Apoptosis and its relation with clinical course in patients with Crimean-Congo hemorrhagic fever

J Med Virol. 2019 Aug;91(8):1385-1393. doi: 10.1002/jmv.25467. Epub 2019 Apr 3.


Crimean-Congo hemorrhagic fever (CCHF) is a tick-mediated viral infection. Patients with CCHF may show various clinical presentations. The cause of this difference in the clinical course is not completely understood. Apoptosis is programmed cell death and plays an important role in regulating the immune system. Our knowledge of the role of apoptosis in CCHF disease is limited. We investigated the role of apoptosis and their relationship with the severity of the disease in CCHF. Thus, in 30 patients with CCHF and 30 healthy individuals, we analyzed the serum levels of cytochrome C, apoptotic protease activating factor-1 (Apaf 1), caspase 3, caspase 8, caspase 9, sFas, sFasL, perforin, granzyme B, and CK18 by enzyme-linked immunosorbent assay. This is the first study that research the serum levels of the mentioned apoptosis markers in adult patients with CCHF. We found that the serum levels of sFasL, cytochrome C, Apaf 1, caspase 3, caspase 8, caspase 9, perforin, granzyme B, and M30 were statistically significantly different in the acute phase of the disease compared with healthy individuals and patients in convalescent period. There was no association between the clinical severity of the disease and apoptosis markers. In conclusion, the results of our study suggested that the extrinsic and intrinsic apoptosis pathway play an important role in CCHF.

Keywords: Crimean-Congo hemorrhagic fever; apoptosis; caspase; cytochrome C; cytotoxic T lymphocyte; soluble FasL.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Apoptosis*
  • Biomarkers / blood*
  • Blood Chemical Analysis
  • Caspases / blood
  • Cytochromes c / blood
  • Fas Ligand Protein / blood
  • Female
  • Hemorrhagic Fever, Crimean / pathology*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Young Adult


  • Biomarkers
  • FASLG protein, human
  • Fas Ligand Protein
  • Cytochromes c
  • Caspases