Background
Cachexia is a paraneoplastic syndrome related with poor prognosis. The tumour microâenvironment contributes to systemic inflammation and increased oxidative stress as well as to fibrosis. The aim of the present study was to characterise the inflammatory circulating factors and tumour microâenvironment profile, as potentially contributing to tumour fibrosis in cachectic cancer patients.
Methods
74 patients (weight stable cancer n = 31; cachectic cancer n = 43) diagnosed with colorectal cancer were recruited, and tumour biopsies were collected during surgery. Multiplex assay was performed to study inflammatory cytokines and growth factors. Immunohistochemistry analysis was carried out to study extracellular matrix components.
Results
Higher protein expression of inflammatory cytokines and growth factors such as epidermal growth factor, granulocyteâmacrophage colonyâstimulating factor, interferonâα, and interleukin (IL)â8 was observed in the tumour and serum of cachectic cancer patients in comparison with weightâstable counterparts. Also, ILâ8 was positively correlated with weight loss in cachectic patients (P = 0.04; r = 0.627). Immunohistochemistry staining showed intense collagen deposition (P = 0.0006) and increased presence of αâsmooth muscle actin (P < 0.0001) in tumours of cachectic cancer patients, characterizing fibrosis. In addition, higher transforming growth factor (TGF)âÎČ1, TGFâÎČ2, and TGFâÎČ3 expression (P = 0.003, P = 0.05, and P = 0.047, respectively) was found in the tumour of cachectic patients, parallel to p38 mitogenâactivated protein kinase alteration. Hypoxiaâinducible factorâ1α mRNA content was significantly increased in the tumour of cachectic patients, when compared with weightâstable group (P = 0.005).
Conclusions
Our results demonstrate TGFâÎČ pathway activation in the tumour in cachexia, through the (nonâcanonical) mitogenâactivated protein kinase pathway. The results show that during cachexia, intratumoural inflammatory response contributes to the onset of fibrosis. Tumour remodelling, probably by TGFâÎČâinduced transdifferentiation of fibroblasts to myofibroblasts, induces unbalanced inflammatory cytokine profile, angiogenesis, and elevation of extracellular matrix components (EMC). We speculate that these changes may affect tumour aggressiveness and present consequences in peripheral organs.