Heart-spleen axis in cancer cachexia-related myocardial injury: mechanisms and therapeutic strategies

Cancer cachexia is a multifactorial clinical syndrome associated with tumors.It is characterized by progressive loss of skeletal muscle mass, weight loss, and anorexia.Conventional nutritional support often fails to fully reverse the condition, significantly compromising survival and quality of life in cancer patients.It is one of the leading causes of death in advanced cancer, with the highest incidence observed in pancreatic cancer.The development of this syndrome is closely linked to systemic metabolic disturbances and inflammatory factors such as tumor necrosis factor-alpha (TNF-α) and interleukin-1β(IL-1β).Current research has focused primarily on skeletal muscle depletion.However, accumulating evidence indicates that cachexia also induces myocardial injury, manifested as reduced cardiac mass and impaired cardiac function.Currently, no effective therapeutic strategies are available for the prevention and treatment of this condition.From the perspective of traditional Chinese medicine, such myocardial impairment corresponds to the categories of "palpitations" or "cardiac consumption, a pattern of consumptive disease".Based on the"heart-spleen axis "theory, the heart governs the blood and vessels, while the spleen governs transportation and transformation.These two organs interact physiologically to maintain the generation, distribution, and function of qi and blood.In cancer cachexia, dysfunction of the heart-spleen axis occurs: spleen deficiency impairs transportation, leading to inadequate generation of qi and blood (root deficiency).Simultaneously, accumulated cancer toxins combine with phlegm and stasis to form" toxic stasis ", which further damages the cardiac collaterals (branch excess).This combination of root deficiency and branch excess ultimately contributes to myocardial atrophy and functional decline.Accordingly, this paper proposes a therapeutic principle of" strengthening the spleen, nourishing the heart, while resolving toxicity and stasis".Through integrated interventions, including Chinese herbal medicine, acupuncture, therapeutic exercises, and dietary therapy, this approach aims to achieve multi-target, holistic regulation, improve nutritional status, suppress systemic inflammation, and protect myocardial structure and function.It may thus offer novel insights for the clinical prevention and treatment of cancer cachexia-associated myocardial injury.