HELLP syndrome

Research hypothesis. Mark Egly's view is that HELLP syndrome, like preeclampsia and eclampsia, is driven by too much neutrophil elastase, which links it to Alpha-1 Antitrypsin. Published studies show neutrophil activation and higher elastase in these conditions, but they show an association, not proof of cause. This is not medical advice. HELLP syndrome is an emergency. Always talk with your doctor about your own health.

What is HELLP syndrome?

HELLP syndrome is a serious problem in pregnancy or just after birth. The name stands for Hemolysis (red blood cells breaking apart), Elevated Liver enzymes (a sign of liver injury), and Low Platelets (the cells that help blood clot). It is usually seen as a severe form of preeclampsia. Anyone with sudden upper belly pain, headache, nausea, or vision changes late in pregnancy should get care right away.

What studies have found about neutrophils

Neutrophils are white blood cells that fight infection. When they are switched on, they release an enzyme called neutrophil elastase. Alpha-1 Antitrypsin (AAT) is the main protein in the blood that keeps this enzyme in check.

• A 1992 Swedish study measured elastase from neutrophils in women with severe preeclampsia, most of whom had HELLP syndrome. Levels were higher at delivery than in normal pregnancies and returned to normal within a week. [1]
• A small study of liver tissue from two women with HELLP syndrome found many neutrophils and strong staining for elastase. Areas with more elastase had more damaged liver cells. [2] This was a very small study.
• Neutrophils from women with HELLP syndrome behaved differently in the lab, and blood serum from these women switched on healthy neutrophils. [3]
• Several studies found higher elastase in the blood of women with preeclampsia and eclampsia, with the highest levels in eclampsia. [4] [5] [8]
• Lab work suggests that proteases such as elastase, which are higher in preeclampsia, can turn on neutrophils in pregnancy. [6]

How this may relate to Alpha-1

Two studies found lower AAT levels and lower AAT activity in women with severe preeclampsia. [7] [8] A large Danish study found that mothers with diagnosed Alpha-1 Antitrypsin Deficiency had about 2.6 times the risk of preeclampsia. [9] A 2026 review describes too much neutrophil activation as a shared feature of preeclampsia and HELLP syndrome. [10]

These findings fit Mark's idea, but they do not prove that elastase causes HELLP syndrome or that AAT treatment would prevent it. No study we found has tested AAT therapy for HELLP syndrome in people. Mark's patent proposes AAT testing and therapy as a research hypothesis only.

What you can do

If you have had HELLP syndrome or preeclampsia, or have Alpha-1 in your family, you can ask your healthcare team whether an AAT blood test makes sense for you. The Mark Egly Foundation offers education and community support:

• Eclampsia, preeclampsia, and hypertension
• Mark's Patent
• Related Conditions
• Self-check tool
• Alpha-1 360
• Contact the foundation

References

1. Haeger M, Unander M, Norder-Hansson B, Tylman M, Bengtsson A. Complement, neutrophil, and macrophage activation in women with severe preeclampsia and the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 1992;79(1):19-26. PubMed 1727579
2. Halim A, Kanayama N, El Maradny E, et al. Immunohistological study in cases of HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) and acute fatty liver of pregnancy. Gynecol Obstet Invest. 1996;41(2):106-112. DOI
3. Zusterzeel PL, Wanten GJ, Peters WH, Merkus HM, Steegers EA. Neutrophil oxygen radical production in pre-eclampsia with HELLP syndrome. Eur J Obstet Gynecol Reprod Biol. 2001;99(2):213-218. DOI
4. Halim A, Kanayama N, El Maradny E, et al. Correlated plasma elastase and sera cytotoxicity in eclampsia. Am J Hypertens. 1996;9(1):33-38. DOI
5. Gupta AK, Gebhardt S, Hillermann R, Holzgreve W, Hahn S. Analysis of plasma elastase levels in early and late onset preeclampsia. Arch Gynecol Obstet. 2006;273(4):239-242. DOI
6. Walsh SW, Nugent WH, Al Dulaimi M, et al. Proteases activate pregnancy neutrophils by a protease-activated receptor 1 pathway: epigenetic implications for preeclampsia. Reprod Sci. 2020;27(11):2115-2127. DOI
7. Twina G, Sheiner E, Shahaf G, et al. Lower circulation levels and activity of alpha-1 antitrypsin in pregnant women with severe preeclampsia. J Matern Fetal Neonatal Med. 2012;25(12):2667-2670. DOI
8. Kunder M, Kutty AM, Lakshmaiah V, Sheela SR. Correlation of plasma neutrophil elastase activity and endogenous protease inhibitor levels with the severity of pre-eclampsia. J Clin Diagn Res. 2017;11(3):BC09-BC12. DOI
9. Orimoloye HT, He D, Li T, et al. Alpha-1 antitrypsin deficiency and pregnancy complications and birth outcomes: a population-based cohort study in Denmark. PLoS One. 2024;19(1):e0296434. DOI
10. Zaimi M, Kambas K, Marinaki S, Theodora M, Daskalakis G, Frangou E. Aberrant neutrophil and complement activation in thrombotic microangiopathies in pregnancy: is there a missing link? Autoimmun Rev. 2026;25(11):104151. DOI