Severity of Plasma Leakage Is Associated With High Levels of Interferon γ–Inducible Protein 10, Hepatocyte Growth Factor, Matrix Metalloproteinase 2 (MMP-2), and MMP-9 During Dengue Virus Infection

• Published in: The Journal of infectious diseases 2017-01, Vol.215 (1), p.42-51
• Main Authors: Her, Zhisheng, Kam, Yiu-Wing, Gan, Victor C., Lee, Bernett, Thein, Tun-Linn, Tan, Jeslin J. L., Lee, Linda K., Fink, Katja, Lye, David C., Rénia, Laurent, Leo, Yee-Sin, Ng, Lisa F. P.
• Format: Article
• Language: English
• Subjects: Adult; Capillary Permeability; Chemokine CXCL10 - blood; Coinfection - immunology; Coinfection - virology; Cytokines - blood; Cytokines - immunology; Dengue - immunology; Dengue - physiopathology; Dengue - virology; Dengue Virus - immunology; Dengue Virus - pathogenicity; Dengue Virus - physiology; Female; Hepatocyte Growth Factor - blood; Humans; Interleukin 1 Receptor Antagonist Protein - blood; Interleukin 1 Receptor Antagonist Protein - immunology; Male; Matrix Metalloproteinase 2 - blood; Matrix Metalloproteinase 9 - blood; Matrix Metalloproteinases - blood; Middle Aged; Receptors, Tumor Necrosis Factor - blood; Receptors, Tumor Necrosis Factor - immunology; Serogroup; Severe Dengue - immunology; Severe Dengue - physiopathology; Severe Dengue - virology; Singapore; Vascular Cell Adhesion Molecule-1 - blood; Vascular Cell Adhesion Molecule-1 - immunology; VIRUSES
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiw494

Background. Dengue virus infection typically causes mild dengue fever, but, in severe cases, life-threatening dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) occur. The pathophysiological hallmark of DHF and DSS is plasma leakage that leads to enhanced vascular permeability, likely due to a cytokine storm. Methods. Ninety patients with dengue during 2010–2012 in Singapore were prospectively recruited and stratified according to their disease phase, primary and secondary infection status, and disease severity, measured by plasma leakage. Clinical parameters were recorded throughout the disease progression. The levels of various immune mediators were quantified using comprehensive multiplex microbead-based immunoassays for 46 immune mediators. Results. Associations between clinical parameters and immune mediators were analyzed using various statistical methods. Potential immune markers, including interleukin 1 receptor antagonist, interferon γ–inducible protein 10, hepatocyte growth factor, soluble p75 tumor necrosis factor α receptor, vascular cell adhesion molecule 1, and matrix metalloproteinase 2, were significantly associated with significant plasma leakage. Secondary dengue virus infections were also shown to influence disease outcome in terms of disease severity. Conclusions. This study identified several key markers for exacerbated dengue pathogenesis, notably plasma leakage. This will allow a better understanding of the molecular mechanisms of DHF and DSS in patients with dengue.