Association of Xanthine Oxidase and Neutrophil Activation Marker Elastase in Preeclampsia: A Case-control Study

Abstract

Introduction: Preeclampsia is an obstetric emergency for both mother and the foetus with unknown aetiology. Delivery is the only effective way in the prompt management. Due to oxidative stress factors, there is an increased conversion of xanthine dehydrogenase to xanthine oxidase, so there is more production of hydrogen peroxide. Hydrogen peroxide affects the cell function of trophoblast. Therefore, oxidative stress is one of the causative factor for complications of preeclampsia. Aim: To determine the association between xanthine oxidase and plasma elastase (Neutrophil activation marker) in preeclampsia. Materials and Methods: The case-control study was conducted from March 2019 to December 2019 on normotensive pregnant females and preeclamptic patient categorised as group 1 (control) and group 2 (case) respectively. The level of xanthine oxidase and plasma elastase were estimated spectrophotometrically. To compare means between the two groups, Student’s t-test was used and correlation between parameters were estimated through Pearson’s correlation coefficient. A p-value of <0.05 was considered statistically significant. Results: A total of 60 subjects were included and analysed in two groups 1 and 2 respectively. Neutrophil activation marker (elastase) was elevated 4.5-fold in group 2 (26.81±7.9) but, it was non significant when compared to group 1 (6.02±3.4). Xanthine oxidase levels amongst group 1 was 34.01±38.26 U/L which was significantly elevated in pregnant group 2 patients as 218.78±220.42 U/L with probability p-value <0.05 and positive correlation of r=0.320. Conclusion: Elevated levels of xanthine oxidase adds to oxidative stress and may result in trophoblastic dysfunction in preeclampsia. The situation is convoyed by increased concentration of pro- inflammatory signaling molecules like cytokines such as Tumour Necrosis Factor-α (TNF-α), activated neutrophils and positive acute phase plasma proteins. Elastase as neutrophil activation marker showed 4.5-fold increase in preeclampsia which shows aggravated inflammatory condition.