scholarly journals The BPH/5 Mouse Model of Superimposed Preeclampsia Is Not a Model of HELLP Syndrome

Biology ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1179
Author(s):  
Andrea N. Johnston ◽  
Tifini L. Batts ◽  
Ingeborg M. Langohr ◽  
Cambri Moeller ◽  
Chin-Chi Liu ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hellp Syndrome ◽  
Late Gestation ◽  
Hepatic Inflammation ◽  
Placental Development ◽  
Elevated Liver Enzymes ◽  
Tnf Α ◽  
Multisystemic Disease ◽  
Liver Transaminases ◽  
Clinicopathologic Findings

Preeclampsia (PE) is a multisystemic disease of pregnancy affecting 2–8% of women worldwide. PE-induced liver disease is a rare but important complication of pregnancy. The pathogenesis of liver dysfunction in PE is poorly understood, but is correlated with dysregulated angiogenic, inflammatory, and hypoxic events in the early phase of placental development. Because BPH/5 mice develop the maternal and fetal hallmarks of PE during pregnancy, we hypothesized that they may also share the clinicopathologic findings of the human PE-associated hemolysis elevated liver transaminases low platelets (HELLP) syndrome. Using this model, we determined that microangiopathic hemolysis, thrombocytopenia, and elevated liver enzymes do not occur in mid to late gestation. Pregnant BPH/5 mice do not develop histologic evidence of hepatic inflammation, but they do have increased microsteatosis scores at preconception and in mid to late gestation that progress to macrosteatosis in a subset of mice in late gestation. The transcriptional upregulation of TNF-α, CXCL-10, and TLR-2 occurs in mid gestation prior to the onset of macrosteatosis. The BPH/5 female mouse is not a model of HELLP syndrome, but may be a model of fatty liver disease associated with pregnancy.

scholarly journals Liver disease in children and Adolescents with Type1 Diabetes Mellitus

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M H Elsayed ◽  
M T Hamza ◽  
M M Elsaeed ◽  
R A F Thabet
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Liver Disease ◽  
Type 1 Diabetes Mellitus ◽  
Children And Adolescents ◽  
Liver Enzymes ◽  
Rare Complication ◽  
Elevated Liver Enzymes ◽  
Liver Transaminases

Abstract Glycogenic hepatopathy (GH) is a very rare complication seen mostly in patients with type 1 diabetes mellitus (T1DM) in whom glycemic control has been poor for a long time. We assessed liver diseases in children and adolescents with type 1 diabetes mellitus by detection of elevated liver transaminases and confirmed by fibro scan and ultrasound. One hundred and seven children and adolescents with T1DM were subjected to detailed history, physical examination, laboratory investigation and radiological investigation. Liver transaminases, mean HbA1c and pelviabdominal ultrasound were done for all patients while fibro scan for those with elevated liver enzymes only. Patients with elevated liver enzymes were reassessed after one year. Only nine of our patients have elevated liver enzymes. HbA1c and fibro scan abnormalities (F stage) were significantly higher in patients with elevated liver enzymes. (p < 0.001) After follow up a significant decrease in liver enzymes, fibro scan abnormalities and HbA1c in the group with elevated liver enzymes initially was detected. (p < 0.001) We concluded that liver disease is not a common complication in patients with long standing uncontrolled diabetes which can be reversed after proper control.

Activated TNF-α/RIPK3 signaling is involved in prolonged high fat diet-stimulated hepatic inflammation and lipid accumulation: inhibition by dietary fisetin intervention

2019 ◽  
Vol 10 (3) ◽  
pp. 1302-1316 ◽  
Author(s):  
Minxuan Xu ◽  
Chenxu Ge ◽  
Yuting Qin ◽  
Tingting Gu ◽  
Jinxiao Lv ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Liver Disease ◽  
Lipid Accumulation ◽  
High Fat Diet ◽  
Fatty Liver Disease ◽  
Hepatic Inflammation ◽  
High Fat ◽  
Predisposing Factor ◽  
Nonalcoholic Fatty Liver ◽  
Tnf Α

