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Naringenin Attenuates Metabolic Disturbances in C-26 Cancer Cachexia Mouse Model

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Naringenin Attenuates Metabolic Disturbances in C-26 Cancer Cachexia Mouse Model Naringenin Attenuates Metabolic Disturbances in C-26 Cancer Cachexia Mouse Model: Transitional Study for Human Application Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Yuko Nishikawa Graduate Program in Food Science and Technology The Ohio State University 2019 Thesis Committee Dr. Yael Vodovotz, Advisor Dr. Martha A. Belury, Co-Advisor Dr. Steven K. Clinton Dr. Christopher Simons Copyrighted by Yuko Nishikawa 2019 2 Abstract Cancer cachexia is a wasting disease which leads to poor disease prognosis and survival. Cachexia affects about 80% of advanced cancer patients and causes up to one- third of all cancer-related deaths. To date, effective treatment that directly targets cancer cachexia to improve longevity and quality of life is lacking. Metabolic disturbance is the underlying driver of the pathogenesis and progression of cancer cachexia. Common observations in cancer patients presenting cachexia include elevated inflammation, insulin resistance, dyslipidemia, and increased energy expenditure resulting in body weight loss that is irreversible by nutrition therapies. The use of metabolic modulators to improve these metabolic disturbances in some studies successfully slowed cachexia development, suggesting the importance of metabolic regulation in cancer cachexia treatment. Naringenin is a flavonoid found primarily in citrus fruits. Stemming from several epidemiological findings of the inverse associations of consumption of naringenin- containing foods and cancer incidence, a number of studies have explored anticancer activities and other bioactivities of naringenin. Naringenin has shown anti-cancer properties in many human cell lines and has successfully improved the inflammatory status, insulin tolerance, plasma glucose, and lipid profiles in mice. The results of some ii animal studies have suggested that naringenin supplementation during weight loss may help maintain lean body mass while regulating diet-induced metabolic disturbances. These observations have pointed to the potential use of naringenin to combat cachexia, a disease of metabolic disturbance, in cancer population by attenuation of tumor growth and metabolic disturbances, as well as the protection of the lean body mass. The first objective of this study was to determine the effect of dietary naringenin on the well-established C-26 cancer cachexia mouse model. We hypothesized that two- percent dietary naringenin would improve the metabolic disturbances in the C-26 model, slowing the progression of cachexia symptoms. Male CD2F1 mice were provided with either a control diet or a two percent naringenin diet, and each diet group was divided into a tumor and a no-tumor group. To our surprise, naringenin fed tumor mice exhibited weight loss and anorexia earlier than the control diet tumor mice. However, the early onset of anorexia and weight loss was not a predictor of worse outcomes in this study, since naringenin improved the inflammatory status, insulin sensitivity, activity, muscle function, and survival. These results confirmed naringenin's positive metabolism- regulating effects and its favorable impact on the outcomes of disease in the C-26 model. The second objective was to begin to provide a method for translation of the beneficial health effects of naringenin suggested by animal studies to human application. Although the first part of the study observed positive effects of naringenin on metabolic regulation, the concentration of naringenin used in our C-26 study was not directly translatable to the quantity that a human can achieve by consuming regular naringenin- containing foods. We hypothesized that the use of lyophilized naringenin-rich grapefruit iii juice and cyclodextrin in a confection would improve the naringenin bioavailability and increase its concentration. Cyclodextrin is a cyclic compound that has the ability to surround a hydrophobic, poorly soluble compound inside its cavity. By doing so, cyclodextrin encapsulation can improve the solubility and the bioavailability of naringenin. Since there is no universal food-safe complexation method for naringenin and β-cyclodextrin, two different methods were tested to encapsulate naringenin and naringin: the stirring method and the kneading method. The analyses of complexation efficiency by differential scanning calorimetry (DSC) and proton nuclear magnetic resonance (H- NMR) revealed that the stirring method was more efficient for the complexation of β- cyclodextrin with both naringin and naringenin. As a preliminary study for the future bioavailability tests, mice were fed with four different types of confections (sucrose, grapefruit confection (GFC), GFC with three percent naringenin, GFC with naringin equivalent to three percent naringenin) after a 12- hour fast and monitored for 2.5 hours. None of the mice finished consuming 1.6 grams of confection in 2.5 hours, and voluntary ingestion of the confection was found to be not suitable for a bioavailability studies, suggesting the need to oral gavage mice or to utilize a larger animal model. iv Acknowledgments I would like to thank my advisor, Dr. Vodovotz for allowing me to join such an exciting research environment, further allowing me to explore the area of my interest, and providing me with the opportunity to connect with researchers in other fields by introducing me to the Belury lab. I would also like to thank former and current Vodovotz lab members and officemates for giving me opportunities to learn important life skills. I would also like to express sincere gratitude to Dr. Belury for guiding me through the last half of my academic life as a master’s student in the nutrition field. I want to thank Deena, Austin, Rachel, Taylor, and other Belury lab members for sparing their precious time to help me with this study and for providing me with emotional support. I am grateful to the other members of my committee, Dr. Clinton and Dr. Simons, for giving me the motivation to challenge myself academically with their expertise. Support from Wes, Amanda, Emily, and my mentor, Dr. Parkin, has helped me propel through my academic life by restoring my energy and fueling my passion for food science. v Vita 2008………………………………………… B.A. Arts and Science, Kwansei Gakuin University, Hyogo, Japan 2009 to 2013………………………………… School Teacher, Hyogo Prefectural Board of Education, Hyogo, Japan 2017…………………………………………. B.S. Food Science, University of Wisconsin-Madison, Madison, WI 2017 to Present………………………………. Graduate Research Associate, Department of Food Science and Technology, The Ohio State University, Columbus OH Fields of Study Major Field: Food Science and Technology vi Table of Contents Abstract ............................................................................................................................... ii Acknowledgments............................................................................................................... v Vita ..................................................................................................................................... vi Table of Contents .............................................................................................................. vii List of Tables ...................................................................................................................... x List of Figures .................................................................................................................... xi Chapter 1. Literature Review .............................................................................................. 1 1.1 Cancer Cachexia ................................................................................................... 1 1.1.1 Definition, Prevalence, and Impact of Cancer Cachexia .............................. 1 1.1.2 Metabolic Disturbance and Cancer Cachexia ............................................... 3 1.1.3 Multi-organ Symptoms of Cancer Cachexia and Brain Function ............... 11 1.1.4 Suggested Mechanisms of Muscle Wasting in Cancer Cachexia ............... 15 1.1.5 Traditional Treatment for Cancer Cachexia ............................................... 19 1.1.6 C-26 Mouse Model for Human Cancer Cachexia Study ............................ 23 1.2 Naringenin .......................................................................................................... 27 1.2.1 Flavonoids and Bioactivities ....................................................................... 27 1.2.2 Food Sources of Naringenin ....................................................................... 32 1.2.3 Metabolism and Bioavailability of Naringenin Species ............................. 33 1.2.4 Naringenin and Inflammation ..................................................................... 35 1.2.5 Naringenin and Glucose Metabolism.......................................................... 36 1.2.6 Naringenin and Lipid Metabolism .............................................................. 37 1.2.7 Naringenin and Energy Expenditure ........................................................... 38 1.2.8 Naringenin and Brain Functions ................................................................. 38 1.2.9 Naringenin and Cancer ............................................................................... 40 1.3 Cyclodextrin ....................................................................................................... 42 vii 1.3.1 Cyclodextrin
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