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Plasma levels of Ceramides and their association with Hematocrit and Thrombocytopenia in Severe and Non-severe dengue

Background Plasma leakage due to endothelial permeability is regarded as a hallmark process in the pathophysiology of severe dengue. In recent years, the importance of ceramide in regulating vascular tone during viral infection and metabolic diseases has gained attention. The present study aimed to evaluate the plasma levels of ceramide and its association with plasma leakage in dengue patients. Methods The study involved 30 dengue samples involving severe dengue (SD-10), Dengue with Warning sign (DWW-10), Dengue without Warning Sign (DWOW-10), along with other febrile illness (OFI-10) controls. Samples were collected on the day of admission (DOA), day of defervescence (DOD), and day of convalescence (DOC). Total plasma ceramides (d18:1/22:0) were quantified using RP-HPLC. The correlation between ceramides and hematocrit/platelet count was evaluated using Spearman Rho Correlation. All the statistical analyses were performed using SPSS software. Results During the febrile phase, a significant (P≤0.05) decrease in the levels of ceramides was observed in dengue compared to OFI (control). Towards the defervescences, the ceramides levels were substantially (P ≤ 0.001) elevated in dengue groups compared to baseline. Most importantly, the ceramide levels were found to be higher in SD patients compared to non-severe dengue (DWW & DWOW) and OFI, particularly at the critical phase of infection. We observed a significant negative correlation (r = -0.867, P ≤0.001) between the platelet count and ceramide levels in SD subjects. Notably, a negative correlation was observed between ceramide and hematocrit during the defervescence phase (R = -0.355, P≤0.05) in the AD group. Conclusion Elevated levels of circulating plasma ceramides during the defervescence phase of severe dengue show an essential role of ceramides in disease pathogenesis, however further studies are required to ascertain it.