Skeletal muscle is defined to be atrophic in osteoporosis models and therefore is a potential target tissue for osteoporosis research. The aim of this longitudinal randomized controlled interdisciplinary study was to analyze the functional, histological, ultra-structral and molecular changes and the role of cachectic muscle atrophy inducer TNF-alpha in the skeletal muscles of the ovariectomized (OVX) rat model which mimics postmenopausal osteoporosis. Female Sprague-Dawley rats were randomly assigned to the control, the OVX and the OVX+10&amp / #956 / g/g/week TNF-alpha antagonist (Remicade) treated OVX-TNF groups. Maximum isometric and tetanic-twitch amplitudes were lower than the control group in the OVX group. Maximum isometric twitch amplitudes recovered in the fast-twitch extensor digitorum longus (EDL) muscles but not in the slow-twitch soleus muscles in the OVX-TNF group. The decrease in tetanic-twitch amplitudes recovered in the OVX-TNF group in both muscle types. Splitting and size variations of fibers, central nuclei and well-preserved overall ultrastructure were noted in the OVX and the OVX-TNF groups. Slow-twitch Type I fiber percentage, areas and diameters increased in EDL muscles of the OVX and the OVX-TNF group comparing to the control group. p65 and MyoD immune-labeling increased in OVX group whereas MyoD and C-Rel increased and p50 decreased in OVX-TNF group. Expressions of 61 genes and 42 unidentified transcripts were significantly different between the control, the OVX and the OVX-TNF groups. To sum up TNF-alpha has a role in skeletal muscle dysfunction in OVX rats and TNF-alpha antagonist administration recovered it. But this modulation was not sufficient for total structural recovery.

The sphingolipids are a family of membrane lipids with only a structural role, influencing lipid bilayer properties, but they also act as effector molecules with essential roles in many aspects of cell biology. The sphingolipids ceramide, sphingosine and S1P have shown opposite effects: whereas ceramide and sphingosine usually inhibit proliferation and promote apoptotic responses to different stress stimuli, S1P is known to stimulate cell growth, and promote cell survival. Ceramide can be produced through the de novo synthesis pathway, and by membrane sphingomyelin hydrolysis catalyzed by sphingomyelinases. Both pathways can be activated by the pro-inflammatory cytokine TNFa. Because this cytokine has been shown to promote muscle loss and seems to be crucial in the development of cachexia, we hypothesized that the formation of ceramide, or a metabolite, can be involved in tumor-induced muscle wasting. We investigated the role of ceramide in the in vitro atrophic effects of TNFa on differentiated C2C12 myotubes, by using cell permeant ceramides and inhibitors of sphingolipid metabolism. We observed that TNFa atrophic effects, as evaluated by the reduction in myotube area, are mimicked by exogenous ceramides, supporting the idea that ceramide can participate in muscle atrophy. To verify if ceramide is a mediator of TNFa-induced atrophy, and to identify the metabolites potentially involved, we analyzed the effects of drugs able to block sphingolipid metabolism at different steps: the inhibition of de novo synthesis pathway was unable to restore myotube size in the presence of TNFa whereas the inhibitors of neutral sphingomyelinases reversed TNFa-induced atrophy. Moreover, an accumulation of ceramide and sphingosine induced pro-atrophic effects, whereas sphingosine-1-phosphate had a protective effect. These observations establish that in C2C12 myotubes, ceramide or other downstream metabolites such as sphingosine, produced by the neutral sphingomyelinase pathway in response to TNFa stimulation, participate in cell atrophy. To evaluate the in vivo role of sphingolipids, we treated BalbC mice carrying C26 adenocarcinoma woth Myriocin, an inhibitor of the de novo pathway of ceramide synthesis, that is able to deplete muscle tissue in all sphingolipids, was administered daily to the animals. This treatment partially protected animals against tumor-induced loss of body weight and muscle weight, without affecting the size of tumors. Moreover, myriocin treatment significantly reversed the decrease in myofiber size associated with tumor development, and reduced the expression of atrogenes Foxo3 and Atrogin-1, showing that it was able to protect against muscle atrophy. These results strongly suggest that ceramide, or a downstream sphingolipid metabolite, is involved in tumor-induced muscle atrophy. The sphingolipid pathway thus appears as a new potential target of pharmacological interventions aiming at protecting muscle tissue against atrophy.

