Stellate Ganglion Block Improves Postoperative Cognitive Dysfunction in aged rats by SIRT1-mediated White Matter Lesion Repair

Abstract

BackgroundPostoperative cognitive dysfunction is a common complication of the central nervous system after surgery, especially in elderly patients. White matter lesions cause cognitive impairment. Although stellate ganglion block (SGB) is an effective intervention for postoperative cognitive dysfunction, the exact mechanism remains unclear. The SIRT1 signaling pathway is involved in the process that SGB alleviates postoperative cognitive dysfunction. However, the underlying mechanisms that SGB improves postoperative cognitive dysfunction through SIRT1 in aged rats and its association with white matter lesion repair are yet to be elucidated. MethodsTo simulate a surgery-induced cognitive dysfunction-like condition, 20-month-old aged male Sprague-Dawley rat was subjected to splenectomy to induce cognitive impairment. Cognitive function was assessed by Morris water maze test. Western blotting was used to determine SIRT1 and NF-κB expression levels in the hippocampus and white matter under different circumstances. Immunohistochemistry was used to examine SIRT1 expression in white matter. The morphology of neural cells in white matter was observed by HE staining. NF-κB activity was measured by EMSA. The serum and white matter TNF-α, IL-6 and IL-10 levels were determined by ELISA. ResultsAfter splenectomy, the expression of SIRT1 in the rat hippocampus and white matter was dramatically decreased, NF-κB activity was enhanced, the levels of TNF-α, IL-6 and IL-10 in serum and white matter were increased, and rat showed signi cant cognitive impairment. After treatment with stellate ganglion block, activation of SIRT1 mediated by the SIRT1/NF-κB signaling pathway alleviated neuroin ammation, reversed white matter injury, and ameliorated surgery-induced cognitive dysfunction. ConclusionIn conclusion, we provide strong evidence to demonstrate that postoperative cognitive dysfunction in elderly patients is associated with white matter injury, and stellate ganglion block can improve postoperative cognitive impairment in the older by reversing white matter lesion by activating SIRT1.

Impaired synaptic plasticity and decreased glutamatergic neuron excitability induced by SIRT1/BDNF downregulation in the hippocampal CA1 region are involved in postoperative cognitive dysfunction

“…SIRT1 also participates in memory formation by regulating synaptic plasticity [ 56 , 57 ]. It has been found that anesthesia/surgery can cause a decrease in the expression of SIRT1 [ 25 , 58 ]. However, administration of the SIRT1 agonist SRT1720 in mice can reduce the level of inflammatory cells and, more importantly, was able to alleviate synaptic plasticity impairment and postoperative cognitive dysfunction [ 59 ].…”

Effect of ultrasound-guided stellate ganglion block on inflammatory cytokines and postoperative recovery after partial hepatectomy: a randomised clinical trial

“…This might provide a theoretical study for selecting the concentration of IL-6 24 h after the operation as a visual evaluation index of the prognosis after SGB. After all, according to the existing literature on SGB and inflammatory response, SGB can improve postoperative cognitive dysfunction, and its mechanism may be through the regulation of silent information regular 1 (SIRT1) -mediated neuroinflammation after SGB and correcting white matter damage to improve postoperative cognitive dysfunction [ 20 – 22 ]. SGB can improve postoperative atrial fibrillation.…”

Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy

“…Research indicates that SGB can block the conduction of sympathetic ganglionic fibers, preventing intracranial artery spasms, and leading to the dilation of ipsilateral head and neck blood vessels. Furthermore, by inhibiting sympathetic nerve excitation, SGB can lower blood catecholamine levels and reduce neuropeptide Y release, thereby diminishing the stress response, maintaining hemodynamic stability, regulating cytokine release, and modulating immune cell activity to preserve homeostasis in the body environment [14][15][16][17]. With the straightforward procedure and low incidence of related complications, ultrasound-guided SGB has been extensively utilized in the realms of pain management and anesthesia.…”