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Hypothyroidism impairs skeletal muscle regeneration after injury by altering myogenic and nonmyogenic pathways
Paola Aguiari, Valentina Villani, Yan-Yun Liu, Gianni Carraro, Gregory A. Brent, Laura Perin, Anna Milanesi
Paola Aguiari, Valentina Villani, Yan-Yun Liu, Gianni Carraro, Gregory A. Brent, Laura Perin, Anna Milanesi
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Research Article Cell biology Endocrinology Muscle biology

Hypothyroidism impairs skeletal muscle regeneration after injury by altering myogenic and nonmyogenic pathways

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Abstract

Thyroid hormone signaling is an essential regulator of skeletal muscle development, function, and metabolism, yet the specific signaling pathways required for muscle regeneration are not yet defined. We used scRNA-seq and the FUCCI (fluorescent ubiquitination-based cell cycle indicator) reporter mouse model to examine how hypothyroidism impacts repair processes after cardiotoxin-induced injury in mice. During regeneration, and up to 2 months after injury, hypothyroid muscles displayed smaller myofibers and a shift to slower oxidative fiber types. scRNA-seq of tibialis anterior muscle during regeneration revealed that hypothyroidism reduced myogenic-lineage diversity. Cell cycle analysis confirmed delayed cell cycle progression at 5 and 14 days after injury, with skeletal muscle stem cells stalled at the G1/S transition, hindering differentiation. Transcriptomic data revealed altered nonmyogenic dynamics, including elevated activated fibro-adipogenic progenitors (FAPs) early in repair and persistent proinflammatory macrophages. Integrative regulon and ligand-receptor analysis further demonstrated that triiodothyronine acted through dual modes: a direct transcriptional control of myogenic cell cycle and oxidative programs and an indirect paracrine remodeling mediated by FAP and immune signaling networks. This study identified what we believe to be novel effects of hypothyroidism on myogenic heterogeneity and impaired tissue repair, offering insights into muscle-wasting mechanisms relevant to hypothyroidism-associated myopathy and sarcopenia.

Authors

Paola Aguiari, Valentina Villani, Yan-Yun Liu, Gianni Carraro, Gregory A. Brent, Laura Perin, Anna Milanesi

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Figure 1

Skeletal muscle regeneration after injury: hypothyroid versus control.

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Skeletal muscle regeneration after injury: hypothyroid versus control.
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(A) Experimental design overview. Tibialis anterior muscles (TAMs) were collected from control and hypothyroid mice before injury and 4, 7, 14, and 28 days and 2 months after cardiotoxin-induced injury. Created in BioRender (Aguiari P, 2026, https://BioRender.com/9ywq1dw). (B) Immunofluorescence of TAM sections from control and hypothyroid mice before and 7, 14, and 28 days and 2 months after cardiotoxin-induced injury. Red, laminin; blue, nuclei (DAPI). Scale bars: 50 μm. (C) Scatter dot plot of minimum Feret diameter of TAM fibers from control and hypothyroid mice before and 7, 14, and 28 days and 2 months after injury. (D) Table showing the percentage decrease of minimum Feret diameter of regenerating skeletal muscle fibers in control and hypothyroid mice relative to the uninjured muscle. Data are presented as mean ± SEM. n = 3. One-way ANOVA and paired 2-tailed Student’s t tests were used for statistical analysis. ****P < 0.001, in hypothyroid compared with time point–matched control fibers. The experiment was repeated 3 times independently under identical conditions. CTRL, control; HYPO, hypothyroid; CTX, cardiotoxin; NI, before injury; d, days after injury; m, months after injury.

Copyright © 2026 American Society for Clinical Investigation
ISSN 2379-3708

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