• Koji Osuka, Yasuo Watanabe, Nobuteru Usuda, Masahiro Aoyama, Reo Kawaguchi, Mikinobu Takeuchi, and Masakazu Takayasu.
• Department of Neurological Surgery, Ai-chi Medical University, Nagakute, Ai-chi, Japan.
• Neurosurgery. 2017 Apr 1; 80 (4): 571-578.

BackgroundChronic subdural hematoma (CSDH) is considered an angiogenic and inflammatory disease. Nuclear factor-kappa B (NF-κB) induces the production of inflammatory cytokines and adhesion molecules, which play an essential role in angiogenesis and inflammation. Recently, the double-stranded RNA-activated protein kinase (PKR) was shown to directly interact with NF-κB subunits to influence its transcriptional activity.ObjectiveTo examine the expression of NF-κB signaling pathway components and PKR in CSDH outer membranes.MethodsEight patients whose outer membranes were successfully obtained during trepanation surgery were included in this study. The IκBα, IKKβ, IKKγ, NF-κB, phosphorylated ( p )-NF-κB, and PKR expression levels were examined using western blotting analysis. NF-κB expression was also examined using immunohistochemistry. We investigated whether CSDH fluid could activate NF-κB in cultured endothelial cells in Vitro.ResultsThe IκBα, IKKβ, IKKγ, and NF-κB levels were approximately the same. Additionally, p -NF-κB and PKR were detected at similar levels. Immunostaining showed that NF-κB was expressed in the vascular endothelium. p -NF-κB expression in endothelial cells was significantly induced immediately after treatment with CSDH fluid. Furthermore, NF-κB activation was significantly inhibited by treatment with antibodies directed against vascular endothelial growth factor.ConclusionPKR might activate NF-κB through vascular endothelial growth factor in endothelial cells, which might be associated with endothelial cell proliferation in the CSDH outer membrane. Thus, the NF-κB signaling pathway could play a critical role in CSDH growth.Copyright © 2016 by the Congress of Neurological Surgeons

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