Role of cathepsin K in the development of chronic subdural hematoma. (November 2017)

• Record Type: Journal Article
• Authors: Tsutsumi, Satoshi; Ogino, Ikuko; Miyajima, Masakazu; Nonaka, Senshu; Ito, Masanori; Yasumoto, Yukimasa; Arai, Hajime
• Is Part Of: Journal of clinical neuroscience. Volume 45(2017:Nov.)
• Page Start: 343
• Page End: 347
• Publication Date: 2017-11
• Subjects: Cathepsin K -- Cerebrospinal fluid -- Chronic inflammation -- Chronic subdural hematoma -- Hypoxia; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2017.08.021
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Intracranial CSF involves high-levels of cathepsin K (CatK). Chronic subdural hematoma (CSDH) involves high-levels of CatK and other CSF-specific biomarkers. Inner environment of CSDH fluid is characterized by marked hypoxia, hypoglycemia, and lactic acidosis. CatK is diffusely present in the outer membrane of CSDH. Cathepsin K may be associated with the development of chronic subdural hematoma. Abstract: Despite extensive investigations, the process of development of chronic subdural hematoma (CSDH) is not known. The present study aims to investigate CSDH by measuring biomarkers in it, gas analysis, and immunohistochemical examination. A total of 42 patients with symptomatic CSDH who underwent burr-hole drainage were enrolled. Intraoperatively, hematoma fluid and peripheral venous blood (PVCSDH ) were simultaneously collected. As controls, peripheral venous blood (PVControl ) and intracranial cerebrospinal fluid (CSF) were collected from other subjects during other surgeries. CatK, lipocalin-type prostaglandin D synthase (PGDS), and cystatin C (CysC) present in these specimens were measured using enzyme-linked immunosorbent assay. Data obtained were statistically analyzed after age correction. In 15 patients, gas analysis was performed for CSDH and PVCSDH . Furthermore, immunohistochemical examination for the outer membrane was performed for four patients. CatK, PGDS, and CysC levels were markedly elevated in the CSF and CSDH. CatK levels in PVCSDH were significantly higher than in PVControl ( P < 0.0001). In contrast, CysC levels in PVCSDH were significantly lower than in PVControl ( P = 0.004). The gas analysis revealed that the internal environment of CSDH is characterized by marked hypoxia, hypoglycemia, and lactic acidosis. Furthermore, the outer membrane consistently showed a diffuse staining for CatK. Based on these, CatK was thought to play a role in the development of CSDH, with the levels in peripheral venous blood elevated in patients with CSDH.