Increased levels of serum hyaluronan in patients with dengue infection

Abstract

Serum hyaluronan (HA) is ubiquitously distributed in connective tissues. Circulating HA is degraded by hepatic sinusoidal endothelial cell. The aim of the present study was to evaluate serum HA levels and to determine their importance in dengue fever (DF)/dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS) patients. Serum HA levels were measured by an ELISA-based method in 16 patients with DF, 14 patients with DHF and 10 patients with DSS. The HA levels were compared with those in 48 acute hepatitis A patients; 8 healthy blood donors serve as controls. In acute phase, mean serum HA levels significantly increased in patients with DSS (7316.3+/-10,359.0 ng/ml) in comparison to patients with hepatitis A (93.8+/-50.4 ng/ml; P<0.0001), and healthy controls (48.3+/-16.3 ng/ml; P<0.0001). Serum levels of HA in patients with DSS rapidly decreased during the convalescent phase, but were still significantly higher than those in healthy controls (915.2+/-1294.8, and 48.3+/-16.3 ng/ml; P<0.0005). The increased HA in dengue patients could be attributed to sinusoidal endothelial damage rendering the endothelium incapable of HA clearance. The elevation of HA production may involve the pathogenesis of dengue infection. Further studies are needed to determine whether the increase in the HA production or decrease in its clearance is responsible for the elevated serum HA.