Skeletal muscle (SM) atrophy complicates many illnesses, diminishing quality of life and increasing disease morbidity, health resource utilization and health care costs. In animal models of muscle atrophy, loss of SM mass results predominantly from ubiquitin-mediated proteolysis and ubiquitin ligases are the key enzymes that catalyze protein ubiquitination. We have previously shown that ubiquitin ligase Nedd4-1 is up-regulated in a rodent model of denervation-induced SM atrophy and the constitutive expression of Nedd4-1 is sufficient to induce myotube atrophy in vitro, suggesting an important role for Nedd4-1 in the regulation of muscle mass. In this study we generate a Nedd4-1 SM specific-knockout mouse and demonstrate that the loss of Nedd4-1 partially protects SM from denervation-induced atrophy confirming a regulatory role for Nedd4-1 in the maintenance of muscle mass in vivo. Nedd4-1 did not signal downstream through its known substrates Notch-1, MTMR4 or FGFR1, suggesting a novel substrate mediates Nedd4-1’s induction of SM atrophy.

Base Teórica: A artrite reumatoide (AR) é uma doença crônica e inflamatória que além de sintomas articulares pode levar à perda de massa muscular com peso estável ou aumentado, condição denominada caquexia reumatoide (CR). A CR está associada com pior prognóstico, mas ainda é negligenciada na prática clínica. Objetivo: Avaliar a prevalência de CR em um hospital público terciário de Porto Alegre e determinar sua correlação com características da AR, com níveis de atividade física e com as medicações em uso. Métodos: Estudo transversal com 91 pacientes com AR que foram submetidos à densitometria corporal total (DEXA) para medida total e regional de índice de massa gorda (IMG; Kg/m2), índice de massa magra (IMM; Kg/m2), conteúdo mineral ósseo (CMO) e índice de massa livre de gordura (IMLG; Kg/m2) para avaliar a prevalência de CR pelas duas definições mais recentemene utilizadas na literatura: IMLG < percentil 10 com IMG > percentil 25 e IMLG < percentil 25 com IMG > percentil 50. Foram exploradas as medidas de associação dos parâmetros de composição corporal com características da AR – idade, duração da doença, atividade de doença (através do DAS 28), capacidade funcional (através do HAQ), atividade inflamatória (através da proteína C reativa – PCR – e velocidade de hemossedimentação – VHS), nível de atividade física (através do questionário IPAQ) e medicações em uso. Resultados: A idade média dos participantes foi 56,8 ± 7,3, a duração de doença foi 9 anos (3-18), o DAS 28 3,65 ± 1,32, o HAQ 1,12 (0,25 – 1,87) e o tempo de uso entre os que usaram biológico foi de 25 meses (17,8 – 52,5). A CR foi evidenciada em 17,6% dos pacientes com AR de acordo com a definição mais rigorosa e em 33% de acordo com a classificação mais abrangente. O IMLG teve correlação negativa com idade (r= -0,219; p=0,037) e duração da doença (rs= -0,214; p=0,042). O IMG teve correlação positiva com PCR (rs=0,229; p=0,029), VHS (rs=0,235; p=0,025), DAS 28 (rs=0,273; p=0,009) e HAQ (rs=0,297; p=0,004). Na comparação de pacientes com e sem CR, de acordo com a definição mais rigorosa, dos 26 pacientes usando biológico apenas 1 tinha CR (3,8%), enquanto dos que não usavam, 15 (23%) tinham CR (p=0,033). Conclusão: A prevalência de CR foi considerável e, portanto, merece estudos adicionais. A composição corporal neste estudo, especialmente o IMLG, teve associação inversa com idade e tempo de diagnóstico. Além disso, pacientes em uso de biológico tiveram diferença significativa na prevalência de CR, sugerindo papel protetor do uso de biológico na CR. / Background: Rheumatoid arthritis (RA) is a chronic and inflammatory disease that besides articular symptoms leads to loss of muscle mass in presence of stable or increased fat mass (FM), condition defined as rheumatoid cachexia (RC). RC is associated with a worse prognosis, but it is still overlooked in clinical practice. Objective: To evaluate the prevalence of rheumatoid cachexia (RC) in patients with rheumatoid arthritis (RA) and determine its correlation with the features of RA, the level of physical activity and with the current therapy. Methods: Ninety one RA patients in a cross-sectional study underwent total body dual-energy x-ray absorptiometry (DXA) for measurement of total and regional fat mass index (FMI; Kg/m2), lean