Fig. 8.

Schematic illustrating novel mechanism underlying S-2HG-mediated perioperative ischemic brain injury. Perioperative risk factors trigger an aberrant metabolic accumulation of S-2HG in peripheral CD8⁺ T cells and thus enhance the activation of CD8⁺ T cells. During the ischemic stroke event, migration and adhesion of activated peripheral CD8⁺ T cells to disrupted BBB and brain parenchyma will further exacerbate ischemic brain injury and neurological dysfunction