CLINICAL SIGNIFICANCE OF EXPRESSION OF NUCLEAR FACTOR KAPPA B (NF-κ B) IN FULMINANT HEPATITIS

Abstract

Purpose: To study the expression of NF-κ B (p50 & p65) in fulminant hepatitis patients and its correlation with the clinical and biochemical profile and the final outcome Methods: The study group included a total of 60 subjects. The case group included 25 cases of fulminant hepatic failure. The control group included 20 healthy voluntary (replacement and altruistic) blood donors without any history or clinical feature suggestive of high risκ Behavior. The control group also included 10 healthy pregnant females (for comparison with pregnant FHF patients) and 5 surgical cases of non-liver disease from which control liver tissue was obtained after an informed consent. Besides routine biochemical parameters, serological tests for viral hepatitis (HAV, HBV, HCV, and HEV) were performed using commercially available ELISA kits. Sera samples were immediately processed for extraction of nuclear protein and detection of NF-kB. The serum was also withdrawn before discharge in patients who recovered from fulminant hepatitis to see for NF-kB expression. NF-kB expression was also studied in post mortem liver tissue of 10 fulminant hepatitis patients. Results: The mean age of the FHF patients was 28.04 ± 4.71 years and male- female ratio was 1.5:1. 12 out of 25 patients were pregnant. Hepatitis E virus was detected in 19/25(76%) of the cases and hepatitis B and C were responsible for 16%(4/25) and 8%(2/25) of FHF respectively. HEV was the most common cause of FHF in pregnant patients - 10/12 (83.3%). There was 76%(19/25) mortality among FHF cases. 60% patients with FHF showed high level of expression of p50 component contrary to complete absence of expression of p65 in majority of cases 52%(13/25). Exactly similar pattern was also observed in post-mortem liver biopsy tissue of FHF cases. On the contrary the control (voluntary healthy blood donors) showed normal expression for both p50 and p65 in majority of cases. Comparable results were also obtained from control livertissue. The patients (n = 6), who recovered after the treatment showed moderate expression of p50 suggesting it as the major component, while p65 showed either low (majority) to moderate expression. Conclusions: That p65 subunit is essential for normal functioning of NF-κ B complex and its absence causes increased apoptosis and degeneration of liver cells leading to severe liver damage and death in FHF patients