mass index (LMI; Kg/m2), bone mineral content (BMC; Kg/m2) and fat free mass index (FFMI; Kg/m2) to assess the prevalence of RC. The associations of measures of body composition with RA features - age, diagnosis time, Health Assessment Questionnaire (HAQ), Disease Activity Score in 28 joints (DAS 28), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) -, level of physical activity (measured by International Physical Activity Questionnaire – IPAQ) and current therapy were explored. Results: Mean age was 56,8 ± 7,3 , disease duration 9 years (3 – 18), DAS28 3,65 ± 1,32, HAQ 1,12 (0,25 – 1,87) and use duration of biological agents was 25 months (17,8 – 52,5). Seventeen per cent of the patients had FFMI below the 10th percentile and FMI above the 25th percentile of a reference population and 33% of the patients had FFMI below the 25th percentile and FMI above the 50th percentile, condition known as RC, according to the more recently used definitions. FFMI correlated negatively only with age (r=-0,219; p=0,037) and disease duration (rs=-0,214; p=0,042). FMI correlated positively with CRP (rs=0,229; p=0,029), ESR (rs=0,235; p=0,025), DAS 28 (rs=0,273; p=0,009) and HAQ (rs=0,297; p=0,004). Of the 26 patients using biological therapy, 25 were non cachetic (p=0,033) according to the stricter definition of RC. In another words, 3,8% (n=1) and 23% (n=15) of the patients receiving and not receiving biological agents had RC, respectively (p=0,033). Conclusion: The prevalence of RC was considerable and deserves additional research. Body composition, in this study, particularly FFMI is inversely associated with age and disease duration. Besides that, patients under biological therapy had lower prevalence of RC, suggesting a protective effect of biological agents.

Made available in DSpace on 2014-06-11T19:31:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-02Bitstream added on 2014-06-13T20:01:40Z : No. of bitstreams: 1 souza_sf_dr_jabo.pdf: 2488552 bytes, checksum: d73363ffa31e0435be147582710b8e53 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Avaliou-se a resposta de diferentes protocolos fisioterapêuticos em cães após a indução de atrofia muscular por meio da imobilização do joelho por 30 dias. Os grupos foram denominados grupo C ou controle, grupo M (massagem e movimentação passiva), grupo E (massagem, movimentação passiva e eletroterapia), grupo H (massagem, movimentação passiva e hidroterapia em esteira aquática) e grupo EH (massagem, movimentação passiva, eletroterapia e hidroterapia em esteira aquática). Foram mensurados, os graus de claudicação, amplitude articular, circunferência da coxa, variação sérica das enzimas creatina-quinase e lactato-desidrogenase, bem como a morfometria muscular das fibras de contração rápida e contração lenta do músculo vasto lateral marcadas pela técnica de imunoistoquímica. Os cães do grupo H apresentaram retorno mais precoce à função do membro pélvico direito, mostrando que a hidroterapia pode ser beneficamente empregada para a recuperação em cães claudicantes. A fisioterapia reduziu a contratura articular. Verificou-se maior recuperação da área transversal das fibras musculares de contração lenta e rápida nos cães submetidos à eletroterapia aos 60 dias de pós-operatório. De acordo com os resultados encontrados, foi possível concluir que as modalidades terapêuticas de massagem, movimentação passiva da articulação, estimulação elétrica neuromuscular e hidroterapia por caminhada em esteira aquática aceleram a recuperação clínica em cães com atrofia muscular induzida / The response to different physiotherapeutic protocols was evaluated in dogs with muscle atrophy induced by a 30-day-long immobilization of the stifle joint. The animals were divided in groups namely: C (control), M (massage and passive range of motion), E (massage, passive range of motion and neuromuscular electrical stimulation), H (massage, passive range of motion and hydrotherapy in underwater treadmill), and EH group (massage, passive range of motion, neuromuscular electrical stimulation and hydrotherapy in underwater treadmill). The degree of lameness, range motion, thigh circumference, range of serum creatine kinase (CK) and lactate dehydrogenase (LDH) were then evaluated, as well as the morphometry of fast- and slow-twitch muscle fibers of the vastus lateralis by