Article*
"Development of the European Network in Orphan Cardiovascular Diseases"
„Rozszerzenie Europejskiej Sieci Współpracy ds Sierocych Chorób Kardiologicznych”
Title: Current approach to treatment of
cachexia
Author: Grzegorz Kopeć
Affiliation: Department of Cardiac and Vascular Diseases, Centre for Rare Cardiovascular
Diseases, John Paul II Hospital, Krakow, Poland
Date:29.09.2014
John Paul II Hospital in Kraków
Jagiellonian University, Institute of Cardiology
80 Prądnicka Str., 31-202 Kraków;
tel. +48 (12) 614 33 99; 614 34 88; fax. +48 (12) 614 34 88
e-mail: rarediseases@szpitaljp2.krakow.pl
www.crcd.eu
Cachexia can be diagnosed when there is loss of more than 5% of body weight over 12
months or less in the presence of a chronic illness such as heart failure, chronic obstructive
pulmonary disease, chronic kidney disease, or cancer. This condition remains a great
challenge in clinical practice and is associated with impaired survival. Current treatment
options include:
1. appetite stimulants
2. antiinflammatory drugs
3. ghrelin
4. anabolics
Overexpression of proinflammatory citokines like interleukin-1, interleukin-6, tumor necrosis
factor, or interferon-γ as well as macrophage inhibitory cytokine-1/growth differentiation
factor 15 has been linked to loss of appetite in patients with chronic diseases. These factors
iduce lipolysis, proteolysis and insulin resistance and affect hypothalamic appetite regulation.
Among appetite stimulants megestrol acetate, talidomide, L-carnitine have been shown to
improve appetite, muscle strength and decrease weight loss in patients with cachexia.
Monoclonal antibody (MABp1) targeting interleukin-1 alfa in pahse II study in human
decreased the level of interleukin-6 and increased lean mass. Ghrelin, a 28-amino acid peptide
hormone mostly produced by stomach increases apetite and inhibits production of several
proinflammatory cytokines like interleukin-1 beta, interleukin-6, and tumor necrosis factor
but also inuces the antiinflammatory cytokines such as interleukin 10. Its plasma level is
increased in cachexia. Several studies tested the role of oral, intravenous or subcutaneous
grelin administration for the treatment of cachexia in chronic heart failure, cancer, or endstage renal disease, however the results are unequivocal.
John Paul II Hospital in Kraków
Jagiellonian University, Institute of Cardiology
80 Prądnicka Str., 31-202 Kraków;
tel. +48 (12) 614 33 99; 614 34 88; fax. +48 (12) 614 34 88
e-mail: rarediseases@szpitaljp2.krakow.pl
www.crcd.eu
Enobosarm is an orally bioavailable nonsteroidal selective androgen receptor modulator with
tissue specific anabolic and androgenic activity. Enobosarm administered to cancer patients
improved muscular strength and increased lean body mass.
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John Paul II Hospital in Kraków
Jagiellonian University, Institute of Cardiology
80 Prądnicka Str., 31-202 Kraków;
tel. +48 (12) 614 33 99; 614 34 88; fax. +48 (12) 614 34 88
e-mail: rarediseases@szpitaljp2.krakow.pl
www.crcd.eu