Resolving postoperative neuroinflammation and cognitive decline
Niccolò Terrando PhD
Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorLars I. Eriksson MD, PhD
Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA
Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institute, Stockholm, Sweden
Search for more papers by this authorJae Kyu Ryu PhD
Gladstone Institute of Neurological Disease, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorTing Yang MD, PhD
Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorClaudia Monaco MD, PhD
Kennedy Institute of Rheumatology, Faculty of Medicine, Imperial College London, London, United Kingdom
Search for more papers by this authorMarc Feldmann FMedSci, FAA, FRS
Kennedy Institute of Rheumatology, Faculty of Medicine, Imperial College London, London, United Kingdom
Search for more papers by this authorMalin Jonsson Fagerlund MD, PhD
Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institute, Stockholm, Sweden
Search for more papers by this authorIsrael F. Charo MD, PhD
Gladstone Institute of Cardiovascular Disease, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorKaterina Akassoglou PhD
Gladstone Institute of Neurological Disease, University of California at San Francisco, San Francisco, CA
Department of Neurology, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorCorresponding Author
Mervyn Maze MB, ChB
Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA
Department of Anesthesia and Perioperative Care, 521 Parnassus Avenue, C455, San Francisco, CA 94143-0648Search for more papers by this authorNiccolò Terrando PhD
Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorLars I. Eriksson MD, PhD
Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA
Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institute, Stockholm, Sweden
Search for more papers by this authorJae Kyu Ryu PhD
Gladstone Institute of Neurological Disease, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorTing Yang MD, PhD
Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorClaudia Monaco MD, PhD
Kennedy Institute of Rheumatology, Faculty of Medicine, Imperial College London, London, United Kingdom
Search for more papers by this authorMarc Feldmann FMedSci, FAA, FRS
Kennedy Institute of Rheumatology, Faculty of Medicine, Imperial College London, London, United Kingdom
Search for more papers by this authorMalin Jonsson Fagerlund MD, PhD
Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institute, Stockholm, Sweden
Search for more papers by this authorIsrael F. Charo MD, PhD
Gladstone Institute of Cardiovascular Disease, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorKaterina Akassoglou PhD
Gladstone Institute of Neurological Disease, University of California at San Francisco, San Francisco, CA
Department of Neurology, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorCorresponding Author
Mervyn Maze MB, ChB
Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA
Department of Anesthesia and Perioperative Care, 521 Parnassus Avenue, C455, San Francisco, CA 94143-0648Search for more papers by this authorAbstract
Objective:
Cognitive decline accompanies acute illness and surgery, especially in the elderly. Surgery engages the innate immune system that launches a systemic inflammatory response that, if unchecked, can cause multiple organ dysfunction. We sought to understand the mechanisms whereby the brain is targeted by the inflammatory response and how this can be resolved.
Methods:
C57BL/6J, Ccr2RFP/+Cx3cr1GFP/+, IkkF/F mice and LysM-Cre/IkkF/F mice underwent stabilized tibial fracture operation under analgesia and general anesthesia. Separate cohorts of mice were tested for systemic and hippocampal inflammation, integrity of the blood–brain barrier (BBB), and cognition. The putative resolving effects of the cholinergic pathway on these postoperative responses were also studied.
Results:
Peripheral surgery disrupts the BBB via release of tumor necrosis factor-alpha (TNFα), which facilitates the migration of macrophages into the hippocampus. Macrophage-specific deletion of Ikappa B kinase (IKK)β, a central coordinator of TNFα signaling through activation of nuclear factor (NF) κB, prevents BBB disruption and macrophage infiltration in the hippocampus following surgery. Activation of the α7 subtype of nicotinic acetylcholine receptors, an endogenous inflammation-resolving pathway, prevents TNFα-induced NF-κB activation, macrophage migration into the hippocampus, and cognitive decline following surgery.
Interpretation:
These data reveal the mechanisms for bidirectional communication between the brain and immune system following aseptic trauma. Pivotal molecular mechanisms can be targeted to prevent and/or resolve postoperative neuroinflammation and cognitive decline. ANN NEUROL 2011;70:986–995
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