immunohistochemistry. Group H dogs regained function of the right hind limb faster than the other groups. This result shows that hydrotherapy helped in the recovery process of lame dogs. Physiotherapy reduced the joint contracture. There was a higher recovery rate of cross-sectional area of slow-twitch and fast-twitch muscle fibers and thigh circumference in dogs submitted to neuromuscular electrical stimulation at 60 days post-surgery. According to these results, it was possible to conclude that therapeutics modalities such as massage, passive range of motion of the joint, neuromuscular electrical stimulation and hydrotherapy by walking on underwater treadmill accelerate clinical recovery in dogs with induced muscle atrophy

L'atrophie musculaire de la cachexie provient du déséquilibre entre la synthèse et la dégradation des protéines. La littérature suggère que les membres de la famille p53 (p53, p63, p73) jouent un rôle dans le contrôle des processus de prolifération, différenciation et mort des précurseurs et des fibres musculaires. Ici nous avons caractérisé le profil d'expression de ces membres dans l'atrophie musculaire de la SLA (Sclérose Latérale Amyotrophique) et dans un modèle de cachexie induite par la doxorubicine. Nous avons montré une augmentation de l'expression des membres de la famille p53 et des atrogènes de manière corrélée sur ces deux modèles ainsi qu’une activation transcriptionnelle de Trim63 par p53, p63 et p73. Aussi, nous avons voulu savoir si les composés de tocophérol possédant une activité antioxydante pouvait réduire l'atrophie musculaire et avons montré que ce composé neutralise l'induction de la voie Notch, importante pour le développement musculaire et la régénération. / Muscle atrophy in cachexia results from the imbalance between protein synthesis and degradation due to activation of the ubiquitin-proteasome pathway. Literature suggests that p53 family members play a role in controlling proliferation, differentiation and death of precursors and muscle fibers. Here we characterize the expression profile of the p53 family members in muscle atrophy in ALS (Amyotrophic Lateral Sclerosis) and in doxorubicin induced cachexia model. We revealed an increased expression of the p53 family members and atrogenes in a correlated manner on both models and a transcriptional activation of Trim63 by p53, p63 and p73. Importantly, we also show that ROS and ceramide accumulation are important for Trim63 induction by doxorubicin. In addition, we tested whether compounds of tocopherol harboring antioxidant activity might reduce muscle atrophy. We showed that this compound counteracts the induction of the Notch pathway, important to muscle development and regeneration.

Made available in DSpace on 2016-06-02T19:23:01Z (GMT). No. of bitstreams: 1 6295.pdf: 4882645 bytes, checksum: 753ebcc5b034e8345c6f3057edbdb562 (MD5) Previous issue date: 2014-03-28 / Universidade Federal de Minas Gerais / The use of glucocorticoids as treatment for allergic and inflammatory conditions has become commom nowadays, although, chronically it can causes many side effects such as peripheral insulin resistance, hyperglycemia and hyperinsulinemia, hypertension, dyslipidemia, body weight loss and muscle atrophy. On the other hand, resistance training (RT) has been recommended as non-pharmacological treatment for some pathological conditions, however little is known about its effects on muscle atrophy induced by chronic treatment with dexamethasone (DEX). The aim of this study was to verify the preventive effect of RT (80% of maximal carrying capacity) on DEX-induced muscle atrophy as well as the responsible mechanisms for this response. Forty-three wistar rats (200-250g) were allocated into four groups: sedentary control (SC), sedentary treated with DEX (SD), trained control (TC) and trained treated with DEX (TD). After a familiarization period on the ladder, a maximal voluntary carrying capacity test (MVCC) was performed to determinate the training intensity and the rats underwent or RT (80% MCCT, 4 days/week, 70 days) or remained sedentary. The MVCC was performed in the beginning, after 4 weeks, before and after the DEX treatment. Through the last ten days, the animals received DEX (0.5 mg/kg/day, i.p.) or saline solution. After 24 hours of the last training session, the animals were euthanized