Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
J Neuroinflammation. 2022 Sep 6;19(1):219. doi: 10.1186/s12974-022-02570-3.
Since the twenty-first century, the development of technological advances in anesthesia and surgery has brought benefits to human health. However, the adverse neurological effects of perioperative-related factors (e.g., surgical trauma, anesthesia, etc.) as stressors cannot be ignored as well. The nervous system appears to be more "fragile" and vulnerable to damage in developing and aging individuals. Ferroptosis is a novel form of programmed cell death proposed in 2012. In recent years, the regulation of ferroptosis to treat cancer, immune system disorders, and neurodegenerative diseases have seen an unprecedented surge of interest. The association of ferroptosis with perioperative neurocognitive disorders has also received much attention. Cognitive impairment can not only affect the individual's quality of life, but also impose a burden on the family and society. Therefore, the search for effective preventive and therapeutic methods to alleviate cognitive impairment caused by perioperative-related factors is a challenge that needs to be urgently addressed. In our review, we first briefly describe the connection between iron accumulation in neurons and impairment of brain function during development and aging. It is followed by a review of the pathways of ferroptosis, mainly including iron metabolism, amino acid metabolism, and lipid metabolism pathway. Furthermore, we analyze the connection between ferroptosis and perioperative-related factors. The surgery itself, general anesthetic drugs, and many other relevant factors in the perioperative period may affect neuronal iron homeostasis. Finally, we summarize the experimental evidence for ameliorating developmental and degenerative neurotoxicity by modulating ferroptosis. The suppression of ferroptosis seems to provide the possibility to prevent and improve perioperative neurocognitive impairment.
自 21 世纪以来，麻醉学和外科学技术的发展进步为人类健康带来了益处。然而，围术期相关因素（如手术创伤、麻醉等）作为应激源引起的不良神经学效应也不容忽视。在发育和衰老个体中，神经系统似乎更为“脆弱”，容易受到损伤。铁死亡是 2012 年提出的一种新的细胞程序性死亡形式。近年来，铁死亡在治疗癌症、免疫系统疾病和神经退行性疾病方面的调控作用引起了前所未有的关注。铁死亡与围术期神经认知障碍的关联也受到了广泛关注。认知障碍不仅会影响个体的生活质量，还会给家庭和社会带来负担。因此，寻找有效的预防和治疗方法来减轻围术期相关因素引起的认知障碍是一个亟待解决的挑战。在本综述中，我们首先简要描述了神经元中铁蓄积与发育和衰老过程中脑功能损害之间的联系。然后我们回顾了铁死亡的途径，主要包括铁代谢、氨基酸代谢和脂质代谢途径。此外，我们还分析了铁死亡与围术期相关因素之间的联系。手术本身、全身麻醉药物以及围术期的许多其他相关因素都可能影响神经元铁稳态。最后，我们总结了通过调节铁死亡来改善发育性和退行性神经毒性的实验证据。抑制铁死亡似乎为预防和改善围术期神经认知障碍提供了可能。
