title: High viral load and deregulation of the progesterone receptor signaling pathway: association with hepatitis E-related poor pregnancy outcome.
abstract: OBJECTIVE
  Hepatitis E virus (HEV) infection is associated with high maternal and fetal mortalities. A prospective study was undertaken to evaluate the role of viral and host factors in HEV related pregnancy outcomes.
  
  
  METHODS
  The study included HEV infected pregnancy cases; acute viral hepatitis (AVH), n=100 and fulminant hepatic failure (FHF), n=43, and healthy pregnancy cases, n=50. HEV genotypes and viremia were studied by nucleotide sequencing and real time PCR, respectively. Progesterone receptor (PR) gene mutations (PROGINS) were studied by PCR, PR expression at the mRNA and protein levels in the placenta were studied by semi-quantitative RT-PCR and immunohistochemistry, respectively. Progesterone induced blocking factor (PIBF) expression was studied by RT-PCR in blood. Serum interleukin-10 (IL-10) and interleukin-12 (IL-12) levels were assayed by ELISA.
  
  
  RESULTS
  HEV viral load was significantly higher in FHF than AVH (p<0.001) and in cases with fetal mortality in AVH (p=0.001) and FHF (p=0.018). PROGINS were predominant in FHF compared to AVH (p=0.26) and showed reduced mRNA and protein expression. The risk of fetal mortality in AVH was two times higher (OR, 2.190; CI, 0.303-15.85) and maternal and fetal mortalities in FHF were 4-fold (OR, 4.0; CI, 0.363-44.113) increased in PROGINS carriers. PR and PIBF expression was lower in AVH and even lower in FHF compared to healthy controls. The higher IL-12/IL-10 ratio observed in FHF compared to other groups correlated with fetal mortality in AVH and FHF (p<0.001).
  
  
  CONCLUSIONS
  In conclusion, reduced expression of PR and PIBF, a higher IL-12/IL-10 ratio, and a high viral load results in poor pregnancy outcome in Hepatitis E.
authors.affiliation: Department of Medicine, LNJP Hospital, MAMC, New Delhi, India.
authors.forename: Purabi Deka
authors.initials: PD
authors.lastname: Bose
authors.forename: Bhudev C
authors.initials: BC
authors.lastname: Das
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.forename: Ranjana
authors.initials: R
authors.lastname: Gondal
authors.forename: Deepak
authors.initials: D
authors.lastname: Kumar
authors.forename: Premashish
authors.initials: P
authors.lastname: Kar
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D016751:Hepatitis E / Q000150:complications* / Q000235:genetics / Q000378:metabolism / Q000821:virology; D006801:Humans; D007231:Infant, Newborn; D016753:Interleukin-10 / Q000378:metabolism; D018664:Interleukin-12 / Q000378:metabolism; D017114:Liver Failure, Acute / Q000150:complications / Q000235:genetics / Q000378:metabolism / Q000821:virology; D008954:Models, Biological; D009154:Mutation; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000235:genetics* / Q000378:metabolism / Q000821:virology*; D011256:Pregnancy Outcome; D011257:Pregnancy Proteins / Q000235:genetics; D011446:Prospective Studies; D012333:RNA, Messenger / Q000235:genetics / Q000378:metabolism; D011980:Receptors, Progesterone / Q000235:genetics*; D015398:Signal Transduction / Q000235:genetics; D013491:Suppressor Factors, Immunologic / Q000235:genetics; D018417:Th1 Cells / Q000276:immunology; D018418:Th2 Cells / Q000276:immunology; D019562:Viral Load; D055815:Young Adult
chemical_list: C508609:IL10 protein, human; C110058:PIBF1 protein, human; D011257:Pregnancy Proteins; D012333:RNA, Messenger; D011980:Receptors, Progesterone; D013491:Suppressor Factors, Immunologic; D016753:Interleukin-10; D018664:Interleukin-12