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Brüggemann Y, Klöhn M, Wedemeyer H, Steinmann E. Hepatitis E virus: from innate sensing to adaptive immune responses. Nat Rev Gastroenterol Hepatol 2024; 21:710-725. [PMID: 39039260 DOI: 10.1038/s41575-024-00950-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/24/2024]
Abstract
Hepatitis E virus (HEV) infections are a major cause of acute viral hepatitis in humans worldwide. In immunocompetent individuals, the majority of HEV infections remain asymptomatic and lead to spontaneous clearance of the virus, and only a minority of individuals with infection (5-16%) experience symptoms of acute viral hepatitis. However, HEV infections can cause up to 30% mortality in pregnant women, become chronic in immunocompromised patients and cause extrahepatic manifestations. A growing body of evidence suggests that the host immune response to infection with different HEV genotypes is a critical determinant of distinct HEV infection outcomes. In this Review, we summarize key components of the innate and adaptive immune responses to HEV, including the underlying immunological mechanisms of HEV associated with acute and chronic liver failure and interactions between T cell and B cell responses. In addition, we discuss the current status of vaccines against HEV and raise outstanding questions regarding the immune responses induced by HEV and treatment of the disease, highlighting areas for future investigation.
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Affiliation(s)
- Yannick Brüggemann
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Mara Klöhn
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Partner Sites Hannover-Braunschweig, Hannover, Germany
- Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
| | - Eike Steinmann
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany.
- German Center for Infection Research (DZIF), External Partner Site, Bochum, Germany.
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Li W, Du L, Ma Y, Tang H. Successful recovery from acute-on-chronic liver failure due to acute hepatitis E virus superinfection in chronic hepatitis B: A case report. IDCases 2024; 37:e02069. [PMID: 39281308 PMCID: PMC11401153 DOI: 10.1016/j.idcr.2024.e02069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 08/16/2024] [Accepted: 08/24/2024] [Indexed: 09/18/2024] Open
Abstract
Introduction Acute hepatitis E virus (HEV) infection is a self-limiting disease, but HEV superinfection in patients with chronic hepatitis B virus (HBV) infection may lead to acute-on-chronic liver failure (ACLF) and significantly increase short-term mortality. Diagnosis and comprehensive management of these patients remain in a dilemma. Case presentation A 32-year-old man with chronic HBV infection for 8 years received entecavir due to abnormal liver function for 4 months. He was admitted for symptomatic hepatitis flare for nearly 2 weeks. Initial investigations did not reveal a cause other than HBV, but repeated tests showed a progressive increase in his anti-HEV IgM. His condition worsened rapidly. Mid-stage ACLF and spontaneous peritonitis were diagnosed. Entecavir and hepatoprotective drugs were continued. Ribavirin, ceftriaxone, and repeated artificial liver support system (ALSS) therapy were administered. His condition gradually improved and his liver function eventually returned to normal. Conclusions Repeated HEV screening is important for patients with chronic liver disease and symptomatic hepatitis flare. Negative anti-HEV IgM for the first time can easily lead clinicians to mistakenly rule out HEV infection. A progressive increase in anti-HEV IgM is one of the diagnostic criteria for HEV infection, which is not rare but deserves attention. Additionally, comprehensive management including ribavirin and ALSS would be effective therapies for patients who superinfect with HEV and develop ACLF.
