PERBANDINGAN RERATA EKSPRESI PROTEIN Bax DAN Bak PADA PREEKLAMPSIA BERAT DAN KEHAMILAN NORMOTENSI

Abstract

PERBANDINGAN RERATA EKSPRESI PROTEIN Bax DAN Bak PADA PREEKLAMPSIA BERAT DAN KEHAMILAN NORMOTENSI Tejo Sujatmiko*, Diah Rumekti H*, Detty S Nurdiati* ABSTRACT Background : Preeclampsia is still become major cause of maternal and perinatal mortality. The placenta is an important and central focus on the pathogenesis of preeclampsia. Failure of trophoblast cells to perform remodeling on spiral arteries due to excessive apoptosis may cause uteroplacental ischemia and endothelial cells damage, this induce clinical manifestations of preeclampsia especially through the intrinsic pathway. Intracellular Bax and Bak are genes that play a role as a cells apoptosis regulator (as proapoptosis). They are located in the mitochondria and endoplasmic reticulum and would in turn activate caspase the intrinsic apoptotic pathway that cascade resulting in cell death processes. Objective : Comparing the mean of Bax and Bak protein expression between normotensive pregnancies and severe preeclampsia. Method : This research is a cross-sectional study design. The subjects were severe preeclampsia and normotensive patients treated at RSUP dr. Sardjito Jogjakarta between October 2011 to March 2012, with total patients of 81. Bak and Bax protein expression were measured with immunohistochemistry techniques. Result and Discussion : The mean expression of Bax and Bak proteins in severe preeclampsia group were significantly higher compared to normotensive group. The mean value of Bax expression was 0,23 (CI 95 % 0,12 - 0,34) and the mean expression of Bak was 0,44 (95 % CI 0,10 - 0,78). Conclusion : Expression of Bax and Bak proteins in severe preeclampsia is higher than normotensive pregnancies and Bax protein gave more effect statistically in preeclampsia compared to Bak protein. Keywords : trophoblast, immunohistochemistry, severe preeclampsia, Bak protein, Bax protein, apoptosis. ABSTRAK Latar belakang : Preeklampsia masih merupakan penyebab kematian maternal dan perinatal yang utama. Plasenta merupakan fokus sentral dan penting pada patogenesis terjadinya preeklampsia. Kegagalan sel trofoblas melakukan remodeling arteri spiralis akibat proses apoptosis yang berlebihan menyebabkan terjadinya iskemia uteroplasenter dan kerusakan sel endotel yang menimbulkan manifestasi klinis preklampsia terutama terjadi melalui jalur intrinsik intraseluler dimana Bax dan Bak adalah gen-gen yang berperan sebagai regulator apoptosis pada sel (sebagai pro-apoptosis). Mereka terletak di dalam mitokondria dan reticulum endoplasma dan bekerja mengaktifkan caspase cascade sehingga terjadi proses kematian sel. Tujuan : Membandingkan rerata ekspresi protein Bax dan Bak antara preeklampsia berat dengan kehamilan normotensi. Metode : Penelitian ini merupakan rancangan penelitian potong lintang dengan sampel penderita preeklampsia berat dan normotensi yang dirawat di RSUP dr. Sardjito Jogjakarta antara bulan Oktober 2011 hingga Maret 2012, sebanyak 81 pasien. Pengamatan ekspresi protein Bak dan Bax dilakukan dengan teknik imunohistokimia. Hasil dan Pembahasan : Rerata ekspresi protein Bax dan Bak pada kelompok preeklampsia berat lebih tinggi secara bermakna di bandingkan kelompok normotensi Dengan nilai rerata ekpresi Bax 0.23 (CI 95% 0.12 – 0.34) dan rerata ekspresi Bak 0.44 (CI 95% 0.10 – 0.78). Kesimpulan : Ekspresi protein Bax dan Bak pada preeklampsia berat lebih tinggi dibanding dengan kehamilan normotensi dan protein Bax lebih berpengaruh pada preeklampsia dibanding dengan protein Bak. Kata kunci : trofoblas, imunohistokimia, preeklampsia berat, protein Bak, protein Bax, apoptosis. * Departement of obstetrics and gynecology * Medical Faculty of Gadjah Mada University * Sardjito Hospital