38 [Abstract]39 Introduction: Oxidative stress is considered an essential mechanism in 40 ICU-acquired weakness. The roles of oxidative stress in autophagy/mitophagy 41 dysfunction remains elusive. Microtubule serves as an essential guide rail for 42 auto/mitophagosome trafficking required for proper maturation of 43 auto/mitophagosomes in normal circumstances, and microtubules network 44 formation is regulated by signal transduction mechanisms involving Akt, GSK3β, 45 and the microtubule plus-end tracking molecule, EB1. We have investigated (1) 46 whether oxidative stress affects this pathway, leading to the defective mitophagy 47 response, and (2) whether trehalose, an auto/mitophagy modulator, can 48 ameliorate these pathological conditions. 49 Methods: By stably transfecting markers for auto/mitophagy or MT synthesis, 50 we have established a few new C2C12 myocyte cell lines, expressing, GFP-LC3, 51 EB1-GFP, and/or tandem-fluorescence LC3 (tfLC3). To monitor microtubule 52 network, the cells were stained by SiR-tubulin. The cells were cultured in the 53 presence or absence of oxidative stress by hydrogen peroxide (H2O2) and 54 treated with or without trehalose. The response of mitophagy parameters 55 including vesicle motion and the maturation status was monitored by stimulating 5 56 the cells with carbonyl cyanide m-chlorophenyl hydrazone (CCCP), an 57 established mitophagy inducer, under a time-lapse confocal microscopy. Signal 58 transduction mechanisms linking mitophagy to microtubule formation was 59 analyzed by Western Blotting against Akt and GSK3β.60 Results: Cells under the oxidative stress, showed abolished MT network 61 formation, decreased microtubule synthesis by EB1, and a decrease in 62 CCCP-invoked response of mitophagosome motion, perturbed mitophagosome 63 maturation, and increased superoxide production. Signal resistance of 64 Akt/GSK3β pathway to mitophagic stimulation, was documented. Trehalose 65 treatment reversed signal resistance, diminished MT synthesis, ameliorated the 66 disturbed MT network, and improved maturation defects, suppressing the 67 production of superoxide. 68 Conclusions: Oxidative stress decreases the response of mitophagy and 69 abolishes microtubule network. Trehalose improves the synthetic ability of 70 microtubule and normalized the disturbed microtubule network, resulting in the 71 improvement of the perturbed mitophagosomes maturation under the oxidative 72 stress. 73 6 74 [Keywords] 75 Muscle weakness, ICU-acquired weakness, Autophagy, Mitophagy, Oxidative 76 stress, Microtubule, Akt, GSK3β, Trehalose, Mitochondria 7 77 [Introduction] 78 Muscle wasting and muscle weakness is one of the major complications among 79 many types of critical illnesses including sepsis, burn, and major trauma [1]. In 80 critical illnesses, muscle wasting occurs mostly in chronic phase. More recently, 81 however, ICU-acquired weakness (ICU-AW), which occurs rapidly in the 82 critically ill patients, has acquired both scientific and clinical attention in the field 83 of critical illnes...