title: Association of cytokines in hepatitis E with pregnancy outcome.
abstract: OBJECTIVE
  The aim of this study was to evaluate tumour necrosis factor-alpha (TNF-α), interleukin (IL)-6, interferon gamma (IFN-γ) and transforming growth factor-beta1 (TGF-β1) in hepatitis E infection during pregnancy and its relation with pregnancy outcome.
  
  
  METHODS
  A total of 272 pregnant and 219 non-pregnant women with hepatitis and 262 age and gestational age matched healthy pregnant women and 208 age matched, healthy non-pregnant women were evaluated on the basis of history, clinical examination, liver function profile. Serological tests of hepatitis A, B, C and E and cytokines using commercially available (ELISA) kits. The patients with hepatitis E were further evaluated for viral load by Real Time PCR. All these were followed till delivery for pregnancy outcome.
  
  
  RESULTS
  HEV viral load in acute viral hepatitis (AVH) and fulminant hepatic failure (FHF) of pregnant women were comparatively higher than non-pregnant women. Significantly higher levels of TNF-α, IL-6, IFN-γ and TGF-β1 were present in HEV infected pregnant women compared to non-pregnant women and controls. TNF-α, IL-6 and IFN-γ had significant positive correlation with viral load, serum bilirubin and prothrombin time in pregnant women. Higher levels of all four cytokines were found in pregnant women with HEV infection having adverse pregnancy outcome compared to that of pregnant women with non-HEV infection and controls.
  
  
  CONCLUSIONS
  In conclusion, severity of HEV infection and associated adverse pregnancy outcome might be mediated by cytokine in pregnancy.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.forename: Salam Gyaneshwori
authors.initials: SG
authors.lastname: Devi
authors.forename: Premashis
authors.initials: P
authors.lastname: Kar
authors.forename: Sarita
authors.initials: S
authors.lastname: Agarwal
authors.forename: Syed Akhtar
authors.initials: SA
authors.lastname: Husain
authors.forename: Ram Kumar
authors.initials: RK
authors.lastname: Gupta
authors.forename: Shashi
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood; D005260:Female; D016751:Hepatitis E / Q000276:immunology*; D016752:Hepatitis E virus / Q000302:isolation & purification*; D006801:Humans; D007371:Interferon-gamma / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D017114:Liver Failure, Acute / Q000821:virology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology* / Q000821:virology; D011256:Pregnancy Outcome; D011517:Prothrombin Time; D053773:Transforming Growth Factor beta1 / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D019562:Viral Load; D055815:Young Adult
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D053773:Transforming Growth Factor beta1; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma; D001663:Bilirubin