AVH-E is more serious infection in pregnant females and is often complicated by acute liver failure (ALF). Little is known about the immunological factors that contribute to development of ALF in pregnancy. Here,we investigated both innate and adaptive immune cells, including expression of TLRs,downstream signaling molecules and phagocytic Estrogen antagonist capacities of innate immune cells. Patients and Methods: PBMCs from patients Gr.1(healthy pregnant females), Grs. 2 & 3 (AVH-E pregnant females with or without ALF) were used for surface and intracellular immunophenotyping

for various immune cells: monocytes(CD14+),mcrophages(CD11b+CD163+),DC’s(DC- SIGN),B-cells(CD19+ CD38+ CD24+) and T-cells (CD45RA+ CCR7+ on CD4+ and CD8+). The expression of TLR 3,7 & 9 was also studied on monocytes, macrophages & DC’s. Gene expression of downstream signaling pathway MyD88 & it molecules MyD88, IRF3 and IRF7 was studied by qRT-PCR. Phagocytic activity of monocytes & macrophages was determined by uptake of opsonized E.coli. Reactive oxygen species (ROS) production by macrophages & monocytes was determined, with and without stimulation of fMLP, E.coli and PMA. Results:Gr.2 and Gr.3 had Epigenetics inhibitor increased monocyte derived macrophages (%age

of CD11b+CD163+macrophages;Gr2. 1.1 ± 0.4%;Gr3. 0.8 ± 0.3% vs. Gr1. 0.6 ± 0.2%, P=0.03, P=0.02) and dendritic cells (DCSIGN MFI; Gr2. 40±5.3, Gr3. 38±7 vs. Gr1. 15±1.2, P=0.0004,P=0.002). However, Gr2. patients showed significantly decreased phagocytic activity of macrophages (38±5 vs 80.2±4,p=0.01) as well as decreased ROS production of macrophages (Resting, p=0.001, E Coli, p=NS, fMLP, p=0.0001 & PMA p=0.0001) respect to Gr.1 but it is non-significant compared to Gr.2, while expression of TLRs and its MYD88 signaling molecules show impaired response in Gr.2 compared to Gr.1 and Gr.3. There was significant reduction of CD4+ and CD8+ effector T cells (CCR7-CD45RA+) in Gr.2 than Gr.3 and 1(1 ± 0.5% vs.

12.5 ± 3.5% and 10.4 ± 2%, P=0.002; 11 ± 3% vs. 30.3 ±4% and 13.2 ±2.6%, 6-phosphogluconolactonase P< 0.05). Conclusions: Our results demonstrate an impaired innate immunity. The expression of TLR 3, 7 and 9 was reduced in AVH-E-ALF patients and also the expression of downstream signaling molecules was reduced. The frequency of effector T-cells was reduced with a Th1 shift which is associated with AVH-E-ALF patients. Therefore, we conclude their is a defect in TLR-mediated activation of innate immune system resulting in flawed innate-adaptive cross-talk which leads to the development of ALF in pregnant females with HEV infection. Further studies with TLR modulation can be explored in AVH-E-ALF to enhance survival rates. Disclosures: The following people have nothing to disclose: Rashi Sehgal, Paul David, Ashish Vyas, Arshi Khanam, Ankit Bhardwaj, Preety Rawal, Syed Hissar, Sharda Patra, Shubha S. Trivedi, Shyam Kottilil, Shiv K.