Increasing evidence indicates that high-fat diet (HFD) is a predisposing factor for metabolic syndrome-associated systemic inflammation and nonalcoholic fatty liver disease (NAFLD).

scholarly journals HELLP syndrome: An experience of treating with plasma exchange

2013 ◽  
Vol 1 (2) ◽  
pp. 102-103
Author(s):  
Shahzadi Sayeeda Tun Nessa ◽  
Mohammd Mufizul Islam Polash ◽  
Md Motiul Islam ◽  
Ahmad Mursel Anam ◽  
Muhammad Mahbubul Rahman Bhuiyan
Keyword(s):  
Hellp Syndrome ◽  
Multidisciplinary Approach ◽  
Delayed Diagnosis ◽  
Severe Preeclampsia ◽  
Coagulation System ◽  
Hepatic Inflammation ◽  
Placental Development ◽  
Low Platelet Count ◽  
Independent Entity ◽  
And Function

In the spectrum of patient with severe pre-eclampsia, there is a potentially lethal complication called HELLP syndrome( haemolysis, elevated liver enzyme and low platelet count).1 The pathogenesis of HELLP syndrome is unclear. If it is a form of severe preeclampsia, it likely originates from aberrant placental development and function. As an independent entity, it has been attributed to abnormal placentation, similar to preeclampsia, but with greater hepatic inflammation and greater activation of the coagulation system than in preeclampsia.2,3,4 HELLP develops in approximately 0.5 to 0.9 percent of all pregnancies and in 10 to 20 percent of women with severe preeclampsia/eclampsia.5 Maternal mortality rate in HELLP syndrome is variable(1-23%) due to severity of disease, delayed diagnosis and presence of multi-organ involvement.6,7 So the recognition of HELLP syndrome and an aggressive multidisciplinary approach are required for the improvement of meternofoetal prognosis. DOI: http://dx.doi.org/10.3329/bccj.v1i2.17204 Bangladesh Crit Care J September 2013; 1 (2): 102-103

Evaluation Of Elevated Transaminases In Children

2018 ◽  
Author(s):  
Pamela L Valentino ◽  
Udeme D Ekong
Keyword(s):  
Liver Disease ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Drug Induced ◽  
Nonalcoholic Fatty Liver ◽  
Elevated Liver Enzymes ◽  
Liver Transaminases ◽  
Biochemical Testing ◽  
End Stage ◽  
Elevated Transaminases

The approach to elevated liver transaminases presented here includes an understanding of the biochemical testing, as well as a sequential pathway of investigations. In the pediatric patient who is not in acute liver failure, we discuss the differential diagnoses that should be considered, categorized in a systems-based approach. Infectious, autoimmune, genetic/metabolic, and cholestatic disease; drug-induced liver injury; and nonalcoholic fatty liver disease are among the categories that should be considered. Following a thorough history and physical examination, the patient should be referred to a pediatric specialist with expertise in the diagnosis and treatment of liver disease. Appropriate investigations by a pediatric gastroenterologist/hepatologist initially include blood tests and abdominal Doppler ultrasonography.   This review contains 4 figures, 3 tables and 42 references Key words: acute liver failure, alanine aminotransferase, aspartate aminotransferase, cholestasis, chronic hepatitis, cirrhosis, elevated liver enzymes, end-stage liver disease, γ-glutamyl transaminase, portal hypertension

Liver Transplantation for HELLP Syndrome

2007 ◽  
Vol 73 (10) ◽  
pp. 1013-1016 ◽  
Author(s):  
Ali Zarrinpar ◽  
Douglas G. Farmer ◽  
R. Mark Ghobrial ◽  
Gerald S. Lipshutz ◽  
Yan Gu ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Liver Failure ◽  
Hellp Syndrome ◽  
Early Recognition ◽  
Survival Rates ◽  
Center Report ◽  
Elevated Liver Enzymes ◽  
The Mean ◽  
End Stage

