Purpose of review: This review highlights recent publications dealing with the nature of the in-vivo response of skeletal muscle to critical illness and approaches to attenuating this response. Studies focused on molecular mechanisms of muscle catabolism are not reviewed.
Recent findings: The general areas covered are the metabolic response to stress, particularly regarding the relationship between muscle protein breakdown, amino acid availability, and muscle protein synthesis. The impact of the profile of amino acids in the context of protein/amino acid intake is also discussed. Advances in our understanding of the hormonal response are considered, and use of insulin therapy to slow muscle catabolism is discussed.
Summary: Muscle catabolism is a fundamental response to severe stress, and the resulting amino acid efflux from muscle provides important precursors for protein synthesis in other parts of the body. The nature of this response (i.e. transport kinetics favoring efflux of amino acids from muscle) makes amelioration of the catabolic response of muscle with nutrition alone very difficult. Many approaches have been used to reverse catabolism, mostly involving various anabolic hormones. Recent studies using insulin therapy are particularly intriguing because of the low cost and powerful anabolic stimulus of insulin.