HELLP Syndrome Is Associated with an Increased Inflammatory Response, Which May Be Inhibited by Administration of Prednisolone

Heimel, Pieter J. van Runnard; Kavelaars, A.; Heijnen, Cobie J.; Peters, Wilbert H.M.; Huisjes, Anjoke; Franx, Arie; Bruinse, Hein W.

doi:10.1080/10641950802174953

Cited by 44 publications

(30 citation statements)

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“…Inclusion in the data analysis of angiogenic factor levels from postpartum samples could have also significantly confounded the sFlt-1 and sEng results published by Wallace et al 35 In humans, prednisolone lowers the level of maternal IL-6, but not IL-1β, IL-10, and soluble IL-6R in HELLP syndrome. 36 The results of this study, consistent with a temporary decrease in the maternal serum levels of the same cytokine, are provocative because IL-6 engages the IL-6 receptor, which is restricted to a few immune cell types such as neutrophils and leukocytes. 37 Neutrophil activation has been implicated in the pathophysiology of preeclampsia and requires binding and transmigration of neutrophils through the endothelium.…”

Section: Discussionsupporting

confidence: 76%

Antenatal Corticosteroids Impact the Inflammatory Rather Than the Antiangiogenic Profile of Women With Preeclampsia

et al. 2014

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Circulating antiangiogenic factors and proinflammatory cytokines are implicated in the pathogenesis of preeclampsia. This study was performed to test the hypothesis that steroids modify the balance of inflammatory and proangiogenic and antiangiogenic factors that potentially contribute to the patient’s evolving clinical state. Seventy singleton women, admitted for antenatal corticosteroid treatment, were enrolled prospectively. The study group consisted of 45 hypertensive women: chronic hypertension (n=6), severe preeclampsia (n=32), and superimposed preeclampsia (n=7). Normotensive women with shortened cervix (<2.5 cm) served as controls (n=25). Maternal blood samples of preeclampsia cases were obtained before steroids and then serially up until delivery. A clinical severity score was designed to clinically monitor disease progression. Serum levels of angiogenic factors (soluble fms-like tyrosine kinase-1 [sFlt-1], placental growth factor [PlGF], soluble endoglin [sEng]), endothelin-1 (ET-1), and proinflammatory markers (IL-6, C-reactive protein [CRP]) were assessed before and after steroids. Soluble IL-2 receptor (sIL-2R) and total immunoglobulins (IgG) were measured as markers of T- and B-cell activation, respectively. Steroid treatment coincided with a transient improvement in clinical manifestations of preeclampsia. A significant decrease in IL-6 and CRP was observed although levels of sIL-2R and IgG remained unchanged. Antenatal corticosteroids did not influence the levels of angiogenic factors but ET-1 levels registered a short-lived increase poststeroids. Although a reduction in specific inflammatory mediators in response to antenatal steroids may account for the transient improvement in clinical signs of preeclampsia, inflammation is unlikely to be the major contributor to severe preeclampsia or useful for therapeutic targeting.

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Section: Discussionsupporting

confidence: 76%

Antenatal Corticosteroids Impact the Inflammatory Rather Than the Antiangiogenic Profile of Women With Preeclampsia

et al. 2014

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“…HELLP serum causes apoptosis of primary human hepatocytes, which could be blocked by a CD95 inhibitor. The increased levels of sCD95L in maternal blood of HELLP patients seem to derive from expression in trophoblasts [144,145].…”

Section: Immunological Backgroundmentioning

confidence: 96%

Immunology of hepatic diseases during pregnancy

2016

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The mother's immune system has to adapt to pregnancy accepting the semi-allograft fetus and preventing harmful effects to the developing child. Aberrations in feto-maternal immune adaptation may result in disease of the mother, such as liver injury. Five pregnancy-associated liver disorders have been described so far, however, little is known concerning immune alterations promoting the respective disease. These liver disorders are pre-eclampsia, hemolysis, elevated liver enzymes, low platelet count (HELLP), acute fatty liver, hyperemesis gravidarum, and intrahepatic cholestasis of pregnancy. On the other hand, pre-existing autoimmune liver injury of the mother can be affected by pregnancy. This review intends to summarize current knowledge linking feto-maternal immunology and liver inflammation with a special emphasis on novel potential biomarkers.

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“…Bu sendrom da C-re ak tif pro te in, in ter lö kin ve glu tat yon s-trans fe raz al fa gi bi inf la ma tu ar si to kin le rin kan dü zey le rin de an lam lı yük sel me ler or ta ya çık makta dır. 15 En do te lin yay gın ak ti vas yo nu trom bo tik mik ro an ji yo pa tik ane mi ye ne den ol mak ta he mo liz ile bir lik te trom bo si to pe ni ve ka ra ci ğer ha sa rı na bağ lı bul gu lar or ta ya çık mak ta dır. Be ta me ta zon 36-54 sa at lik ya rı öm rü ve uzun et ki sü re si ile en do tel hüc re le ri nin, mak ro faj, eo zi no fil, T len fo sit ve mast hüc re le ri nin si to kin üre ti mi ni in hi be ede rek güç lü an ti inf la ma tu ar özel lik ler gös te rir.…”

Section: Tar Tiş Maunclassified

The Effects of High Dose Betamethasone Application on Hellp Syndrome

Çalışkan¹,

Çakıroğlu²,

Döğer³

et al. 2010

Turkiye Klinikleri J Med Sci

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HELLP Syndrome Is Associated with an Increased Inflammatory Response, Which May Be Inhibited by Administration of Prednisolone

Abstract: HELLP syndrome is associated with an increased inflammatory response. Circulating IL-6 levels in HELLP syndrome are reduced during prednisolone administration, suggesting a stabilizing effect on the inflammatory endothelial process.

Cited by 44 publications

References 30 publications

Antenatal Corticosteroids Impact the Inflammatory Rather Than the Antiangiogenic Profile of Women With Preeclampsia

Antenatal Corticosteroids Impact the Inflammatory Rather Than the Antiangiogenic Profile of Women With Preeclampsia

Immunology of hepatic diseases during pregnancy

The Effects of High Dose Betamethasone Application on Hellp Syndrome

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