Free-heme induces neuroinflammation and cognitive impairment by microglial activation via the TLR4/MyD88/NF-kB signaling pathway

Abstract Background: Red blood cells (RBCs) transfusion is related to perioperative neurocognitive disorders. The toxic effect of free-heme has been identified in many pathologies. However, the underlying mechanisms of RBCs transfusion or free-heme in cognitive impairment have not been clearly explored. Therefore, this research was conducted to determine the mechanism of heme-induced neuroinflammation and cognitive impairment. Methods: Rats were received intraperitoneal injection of hemin alone or combined with intracerebroventricular injection of Hemopexin (HPX), and MWM test was conducted to measure cognitive function. The elimination condition of heme-HPX complexes was evaluated by flow cytometry for CD91+ cells. The microglial inflammatory response in rat brain and BV2 cells was observed by immunofluorescence staining of Iba-1 and ELISA analysis of TNF-α, IL-1β and IL-6. Furthermore, neuronal apoptosis in HT22 cells alone and in HT22 + BV2 coculture system was detected by flow cytometry and immunofluorescence staining. Finally, western blot was conducted to detect TLR4/MyD88/NF-kB proteins in rat brain and BV2 cells treated with hemin or combined with pathway inhibitors. Additionally, the M1 surface marker CD86 was observed in BV2 cells to further confirm neuroinflammation. Results: Intraperitoneal injection of hemin induced cognitive impairment, increase of CD91+ cells, up-regulation of TNF-α and IL-1β, down-regulation of IL-6, activation of microglia, and activation of the TLR4/MyD88/NF-kB signaling pathway in rat brain. Significantly, intracerebroventricular injection of HPX reduced the above effects. Hemin induced boost of TNF-α, IL-1β and IL-6 in BV2 cells, as well as apoptosis in HT22 cells. Notably, when HT22 cells were cocultured with BV2 cells, apoptosis was significantly increased. Hemin also induced activation of the TLR4/MyD88/NF-kB signaling pathway and increased the M1 surface marker CD86 in BV2 cells, and inhibiting this pathway reduced the inflammatory responses. Conclusions: Free-heme induces cognitive impairment, and the underlying mechanism may involve neuronal apoptosis and microglial inflammation via the TLR4/MyD88/NF-kB signaling pathway. HPX may have potential therapeutic effects.