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Cong C, Xia Y, Gong S, Li T, Liu H, Zhong G, Chen D, Zhao W, Yu W, Yao Y, Liu J, Wei D, Cao H, Huang F. Infectious hepatitis E virus excreted into the vagina. FASEB J 2024; 38:e23500. [PMID: 38441537 DOI: 10.1096/fj.202301519rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 03/07/2024]
Abstract
Hepatitis E virus (HEV) persists in the male genital tract that associates with infertility. However, the presence of HEV in the female genital tract is unreported. Vaginal secretions, cervical smears, and cervix uteri were collected to explore the presence of HEV in the female genital tract. HEV RNA and/or antigens were detected in the vaginal secretions, cervical smears, and the cervix uteri of women. The infectivity of HEV excreted into vaginal secretions was further validated in vitro. In addition, HEV replicates in the female genital tract were identified in HEV-infected animal models by vaginal injection or vaginal mucosal infection to imitate sexual transmission. Serious genital tract damage and inflammatory responses with significantly elevated mucosal innate immunity were observed in women or animals with HEV vaginal infection. Results demonstrated HEV replicates in the female genital tract and causes serious histopathological damage and inflammatory responses.
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Affiliation(s)
- Chao Cong
- School of Medicine, The Academy for Cells and Life Health, Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, PR China
| | - Yueping Xia
- School of Medicine, The Academy for Cells and Life Health, Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, PR China
| | - Shilin Gong
- School of Medicine, The Academy for Cells and Life Health, Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, PR China
| | - Tengyuan Li
- School of Medicine, The Academy for Cells and Life Health, Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, PR China
| | - Huichan Liu
- School of Medicine, The Academy for Cells and Life Health, Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, PR China
| | - Guo Zhong
- School of Medicine, The Academy for Cells and Life Health, Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, PR China
| | - Dongxue Chen
- School of Medicine, The Academy for Cells and Life Health, Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, PR China
| | - Wanqiu Zhao
- School of Medicine, The Academy for Cells and Life Health, Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, PR China
| | - Wenhai Yu
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, PR China
| | - Yinjie Yao
- Kunming City Maternal and Child Health Hospital, Kunming, PR China
| | - Jiankun Liu
- 920th Hospital of the PLA Joint Logistics Support Force, Kunming, PR China
| | - Daqiao Wei
- School of Medicine, The Academy for Cells and Life Health, Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, PR China
| | - Hongcui Cao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
| | - Fen Huang
- School of Medicine, The Academy for Cells and Life Health, Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, PR China
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
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Beer A, Holzmann H, Pischke S, Behrendt P, Wrba F, Schlue J, Drebber U, Neudert B, Halilbasic E, Kreipe H, Lohse A, Sterneck M, Wedemeyer H, Manns M, Dienes HP. Chronic Hepatitis E is associated with cholangitis. Liver Int 2019; 39:1876-1883. [PMID: 31102493 PMCID: PMC6790616 DOI: 10.1111/liv.14137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 12/21/2018] [Accepted: 02/06/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Sporadic hepatitis E is an emerging indigenous disease in Europe induced by genotype 3 of the virus. While the disease takes an acute self-limited course in immunocompetent individuals, under immunocompromised conditions chronic hepatitis E might develop. The histology of chronic hepatitis E has not been described in detail systematically. METHODS Liver biopsies from 19 immunosuppressed patients with chronic hepatitis E were collected: 17 were organ transplant recipients, one had a CD4-deficiency and one had received steroid therapy because of ulcerative colitis. Biopsies were processed with standard stains. Evaluation of histologic activity and fibrosis was performed according to Ishak. Additionally, immunohistochemistry with antibodies directed against open reading frame 2 and 3 of the virus was performed and liver biopsies were tested for hepatitis E virus RNA. RESULTS Biochemical data showed an increase in alanine transaminase, aspartate transaminase, gamma-glutamyl transferase and total bilirubin. Histopathology displayed typical features of chronic hepatitis with mild to moderate activity. The number of polymorphonuclear leucocytes was considerably increased and all patients had a florid cholangitis that presented as a destructive form in five of them. Hepatocytes and bile duct epithelia stained positive for hepatitis E virus by immunohistochemistry. CONCLUSIONS Chronic hepatitis E in immunocompromised individuals runs a similar course as hepatitis B and C and shows similar histopathology. However, the presence of destructive cholangitis in some cases accompanied by an increased number of polymorphonuclear leucocytes is markedly different. Immunohistochemically the virus is present in bile duct epithelia, seemingly the cause for cholangitis.