and the flexor hallucis longus (FHL), tibialis anterior (TA) and soleus (SOL) muscles were collected and weighted for further analysis of mTOR, p70S6K, FOXO3a, Atrogin-1 and MuRF-1 protein levels. The results were presented as mean ± SEM, &#945;<0.05. DEX treatment evoked adrenal gland atrophy (-47%), body weight loss (-21%) and food intake reduction (-28%). The RT increased MVCC of trained animals (+215%). Also, DEX treatment reduced FHL and TA muscles mass (-19.6% e -17.7%, respectively), which was associated with the MuRF-1 protein level increase (+37% e +45,5%, respectively). We did not observe any alterations in mTOR, p70S6K, FOXO3a and Atrogin-1 protein levels after DEX treatment. RT was be able to attenuate FHL muscle atrophy due to blockade of MuRF-1 increase (-3.5%). In addition, it did increase mTOR (+63% for TC e TD) e p70S6K (+46% and +49% for TC e TD, respectively) protein levels in FHL muscle. FOXO3a and Atrogin-1 protein levels were not altered by RT. SOL muscle was not affected by neither treatment nor training. Therefore, these results allow us to suggest that DEX-induced muscle atrophy observed in the FHL and TA muscles can be associated with increases in MuRF-1 protein level. RT-induced attenuation of FHL muscle atrophy involved increases in mTOR and p70S6K protein levels associated with maintenance of MuRF-1 protein levels. / O uso de glicocorticoides como tratamento de quadros inflamatórios e alérgicos tem sido uma constante na atualidade, embora, cronicamente provoque vários efeitos colaterais como resistência periférica à insulina, hiperglicemia e hiperinsulinemia, hipertensão, dislipidemia, perda de peso corporal e atrofia muscular. Por outro lado o treinamento resistido (TR) tem sido recomendado como tratamento não farmacológico em alguns estados patológicos, embora pouco se conheça sobre seus efeitos sobre a atrofia muscular induzida pelo tratamento crônico com dexametasona (DEX). O objetivo principal deste trabalho foi verificar o efeito preventivo do TR a 80% do carregamento máximo sobre a atrofia muscular induzida pela DEX, bem como os mecanismos responsáveis por esta resposta. Foram utilizados 43 ratos Wistar (200-250g) distribuídos em 4 grupos: sedentário controle (SC), sedentário tratado com DEX (SD), treinado controle (TC) e treinado tratado com DEX (TD). Após um período de adaptação na escada, foi realizado um teste de carregamento máximo (TCM) para determinação da intensidade do treino. Em seguida, os ratos foram submetidos ao treinamento resistido (80% da capacidade máxima, 4 dias/semana, 70 dias) ou mantidos sedentários. Os TCM foram realizados no início do protocolo experimental, após 4 semanas, antes e após o tratamento com DEX. Nos últimos 10 dias, os animais receberam DEX (0,5 mg/kg por dia, i.p.) ou solução salina. Após 24 horas da última sessão de exercício, os animais foram eutanasiados e os músculos flexor longo do hálux (FHL), tibial anterior (TA) e sóleo (SOL) foram coletados, pesados e seus valores normalizados pelo tamanho da tíbia. Analisamos a produção das proteínas mTOR, p70S6K, FOXO3a, Atrogina-1 e MuRF-1. Os resultados são apresentados como média ± EPM, &#945;<0,05. A DEX provocou redução do peso da glândula adrenal (-47%), peso corporal (-21%) e ingestão alimentar (- 28%). O TR aumentou a capacidade física dos animais treinados (+215%). O tratamento com DEX reduziu a massa muscular do FHL e TA (-19,6% e -17,7%, respectivamente), que foi associada ao aumento da proteína MuRF-1 (+37% e +45,5%, respectivamente), não foram observadas alterações nas proteínas mTOR, p70S6K, FOXO3a e Atrogina-1 após o tratamento com DEX. O TR foi capaz de atenuar a atrofia no músculo FHL, pois conseguiu bloquear o aumento da proteína MuRF-1 (-3,5%), além de aumentar os níveis de mTOR (+63% para TC e TD) e p70S6K (+46% e +49% para TC e TD, respectivamente), embora não tenha alterado os valores de FOXO3a e Atrogina-1. O músculo SOL não foi alterado nem pelo tratamento nem pelo treinamento. Portanto, os resultados obtidos até o presente momento permite-nos sugerir que a atrofia observada nos músculos TA e FHL causadas por 10 dias de tratamento com DEX pode estar associada ao aumento da proteína MuRF-1. Por sua vez, o TR foi capaz de prevenir a atrofia no músculo FHL em decorrência do aumento de mTOR e p70S6K somados a manutenção dos valores de MuRF-1.

