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Dysregulated cell death and inflammation in Perioperative Medicine: Mechanisms and therapeutic opportunities

Jiaqi Li1,*, Chenglong Zhu1,*, Yan Liao1,*, Xuan Yin1,*, Rui Zhao2 , Changli Wang3, Doblin Sandai4, Haoling Zhang4 , Wangzheqi  Zhang1


1School of Anesthesiology, Naval Medical University, Shanghai 200433, China. 

2Gansu University of Chinese Medicine, No. 35 Dingxi East Road, Lanzhou 730000, Gansu, China. 

3Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai 200433, China. 

4Department of Biomedical Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang 13200, Malaysia. 

*The authors contribute equally.


Address correspondence to: Doblin Sandai, Department of Biomedical Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang 13200, Malaysia. E-mail: doblin@usm.my. Haoling Zhang, Department of Biomedical Sciences, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang 13200, Malaysia. E-mail: zhanghaolingedu@163.com. Wangzheqi Zhang, School of Anesthesiology, Naval Medical University, 800 Xiangyin Road, Yangpu District, Shanghai 200433, China. E-mail: zwzq001031@smmu.edu.cn.


DOI: https://doi.org/10.61189/775612vwvmhm


Received October 3, 2025; Accepted February 28, 2026; Published March 31, 2026

Abstract

Cell death is a fundamental process influencing tissue homeostasis and recovery following surgical trauma. In the perioperative context, regulated cell death aids in clearing damaged cells and initiating repair. However, excessive or dysregulated cell deathoften exacerbated by ischemia-reperfusion injury, surgical stress, and anesthetic agentscan trigger intense inflammatory responses, leading to complications such as postoperative organ dysfunction (e.g., acute lung injury, delirium, and myocardial injury), impaired wound healing, and increased risk of infections. Mitochondrial dysfunction, a key contributor to these processes, releases damage-associated molecular patterns, further amplifying perioperative inflammation. Emerging evidence suggests that modulating specific cell death pathways (e.g., apoptosis, pyroptosis, necroptosis) and associated inflammatory signaling (e.g., via NLRP3 inflammasome or TLR4 inhibition) may offer novel strategies to improve perioperative outcomes. This review explores the interplay between cell death and inflammation, with emphasis on perioperative relevance, and discusses emerging therapeutic targets that may facilitate precision medicine in surgical patients.

Keywords: Cell death, Perioperative medicine, Inflammation, Ischemia-reperfusion injury, Damage-associated molecular patterns, Precision medicine, Organ protection

Cite

Li JQ, Zhu CL, Liao Y, Yin X, Zhao R, Wang CL, Sandai D, Zhang HL, Zhang WZQ. Dysregulated cell death and inflammation in Perioperative Medicine: Mechanisms and therapeutic opportunities. Perioper Precis Med. 2026 Mar; 4 (1): 1-43. doi: 10.61189/775612vwvmhm

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