# Beyond muscle weakness: pathogenesis of sepsis-induced myopathy and its management

**Authors:** Yukun Liu, Xuan Zhao, Zhikai Xu, Qinxin Liu, Yuchang Wang

PMC · DOI: 10.1515/med-2025-1342 · Open Medicine · 2026-03-06

## TL;DR

This paper reviews the causes and treatments of sepsis-induced myopathy, emphasizing the need for integrated molecular and rehabilitation strategies to improve patient outcomes.

## Contribution

The paper provides a comprehensive review of molecular mechanisms and emerging therapies for sepsis-induced myopathy.

## Key findings

- Current management includes infection control, inflammation modulation, and structured rehabilitation.
- Emerging therapies like stem cell therapy and gene-editing show promise for treating SIM.
- Personalized medicine approaches may enhance recovery and quality of life for patients.

## Abstract

Sepsis-induced myopathy (SIM)significantly contributes to long-term disability and mortality among sepsis survivors. A comprehensive understanding of both the molecular mechanisms and rehabilitation strategies is crucial for effective management.

A review of pertinent studies was conducted, focusing on the molecular pathogenesis, therapeutic strategies, and rehabilitation interventions for SIM, with particular attention to clinical and translational advancements.

Current management strategies encompass infection control, modulation of inflammation, nutritional support, and structured rehabilitation programs, including early mobilization and physiotherapy. Emerging therapies that target inflammation, cellular protection, and regeneration – such as stem cell therapy and gene-editing techniques – demonstrate potential. Furthermore, advancements in personalized medicine, including genomics, transcriptomics, and individualized metabolic interventions, may further improve outcomes.

Optimizing both mechanistic and rehabilitation strategies is essential for enhancing functional recovery and quality of life in patients with SIM. An integrated clinical and molecular approach presents the most promising path forward. Keywords: sepsis-induced myopathy, sepsis.

