Jane Magdalena Kalatiku, Berti J Nelwan, Andi Alfian Zainuddin, Cahyono Kaelan, Djumadi Achmad, Rina Masadah

Significance of HBsAg Expression in Placental Tissue with Serum Positivity in Hepatitis B Virus-infected Mother

Introduction

Significance of hbsag expression in placental tissue with serum positivity in hepatitis b virus-infected mother. Investigate HBsAg expression in placental tissue & maternal serum to predict mother-to-child HBV transmission risk. Study in Makassar, Indonesia, informs prevention & therapy.

Abstract

Introduction: Hepatitis B virus infection in fetal and newborn may result from the intrauterine vertical transmission. The purpose of our study is to determine the association between HBsAg expression in the placental and HBsAg serum in pregnant women. Methods: Total 67 placental tissues and serum were obtained from HBV-infected mothers. This study was conducted in various hospitals in Makassar, Indonesia from December 2017 until August 2018. Maternal serum and placental tissues were tested by ELISA and Immunohistochemistry staining. Results: 67 samples from placental tissues and serum were categorized into two different levels of serum titer and staining positivity. Twenty nine samples (43.3%) were categorized in low titer of HBsAg positive serum and 38 samples (56.7%) in high titer of HBsAg positive serum. From the total of 67 placental samples, 43 (64.2%) samples had positive expression of HBsAg immunohistochemistry staining and 24 (34.8%) samples had negative expressions. Conclusions: There was a significant correlation between the expressions of HBsAg in the placental tissues and serum titers of HBV-infected mothers that is important in predicting the risk of transplacental transmission. The results of this study can be used as guidelines for the prevention and therapeutic approach of mother-to-child HBV infection.

Review

This study addresses a crucial aspect of Hepatitis B virus transmission, specifically the role of HBsAg expression in placental tissue in relation to maternal serum positivity, with implications for intrauterine vertical transmission. The authors aim to establish a link between HBsAg expression in the placenta and maternal serum HBsAg levels, utilizing a cohort of 67 HBV-infected mothers in Makassar, Indonesia. The finding of a significant correlation between placental HBsAg expression and maternal serum titers provides valuable insight into potential mechanisms of mother-to-child transmission and offers a novel avenue for risk prediction. This research is particularly pertinent in regions with high HBV endemicity, where vertical transmission remains a significant public health challenge. Methodologically, the study employs both ELISA for maternal serum and immunohistochemistry (IHC) for placental tissue, which is an appropriate combination for investigating HBsAg presence at both systemic and local levels. The results indicate that a substantial proportion (64.2%) of placental samples exhibited positive HBsAg expression, underscoring the potential for the placenta to harbor the antigen. The categorization of maternal serum into low and high HBsAg titer groups, and the subsequent correlation with placental IHC positivity, provides quantitative data that supports the study's central hypothesis. This descriptive analysis sets a foundation for understanding the burden of HBsAg in the feto-maternal interface and its relationship with maternal viral activity. While the study provides compelling evidence for HBsAg presence in the placenta and its correlation with maternal serum levels, its direct applicability in "predicting the risk of transplacental transmission" is limited by the absence of data on actual fetal or neonatal HBV infection outcomes. The abstract claims this importance, but without linking placental HBsAg expression to confirmed instances of vertical transmission, the predictive value remains hypothetical. Furthermore, the abstract lacks specificity regarding the criteria for categorizing "low" and "high" serum titer levels, which would be crucial for reproducibility and clinical interpretation. Future research should aim to correlate placental HBsAg expression with neonatal HBV status to definitively establish its predictive power and to explore the specific cell types within the placenta harboring HBsAg, which could offer insights into the mechanisms of transmission and potential therapeutic targets.

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