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Bupivacaine Induces ROS-Dependent Autophagic Damage in DRG Neurons via TUG1/mTOR in a High-Glucose Environment


Bupivacaine (BP) is a commonly clinically used local anesthetic (LA). Current studies suggest that neurological complications are increased in diabetic patients after LA application, but the molecular mechanism is poorly understood. LA-induced autophagy and neuronal injury have been reported. We hypothesized that a high-glucose environment aggravates BP-induced autophagic damage. Mouse dorsal root ganglion (DRG) neurons were treated with BP in a high-glucose environment, and the results showed that reactive oxygen species (ROS) levels increased, autophagy was activated, autophagy flux was blocked, and cell viability decreased. Pretreatment with the ROS scavenger N-acetyl-cysteine (NAC) attenuated ROS-mediated autophagy regulation. Moreover, the expression of the long noncoding RNA (lncRNA) taurine upregulated gene 1 (TUG1) increased, and NAC and TUG1 siRNA inhibited the expression of TUG1/mammalian target of rapamycin (mTOR) in DRGs treated with BP in a high-glucose environment. Intriguingly, contrary to previous reports on a positive effect on neurons, we found that rapamycin, an autophagy activator, and chloroquine, an autophagy and lysosome inhibitor, both exacerbated autophagic damage. These data suggest that a high-glucose environment exacerbated BP induced ROS-dependent autophagic damage in DRG neurons through the TUG1/mTOR signaling pathway, which provides a theoretical basis and target for the clinical prevention and treatment of BP neurotoxicity in diabeties.

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Local anesthetic


Reactive oxygen species


Long non-coding RNA


Taurine upregulated gene1


Mammalian target of rapamycin


Dorsal root ganglion






Nerve growth factor


Transient neurological syndrome


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We thank the Laboratory of Pharmacy College of Southern Medical University (Guangzhou, Guangdong province, China) for their support. We also thank Hongfen Shen (M.S.. Cancer Research Institute of Southern Medical University, Guangzhou, Guangdong province, China) for the technical assistance.


This research was supported by the grants from the National Natural Science Foundation of China (No. 81501082 to Fengxian Li, No. 81771315 to Shiyuan Xu, and No. 82171357 to Le Li).

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Luying Lai performed primary neurons culture, immunofluorescence staining, DAP-green detection, and ROS fluorescence detection; Yongwei Wang performed primary neurons culture, cell viability assay, and western blot; Shenghui Peng participated in DAP-green detection and ROS flourescence detection; Wenjing Guo participated in primary neurons culture and western blot; Guanshan Wei and Le Li participated in western blot; Zhengyuan Xia contributed to experimental design and manuscript preparation; Luying Lai and Fengxian Li participated in data analysis, manuscript preparation, and wrote the paper; Fengxian Li and Shiyuan Xu planned and directed all experiments. All authors contributed to and have approved the final manuscript.

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Correspondence to Fengxian Li or Shiyuan Xu.

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Lai, L., Wang, Y., Peng, S. et al. Bupivacaine Induces ROS-Dependent Autophagic Damage in DRG Neurons via TUG1/mTOR in a High-Glucose Environment. Neurotox Res 40, 111–126 (2022).

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  • High glucose
  • Bupivacaine
  • ROS
  • TUG1
  • mTOR
  • Autophagy