“…The binding of OPN with integrins initiates the activation of several downstream signaling effectors, such as phosphatidylinositol 3 kinase (PI3K) /protein kinase B (AKT), focal adhesion kinase (FAK)/AKT and nuclear factor kappa-B (NF-κB), leading to cell proliferation, migration, epithelial–mesenchymal transition (EMT), inflammation, neurotoxic microglial phenotype, tumor growth, migration and invasion, as well as angiogenesis within the chronic subdural hematoma (CSDH) outer membrane [ 15 , 16 , 17 , 18 , 19 , 20 ]. In addition, OPN regulates other signal pathways or signal molecules, such as Janus kinase (JAK)/signal transducer and activator of transcription (STAT) [ 21 , 22 , 23 , 24 ], PI3K/AKT [ 15 , 25 , 26 , 27 ], NOTCH [ 28 , 29 ], extracellular regulated protein kinase1/2 (ERK1/2) [ 30 ], the ubiquitin C -terminal hydrolase L1 (UCHL1)–ubiquitin–proteasome system (UPS) axis [ 31 ] and transforming growth factor β (TGF-β) [ 32 ], influencing cellular physiological processes and disease progression. OPN also acts as a ligand for CD44 that results in attracting mesenchymal stem cells (MSCs) to the tumor microenvironment, promoting EMT and tumor budding (TB), inducing macrophage migration and activation, stimulating intestinal growth, differentiation and maturation, cell growth, proliferation, migration and cell-cycle activity and promoting oxidative stress [ 15 , 17 , 23 , 33 , 34 , 35 , 36 ].…”