May human epididymis 4 protein play a role in the etiopathogenesis of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome?

Abstract

Aim Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is an extremely advanced form of preeclampsia. Currently, there is no parameter or marker to predict this syndrome; however, it is emphasized that vascular endothelial damage and abnormal immune responses can be the possible etiologies of HELLP syndrome. It is known that human epididymis protein 4 (HE4) is a protease inhibitor and previous studies have shown that HE4 protein levels are increased in many malignancies and inflammatory conditions. Considering that metalloproteinases may also play a role in endothelial damage, which is thought to be involved in the etiopathogenesis of HELLP syndrome, we thought that HE4 protein, which is a protease inhibitor, may be associated with vascular damage. We aimed to investigate the relationship between HELLP syndrome and HE4 protein and to identify a biomarker that can be utilized in the diagnosis of HELLP syndrome. Study Design In this study, 40 patients with HELLP syndrome and 40 healthy pregnant women with similar characteristics without HELLP syndrome were compared. Results When the results were evaluated, no statistically significant difference was found between serum HE4 protein levels in patients with HELLP syndrome and patients without HELLP syndrome in this study (p: 0.29). Conclusion HE4 protein has no field of use in obstetrics yet. In our study, we aimed to find a new biomarker to identify patients with HELLP syndrome. However, we could not find any statistically significant difference in terms of HE4 protein levels between patients with and without HELLP syndrome. Our study is an important study as it is the first study aiming to use HE4 protein in obstetrics.

Exploring the relationship between preeclampsia and human epididymis protein 4

“…Our literature search revealed a lack of comparative research. Only a few studies have determined HE4 levels during pregnancy, and although a recent study evaluated HE4 protein levels in pregnant women with HELLP syndrome [14], there are currently no studies that have evaluated HE4 levels in women with preeclampsia. Furthermore, it should be noted that because of the variable range in the HE4 protein levels between studies caused by differences in the kits and devices used for measurement, the results were not comparable among studies.…”

“…In a recently study conducted by Cam et al [14] HE4 protein levels in pregnant women with HELLP syndrome, an extremely advanced form of preeclampsia were compared, with healthy pregnant women. Similar to our study, they found that the mean HE4 protein levels in HELLP syndrome patients were lower, but in contrast to our study, the result was not statistically significant.…”