Qiu Jianlei, Shi Pengcai, Mao Wude, Zhao Yuyi, Liu Wenshuai, Wang Yuelan
Department of Anesthesiology, Dezhou People's Hospital, Dezhou, Shandong China ; School of Medicine, Shandong University, Ji'nan, Shandong China.
Department of Anesthesiology, Shandong Provincial Qianfoshan Hospital, Ji'nan, Shandong China.
BMC Anesthesiol. 2015 Mar 7;15:25. doi: 10.1186/s12871-015-0018-8. eCollection 2015.
At present, sevoflurane inhalation anesthesia used on infants is well-known. But long-time exposure to inhalation anesthetic could cause neurologic disorder, especially nerve degeneration in infant and developing brain. The central nervous system degeneration of infants could affect the memory and cognitive function. γ-Aminobutyric acid (GABA) is a known inhibitory neurotransmitter in central nervous system. Inhalation anesthetic sevoflurane may activate GABAA receptor to inhibit central nervous system, leading to apoptosis of neural degeneration, cognitive dysfunction in the critical period of brain development.
Neural stem cells were derived from Wistar embryos, cultured in vitro. Third generation of neural stem cells were randomly divided into four groups according to cultured suspension: Sevoflurane group (Group S), GABAA receptor antagonists, Bicuculline group (Group B), Sevoflurane + GABAA receptor antagonists, Bicuculline group (Group S + B), dimethyl sulphoxide (DMSO) group (Group D). Group B and Group D did not receive sevoflurane preconditioning. Group S and Group S + B were pretreated with 1 minimum alveolar concentration (MAC) sevoflurane for 0 h, 3 h, 6 h, and 12 h. Group S + B and Group B were pretreated with bicuculline (10 uM). Group D was treated with DMSO (10 uL/mL). After treatments above, all groups were cultured for 48 h. Then we measured the cells viability by Cell Counting Kit (CCK-8) assay, cytotoxicity by Lactate Dehydrogenase (LDH) assay, apoptosis ratio with Annexin V/propidium iodide (PI) staining by flow cytometry, and the expression of GABAAR, anti-apoptotic protein Bcl-2, pro-apoptotic protein Bax and Caspase-3 by western blotting.
After exposing to sevoflurane for 0 h, 3 h, 6 h, and 12 h with 1MAC, we found that cell viability obviously decreased and cytotoxicity increased in time-dependent way. And Annexin V/PI staining indicated increased apoptosis ratio by flow cytometry. The protein level of GABAA receptor, pro-apoptotic protein Bax and apoptosis protein Caspase-3 increased; while anti-apoptotic protein Bcl-2 decreased. And bicuculline could reverse all detrimental results caused by sevoflurane.
Sevoflurane can inhibit the central nervous system by activating GABAA, resulting in apoptosis of neural stem cells, thus leading to the NSCs degeneration.
目前,七氟醚吸入麻醉在婴儿中应用广泛。但长时间暴露于吸入性麻醉剂可能导致神经功能障碍,尤其是对婴儿及发育中的大脑造成神经退行性变。婴儿中枢神经系统的退行性变可能影响记忆和认知功能。γ-氨基丁酸(GABA)是中枢神经系统中一种已知的抑制性神经递质。吸入性麻醉剂七氟醚可能激活GABAA受体以抑制中枢神经系统,导致神经退行性变的细胞凋亡,在大脑发育的关键时期出现认知功能障碍。
从Wistar胚胎中获取神经干细胞并进行体外培养。将第三代神经干细胞根据培养悬液随机分为四组:七氟醚组(S组)、GABAA受体拮抗剂荷包牡丹碱组(B组)、七氟醚+GABAA受体拮抗剂荷包牡丹碱组(S+B组)、二甲基亚砜(DMSO)组(D组)。B组和D组未接受七氟醚预处理。S组和S+B组用1个最低肺泡有效浓度(MAC)的七氟醚预处理0小时、3小时、6小时和12小时。S+B组和B组用荷包牡丹碱(10μM)预处理。D组用DMSO(10μL/mL)处理。经过上述处理后,所有组均培养48小时。然后我们通过细胞计数试剂盒(CCK-8)检测法测量细胞活力,通过乳酸脱氢酶(LDH)检测法检测细胞毒性,通过流式细胞术用膜联蛋白V/碘化丙啶(PI)染色检测细胞凋亡率,并通过蛋白质印迹法检测GABAAR、抗凋亡蛋白Bcl-2、促凋亡蛋白Bax和半胱天冬酶-3的表达。
用1MAC的七氟醚分别暴露0小时、3小时、6小时和12小时后,我们发现细胞活力明显下降,细胞毒性呈时间依赖性增加。膜联蛋白V/PI染色通过流式细胞术显示细胞凋亡率增加。GABAA受体、促凋亡蛋白Bax和凋亡蛋白半胱天冬酶-3的蛋白水平升高;而抗凋亡蛋白Bcl-2降低。并且荷包牡丹碱可以逆转七氟醚引起的所有有害结果。
七氟醚可通过激活GABAA抑制中枢神经系统,导致神经干细胞凋亡,从而导致神经干细胞退变。