Nervous System Diseases

Symptoms and General Pathology

All Conditions

Neoplasms

Respiratory Tract (Lung and Bronchial) Diseases

Nutritional and Metabolic Diseases

Muscular Atrophy

Lung Neoplasms

Atrophy

Wasting Syndrome

Cachexia

Pathological Conditions, Anatomical

Neuromuscular Manifestations

Neurologic Manifestations

No intervention

Julien ANIORT

Muscle wasting is present in almost 50% of patients treated with chronic hemodialysis. It is associated with an increased risk of death (particularly from cardiovascular causes) and compromises quality of life (loss of autonomy and fatigue). The mechanisms leading to muscle wasting in chronic kidney disease have been the subject of several studies in animals. These have highlighted the role of the ubiquitin-proteasome system (UPS). Activation of UPS during chronic kidney disease is multifactorial. It is the result of resistance to the action of insulin/IGF1, metabolic acidosis, low grade prolonged inflammation and increased production of myostatin. To date few studies have been conducted in humans.

The investigators want to identify blood markers related to muscle protein breakdown in patients undergoing hemodialysis. In parallel, the investigators want to adress the mechanisms involved in muscle proteolysis. In addition, the investigators want to identify the proteins degraded and the ubiquitination enzymes (E2/E3 couples) specifically involved in muscle loss during hemodialysis.

Muscle biopsies and blood sample will beperformed during scheduled surgeries in healthy volunteers (negative control), cancer patients (positive control) or undergoing chronic hemodialysis. RNA seq analysis will be performed in blood samples and proteomic mass spectrometry analysis for establishing a specific profile between muscle and blood markers. A limited subset of blood markers common to cancer and hemodialysis atrophying muscles will be used for elaborating a chip dedicated to early detect an atrophying process.

Thus, the investigators will first design a diagnostic tool for detecting non-invasively muscle protein breakdown before the onset of muscle atrophy. This will enable early and efficient nutritional counter-measures.

Hypothesis Measuring urinary 3-methylhistidine is a simple tool to assess proteolysis in clinical practice. However it is not totally specific of muscle proteolysis because it may reflect an intestinal catabolism. Moreover, its dosage cannot be used in patients with renal impairment especially in case of anuria. Apart from achieving muscle biopsy or measuring the overall kinetics of proteins it does not yet exist simple and reproducible diagnostic tool for measuring muscle proteolysis. With the present study, the investigators expect to identify in the blood of patients a particular transcriptomic profile related to the activation of muscle proteolysis, including increased proinflammatory cytokine transcripts.

Rodent models of CKD were used to identify major proteolytic system and signal pathway implicated in muscle wasting caused by uremia. These finding needs to be confirmed in humans studies. Also, other actors of muscle atrophy could be identified in humans. Notably, so far, few studies have been performed in order to determine which E2 are involved in muscle atrophy, and to knowledge of the investigators no one in CKD. Finally, data on muscle proteasome substrates are limited since only actin was clearly identified in humans by the team. The investigators expect an activation of the proteasome system with an increase in the expression of enzymes E2s, E3s including MURF1 and MAFbx and proteasome subunit in patients treated with hemodialysis. The investigators could also observe an activation of caspase system which is thought to work in concert with the UPS.

Materials and methods 2.1. Population The experiments will be performed using blood sample and human muscle biopsies obtained during programmed orthopedic surgery (negative control), cancer (positive control) and hemodialysis patients. This translational research program has already been accepted (DGS 2008-A00479-46) and inclusion of patients already started. A maximum of 15 patients per group will be included. Inclusion and exclusion criteria were set-up according to the objectives (absence of any pathology for controls, etc.) and the legislation (written consent, etc.). Thirty-two patients have already been included so far, and biopsies are stored in liquid nitrogen. Blood samples are collected just before surgery using Paxgene RNA tubes and stored following the manufacturer's instructions until analysis.