Of the approximately one in 1000 pregnant women who develop the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP), 2 to 3 per cent develop hepatic complications, including liver failure for which liver transplantation (LT) may be required. Between February 1, 1984, and December 31, 2006, eight women without a history of liver disease underwent LT for complications of HELLP syndrome. All received cadaveric grafts with a mean interval from delivery to LT of 7 days. The mean admission Child-Turcotte-Pugh score was 13.1 (class C), and the mean model for end-stage liver disease score was 40. Manifestations of liver failure included encephalopathy (seven patients), renal failure (four), disseminated intravascular coagulation (three), and respiratory failure (one). There were no intraoperative deaths. Complications of LT included biliary leaks (three patients), reoperation (three), and retransplantation (two). There was one death from sepsis on postoperative day 91 and one death from cholangitis/sepsis more than 5 years postoperatively. After LT, 1-, 5-, and 10-year patient survival rates were 88 per cent, 88 per cent, and 65 per cent; 1-, 5-, and 10-year graft survival rates were 64 per cent, 64 per cent, and 48 per cent. This is the largest single-center report of LT for HELLP. Early recognition and transfer to a transplant center will yield best results with this challenging complication of pregnancy.

Early-Onset Preeclampsia with Pulmonary Edema and Massive Ascites: A Rare Presentation of Severe Preeclampsia or Concomitant Diagnoses?

2020 ◽  
Vol 2020 ◽  
Author(s):  
Elizabeth St. Laurent ◽  
Rebecca Fryer-Gordon ◽  
Tom McNeilis, ◽  
Leonard B. Goldstein
Keyword(s):  
Pulmonary Edema ◽  
Early Onset ◽  
Hellp Syndrome ◽  
Disease Process ◽  
Massive Ascites ◽  
Elevated Liver Enzymes ◽  
Biophysical Profile ◽  
Patient Reported ◽  
Early Onset Preeclampsia ◽  
New Onset

Preeclampsia, eclampsia, and HELLP syndrome, are a continuum of a dangerous disease process that can occur in pregnancy. Preeclampsia is defined by new onset hypertension and proteinuria. In more severe cases, preeclampsia can be associated with pulmonary edema, oliguria, persistent headaches, and impaired liver function. These symptoms reveal maternal end organ damage which may result in danger to the fetus such as oligohydramnios, decreased fetal growth, and placental abruption. The defining difference between preeclampsia and eclampsia is the presence of new onset seizure activity. HELLP syndrome occurs when the mother experiences hemolysis, elevated liver enzymes, and low platelets. This syndrome is seen in about 0.6% of pregnancies. Each of these conditions (preeclampsia, eclampsia, and HELLP) increase both the fetal and maternal morbidity and mortality rates with the most definitive cure being delivery of child and placenta.A 28 year-old Caucasian, G1P0 female at 26w4d presented to OB triage on the recommendation of her physician due to elevated uric acid levels and a recorded blood pressure of 180/110. The patient reported rapid onset of weight gain, facial edema, diminished fetal movements, and frequent headaches. Although the patient denied labor symptoms, she complained of back pain and was admitted to the hospital at 26w4d for observation due to elevated blood pressures. The patient was diagnosed with preeclampsia with severe features. As her presentation progressed, the patient developed massive ascites and pulmonary edema along with decreasing platelet counts and increasing liver enzyme values. Due to decreasing biophysical profile (BPP) scores of the fetus and decompensating lab values of the mother, an emergency cesarean was performed for the safety of mother and baby.This case presentation demonstrates the progression of hypertensive disorders of pregnancy with a rare and severe presentation of early-onset preeclampsia with severe features, pulmonary edema, and massive ascites that ultimately led to class III HELLP syndrome and extreme prematurity of the infant.

scholarly journals Haemolysis, elevated liver enzymes and low platelets: Diagnosis and management in critical care

