Myostatin, activin-A and follistatin are produced by the tumor in head and neck cancer and likely contribute to sarcopenia: A case-control, cross-sectional exploratory study.

BACKGROUND AND AIMS: Myostatin (M), activin-A (A) and follistatin (F), three TGF-β superfamily members, play a role in cancer sarcopenia. The aim of our study was to assess the association of MAF in head and neck cancer (HNC) skeletal muscle loss.

MATERIALS AND

METHODS

This prospective study involved 55 patients, 32 with HNC and 23 controls. The patients underwent a full nutritional assessment just before surgery. Tumor, muscle and plasma were harvested at the time of surgery. Plasma was harvested a second time 7 days after the procedure. Tumor explants were cultured and MAF were measured in the incubation medium.

RESULTS

A and F plasma levels were higher in cancer patients compared to control (320 vs. 203 pg/ml, p < 0.001, ES = 0.96 95 % CI [0.40; 1.52] and 3593 vs 2148 pg/ml, p < 0.001, ES = 1.10 95%CI [0.53; 1.66], respectively) and M plasma level lower (1542 vs. 2100 pg/ml, p = 0.01, ES = -0.70 95%CI [-1.24; -0.15]). M plasma level was correlated with the skeletal muscle index at the third lumbar vertebra (r = 0.44; p < 0.05) and negatively correlated with weight loss (r = -0.65; p < 0.05) and the C Reactive protein level (-0.44; p = 0.02). At the seventh postoperative day (D), A was increased (D7 vs D0) in the cancer group (379 vs 320 pg/ml; p < 0.001) while the concentrations of M and F were unchanged from the presurgical level. There was no difference between groups in the transcript levels of M and A in skeletal muscles. MAF were systematically detected in the tumor incubation medium with no correlation between tumor incubation medium level and plasma level at D0.

CONCLUSION

The MAF secretory profile is modified in HNC. In particular, A seems to play a role in muscle loss while F protects against skeletal muscle mass loss.