Myostatin and other musculoskeletal markers in lung transplant recipients

Published on October 13, 2018 by Kerschan-Schindl K, Ebenbichler G, Gruther W, Föger-Samwald U, Kudlacek S, Patsch J, Gleiss A, Jaksch P, Klepetko W, Pietschmann P

Key Takeaway

Even as physical function improves after lung transplantation, persistent abnormalities in biomarkers like myostatin highlight the ongoing need for targeted, long-term musculoskeletal rehabilitation.

Kerschan-Schindl K., Ebenbichler G., Gruther W., Föger-Samwald U., Kudlacek S., Patsch J., Gleiss A., Jaksch P., Klepetko W., Pietschmann P.. (2018). Myostatin and other musculoskeletal markers in lung transplant recipients. https://doi.org/10.1007/s10238-018-0532-3

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What this study found

This study monitored 37 lung transplant recipients from hospital discharge to six months post-transplant, comparing them to 30 healthy controls. Researchers evaluated physical performance alongside key musculoskeletal biomarkers. While patients demonstrated significant improvements in lung capacity, the six-minute walk test, and chair-rising times over the six-month period, their biochemical profiles remained highly abnormal. Specifically, levels of myostatin—a protein that inhibits muscle growth—were persistently elevated. Additionally, bone-related markers such as sclerostin were reduced, while dickkopf 1 and periostin were elevated compared to healthy peers, reflecting ongoing musculoskeletal distress.

Why it matters

For clinicians in physical medicine and rehabilitation, these findings highlight that functional recovery after major thoracic surgery does not equate to physiological normalization. Post-transplant sarcopenia and osteoporosis are major clinical challenges, driven by pre-operative deconditioning and post-operative immunosuppressive therapy. The persistence of elevated myostatin and altered bone markers suggests that standard short-term rehabilitation may be insufficient to fully reverse tissue-level degradation. Monitoring these biomarkers could help clinicians risk-stratify patients who require more aggressive, prolonged, or targeted resistance training protocols to restore muscle mass and bone density.

Limitations

The study is limited by its relatively small sample size and a short follow-up window of six months. Further research is needed to determine whether these metabolic abnormalities eventually resolve with long-term exercise therapy or if they represent permanent physiological shifts requiring novel pharmacological interventions.

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