2.2. Blood sample Total RNA will be extracted from blood using Paxgene RNA Extraction kit and analysed by RNAseq 2.3. Muscle biopsies 2.3.1. Transcriptomic analysis Total RNA will be extracted from human muscle biopsies using commercial kits. The investigators will first verify that known muscles markers are up-regulated in cancer patient biopsies (positive controls) and address their levels in muscle biopsies from hemodialysis patients. We will thus perform qRT-PCR UBE2B, UBE2D2, MaFbx, MuRF1, Ozz, ASB2, E4B, Nedd4, Mdm2 and 26S proteasome subunits.

2.3.2. Proteomic analysis Proteomic analysis will be performed usin shot gun spectrometry analysis

Muscle Wasting in Hemodialysis Patient

Study of Muscle Wasting Mechanisms and Biomarkers in Hemodialysis Patient

Total RNA will be extracted from blood using Paxgene RNA Extraction kit and analysed by RNAseq and a comparison made between patients and control.

1. To confirm the implication of UPS in muscular proteolysis of IRCH patients by the detection of an increasing of ARNm, except ubiquitin, implicated in the quantitative RT-PCR system and by the identification of substrates.
2. To locate on the proteins that have to be deteriorated, the sites used by the UPS to fix polyubiquitin chains.

Total RNA will be extracted from human muscle biopsies using commercial kits. We will first verify that known muscles markers are up-regulated in cancer patient biopsies (positive controls) and address their levels in muscle biopsies from hemodialysis patients. We will thus perform qRT-PCR UBE2B, UBE2D2, MaFbx, MuRF1, Ozz, ASB2, E4B, Nedd4, Mdm2 and 26S proteasome subunits.

Proteomic analysis will be performed usin shot gun spectrometry analysis

University Hospital, Clermont-Ferrand

Blood and Lymph Conditions

Immune System Diseases

Digestive System Diseases

Rare Diseases

Carcinoma

Body Weight

Lymphoma

Weight Loss

Gastrointestinal Neoplasms

Hodgkin Disease

Digestive System Neoplasms

Carcinoma, Bronchogenic

Neoplasms by Histologic Type

Lymphoproliferative Disorders

Lymphatic Diseases

Immunoproliferative Disorders

Body Weight Changes

Gastrointestinal Diseases

Bronchial Neoplasms

Respiratory Tract Neoplasms

Thoracic Neoplasms

Lung Diseases

Respiratory Tract Diseases

Lymphosarcoma

Hodgkin Lymphoma

Anti-Infective Agents

Respiratory System Agents

All Drugs and Chemicals

Acetylcysteine

N-monoacetylcystine

Antioxidants

Antiviral Agents

Expectorants

Protective Agents

Antidotes

N-acetylcysteine

Wulf Hildebrandt, MD

The purpose of the study is to tests the hypothesis, that N-acetylcysteine (a thiol-antioxidant)improves the exercise training effect on cancer patients that experience weight loss (cachexia) as assessed by muscle mass and function as well as histomorphology.

Effect of an Antioxidant on Cancer-Cachectic Patients Undergoing Exercise Training

Effect of N-Acetylcysteine on Skeletal Muscle in Cachectic Cancer Patients Undergoing a Resistance Training Program (Phase 2 Study)

Heidelberg University

German Cancer Research Center

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Muscle Wasting in Hemodialysis Patient	NCT03583177	Muscle Atrophy ...	No intervention	18 Years - 75 Years	University Hospital, Clermont-Ferrand
Effect of an Antioxidant on Cancer-Cachectic Patients Undergoing Exercise Training	NCT00196885	Gastrointestina... Bronchial Carci... Hodgkin Disease Non-Hodgkin Lym... Weight Loss	N-acetylcystein...	20 Years - 80 Years	German Cancer Research Center
Effect of an Antioxidant on Cancer-Cachectic Patients Undergoing Exercise Training	NCT00196885	Gastrointestina... Bronchial Carci... Hodgkin Disease Non-Hodgkin Lym... Weight Loss	N-acetylcystein...	20 Years - 80 Years	German Cancer Research Center

Spots Global Cancer Trial Database for proteolysis

Every month we try and update this database with for proteolysis cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Spots Global Cancer Trial Database for proteolysis

Every month we try and update this database with for proteolysis cancer trials from around the world to help patients and their families find trials that might be right for them. We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Every month we try and update this database with for proteolysis cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.