Stem cell-based therapy and its potential in perioperative neurocognitive disorders

Editor—Perioperative brain health is becoming a significant global health concern, with rapidly growing numbers of ageing patients receiving surgical procedures. Perioperative neurocognitive disorders (PNDs) are the most common postoperative neuropsychiatric complications among these ageing individuals. 1 Mahanna-Gabrielli E. Schenning K.J. Eriksson L.I. et al. State of the clinical science of perioperative brain health: report from the American society of anesthesiologists brain health initiative summit 2018. Br J Anaesth. 2019; 123: 464-478 Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar Peripheral inflammation induced by surgical trauma can break down the integrity of the blood–brain barrier and cause a neuroinflammatory cascade, leading to brain damage. 2 Yang T. Velagapudi R. Terrando N. Neuroinflammation after surgery: from mechanisms to therapeutic targets. Nat Immunol. 2020; 21: 1319-1326 Crossref PubMed Scopus (95) Google Scholar Anti-inflammatory strategies have been explored as preventive and therapeutic approaches for PNDs 1 Mahanna-Gabrielli E. Schenning K.J. Eriksson L.I. et al. State of the clinical science of perioperative brain health: report from the American society of anesthesiologists brain health initiative summit 2018. Br J Anaesth. 2019; 123: 464-478 Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar ; however, potential risks include immunosuppression and impaired wound healing. 2 Yang T. Velagapudi R. Terrando N. Neuroinflammation after surgery: from mechanisms to therapeutic targets. Nat Immunol. 2020; 21: 1319-1326 Crossref PubMed Scopus (95) Google Scholar Moreover, anti-inflammatory strategies are unlikely to aid repair or regeneration of already damaged neural tissues after surgery. Owing to a lack of identified key pathogenic mechanisms and molecular pathways that modulate disease progression, traditional pharmacological interventions focusing on small molecules or inflammation-based treatment for PNDs have had limited success. 3 Eckenhoff R.G. Maze M. Xie Z. et al. Perioperative neurocognitive disorder: state of the preclinical science. Anesthesiology. 2020; 132: 55-68 Crossref PubMed Scopus (94) Google Scholar Recent failure to translate anti-inflammatory therapies from preclinical studies to clinical settings has prompted exploration of novel therapeutic strategies. 4 Takazawa T. Horiuchi T. Orihara M. et al. Prevention of postoperative cognitive dysfunction by minocycline in elderly patients after total knee arthroplasty: a randomized, double-blind, placebo-controlled clinical trial. Anesthesiology. 2023; 138: 172-183 Crossref PubMed Scopus (5) Google Scholar