ATF5-Dependent GDF15 Expression Mediates Anesthesia-Induced Neuroprotection Against Stroke

The incidence of perioperative stroke, a rare but severe complication, is increasing in aging populations. Although anesthetics such as sevoflurane may provide protective preconditioning against ischemic injury, clinical outcomes have been inconsistent. In this study, we demonstrated that sevoflurane-induced neuroprotection is associated with the upregulation of genes involved in the mitochondrial unfolded protein response (UPR ^mt ) and mitochondrial bioenergetic metabolism. Our findings emphasize the critical role of ATF5, a key transcription factor, in mediating these protective effects. Specifically, we observed that sevoflurane preconditioning significantly upregulates ATF5 and its downstream target GDF15 – a regulator of mitochondrial function – in the cerebral cortex. Notably, we found that this mechanistic pathway was not activated in the brain of aged mice, suggesting that age-specific strategies may be necessary for reducing the risk of perioperative stroke. Considering the steadily increasing age of patients, therapeutic approaches that enhance mitochondrial function in the aged brain may provide additional protection against perioperative stroke.