## Full-text entities

- **Genes:** PIK3R4 (phosphoinositide-3-kinase regulatory subunit 4) [NCBI Gene 30849] {aka VPS15, p150}, NUP62 (nucleoporin 62) [NCBI Gene 23636] {aka IBSN, SNDI, p62}, Nlrp3 (NLR family, pyrin domain containing 3) [NCBI Gene 216799] {aka AGTAVPRL, AII/AVP, Cias1, FCAS, FCU, MWS}, Ggh (gamma-glutamyl hydrolase) [NCBI Gene 25455], Apobec2 (apolipoprotein B mRNA editing enzyme, catalytic polypeptide 2) [NCBI Gene 11811] {aka Arp1}, CASP1 (caspase 1) [NCBI Gene 834] {aka ICE, IL1BC, P45}, Ppargc1b (peroxisome proliferative activated receptor, gamma, coactivator 1 beta) [NCBI Gene 170826] {aka 4631412G21Rik, PGC-1beta, PGC-1beta/ERRL1, PPARGC-1-beta, Perc}, USP2 (ubiquitin specific peptidase 2) [NCBI Gene 9099] {aka UBP41, USP9}, Jak2 (Janus kinase 2) [NCBI Gene 24514], Akt1 (AKT serine/threonine kinase 1) [NCBI Gene 24185] {aka Akt}, MTOR (mechanistic target of rapamycin kinase) [NCBI Gene 2475] {aka FRAP, FRAP1, FRAP2, RAFT1, RAPT1, SKS}, Hdac6 (histone deacetylase 6) [NCBI Gene 15185] {aka Hd6, Hdac5, Sfc6, mHDA2}, USP25 (ubiquitin specific peptidase 25) [NCBI Gene 29761] {aka EIG19, USP21}, Foxo1 (forkhead box O1) [NCBI Gene 84482] {aka Fkhr, Foxo1a}, ATG14 (autophagy related 14) [NCBI Gene 22863] {aka ATG14L, BARKOR, KIAA0831}, Tnf (tumor necrosis factor) [NCBI Gene 21926] {aka DIF, TNF-a, TNF-alpha, TNFSF2, TNFalpha, Tnfa}, CASP8 (caspase 8) [NCBI Gene 841] {aka ALPS2B, CAP4, Casp-8, FLICE, MACH, MCH5}, Mul1 (mitochondrial ubiquitin ligase activator of NFKB 1) [NCBI Gene 68350] {aka 0610009K11Rik, Gide, Tnrip-1}, ACTN2 (actinin alpha 2) [NCBI Gene 88] {aka CMD1AA, CMH23, CMYO8, CMYP8, MPD6, MYOCOZ}, PPP3CA (protein phosphatase 3 catalytic subunit alpha) [NCBI Gene 5530] {aka ACCIID, CALN, CALNA, CALNA1, CNA1, DEE91}, Mfn2 (mitofusin 2) [NCBI Gene 170731] {aka D630023P19Rik, Fzo}, TMPRSS11D (transmembrane serine protease 11D) [NCBI Gene 9407] {aka ASP, HAT}, UBA7 (ubiquitin like modifier activating enzyme 7) [NCBI Gene 7318] {aka D8, UBA1B, UBE1L, UBE2, UBE7}, Trim55 (tripartite motif-containing 55) [NCBI Gene 381485] {aka D830041C10Rik, MuRF-2, Murf2, Rnf29}, Hdac3 (histone deacetylase 3) [NCBI Gene 15183], Tnni3 (troponin I, cardiac 3) [NCBI Gene 21954] {aka Tn1, cTnI}, Il6st (interleukin 6 cytokine family signal transducer) [NCBI Gene 25205] {aka Ac1055, Gp130, Il-6rb}, MYH14 (myosin heavy chain 14) [NCBI Gene 79784] {aka DFNA4, DFNA4A, FP17425, MHC16, MYH17, NMHC II-C}, UTRN (utrophin) [NCBI Gene 7402] {aka DMDL, DRP, DRP1}, DES (desmin) [NCBI Gene 1674] {aka CDCD3, CSM1, CSM2, LGMD1D, LGMD1E, LGMD2R}, PRKAA2 (protein kinase AMP-activated catalytic subunit alpha 2) [NCBI Gene 5563] {aka AMPK, AMPK2, AMPKa2, PRKAA}, MICU1 (mitochondrial calcium uptake 1) [NCBI Gene 10367] {aka CALC, CBARA1, EFHA3, MPXPS, ara CALC}, PIK3CB (phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit beta) [NCBI Gene 5291] {aka P110BETA, PI3K, PI3KBETA, PIK3C1}, GSK3B (glycogen synthase kinase 3 beta) [NCBI Gene 2932], Igf1r (insulin-like growth factor I receptor) [NCBI Gene 16001] {aka A330103N21Rik, CD221, D930020L01, IGF-1R, hyft}, HMOX1 (heme oxygenase 1) [NCBI Gene 3162] {aka HMOX1D, HO-1, HSP32, bK286B10}, BECN1 (beclin 1) [NCBI Gene 8678] {aka ATG6, VPS30, beclin1}, Trim63 (tripartite motif containing 63) [NCBI Gene 140939] {aka Murf, Murf1, Rnf28}, Ghrl (ghrelin and obestatin prepropeptide) [NCBI Gene 59301], Akt1 (Akt serine/threonine kinase 1) [NCBI Gene 11651] {aka Akt, LTR-akt, PKB, PKB/Akt, PKBalpha, Rac}, RELA (RELA proto-oncogene, NF-kB subunit) [NCBI Gene 5970] {aka AIF3BL3, CMCU, NFKB3, p65}, BAG3 (BAG cochaperone 3) [NCBI Gene 9531] {aka BAG-3, BIS, CAIR-1, CMD1HH, CMT2JJ, HMND15}, Foxo3 (forkhead box O3) [NCBI Gene 294515] {aka Fkhrl1, Foxo3a}, AMBRA1 (autophagy and beclin 1 regulator 1) [NCBI Gene 55626] {aka DCAF3, WDR94}, ACTN1 (actinin alpha 1) [NCBI Gene 87] {aka BDPLT15}, TRIM63 (tripartite motif containing 63) [NCBI Gene 84676] {aka CMH31, IRF, MURF1, MURF2, RNF28, SMRZ}, Pik3c3 (phosphatidylinositol 3-kinase catalytic subunit type 3) [NCBI Gene 225326] {aka 5330434F23Rik, Vps34}, Mtor (mechanistic target of