Muscle wasting: A review of exercise, classical and non-classical RAS axes

This review identifies how the classical/non-classical renin-angiotensin system (RAS) and exercise influence muscle wasting. The classical RAS axis enhances muscle loss through the interaction with NADPH oxidase (NOX), ubiquitin proteasome system (UPS), protein synthesis and fibrosis pathways. The mainstream hypothesis identifies reactive oxygen species (ROS) as the key pathway in muscle, this review recognizes alternative pathways that lead to an increase in muscle wasting through the classical RAS axis. In addition, pathways in which the non-classical RAS axis and exercise inhibit the classical RAS axis are also explored. The non-classical RAS axis and exercise have a significant negative impact on ROS production and protein synthesis. The non-classical RAS axis has been identified in this review to directly affect protein synthesis pathways not by altering the pre-existing intracellular ROS level, further supporting the idea that muscle wasting caused by the classical RAS system is not entirely due to ROS production. Exercise has been identified to modify the RAS axes making it a therapeutic option.