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Updated: May 23, 2026

Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
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Impact of Prematurity on Nutrient Signaling and Protein Synthesis in Skeletal Muscle

Antonio C Ramos Dos Santos1, Ki Beom Jang2, Marta L Fiorotto3

  • 1Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Research, College Station, Texas, USA ;

Annual Review of Nutrition
|May 21, 2026
PubMed

Insights

Preterm birth impairs muscle growth by disrupting nutrient signaling pathways like mTORC1. Nutritional strategies mimicking natural feeding patterns can help restore muscle protein synthesis in preterm infants.

Area of Science:

  • Biochemistry
  • Physiology
  • Neonatology

Background:

  • Preterm birth significantly impacts skeletal muscle development and long-term metabolic health.
  • Infants born preterm frequently exhibit postnatal growth failure, characterized by inadequate lean mass.
  • Nutrient-responsive signaling pathways are crucial for muscle growth but are disrupted by prematurity.

Purpose of the Study:

  • To review how prematurity affects insulin and amino acid signaling to mTORC1, a key regulator of protein synthesis.
  • To explore the molecular mechanisms underlying impaired muscle growth in preterm infants.
  • To identify potential nutritional interventions for improving muscle anabolism.

Main Methods:

  • Review of translational research models investigating signaling pathways in preterm infants.
  • Analysis of insulin and amino acid signaling pathways, including mTORC1, PDK1/mTORC2-Akt, and leucine sensing.
  • Examination of evidence regarding the impact of feeding strategies on anabolic signaling.

Main Results:

  • Prematurity intrinsically blunts the activation of mTORC1 and its downstream targets, irrespective of birth weight or comorbidities.
  • Defects in insulin signaling (via PDK1/mTORC2-Akt) and amino acid sensing impair mTORC1-dependent translation initiation.
  • Reduced muscle protein synthesis is a direct consequence of these signaling defects.

Conclusions:

  • Understanding the molecular basis of impaired muscle growth in preterm infants is essential for developing targeted interventions.
  • Nutritional strategies that promote physiological nutrient pulsatility, such as bolus feeding or pulsatile leucine supplementation, show potential for restoring anabolic signaling.
  • Improving muscle growth in preterm infants can mitigate long-term metabolic health risks.

Keywords:
amino acid sensinganabolic resistanceinsulin signalinglean mass accretionmTORC1nutritional care

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