High CSF TGFbeta levels after subarachnoid haemorrhage: association with chronic communicating hydrocephalus

BACKGROUND: Chronic communicating hydrocephalus is a common sequela of subarachnoid haemorrhage and develops when the flow and drainage of cerebrospinal fluid (CSF) are impaired after fibrosis in the subarachnoid space. Transforming growth factor (TGF)beta1/beta2 are potent fibrogenic agents released by platelets into the CSF after subarachnoid haemorrhage, which may promote post-haemorrhagic fibrosis after chronic communicating hydrocephalus. METHODS: Temporal changes in total (latent plus active) TGFss1/ss2 CSF levels of post-haemorrhage patients developing acute hydrocephalus were measured using ELISA to discover if titres were higher in patients that subsequently developed chronic communicating hydrocephalus, compared to those that did not. RESULTS: Mean +/-SD CSF levels of total TGFbeta1 were 97+/-42pg/ml and total TGFbeta2 were 395+/-39pg/ml in control patients with non-haemorrhagic hydrocephalus at 1-5 days post-haemorrhage (dph). Levels rose to a peak of 1427+/-242pg/ml and 976+/-191pg/ml for total TGFss1 and TGFss2, respectively. Beyond 5dph, total TGFss1/ss2 levels declined, but remained significantly elevated (p