rapamycin kinase) [NCBI Gene 56717] {aka 2610315D21Rik, FRAP, FRAP2, Frap1, RAFT1, RAPT1}, EP300 (EP300 lysine acetyltransferase) [NCBI Gene 2033] {aka KAT3B, MKHK2, RSTS2, p300}, PIK3C3 (phosphatidylinositol 3-kinase catalytic subunit type 3) [NCBI Gene 5289] {aka VPS34, Vps34, hVps34}, Map1lc3b (microtubule-associated protein 1 light chain 3 beta) [NCBI Gene 67443] {aka 1010001C15Rik, Atg8, LC3b, MAP1A/MAP1B, Map1lc3}, Stat3 (signal transducer and activator of transcription 3) [NCBI Gene 25125], SKP1 (S-phase kinase associated protein 1) [NCBI Gene 6500] {aka EMC19, OCP-II, OCP2, SKP1A, TCEB1L, p19A}, CAPN2 (calpain 2) [NCBI Gene 824] {aka CANP2, CANPL2, CANPml, mCANP}, FBXO32 (F-box protein 32) [NCBI Gene 114907] {aka Fbx32, MAFbx}, INS (insulin) [NCBI Gene 3630] {aka IDDM, IDDM1, IDDM2, ILPR, IRDN, MODY10}, Fbxo32 (F-box protein 32) [NCBI Gene 171043] {aka Atrogin1, MAFbx}, Tlr4 (toll-like receptor 4) [NCBI Gene 21898] {aka Lps, Ly87, Ran/M1, Rasl2-8}, Il1b (interleukin 1 beta) [NCBI Gene 16176] {aka IL-1beta, Il-1b}, PRKN (parkin RBR E3 ubiquitin protein ligase) [NCBI Gene 5071] {aka AR-JP, LPRS2, PARK2, PDJ}
- **Diseases:** insulin resistance (MESH:D007333), weight loss (MESH:D015431), endocrine dysregulation (MESH:D004700), hypertrophy (MESH:D006984), immunological dysregulation (MESH:D007154), infection (MESH:D007239), muscle hypertrophy (MESH:C536106), endotoxemia (MESH:D019446), microvascular deficiencies (MESH:D017566), ALS (MESH:D008113), Sepsis (MESH:D018805), diaphragmatic atrophy (MESH:C536880), muscle cell (MESH:D002292), septic (MESH:D001170), septic shock (MESH:D012772), muscular dystrophies (MESH:D009136), SIM (MESH:D000081030), muscle dysfunction (MESH:D009135), inflammatory cytokines (MESH:D000080424), muscle degeneration (MESH:D009410), atrophy (MESH:D001284), disuse muscle degeneration (MESH:D020966), spinal muscular atrophy (MESH:D009134), polytrauma (MESH:D009104), cancer (MESH:D009369), diabetes (MESH:D003920), ICU-acquired weakness (MESH:D018908), inflammatory damage (MESH:D018746), diminished (MESH:D015354), mitochondrial failure (MESH:D051437), mitochondrial abnormalities (MESH:D028361), muscle (MESH:D019042), defective and (MESH:D000013), sarcopenia (MESH:D055948), Inflammation (MESH:D007249), muscle atrophy (MESH:D009133), slow-channel congenital myasthenic syndrome (MESH:D020294), synaptic degeneration (MESH:D012183), muscle mass (MESH:C536030), genetic abnormalities (MESH:D030342), muscle inactivity (MESH:C564765), metabolic dysregulation (MESH:D021081), Duchenne muscular dystrophy (MESH:D020388), fatigue (MESH:D005221), paralysis (MESH:D010243), obesity (MESH:D009765), multiple organ dysfunction (MESH:D009102)
- **Chemicals:** amino acids (MESH:D000596), Dexmedetomidine (MESH:D020927), dexamethasone (MESH:D003907), selenomethionine (MESH:D012645), curcumin (MESH:D003474), melatonin (MESH:D008550), Ca2+ (-), calcium (MESH:D002118), ROS (MESH:D017382), glucose (MESH:D005947), lithium chloride (MESH:D018021), Lysine (MESH:D008239), TAK-242 (MESH:C507035), lipid (MESH:D008055), LPS (MESH:D008070), Gln (MESH:D005973), testosterone propionate (MESH:D043343), Triptolide (MESH:C001899), Polyphenols (MESH:D059808), ATP (MESH:D000255), SFN (MESH:C016766), N (MESH:D009584), dietary fiber (MESH:D004043), vitamin D (MESH:D014807), hemin (MESH:D006427), Apigenin (MESH:D047310), Glyc (MESH:D006003), Leu (MESH:D007930)
- **Species:** Homo sapiens (human, species) [taxon 9606], Rattus norvegicus (brown rat, species) [taxon 10116], Saccharomyces cerevisiae (baker's yeast, species) [taxon 4932], Mus musculus (house mouse, species) [taxon 10090]
- **Cell lines:** C2C12 — Mus musculus (Mouse), Spontaneously immortalized cell line (CVCL_0188)

## Full text

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## Figures

5 figures with captions in the complete paper: https://tomesphere.com/paper/PMC12962735/full.md

## References

188 references — full list in the complete paper: https://tomesphere.com/paper/PMC12962735/full.md

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Source: https://tomesphere.com/paper/PMC12962735