Current management strategies for sarcopenia and frailty in cirrhosis: Missing link in transplant candidacy

Table 4 Emerging therapies for sarcopenia and their proposed mechanisms

Emerging therapies	Proposed mechanism
Mineralocorticoid receptor antagonists such as spironolactone and tolvaptan	Mineralocorticoid receptors have a central role in insulin resistance and critical catabolic pathways like aging of skeletal muscle
L-ornithine L-aspartate	Promotes ammonia metabolism by increasing glutamine synthesis in skeletal muscle
Leucine	Increases the synthesis of albumin
Beta-hydroxy-beta-methylbutyrate	Activates the mTOR pathway and promotes IGF-1 production = anabolic effects
Long-chain omega-3 polyunsaturated fatty acids and medium-chain fatty acids	Anti-inflammatory properties
Vitamin D	Enhances cell proliferation and differentiation
L-carnitine	Enhances ATP production for muscle function
Follistatin	Natural antagonist to myostatin
Landogrozumab and bimagrumab	Monoclonal antibodies targeting myostatin

mTOR: Mechanistic target of rapamycin; IGF-1: Insulin-like growth factor 1.