2021 ◽  
pp. 175114372110254
Author(s):  
Evangelia Poimenidi ◽  
Yavor Metodiev ◽  
Natasha Nicole Archer ◽  
Richard Jackson ◽  
Mansoor Nawaz Bangash ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critical Care ◽  
Liver Failure ◽  
Hellp Syndrome ◽  
Seizure Control ◽  
Liver Enzymes ◽  
Kidney Injury ◽  
Definitive Treatment ◽  
Multisystem Disease ◽  
Elevated Liver Enzymes

A thirty-year-old pregnant woman was admitted to hospital with headache and gastrointestinal discomfort. She developed peripheral oedema and had an emergency caesarean section following an episode of tonic-clonic seizures. Her delivery was further complicated by postpartum haemorrhage and she was admitted to the Intensive Care Unit (ICU) for further resuscitation and seizure control which required infusions of magnesium and multiple anticonvulsants. Despite haemodynamic optimisation she developed an acute kidney injury with evidence of liver damage, thrombocytopenia and haemolysis. Haemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome, a multisystem disease of advanced pregnancy which overlaps with pre-eclampsia, was diagnosed. HELLP syndrome is associated with a range of complications which may require critical care support, including placental abruption and foetal loss, acute kidney injury, microangiopathic haemolytic anaemia, acute liver failure and liver capsule rupture. Definitive treatment of HELLP is delivery of the fetus and in its most severe forms requires admission to the ICU for multiorgan support. Therapeutic strategies in ICU are mainly supportive and include blood pressure control, meticulous fluid balance and possibly escalation to renal replacement therapy, mechanical ventilation, neuroprotection, seizure control, and management of liver failure-related complications. Multidisciplinary input is essential for optimal treatment.

scholarly journals Addressing the liver progenitor cell response and hepatic oxidative stress in experimental non-alcoholic fatty liver disease/non-alcoholic steatohepatitis using amniotic epithelial cells

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Mihiri Goonetilleke ◽  
Nathan Kuk ◽  
Jeanne Correia ◽  
Alex Hodge ◽  
Gregory Moore ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Liver Disease ◽  
Epithelial Cells ◽  
Fatty Liver ◽  
Progenitor Cells ◽  
Fatty Liver Disease ◽  
Hepatic Inflammation ◽  
Alcoholic Fatty Liver ◽  
And Oxidative Stress ◽  
Alcoholic Fatty Liver Disease

Abstract Background Non-alcoholic fatty liver disease is the most common liver disease globally and in its inflammatory form, non-alcoholic steatohepatitis (NASH), can progress to cirrhosis and hepatocellular carcinoma (HCC). Currently, patient education and lifestyle changes are the major tools to prevent the continued progression of NASH. Emerging therapies in NASH target known pathological processes involved in the progression of the disease including inflammation, fibrosis, oxidative stress and hepatocyte apoptosis. Human amniotic epithelial cells (hAECs) were previously shown to be beneficial in experimental models of chronic liver injury, reducing hepatic inflammation and fibrosis. Previous studies have shown that liver progenitor cells (LPCs) response plays a significant role in the development of fibrosis and HCC in mouse models of fatty liver disease. In this study, we examined the effect hAECs have on the LPC response and hepatic oxidative stress in an experimental model of NASH. Methods Experimental NASH was induced in C57BL/6 J male mice using a high-fat, high fructose diet for 42 weeks. Mice received either a single intraperitoneal injection of 2 × 106 hAECs at week 34 or an additional hAEC dose at week 38. Changes to the LPC response and oxidative stress regulators were measured. Results hAEC administration significantly reduced the expansion of LPCs and their mitogens, IL-6, IFNγ and TWEAK. hAEC administration also reduced neutrophil infiltration and myeloperoxidase production with a concurrent increase in heme oxygenase-1 production. These observations were accompanied by a significant increase in total levels of anti-fibrotic IFNβ in mice treated with a single dose of hAECs, which appeared to be independent of c-GAS-STING activation. Conclusions Expansion of liver progenitor cells, hepatic inflammation and oxidative stress associated with experimental NASH were attenuated by hAEC administration. Given that repeated doses did not significantly increase efficacy, future studies assessing the impact of dose escalation and/or timing of dose may provide insights into clinical translation.

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