Int J Neurosci. 2023 Sep 25. 1-16
Postoperative cognitive dysfunction (POCD) is a common postoperative complication, especially in elderly patients. It extends hospital stay, increases the mortality rate and are heavy burdens to the family and society. Accumulating research has indicated that overactivation of pyrin domain-containing protein 3 (NLRP3) inflammasomes is related to POCD. The NLRP3 inflammasome plays a critical role in activating pro-inflammatory cytokines. According to existing studies, indoleamine 2,3-dioxygenase (IDO) is potently up-regulated by inflammatory factors, tryptophan in brain is mainly catalyzed by IDO to kynurenine (KYN), IDO-Kynurenine metabolism may contribute to the development of depressive disorder and memory deficits. Hence, this study elucidated whether IDO-Kynurenine pathway mediates NLRP3 inflammasome activation-induced postoperative cognitive impairment in aged mice.POCD model was established in aged C57BL/6J mice by exploratory laparotomy under isoflurane anesthesia. Morris Water maze (MWM) was used to evaluate learning and memory abilities. We found that IDO and kynurenine aminotransferase-II (KAT-II) mRNA in hippocampus was up-regulated, and NLRP3, ASC, IL-1β and IDO overexpressed, KYN levels increased after anesthesia and surgery. Furthermore, we treated these mice with the NLRP3 inflammasome inhibitor (MCC950) to observe its effect on the expression of the NLRP3, ASC, IL-1β and IDO and KYN levels. We found that MCC950 reversed NLRP3, ASC, IL-1β and IDO overexpression, and the elevation of KYN levels, suggesting that IDO may be a downstream medium of the NLRP3 inflammasome. To clarify the role of IDO-Kynurenine pathway in postoperative cognitive impairment, we treated these mice with the IDO inhibitor 1-methyl-Ltryptophan (1-MT) to observe its effect on learning and memory abilities and the tryptophan (TRP), KYN and kynurenic acid (KYNA) levels. We found that 1-MT reduced the elevation of KYN and KYNA levels, and the reduction of TRP levels in the hippocampus, as well as improved learning and memory abilities in anesthesia/surgery mice. Finally, IDO overexpression led to the increase of KYNA levels in brain and cognitive impairment. Further study revealed that PF-04859989, a inhibitor of KAT-II (the major enzyme for brain KYNA synthesis) reduced brain KYNA levels, as well as restored the cognitive impairment. Together, these results reveal that IDO-Kynurenine pathway mediates NLRP3 inflammasome activation-induced postoperative cognitive impairment. IDO-Kynurenine pathway may be a novel target for the treatment of cognitive impairment induced by anesthesia and surgery in old patients.
Keywords: 3-dioxygenase; aged mice; indoleamine 2; inflammation; kynurenic acid; postoperative cognitive deficit