Losartan Restores Skeletal Muscle Remodeling and Protects Against Disuse Atrophy in Sarcopenia

Losartan improves muscle remodeling and protects against immobilization atrophy by mediating pathways critical for muscle homeostasis. Losartan Comes of Age The Little Old Lady from Pasadena describes a diminutive woman of advanced years who aggressively drives her Dodge around a southern California city. In popular culture, people link long life spans with being “little”; yet, shortened stature is only one physical change associated with aging. Another, less jocular, transformation is loss of muscle mass and strength—called sarcopenia—which can cause disability and predicts impending death in older adults. Burks et al. now identify losartan, an angiotensin II receptor antagonist commonly used to treat high blood pressure, as a new drug candidate for treating sarcopenia. Although the causes of sarcopenia are poorly understood, transforming growth factor–β (TGF-β) may contribute to faulty repair in aged muscle. Burks et al. used losartan to antagonize TGF-β signaling in an aged mouse model of sarcopenia. Losartan treatment improved muscle remodeling after injury and protected sarcopenic muscle from further loss of muscle mass caused by immobilization; these effects were mediated via two signaling circuits critical for skeletal muscle homeostasis: the TGF-β and insulin-like growth factor 1 (IGF-1)/Akt/mammalian target of rapamycin (mTOR) pathways. These observations suggest that treatment with losartan, a Food and Drug Administration (FDA)–approved drug, may benefit sarcopenia patients and allow little old ladies everywhere to continue their street racing for many years to come. Go granny go. Sarcopenia, a critical loss of muscle mass and function because of the physiological process of aging, contributes to disability and mortality in older adults. It increases the incidence of pathologic fractures, causing prolonged periods of hospitalization and rehabilitation. The molecular mechanisms underlying sarcopenia are poorly understood, but recent evidence suggests that increased transforming growth factor–β (TGF-β) signaling contributes to impaired satellite cell function and muscle repair in aged skeletal muscle. We therefore evaluated whether antagonism of TGF-β signaling via losartan, an angiotensin II receptor antagonist commonly used to treat high blood pressure, had a beneficial impact on the muscle remodeling process of sarcopenic mice. We demonstrated that mice treated with losartan developed significantly less fibrosis and exhibited improved in vivo muscle function after cardiotoxin-induced injury. We found that losartan not only blunted the canonical TGF-β signaling cascade but also modulated the noncanonical TGF-β mitogen-activated protein kinase pathway. We next assessed whether losartan was able to combat disuse atrophy in aged mice that were subjected to hindlimb immobilization. We showed that immobilized mice treated with losartan were protected against loss of muscle mass. Unexpectedly, this protective mechanism was not mediated by TGF-β signaling but was due to an increased activation of the insulin-like growth factor 1 (IGF-1)/Akt/mammalian target of rapamycin (mTOR) pathway. Thus, blockade of the AT1 (angiotensin II type I) receptor improved muscle remodeling and protected against disuse atrophy by differentially regulating the TGF-β and IGF-1/Akt/mTOR signaling cascades, two pathways critical for skeletal muscle homeostasis. Thus, losartan, a Food and Drug Administration–approved drug, may prove to have clinical benefits to combat injury-related muscle remodeling and provide protection against disuse atrophy in humans with sarcopenia.