Mechanisms involved in postoperative recovery: a focus on pain, delirium, and neuroinflammation

人类术后恢复的差异很大，涉及的机制也很差。 明白了。外周血单核细胞和脑小胶质细胞处于激活状态，可能对 影响术后疼痛和精神错乱等合并症的炎症分解途径 恢复。激活状态的范围与观察到的术后恢复可能性的范围相关 在临床和实验环境中。这可能解释了为什么研究人员和临床医生无法 充分预测患者术后疼痛或精神错乱的结果，尽管有广泛的基础和 翻译研究。我的研究计划的主要重点是识别神经免疫 导致术后恢复不同的机制，如疼痛、认知和 抑郁症，考虑了年龄和性别。我们的方法将结合创新技术和 相关的临床前实验模型研究单核细胞/小胶质细胞参与 术后恢复，重点是疼痛和精神错乱。在过去的5年里，我们开始澄清 年龄和性别如何影响涉及疼痛和认知障碍的神经炎性过程 刺激，一种像手术一样的情况。我们和其他人已经确定，疼痛和认知状态在年龄上的变化 是与免疫系统的“启动”有关，而不是与“当前”状况有关。从我们目前的工作开始，完毕 在接下来的五年里，我们建议：1)建立一个与临床相关的术后评估系统 啮齿动物疼痛和精神错乱的恢复期。评估体重减轻、身体状况的初步实验 男性和女性青年和高龄组的体温和卧床运动将设定一个 重要的前提。2)确定年龄和性别如何影响单核细胞(疼痛)和小胶质细胞(精神错乱) 调节神经元的处理是迈向治疗发展的必要一步。我们将应用基因组学 翻译核糖体亲和纯化方法(TRAP)，外周血单核细胞和脑小胶质细胞。一个 TRAP的主要优势是能够识别特定于细胞的“功能转录组”。这种方法利用 转基因小鼠，并捕获蛋白质合成过程中主动翻译位于核糖体上的mRNAs。这 允许使用测序技术对翻译的RNA进行量化。创新和创新的一个重要方面 我们提议的工作的影响是免疫细胞中功能性mRNAs在年龄、性别和手术中的身份 将会被揭晓。最令人感兴趣的将是调节已知的促进疼痛和/或 手术后神志不清。提出的工作具有很高的创新性，因为它集成了先进的方法来解决 我们对术后疼痛和精神错乱的理解，最终将这些分子洞察力推向新的 治疗策略，这与我家对人类分子神经科学的日益重视相一致 系和研究中心。我们的愿景是将行为和数量、细胞类型特定的 转录学为术后观察到的各种恢复结果创建直观的描述。

Postoperative recovery in humans varies over a large range and the mechanisms involved are poorly understood. Peripheral monocytes and brain microglia adopt activation states that can be detrimental to inflammation resolution pathways involved in postoperative comorbidities like pain and delirium that impact recovery. The range of activation states correlates to the range of postoperative recovery possibilities observed in both clinical and experimental settings. This potentially explains the inability of researchers and clinicians to adequately predetermine a patient’s pain or delirium outcome after surgery, despite extensive basic and translational studies. The overarching focus of my research program is to identify neuroimmune mechanisms that contribute to variations in postoperative recovery, such as, pain, cognition, and depression, accounting for age and sex. Our approach will combine innovative technologies and relevant pre-clinical experimental models to investigate monocyte/microglia involvement in postoperative recovery with a focus on pain and delirium. In the past 5 years, we have begun to elucidate how age and sex influences neuroinflammatory processes involved in pain and cognitive deficits to inflammatory stimuli, a condition like surgery. We and others have determined that changes in pain and cognitive states in age is related to “priming” of the immune system and not “current” conditions. Building from our current work, over the next five years we propose to: 1) Build a clinically relevant postoperative assessment system to evaluate recovery phases in the context of pain and delirium in rodents. Initial experiments to assess weight loss, body temperature, and ambulatory movement in male and female young and advanced age groups will set an important premise. 2) Determine how age and sex influence monocytes (pain) and microglia (delirium) to modulate neuronal processing is an imperative step toward therapeutic development. We will apply the genomics method of “translating ribosome affinity purification”, (TRAP) to peripheral monocytes and brain microglia. A major strength of TRAP is the ability to identify a cell-specific “functional transcriptome”. This approach utilizes transgenic mice and captures actively translating mRNAs located on ribosomes during protein synthesis. This allows for quantification of translated RNAs using sequencing techniques. An important point of innovation and impact for our proposed work is that the identity of functional mRNAs in immune cells in aging, sex, and surgery will be revealed. Of most interest will be regulation of inflammatory cytokines known to promote pain and/or delirium after surgery. The work proposed is highly innovative because it integrates advanced methods to resolve our understanding of postoperative pain and delirium, to eventually move these molecular insights toward new therapeutic strategies, which aligns with the growing emphasis on human molecular neuroscience in my home department and research center. Our vision is to integrate behavioral and quantitative, cell-type specific transcriptomics to create intuitive descriptions of the diverse recovery outcomes observed postoperatively.