title: Nuclear transcription factor-kappa beta-dependent ultrastructural alterations within the placenta and systemic inflammatory activation in pregnant patients with hemolysis, elevated liver functions and low thrombocyte count (HELLP) syndrome: a case-control study.
abstract: OBJECTIVE
  Preeclampsia appears to be associated with a higher extent of inflammation than in uncomplicated pregnancies. We aimed to test whether this was the case in patients with hemolysis, elevated liver functions and low platelet count (HELLP) syndrome and to clarify the contribution of placental and systemic inflammatory variables in the development of this syndrome.
  
  
  METHODS
  Thirty healthy pregnant women (control group) and 20 patients with HELLP syndrome (study group) were included in the study. Placental inflammatory activity was evaluated by quantifying immunohistochemically the levels of p65/RelA expression of nuclear transcription factor-kappa beta (NF-kB) in paraffin-embedded tissue samples. In addition, ultrastructural changes in placental morphology in HELLP patients were evaluated by transmission electron microscopy (TEM). The serum concentrations of myeloperoxidase (MPO) and C-reactive protein (CRP) were also measured and compared.
  
  
  RESULTS
  p65/RelA immunoexpression and serum MPO and CRP levels were significantly higher in patients with HELLP syndrome (p < 0.05). TEM of placenta in the study group revealed severely vacuolized syncytiotrophoblasts, irregular basal lamina and damaged capillary endothelium when compared with the placenta of control subjects.
  
  
  CONCLUSIONS
  Our results suggest that over-expression of placental NF-kB is correlated with elevation of serum inflammatory markers and placental ultrastructural changes, which may point to an important role of local and systemic inflammatory activation in the pathogenesis of HELLP syndrome.
authors.affiliation: Department of Obstetrics and Gynecology, Inonu University Faculty of Medicine, Malatya, Turkey. dryavuzsimsek@gmail.com
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Simsek
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gul
authors.forename: Onder
authors.initials: O
authors.lastname: Celik
authors.forename: Nasuhi Engin
authors.initials: NE
authors.lastname: Aydin
authors.forename: Senem
authors.initials: S
authors.lastname: Arda Düz
authors.forename: Ebru
authors.initials: E
authors.lastname: Celik
authors.forename: Elif
authors.initials: E
authors.lastname: Ozerol
authors.forename: Ibrahim Halil
authors.initials: IH
authors.lastname: Özerol
authors.forename: Kevser
authors.initials: K
authors.lastname: Tanbek
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D017359:HELLP Syndrome / Q000209:etiology / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D016328:NF-kappa B / Q000378:metabolism*; D009195:Peroxidase / Q000378:metabolism; D010920:Placenta / Q000648:ultrastructure*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D016328:NF-kappa B; D002097:C-Reactive Protein; D009195:Peroxidase