Perioperative stroke deteriorates white matter integrity by enhancing cytotoxic CD8⁺ T-cell activation

To explore the regulatory mechanisms of microglia-mediated cytotoxic CD8⁺ T-cell infiltration in the white matter injury of perioperative stroke (PIS).

Adult male C57BL/6 mice were subjected to ileocolic bowel resection (ICR) 24 h prior to permanent distant middle cerebral artery occlusion (dMCAO) to establish model PIS. White matter injury, functional outcomes, peripheral immune cell infiltration, and microglia phenotype were assessed up to 28 days after dMCAO using behavioral phenotyping, immunofluorescence staining, transmission electron microscopy, western blot, and FACS analysis.

We found surgery aggravated white matter injury and deteriorated sensorimotor deficits up to 28 days following PIS. The PIS mice exhibited significantly increased activation of peripheral and central CD8⁺ T cells, while significantly reduced numbers of mature oligodendrocytes compared to IS mice. Neutralizing CD8⁺ T cells partly reversed the aggravated demyelination following PIS. Pharmacological blockage or genetic deletion of receptor-interacting protein kinase 1 (RIPK1) activity could alleviate CD8⁺ T-cell infiltration and demyelination in PIS mice.

Surgery exacerbates demyelination and worsens neurological function by promoting infiltration of CD8⁺ T cells and microglia necroptosis, suggesting that modulating interactions of CD8⁺ T cells and microglia could be a novel therapeutic target of long-term neurological deficits of PIS.