IMMUNOHISTOLOGICAL STUDY IN CASES OF HELLP-SYNDROME (HEMOLYSIS, ELEVATED LIVER-ENZYMES AND LOW PLATELETS) AND ACUTE FATTY LIVER OF PREGNANCY

We immunohistologically studied the hepatic tissue sections in cases w ith the syndrome of hemolysis, elevated liver enzymes, and low platele ts (HELLP syndrome; n = 2) and acute fatty liver of pregnancy (AFLP; n = 2) compared to necropsy controls. Unlike in the AFLP cases, a marke d infiltration of neutrophils in liver tissues was found in both cases of the HELLP syndrome. Immunostaining with the antihuman (polyclonal) TNF-alpha, IL-1 beta, IL-8 and antihuman neutrophil elastase (monoclo nal antibody) was performed in paraffin-embedded hepatic tissue sectio ns. Liver tissues in HELLP syndrome patients were stained strongly wit h TNF-alpha and neutrophil elastase antibody. The strongest staining p attern was observed in the eclamptic case, whereas in the AFLP cases, as in the necropsy controls, a very weak staining for anti-TNF-alpha a nd elastase antibody was found. The liver sections of the HELLP syndro me cases were moderately stained with polyclonal IL-1 beta and IL-8 an tibodies whereas AFLP and controls had a very faint staining. Signific ant correlations were found between the numbers of necrotic hepatocyte s and elastase dots in the same microscopic fields (randomly selected) of liver sections from two cases of HELLP syndrome (r(2) = 0.63; p < 0.0001), which might suggest a neutrophil-mediated tissue damage in su ch a disease. This study suggests that a cytokine- and neutrophil-medi ated liver injury occurs in the HELLP syndrome but not in AFLP.