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Affiliation(s)
- Weixiu Li
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan Province 610041, PR China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan Province 610041, PR China
| | - Lingyao Du
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan Province 610041, PR China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan Province 610041, PR China
| | - Yuanji Ma
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan Province 610041, PR China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan Province 610041, PR China
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan Province 610041, PR China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan Province 610041, PR China
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Letafati A, Taghiabadi Z, Roushanzamir M, Memarpour B, Seyedi S, Farahani AV, Norouzi M, Karamian S, Zebardast A, Mehrabinia M, Ardekani OS, Fallah T, Khazry F, Daneshvar SF, Norouzi M. From discovery to treatment: tracing the path of hepatitis E virus. Virol J 2024; 21:194. [PMID: 39180020 PMCID: PMC11342613 DOI: 10.1186/s12985-024-02470-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 08/14/2024] [Indexed: 08/26/2024] Open
Abstract
The hepatitis E virus (HEV) is a major cause of acute viral hepatitis worldwide. HEV is classified into eight genotypes, labeled HEV-1 through HEV-8. Genotypes 1 and 2 exclusively infect humans, while genotypes 3, 4, and 7 can infect both humans and animals. In contrast, genotypes 5, 6, and 8 are restricted to infecting animals. While most individuals with a strong immune system experience a self-limiting infection, those who are immunosuppressed may develop chronic hepatitis. Pregnant women are particularly vulnerable to severe illness and mortality due to HEV infection. In addition to liver-related complications, HEV can also cause extrahepatic manifestations, including neurological disorders. The immune response is vital in determining the outcome of HEV infection. Deficiencies in T cells, NK cells, and antibody responses are linked to poor prognosis. Interestingly, HEV itself contains microRNAs that regulate its replication and modify the host's antiviral response. Diagnosis of HEV infection involves the detection of HEV RNA and anti-HEV IgM/IgG antibodies. Supportive care is the mainstay of treatment for acute infection, while chronic HEV infection may be cleared with the use of ribavirin and pegylated interferon. Prevention remains the best approach against HEV, focusing on sanitation infrastructure improvements and vaccination, with one vaccine already licensed in China. This comprehensive review provides insights into the spread, genotypes, prevalence, and clinical effects of HEV. Furthermore, it emphasizes the need for further research and attention to HEV, particularly in cases of acute hepatitis, especially among solid-organ transplant recipients.
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Affiliation(s)
- Arash Letafati
- Department of Virology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran.
| | - Zahra Taghiabadi
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Mahshid Roushanzamir
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
- Department of Pharmacological and Biomolecular Science, University of Milan, Milan, Italy
| | - Bahar Memarpour
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
- Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Saba Seyedi
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | | | - Masoomeh Norouzi
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Saeideh Karamian
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Arghavan Zebardast
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Marzieh Mehrabinia
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Omid Salahi Ardekani
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Tina Fallah
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Fatemeh Khazry
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Samin Fathi Daneshvar
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Mehdi Norouzi
- Department of Virology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
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Zaman K, Julin CH, Aziz AB, Stene-Johansen K, Yunus M, Qadri F, Gurley ES, Sandbu S, Øverbø J, Dembinski JL, Laake I, Bhuiyan TR, Rahman M, Haque W, Khanam M, Clemens JD, Dudman S. Safety and effectiveness of a recombinant hepatitis E vaccine in women of childbearing age in rural Bangladesh: a phase 4, double-blind, cluster-randomised, controlled trial. Lancet Glob Health 2024; 12:e1288-e1299. [PMID: 39030060 DOI: 10.1016/s2214-109x(24)00192-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Hepatitis E virus (HEV) leads to high mortality in pregnant women in low-income countries. We aimed to evaluate the safety of a HEV vaccine and its effectiveness in preventing hepatitis E during pregnancy. METHODS In this phase 4, double-blind, cluster-randomised trial, 67 villages in Matlab, Bangladesh, were randomised 1:1 to receive HEV239 (a recombinant HEV vaccine) or a control vaccine (Hepa-B, a hepatitis B vaccine), using block randomisation with random number tables and blocks of size eight, stratified by cluster population size. Eligible non-pregnant women (aged 16-39 years) were vaccinated intramuscularly on day 0, at 1 month, and at 6 months, and followed up for 2 years after the last immunisation. The primary endpoint was hepatitis E in the pregnant, per-protocol population (those who received all three doses within 2 days of the scheduled dates), while safety was a secondary endpoint, assessed in the intention-to-treat (ITT) population (participants who received at least one dose). Solicited adverse events were recorded for the first 7 days after each dose, and unsolicited events until 2 years after a participant's final dose. Pregnancy-related safety outcomes were assessed in the pregnant ITT population. This study is registered with ClinicalTrials.gov (NCT02759991). FINDINGS Between Oct 2, 2017, and Feb 28, 2019, 19 460 participants were enrolled and received either HEV239 (9478 [48·7%] participants, 33 clusters) or Hepa-B (9982 [51·3%] participants, 34 clusters), of whom 17 937 (92·2%) participants received three doses and 17 613 (90·5%) were vaccinated according to protocol (8524 [48·4%] in the HEV239 group and 9089 [51·6%] in the control group). No pregnant participants were confirmed to have hepatitis E in either treatment group. HEV239 showed a mild safety profile, similar to Hepa-B, with no difference in the proportion of solicited adverse events between groups and no severe solicited events. Pain was the most common local symptom (1215 [12·8%] HEV239 recipients and 1218 [12·2%] Hepa-B recipients) and fever the most common systemic symptom (141 [1·5%] HEV239 recipients and 145 [1·5%] Hepa-B recipients). None of the serious adverse events or deaths were vaccine related. Among pregnant participants, the HEV239 group had a higher risk of miscarriage (136 [5·7%] of 2407 pregnant participants) compared with the control group (102 [3·9%] of 2604; adjusted odds ratio 1·54 [95% CI 1·15-2·08]). INTERPRETATION The effectiveness of HEV239 in pregnant women remains uncertain. HEV239 was safe and well tolerated in non-pregnant women, but findings regarding miscarriage warrant further investigation. FUNDING Research Council of Norway; Innovax.