Orientador: Robson Francisco Carvalho / Resumo: A caquexia associada ao câncer é uma síndrome caracterizada pela grave perda de tecido musculo esquelético; que se estima que afeta mais de 50% de todos os pacientes com câncer e resulta em menor qualidade de vida devido a fadiga, fraqueza, redução da função imune, resistência à insulina e baixa tolerância e resposta à quimioterapia. Notavelmente, 20% das mortes relacionadas ao câncer são diretamente causadas pela caquexia. A principal limitação de que atualmente não há terapia direcionada, é o uso de abordagens tradicionais que não tratam a complexidade em sistemas biológicos, caracterizada por interações não-lineares de redes de regulação genética (GRN, do inglês Gene Regulatory Networks). Por esse motivo, ainda é necessária uma identificação dos componentes da GRN e uma compreensão quantitativa de sua integração temporal no controle das respostas celulares. Adquirir tal conhecimento é fundamental para capturar detalhes mecanicistas essenciais para direcionar estratégias terapêuticas para uma doença complexa, como a caquexia do câncer. Neste trabalho, examinamos a expressão genética do músculo esquelético em dois abordagens metodológicos diferentes: usando dados de expressão de genes estáticos e dinâmicos. Estruturamos nosso trabalho da seguinte maneira: o Capítulo 1 apresenta uma caracterização quantitativa das vias de sinalização e uma reconstrução de GRN no tecido musculo esquelético em ratos portadores de carcinoma de pulmão de Lewis (LLC, do inglês Lewis lung carcinoma... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Cancer cachexia is a syndrome characterized by the severe skeletal muscle wasting tissue; that affects more than 50% of all cancer patients and results in lower quality of life due to compromised fatigue, weakness, decreased immune function, insulin resistance and poor tolerance and response to radio and chemotherapy. Remarkably, approximately 20% of cancer-related deaths are estimated to be directly caused by cachexia. There is currently no effective targeted therapy and the main limitation lays on the traditional approaches that not deal with the inherent complexity, characterized by non-linear interactions, of gene regulatory networks (GRN). Thus, a clear identification of the components of gene regulation, and a quantitative understanding of their temporal integration to control cellular responses is fundamental for capture essential mechanistic details that will ultimately enable the development of direct therapeutic strategies for the treatment of cancer cachexia. Here, we examine genome-wide gene expression of muscle wasting under two different frameworks, using static and dynamic gene expression data. We structure this approach as follow: Chapter 1 presents a quantitative characterization of the signaling pathways and a GRN reconstruction of muscle wasting in Lewis Lung Carcinoma (LLC) tumor-bearing mice by integrating static mRNAs and microRNAs expression profiles. The results show that LLC mice reduced body weight in 20% and presented muscle and fat tissue wasting a... (Complete abstract click electronic access below) / Doutor

Base Teórica: A artrite reumatoide (AR) é uma doença crônica e inflamatória que além de sintomas articulares pode levar à perda de massa muscular com peso estável ou aumentado, condição denominada caquexia reumatoide (CR). A CR está associada com pior prognóstico, mas ainda é negligenciada na prática clínica. Objetivo: Avaliar a prevalência de CR em um hospital público terciário de Porto Alegre e determinar sua correlação com características da AR, com níveis de atividade física e com as medicações em uso. Métodos: Estudo transversal com 91 pacientes com AR que foram submetidos à densitometria corporal total (DEXA) para medida total e regional de índice de massa gorda (IMG; Kg/m2), índice de massa magra (IMM; Kg/m2), conteúdo mineral ósseo (CMO) e índice de massa livre de gordura (IMLG; Kg/m2) para avaliar a prevalência de CR pelas duas definições mais recentemene utilizadas na literatura: IMLG < percentil 10 com IMG > percentil 25 e IMLG < percentil 25 com IMG > percentil 50. Foram exploradas as medidas de associação dos parâmetros de composição corporal com características da AR – idade, duração da doença, atividade de doença (através do DAS 28), capacidade funcional (através do HAQ), atividade inflamatória (através da proteína C reativa – PCR – e velocidade de hemossedimentação – VHS), nível de atividade física (através do questionário IPAQ) e medicações em uso. Resultados: A idade média dos participantes foi 56,8 ± 7,3, a duração de doença foi 9 anos (3-18), o DAS 28 3,65 ± 1,32, o HAQ 1,12 (0,25 – 1,87) e o tempo de uso entre os que usaram biológico foi de 25 meses (17,8 – 52,5). A CR foi evidenciada em 17,6% dos pacientes com AR de acordo com a definição mais rigorosa e em 33% de acordo com a classificação mais abrangente. O IMLG teve correlação negativa com idade (r= -0,219; p=0,037) e duração da doença (rs= -0,214; p=0,042). O IMG teve correlação positiva com PCR (rs=0,229; p=0,029), VHS (rs=0,235; p=0,025), DAS 28 (rs=0,273; p=0,009) e HAQ (rs=0,297; p=0,004). Na comparação de pacientes com e sem CR, de acordo com a definição mais rigorosa, dos 26 pacientes usando biológico apenas 1 tinha CR (3,8%), enquanto dos que não usavam, 15 (23%) tinham CR (p=0,033). Conclusão: A prevalência de CR foi considerável e, portanto, merece estudos adicionais. A composição corporal neste estudo, especialmente o IMLG, teve associação inversa com idade e tempo de diagnóstico. Além disso, pacientes em uso de biológico tiveram diferença significativa na prevalência de CR, sugerindo papel protetor do uso de biológico na CR. / Background: Rheumatoid arthritis (RA) is a chronic and inflammatory disease that besides articular symptoms leads to loss of muscle mass in presence of stable or increased fat mass (FM), condition defined as rheumatoid cachexia (RC). RC is associated with a worse prognosis, but it is still overlooked in clinical practice. Objective: To evaluate the prevalence of rheumatoid cachexia (RC) in patients with rheumatoid arthritis (RA) and determine its correlation with the features of RA, the level of physical activity and with the current therapy. Methods: Ninety one RA patients in a cross-sectional study underwent total body dual-energy x-ray absorptiometry (DXA) for measurement of total and regional fat mass index (FMI; Kg/m2), lean mass index (LMI; Kg/m2), bone mineral content (BMC; Kg/m2) and fat free mass index (FFMI; Kg/m2) to assess the prevalence of RC. The associations of measures of body composition with RA features - age, diagnosis time, Health Assessment Questionnaire (HAQ), Disease Activity Score in 28 joints (DAS 28), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) -, level of physical activity (measured by International Physical Activity Questionnaire – IPAQ) and current therapy were explored. Results: Mean age was 56,8 ± 7,3 , disease duration 9 years (3 – 18), DAS28 3,65 ± 1,32, HAQ 1,12 (0,25 – 1,87) and use duration of biological agents was 25 months (17,8 – 52,5). Seventeen per cent of the patients had FFMI below the 10th percentile and FMI above the 25th percentile of a reference population and 33% of the patients had FFMI below the 25th percentile and FMI above the 50th percentile, condition known as RC, according to the more recently used definitions. FFMI correlated negatively only with age (r=-0,219; p=0,037) and disease duration (rs=-0,214; p=0,042). FMI correlated positively with CRP (rs=0,229; p=0,029), ESR (rs=0,235; p=0,025), DAS 28 (rs=0,273; p=0,009) and HAQ (rs=0,297; p=0,004). Of the 26 patients using biological therapy, 25 were non cachetic (p=0,033) according to the stricter definition of RC. In another words, 3,8% (n=1) and 23% (n=15) of the patients receiving and not receiving biological agents had RC, respectively (p=0,033). Conclusion: The prevalence of RC was considerable and deserves additional research. Body composition, in this study, particularly FFMI is inversely associated with age and disease duration. Besides that, patients under biological therapy had lower prevalence of RC, suggesting a protective effect of biological agents.

