Effect of plasma exchange on hepatocyte oxidative stress, mitochondria function, and apoptosis in patients with acute fatty liver of pregnancy.

Acute fatty liver of pregnancy (AFLP) is an uncommon but clinically severe hepatopathy, and reactive oxygen species (ROS)-mediated mitochondrial apoptosis may be its key pathogenesis. Traditional therapy is inadequate for patients with severe conditions so the application of plasma exchange (PE) has been attempted. The present study aims to determine whether or not PE can lessen injuries to hepatocytes by ameliorating ROS and mitochondrial functions. Thirteen patients with AFLP were included in the experimental group, while fifteen patients made up the case-control group. PE was applied to patients in the PE group once a day for 1-3 days. Cultured hepatocytes were treated with serum or replacement fluid from patients and controls, respectively. Malondialdehyde, superoxide dismutase (SOD), mitochondrial membrane potential (MMP), caspase-3, caspase-9, and apoptosis of hepatocytes were measured. The clinical details and prognoses were also assessed. Patients in the experimental group had shorter durations of hepatic function recovery, intensive care unit (ICU) stay, and hospitalization than those in the case-control group, although both groups showed the same mortality. PE could induce the production of SOD, inhibit the production of malondialdehyde, and recover MMP. The upregulation of caspase-3 and caspase-9 expression, as well as increase in apoptosis rate in the AFLP group, could be inhibited by PE. Moreover, PE also appeared to have a dose-dependent effect. PE protects hepatocytes by reducing damage to the mitochondria caused by oxidative stress; thus, it could be beneficial in the treatment of patients with severe AFLP and induce liver function recovery.