{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:14:41Z","timestamp":1787015681866,"version":"build-2736575974"},"reference-count":32,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2013,5,19]],"date-time":"2013-05-19T00:00:00Z","timestamp":1368921600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2013,10]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Viral hepatitis E clinically ranges between acute self\u2010limiting hepatitis (\n AVH<\/jats:styled-content>\n ) and acute liver failure (\n ALF<\/jats:styled-content>\n ). The varied clinical course of the disease possibly thought to be immune\u2010mediated. High\u2010mobility group box 1 (\n HMGB<\/jats:styled-content>\n 1) is a non\u2010histone chromosomal nuclear protein with recently discovered pro\u2010inflammatory and immunomodulatory action. Its presence in abundance within hepatocytes is thought provoking in patients with hepatitis.\n <\/jats:p>\n <\/jats:sec>\n \n Aim<\/jats:title>\n \n The present study was designed to elucidate the role of circulating\n HMGB<\/jats:styled-content>\n 1 and its gene expression in patients with viral hepatitis E.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Blood samples were obtained from\n AVH<\/jats:styled-content>\n (\n n<\/jats:italic>\n \u00a0=\u00a038),\n ALF<\/jats:styled-content>\n (\n n<\/jats:italic>\n \u00a0=\u00a034) and healthy controls (\n HC<\/jats:styled-content>\n ,\n n<\/jats:italic>\n \u00a0=\u00a030). The\n HMGB<\/jats:styled-content>\n 1 levels were estimated in serum by quantitative\u2010micro\u2010\n ELISA<\/jats:styled-content>\n . Gene expression levels were studied in the patient's\n PBMC<\/jats:styled-content>\n s by real\u2010time\n PCR<\/jats:styled-content>\n . Lymphocyte proliferation was estimated by colorimetric\u2010\n MTT<\/jats:styled-content>\n assay.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Mean circulating\n HMGB<\/jats:styled-content>\n 1 levels in\n HC<\/jats:styled-content>\n ,\n AVH<\/jats:styled-content>\n and\n ALF<\/jats:styled-content>\n patients were found to be 12.04\u00a0\u00b1\u00a02.23, 112.6\u00a0\u00b1\u00a013.33 and 225.3\u00a0\u00b1\u00a015.04\u00a0ng\/ml respectively. The levels were significantly higher in\n ALF<\/jats:styled-content>\n than\n AVH<\/jats:styled-content>\n and\n HC<\/jats:styled-content>\n (\n P<\/jats:italic>\n \u00a0<\u00a00.0001). Moreover, 88.2% of\n ALF<\/jats:styled-content>\n patients with\n ><\/jats:styled-content>\n 250\u00a0ng\/ml of circulating\n HMGB<\/jats:styled-content>\n 1 had a fatal outcome. The gene expression of\n HMGB<\/jats:styled-content>\n 1 in the\n PBMC<\/jats:styled-content>\n s of\n ALF<\/jats:styled-content>\n and\n AVH<\/jats:styled-content>\n patients were comparable. A positive correlation was observed between\n HMGB<\/jats:styled-content>\n 1 level and\n INR<\/jats:styled-content>\n . A significantly low lymphocyte proliferation was observed in\n ALF<\/jats:styled-content>\n patients (\n P<\/jats:italic>\n \u00a0=\u00a00.008).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Massive necrosis of hepatocytes in\n ALF<\/jats:styled-content>\n patients might predispose to excessive accumulation of extracellular\n HMGB<\/jats:styled-content>\n 1 leading to suppression of T\u2010cell proliferation. Therefore, it is proposed that excessive circulating\n HMGB<\/jats:styled-content>\n 1 might play an important role in immunosuppression and fulminant course of the disease following\n HEV<\/jats:styled-content>\n infection.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/liv.12197","type":"journal-article","created":{"date-parts":[[2013,4,19]],"date-time":"2013-04-19T05:41:11Z","timestamp":1366350071000},"page":"1341-1348","source":"Crossref","is-referenced-by-count":28,"title":["High levels of circulating\n HMGB<\/scp>\n 1 as a biomarker of acute liver failure in patients with viral hepatitis E"],"prefix":"10.1111","volume":"33","author":[{"given":"Manasi","family":"Majumdar","sequence":"first","affiliation":[{"name":"Department of Virology Postgraduate Institute of Medical Education & Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radhakanta","family":"Ratho","sequence":"additional","affiliation":[{"name":"Department of Virology Postgraduate Institute of Medical Education & Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yogesh","family":"Chawla","sequence":"additional","affiliation":[{"name":"Department of Hepatology Postgraduate Institute of Medical Education & Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mini P.","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Virology Postgraduate Institute of Medical Education & Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,5,19]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-008-9071-4"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(81)90758-0"},{"key":"e_1_2_7_4_1","first-page":"203","article-title":"Viral hepatitis in India","volume":"19","author":"Acharya SK","year":"2006","journal-title":"Natl Med J 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