A ausência de terapias eficazes para a caquexia permanece como um problema central para o tratamento do câncer no mundo. Em contrapartida, o treinamento de força (i.e. também conhecido como treinamento resistido) tem sido amplamente utilizado como uma estratégia não farmacológica anticatabólica, prevenindo a perda da massa e da função da musculatura esquelética. Entretanto, o papel terapêutico do treinamento de força na caquexia do câncer permanece apenas especulativo. Portanto, nesse estudo avaliamos se o treinamento de força poderia atenuar a perda da massa e da função da musculatura esquelética em um severo modelo de caquexia do câncer em ratos. Para isso, ratos machos da linhagem Wistar foram randomizados em quatro grupos experimentais: 1) ratos sedentários injetados com solução salina na medula óssea (Controle); 2) ratos injetados com solução salina na medula óssea e submetidos ao treinamento de força (Controle + T); 3) ratos sedentários injetados com células do tumor Walker 256 na medula óssea (Tumor); e 4) ratos injetados com células do tumor Walker 256 na medula óssea e submetidos ao treinamento de força (Tumor + T). Foram avaliados a massa e a área de secção transversa da musculatura esquelética, marcadores de disfunção metabólica e do turnover proteico, a função da musculatura esquelética in vivo e ex vivo, o consumo alimentar, o crescimento tumoral e a sobrevida dos grupos experimentais com tumor. O grupo Tumor apresentou atrofia muscular após quinze dias da injeção das células tumorais como pode ser observado pela redução na massa dos músculos Plantaris (- 20,5%) e EDL (-20%). A atrofia no músculo EDL foi confirmada por análises histológicas, demonstrando uma redução de 43,8% na área de secção transversa. Embora o treinamento de força tenha aumentado o conteúdo proteico da lactato desidrogenase e revertido totalmente o conteúdo da forma fosforilada de 4EBP-1 (i.e. repressor da transcrição de mRNA), ele não atuou na morfologia da musculatura esquelética nos animais com tumor. Além disso, o treinamento de força não atenuou a perda de função da musculatura esquelética, a anorexia, o crescimento tumoral ou a taxa de mortalidade. Contudo, a força muscular, avaliada pelo teste de 1RM, apresentou uma correlação negativa com a sobrevida dos animais (p = 0,02), sugerindo que a perda de força prediz a mortalidade nesse modelo experimental de caquexia do câncer. Em suma, a injeção de células do tumor Walker 256 na medula óssea induz caquexia do câncer em ratos. O treinamento de força não foi eficaz em atenuar a perda de massa e função da musculatura esquelética nesse modelo. Entretanto, a força muscular prediz a sobrevida dos animais, sugerindo que novos estudos são necessários para elucidar o possível efeito terapêutico do treinamento de força para atenuar a caquexia do câncer e a progressão tumoral / The lack of therapies for cachexia is a key problem in cancer treatment. In contrast, resistance exercise training (RET) has been adopted as nonpharmacological anti-catabolic strategy, preventing muscle wasting and muscle dysfunction. However, the role of RET to counteract cancer cachexia is still speculative. Presently, we test whether RET would counteract skeletal muscle wasting in a severe cancer cachexia rat model. Methods: Male Wistar rats were randomly assigned into four experimental groups; 1) untrained control rats injected with saline solution in the bone marrow (control), 2) rats injected with saline solution in the bone marrow and submitted to RET (control + RET), 3) untrained rats injected with Walker 256 tumor cells in the bone marrow (tumor) and 4) rats injected with Walker 256 tumor cells in the bone marrow and submitted to RET (tumor + RET). Skeletal muscle mass and fiber cross sectional area, markers of metabolic and protein turnover impairment, in vivo and ex vivo skeletal muscle function, food intake, tumor growth and mortality rate were assessed. Results: Tumor group displayed skeletal muscle atrophy fifteen days post tumor cells injection as assessed by Plantaris (-20.5%) and EDL (-20.0%) muscle mass. EDL atrophy was confirmed by histological analysis, showing 43.8% decline in the fiber cross sectional area. Even though RET increased the lactate dehydrogenase protein content and fully restored phosphorylated form of 4EBP-1 (i.e. a repressor of mRNA translation) to the control levels in skeletal muscle, it failed to rescue muscle morphology in tumorbearing rats. Indeed, RET has not mitigated loss of muscle function, anorexia, tumor growth or mortality rate. However, loss of strength capacity (assessed by 1-RM test performance) demonstrated a negative correlation with rats´ survival (p = 0.02), suggesting that loss of strength capacity predicts cancer mortality. Conclusions: Bone marrow injection of Walker 256 tumor cells in rats induces cancer cachexia. RET is ineffective to mitigate cancer-induced skeletal muscle wasting in this rat model. However, strength capacity predicts cancer survival, suggesting that new studies are needed to elucidate the putative therapeutic role of different exercise training regimens in counteracting cancer cachexia and tumor progression