Neuromuscular junction instability with inactivity: morphological and functional changes after 10 days of bed rest in older adults

The neuromuscular junction (NMJ) plays a key role in modulating muscle contraction, but the impact of short-term disuse on NMJ structure and function, particularly in older humans, remains unclear. This study aimed to investigate NMJ alterations following 10 days of horizontal bed rest in 10 older males (68.5 +/- 2.6 years). Before and after bed rest, vastus lateralis muscle biopsies were obtained to evaluate NMJ morphology, intramuscular EMG (iEMG) was recorded to assess NMJ function and blood samples were collected to determine circulating C-terminal agrin fragment (CAF) concentration, a biomarker of NMJ remodelling. In a sub-cohort of six participants who had NMJs in both pre- and post-bed rest biopsies, we observed altered NMJ morphology, including reduced overlap between NMJ terminals, as well as increased endplate area and perimeter. CAF concentration was elevated after bed rest, suggesting ongoing NMJ remodelling. iEMG analysis showed increased motor unit potential complexity and reduced firing rate. In addition, we observed impaired NMJ transmission, inferred from increased near-fibre jiggle and segment jitter. These findings suggest that older male individuals are susceptible to NMJ remodelling and impaired transmission with short-term disuse, providing valuable insights into the morphological and functional consequences of inactivity in an ageing population. Our study highlights the importance of developing interventions for mitigating the detrimental consequences of inactivity on neuromuscular health in older adults, which they frequently experience following injury, trauma, illness or surgery.