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Affiliation(s)
- Andrea Beer
- Department of PathologyMedical University of ViennaViennaAustria
| | | | | | - Patrick Behrendt
- Department of Gastroenterology, Hepatology and EndocrinologyMedical School of HanoverHanoverGermany
| | - Fritz Wrba
- Department of PathologyMedical University of ViennaViennaAustria
| | - Jerome Schlue
- Institute for PathologyMedical School of HanoverHanoverGermany
| | - Uta Drebber
- Institute of PathologyUniversity Hospital CologneCologneGermany
| | - Barbara Neudert
- Department of PathologyMedical University of ViennaViennaAustria
| | - Emina Halilbasic
- Department of GastroenterologyMedical University of ViennaViennaAustria
| | - Hans Kreipe
- Institute for PathologyMedical School of HanoverHanoverGermany
| | | | | | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and EndocrinologyMedical School of HanoverHanoverGermany
| | - Michael Manns
- Department of Gastroenterology, Hepatology and EndocrinologyMedical School of HanoverHanoverGermany
| | - Hans P. Dienes
- Department of PathologyMedical University of ViennaViennaAustria
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Barragué H, Condat B, Petitdidier N, Champagne E, Renou C, Izopet J, Abravanel F. Chronic hepatitis E virus infection in a cirrhotic patient: A case report. Medicine (Baltimore) 2017; 96:e7915. [PMID: 28953614 PMCID: PMC5626257 DOI: 10.1097/md.0000000000007915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Acute hepatitis E virus (HEV) infections are usually self-limiting in immunocompetent patients. HEV persistence has been described only in immunosuppressed patients such as solid-organ transplant recipients, patients with hematological diseases, or patients with human immunodeficiency virus (HIV) infection. PATIENT CONCERNS A 61-year-old patient was admitted in hospital for jaundice and asthenia. DIAGNOSES The patient had underlying cirrhosis and developed a chronic HEV infection. INTERVENTION Ribavirin therapy was initiated. OUTCOMES Ribavirin therapy for 12 months allowed the clearance of the virus and HEV viral load remained undetectable thereafter. This patient had taken no immunosuppressive drugs, was not suffering from any autoimmune disease and was not infected with HIV. We studied the patient's anti-HEV immune response months after the viral clearance. His peripheral blood mononuclear cells (PBMC) were stimulated in vitro by HEV peptides. The patient had a mild T lymphopenia, but polyclonal stimulation of PBMC showed a robust T cell response. The response of his anti-HEV specific interferon-γ producing T cells was low. LESSONS Other studies are now needed to identify the population with a chronic evolution of HEV infection despite no apparent immunodepression.
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Affiliation(s)
- Hugo Barragué
- Centre de Physiopathologie de Toulouse Purpan, INSERM U1043/CNRS UMR5282/Université Toulouse III Paul-Sabatier, Toulouse
| | | | | | - Eric Champagne
- Centre de Physiopathologie de Toulouse Purpan, INSERM U1043/CNRS UMR5282/Université Toulouse III Paul-Sabatier, Toulouse
| | | | - Jacques Izopet
- Centre de Physiopathologie de Toulouse Purpan, INSERM U1043/CNRS UMR5282/Université Toulouse III Paul-Sabatier, Toulouse
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Laboratoire de virologie, Centre National de Référence Hépatite E, Institut fédératif de biologie de Purpan, Toulouse, France
| | - Florence Abravanel
- Centre de Physiopathologie de Toulouse Purpan, INSERM U1043/CNRS UMR5282/Université Toulouse III Paul-Sabatier, Toulouse
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Laboratoire de virologie, Centre National de Référence Hépatite E, Institut fédératif de biologie de Purpan, Toulouse, France
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Huang F, Li Y, Yu W, Jing S, Wang J, Long F, He Z, Yang C, Bi Y, Cao W, Liu C, Hua X, Pan Q. Excretion of infectious hepatitis E virus into milk in cows imposes high risks of zoonosis. Hepatology 2016; 64:350-9. [PMID: 27286751 DOI: 10.1002/hep.28668] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 12/23/2022]
Abstract
UNLABELLED Hepatitis E virus (HEV) represents the main cause of acute hepatitis worldwide. HEV infection in immunocompromised patients involves a high risk for the development of chronic hepatitis. Because HEV is recognized as a zoonotic pathogen, it is currently believed that swine is the primary reservoir. However, this is not sufficient to justify the strikingly high seroprevalence of HEV in both developing and Western countries. Thus, this study aimed to identify new zoonotic sources that bear a high risk of transmission to humans. We collected fecal, blood, and milk samples of cows in a typical rural region of Yunnan Province in southwest China, where mixed farming of domestic animals is a common practice. HEV RNA was quantified by quantitative real-time polymerase chain reaction, and the whole genome was sequenced. HEV infectivity was assessed in rhesus macaques. We found a high prevalence of active HEV infection in cows as determined by viral RNA positivity in fecal samples. Surprisingly, we discovered that HEV is excreted into milk that is produced by infected cows. Phylogenetic analysis revealed that all HEV isolates from cow/milk belong to genotype 4 and subtype 4h. Gavage with HEV-contaminated raw and even pasteurized milk resulted in active infection in rhesus macaques. Importantly, a short period of boiling, but not pasteurization, could completely inactivate HEV. CONCLUSION Infectious HEV-contaminated cow milk is recognized as a new zoonotic source that bears a high risk of transmission to humans; these results call attention to understanding and establishing proper measurement and control of HEV zoonotic transmission, particularly in the setting of mixed farming of domestic animals. (Hepatology 2016;64:350-359).
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Affiliation(s)
- Fen Huang
- Medical Faculty, Kunming University of Science and Technology, Kunming, PR China
| | - Yunlong Li
- Medical Faculty, Kunming University of Science and Technology, Kunming, PR China
| | - Wenhai Yu
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, PR China
| | - Shenrong Jing
- Medical Faculty, Kunming University of Science and Technology, Kunming, PR China
| | - Jue Wang
- Medical Faculty, Kunming University of Science and Technology, Kunming, PR China
| | - Feiyan Long
- Medical Faculty, Kunming University of Science and Technology, Kunming, PR China
| | - Zhanlong He
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, PR China
| | - Chenchen Yang
- Medical Faculty, Kunming University of Science and Technology, Kunming, PR China
| | - Yanhong Bi
- Medical Faculty, Kunming University of Science and Technology, Kunming, PR China
| | - Wentao Cao
- Medical Faculty, Kunming University of Science and Technology, Kunming, PR China
| | - Chengbo Liu
- Medical Faculty, Kunming University of Science and Technology, Kunming, PR China
| | - Xiuguo Hua
- Agriculture and Biotechnology, Shanghai Jiaotong University, Shanghai, PR, China
| | - Qiuwei Pan
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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