‐treated mice. Signalling factors related to the mammalian/mechanistic target of rapamycin complex 1 (mTORC1), protein synthesis, autophagy and the ubiquitin proteasome system will be measured. Key enzymes responsible for the breakdown of the branched chain amino acids (BCAAs), mainly branched‐chain alpha‐ketoacid dehydrogenase complex (BCKD) and branched‐chain amino acid transferase 2 (BCAT2) will also be measured in the skeletal muscle. Along this line, in cell culture, we have previously shown decreased (~20%) activity of the BCKD enzyme, corresponding with decreased amino acid concentrations of leucine (~40%), isoleucine (~60%), valine (~50%), alanine (~30%), arginine (~60%), phenylalanine (50%), serine (50%) and glutamate (50%) in chemotherapy‐treated myotubes. We also observed decreased (~65%) expression of amino acid transporters sodium‐coupled neutral amino acid transporter 1 (SNAT1) and large neutral amino acid transporter 1 (LAT1). Timepoint analysis showed SNAT1 expression to be decreased prior to decreases in BCKD activity, signifying that alterations in BCAA metabolism may be a result of decreased levels of BCAAs and amino acids in chemotherapy‐treated myotubes. Therefore, these findings stemmed our interest in how the BCAAs, and their metabolites are affected in‐vivofollowing chemotherapy treatment. Findings from this study will help to elucidate whether unique signatures of cachexia are experienced in older mice. Better understanding of the mechanisms underlying muscle mass regulation following chemotherapy treatment may help combat cachexia.