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Original ArticleOpen Access
The Role of Prostacyclin (PGI) and Thromboxane A 2 (TXA) in Pathogenesis of Dengue Hemorrhagic Fever (DHF)
Preeyasombat C 
,
Treepongkaruna S ,
Sriphrapradang A ,
Choubtum L
,
Treepongkaruna S ,
Sriphrapradang A ,
Choubtum L In previous studies it has been demonstrated that the levels of plasma 6 keto-prostaglandin
F1α (6-K-PGF1), the stable metabolite of PGI2 were elevated in DHF patients during
shock. In this study it is hypothesized that excessive PGI2 production plays a very important
role in developing serious clinical manifestations of dengue shock syndrome (DSS) patients.
In addition, an attempt was made to determine whether TXA2 has any significant role in
such patients. Plasma 6-K-PGF 1 and thromboxane B2 (TXB2), the stable metabolites of
TXA2 were determined in 43 normal healthy children (NC) and 54 DHF patients without
shock (DHF-N) and 33 DHF patients with shock (DHF-S). Subjects aged between 2 and
14 years. Plasma 6-K-PGF 1 and TXB2 were measured by radioimmunoassay and the ratio
of TXB2/6-K-PGF1 were also calculated. In 43 NC the values of plasma TXB2, 6-K-PGF 1
and TXB2/6-K-PGF1 ratio were (mean± SE) 372.3 ± 17.1, 150.1 ± 2.4 and 2.52 ± 0.12 pg/ml,
respectively. In 54 DHF-N patients the corresponding values were 409.1 ± 16.0, 278.4 ± 11.6
and 1.54 ± 0.06 pg/ml; whereas those in 33 DHF-S patients were 254.3 ± 26.2, 349.1 ± 20.5
and 0.757 ± 0.073 pg/ml, respectively. Plasma 6-K-PGF1 levels of DHF-N and DHF-S
patients were significantly greater than those in normal children (p < 0.001, p < 0.01 respectively).
The plasma 6-K-PGF 1 levels seem to be greater in DHF-S patients than in the
DHF-N patients, however the difference in values were not statistically significant (p > 0.05).
These findings indicate that plasma PGI2 level is significantly increased in DHF particularly
during shock. Plasma TXB2 levels of DHF-N had no significant statistical difference
from those of NC (p > 0.05); however, those in DHF-S patients were significantly lowered
(p < 0.001) than those of NC and DHF-N patients. The findings suggest the important role
of TXA2 to compensate for excessive PGI2 secretion in DHF patients. The failure or inadequate
TXA2 production may eventually lead to shock. The ratios were significantly reduced
in both DHF-N and DHF-S patients when compared to those of NC (p < 0.001 both). The
ratio in DHF-S patients was also significantly lowered than that in DHF-N patients
(p < 0.001). It is suggested that the imbalance between TXA2 and PGI2 production exists
during DHF infection. The more reduction of plasma TXA2/PGI2 ratio leads to more overt
and serious clinical manifestations of the disease.
Key word : Prostacyclin, Thromboxane, Dengue Hemorrhagic Fever, Dengue Shock Syndrome
F1α (6-K-PGF1), the stable metabolite of PGI2 were elevated in DHF patients during
shock. In this study it is hypothesized that excessive PGI2 production plays a very important
role in developing serious clinical manifestations of dengue shock syndrome (DSS) patients.
In addition, an attempt was made to determine whether TXA2 has any significant role in
such patients. Plasma 6-K-PGF 1 and thromboxane B2 (TXB2), the stable metabolites of
TXA2 were determined in 43 normal healthy children (NC) and 54 DHF patients without
shock (DHF-N) and 33 DHF patients with shock (DHF-S). Subjects aged between 2 and
14 years. Plasma 6-K-PGF 1 and TXB2 were measured by radioimmunoassay and the ratio
of TXB2/6-K-PGF1 were also calculated. In 43 NC the values of plasma TXB2, 6-K-PGF 1
and TXB2/6-K-PGF1 ratio were (mean± SE) 372.3 ± 17.1, 150.1 ± 2.4 and 2.52 ± 0.12 pg/ml,
respectively. In 54 DHF-N patients the corresponding values were 409.1 ± 16.0, 278.4 ± 11.6
and 1.54 ± 0.06 pg/ml; whereas those in 33 DHF-S patients were 254.3 ± 26.2, 349.1 ± 20.5
and 0.757 ± 0.073 pg/ml, respectively. Plasma 6-K-PGF1 levels of DHF-N and DHF-S
patients were significantly greater than those in normal children (p < 0.001, p < 0.01 respectively).
The plasma 6-K-PGF 1 levels seem to be greater in DHF-S patients than in the
DHF-N patients, however the difference in values were not statistically significant (p > 0.05).
These findings indicate that plasma PGI2 level is significantly increased in DHF particularly
during shock. Plasma TXB2 levels of DHF-N had no significant statistical difference
from those of NC (p > 0.05); however, those in DHF-S patients were significantly lowered
(p < 0.001) than those of NC and DHF-N patients. The findings suggest the important role
of TXA2 to compensate for excessive PGI2 secretion in DHF patients. The failure or inadequate
TXA2 production may eventually lead to shock. The ratios were significantly reduced
in both DHF-N and DHF-S patients when compared to those of NC (p < 0.001 both). The
ratio in DHF-S patients was also significantly lowered than that in DHF-N patients
(p < 0.001). It is suggested that the imbalance between TXA2 and PGI2 production exists
during DHF infection. The more reduction of plasma TXA2/PGI2 ratio leads to more overt
and serious clinical manifestations of the disease.
Key word : Prostacyclin, Thromboxane, Dengue Hemorrhagic Fever, Dengue Shock Syndrome
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