Resveratrol‑mediated activation of SIRT1 inhibits the PERK‑eIF2α‑ATF4 pathway and mitigates bupivacaine‑induced neurotoxicity in PC12 cells

Endoplasmic reticulum (ER) stress and apoptosis play significant roles in the development of neurotoxicity caused by bupivacaine (BUP). By activating sirtuin 1 (SIRT1), resveratrol (RSV) can regulate various cellular processes associated with anti-oxidative stress, anti-apoptosis and anti-inflammatory responses, thereby exerting neuroprotective effects. However, it remains unknown whether the activation of SIRT1 by RSV is able to attenuate BUP-induced ER stress and apoptosis. Therefore, the present study aimed to explore the effect of RSV on BUP-induced cytotoxicity in PC12 cells and the underlying mechanism. Cell Counting Kit-8 assays, flow cytometry and inverted phase-contrast microscopy were used to assess the viability, apoptosis rate and morphological changes of the cells, respectively. Western blotting and immunofluorescence staining were used to analyze the levels of SIRT1, the apoptosis-related proteins Bax, Bcl-2 and cleaved caspase-3, the ER stress-related proteins glucose-regulated protein 78, caspase-12 and CHOP, and the protein kinase RNA-like ER kinase (PERK)-eukaryotic translation initiation factor 2 α (eIF2α)-activating transcription factor 4 (ATF4) pathway-associated proteins phosphorylated (p)-PERK, PERK, p-eIF2α, eIF2α and ATF4. The results revealed that BUP induced cell apoptosis and decreased cell viability, accompanied by the downregulation of SIRT1. However, RSV restored SIRT1 protein expression, downregulated the expression of the pro-apoptotic protein Bax, upregulated the expression of the anti-apoptotic protein Bcl-2, decreased the apoptosis rate of the cells and increased cell viability. Furthermore, the anti-apoptotic effects exhibited by RSV were associated with inhibition of the PERK-eIF2α-ATF4 pathway of ER stress. However, the protective effect of RSV was significantly mitigated by the SIRT1 inhibitor EX527. These results indicate that the activation of SIRT1 by RSV alleviates BUP-induced PC12 cell ER stress and apoptosis via regulation of the PERK-eIF2α-ATF4 pathway. These findings offer insights into the molecular mechanism underlying BUP-induced apoptosis and suggest the potential of RSV as a therapeutic agent against the neurotoxicity caused by BUP.