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Seeking the mechanism(s) of action for corticosteroids in HELLP syndrome: SMASH study

Item Type:Article
Title:Seeking the mechanism(s) of action for corticosteroids in HELLP syndrome: SMASH study
Creators Name:Wallace, K. and Martin, J.N. and Tam, K.T. and Wallukat, G. and Dechend, R. and Lamarca, B. and Owens, M.Y.
Abstract:INTRODUCTION: Administration of dexamethasone to HELLP syndrome patients (10mg i.v. every 12hours) shortens disease course and reduces maternal morbidity, in patients treated at the University of Mississippi Medical Center (UMMC), associated with this severe form of preeclampsia. However, the pathophysiologic mechanisms involved with this intervention remain unclear. OBJECTIVE: We sought to investigate the potential role of i.v. dexamethasone to restore the imbalance among anti-angiogenic and inflammatory factors known to be significantly elevated in women with HELLP syndrome. STUDY DESIGN: Single center prospective study of women diagnosed with HELLP syndrome that were treated for i.v. dexamethasone at UMMC. Blood was drawn prior to dexamethasone administration and again 12 and 24hrs post initial dexamethasone administration. Enzyme linked immune assays were used to measure circulating inflammatory cytokines and anti-angiogenic factors. Repeated measures ANOVA was used to analyze the data collected before, after and during dexamethasone administration. RESULTS: 17 women with HELLP syndrome were enrolled in this study. Dexamethasone significantly decreased evidence of hemolysis (p=0.002) and liver enzymes (p=0.003), while significantly increasing platelets (p=0.0001) within 24hrs of administration. Circulating IL-6 levels after 24hrs were decreased (p<0.001); sFlt-1 and sEndoglin were also significantly decreased by 24hrs post dexamethasone administration (p<0.002, p<0.004). There were no significant differences in circulating levels of PlGF (p=0.886) due to dexamethasone administration. AT1- autoantibody levels were unchanged by dexamethasone administration. CONCLUSION: We conclude that one important mechanism of dexamethasone administration is to blunt the release of both anti-angiogenic and inflammatory factors suggested to play role in the pathophysiology of HELLP syndrome.
Keywords:HELLP Syndrome, Inflammatory Cytokines, Severe Preeclampsia, sFlt-1, Soluble Endoglin
Source:American Journal of Obstetrics and Gynecology
Page Range:380.e1-380.e8
Date:May 2013
Official Publication:https://doi.org/10.1016/j.ajog.2013.01.049
PubMed:View item in PubMed

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