Activated nuclear factor-B (NFB) has been shown to increase transcription of several genes that could potentially contribute to neuronal damage, such as proinflammatory cytokines, chemokines, and inducible nitric oxide synthase. The aim of our study was to investigate whether inhibition of NFB activation could prevent hypoxia/ischemia (HI)-induced cerebral damage in neonatal rats. We used a cell permeable peptide (NEMO binding domain [NBD] peptide) that is known to prevent the association of the regulatory protein NEMO with IKK, the kinase that activates NFB. Via this mechanism, the NBD peptide can specifically block the activation of NFB, without inhibiting basal NFB activity. Cerebral HI was induced in neonatal rats by occlusion of the right carotid artery followed by 90 min of hypoxia (FiO 2 ϭ 0.08). Immediately upon reoxygenation, as well as 6 and 12 h later, rats were treated with vehicle or NBD peptide (20 mg/kg i.p.). Histologic analysis of brain damage was performed at 6 wk after HI. To assess NFB activation, electromobility shift assays (EMSAs) were performed on brain nuclear extracts obtained 6 h after reoxygenation. Increased NFB activity could be shown at 6 h after HI in both hemispheres. Peripheral administration of NBD peptide prevented this HI-induced increase in NFB activity in both hemispheres. Histologic analysis of long-term cerebral damage revealed that inhibition of NFB activation by administration of NBD peptide at 0, 6, and 12 h after HI resulted in an increment of neuronal damage. In conclusion, our data suggest that inhibition of NFB activation using NBD peptide early after HI increases brain damage in neonatal rats. (Pediatr Res 59: 232-236, 2006) P erinatal HI is a common cause of neonatal mortality and morbidity. Long-term effects can be cerebral palsy and/or impaired neurodevelopmental outcome (1,2). During HI and in particular upon reperfusion and reoxygenation, a cascade of potentially destructive pathways is activated eventually leading to neuronal cell death (3,4).Activation of the transcription factor NFB regulates the production of pro-and anti-inflammatory cytokines, chemokines, and inducible nitric oxide synthase and of adhesion molecules, which together will promote apoptosis and neuronal cell death (5,6). In resting cells, the heterodimeric NFB, consisting of a p50 and a p65 protein, is retained in the cytoplasm through interaction with the inhibitory protein IB. Activation of NFB requires phosphorylation of IB by the I-kinase complex, consisting of IKK␣, IKK, and the regulatory protein NEMO. Phosphorylated IB will be ubiquitinated and degraded via the proteasome pathway. The free or activated NFB can then translocate to the nucleus of the cell and will bind to the promoter sequences of many target genes (7).Evidence of a role for NFB activation in HI-induced cerebral damage comes from animal models. In NFB-p50 knockout mice, neuronal damage was significantly reduced in an adult model of stroke by occlusion of the middle cerebral artery (8). Similarly, inhibitio...