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Neuroinflammation after surgery: from mechanisms to therapeutic targets

Nature Immunology volume 21, pages 1319–1326 (2020)Cite this article

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Abstract

Injury is a key driver of inflammation, a critical yet necessary response involving several mediators that is aimed at restoring tissue homeostasis. Inflammation in the central nervous system can be triggered by a variety of stimuli, some intrinsic to the brain and others arising from peripheral signals. Fine-tuned regulation of this response is crucial in a system that is vulnerable due to, for example, aging and ongoing neurodegeneration. In this context, seemingly harmless interventions like a common surgery to repair a broken limb can overwhelm the immune system and become the driver of further complications such as delirium and other perioperative neurocognitive disorders. Here, we discuss potential mechanisms by which the immune system affects the central nervous system after surgical trauma. Together, these neuroimmune interactions are becoming hallmarks of and potential therapeutic targets for multiple neurologic conditions, including those affecting the perioperative space.

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Fig. 1: Innate immune response to sterile surgical trauma.
Fig. 2: Neuro–immune interactions in the brain after peripheral trauma.

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Acknowledgements

We thank Kathy Gage (Duke University Medical Center) for editorial assistance. T.Y. acknowledges a Department of Medicine Chair Research Award (Duke University) and an ASN Kidney Cure Carl W. Gottschalk Research Scholar Grant. N.T. is supported by NIA grants R01AG057525, R21 AG055877-01A1 and R03 AG064260-01; the Department of Anesthesiology; and Duke Institute of Brain Sciences.

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  1. Department of Medicine, Division of Nephrology, Duke University Medical Center, Durham, NC, USA

    Ting Yang

  2. Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA

    Ravikanth Velagapudi & Niccolò Terrando

  3. Department of Cell Biology, Duke University Medical Center, Durham, NC, USA

    Niccolò Terrando

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Yang, T., Velagapudi, R. & Terrando, N. Neuroinflammation after surgery: from mechanisms to therapeutic targets. Nat Immunol 21, 1319–1326 (2020). https://doi.org/10.1038/s41590-020-00812-1

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