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Affiliation(s)
- Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Cathinka Halle Julin
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Asma Binte Aziz
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; International Vaccine Institute, Seoul, South Korea
| | | | - Md Yunus
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Emily S Gurley
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Synne Sandbu
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Joakim Øverbø
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Jennifer L Dembinski
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Ida Laake
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Warda Haque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mahbuba Khanam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - John D Clemens
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Susanne Dudman
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Oslo University Hospital, Oslo, Norway.
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Rivero MA, Arce LP, Gutiérrez SE, Tisnés A, Passucci JA, Silva JA, Barón Prato A, Sánchez F, Matias Brancher J, Estein SM, Vizoso-Pinto MG. Exploring hepatitis E virus seroprevalence and associated risk factors among the human population in Tandil, Buenos Aires, Argentina. Front Public Health 2023; 11:1257754. [PMID: 37869189 PMCID: PMC10585172 DOI: 10.3389/fpubh.2023.1257754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Background Hepatitis E virus (HEV) infection is a common cause of acute clinical hepatitis worldwide and is emerging as a disease in Argentina. It is primarily transmitted through contaminated water and food, following the fecal-oral route. Furthermore, is a zoonotic disease with swine as the primary reservoir. Prevalence of HEV infection in humans in several regions of Argentina remains unknown. Objectives (i) Determine the seroprevalence of HEV among the human population in Tandil, Buenos Aires, Argentina; (ii) Evaluate its association with demographic, socioeconomic and other risk exposures variables, and (iii) Describe and analyze spatial patterns related to HEV infection. Methods From August 2020 to July 2021, serum samples were collected from 969 individuals aged 1-80 years. Seroprevalence and 95% Confidence Interval was determined. To assess the factors associated with the presence of anti-HEV antibodies, associations between the variables and seropositivity were evaluated through bivariate and multivariate analysis. Spatial scanning for clusters of positivity was carried out. Factors associated with these clusters were also assessed. Results Anti-HEV antibodies were detected in 4.64% (IC 95% 3.27-6.02) of samples. Dark urine was associated with seropositivity (p = 0.02). Seropositivity was linked with the presence of natural water courses near their households (p = 0.02); the age (p = 0.04); and previous travel to Europe (p = 0.04). A spatial cluster of low rates of HEV seropositivity was detected, with greater distance of the households to water courses associated to the cluster, and male sex inversely associated to it. Discussion and conclusion This study is the first study to investigate the prevalence of HEV in the population from Tandil, Buenos Aires, Argentina. Considering HEV infection in the differential diagnosis in individuals presenting acute hepatitis is highlighted. The incorporation of HEV testing into blood screening policies should be mandatory. Factors related to the infection and spatial patterns of high and low risk were determined, and should be considered when implementing specific preventive measures.
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Affiliation(s)
- Mariana Alejandra Rivero
- Centro de Investigación Veterinaria de Tandil (UNCPBA-CICPBA-CONICET), Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Tandil, Argentina
| | - Lorena Paola Arce
- Laboratorio de Biología de las Infecciones, Instituto Superior de Investigaciones Biológicas (INSIBIO), CONICET-UNT, Tucumán, Argentina
- Laboratorio de Ciencias Básicas Or. Genética, Facultad de Medicina de la Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Silvina Elena Gutiérrez
- Centro de Investigación Veterinaria de Tandil (UNCPBA-CICPBA-CONICET), Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Tandil, Argentina
| | - Adela Tisnés
- Facultad de Ciencias Humanas, CIG- IGEHCS- CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Tandil, Argentina
| | - Juan Antonio Passucci
- Centro de Investigación Veterinaria de Tandil (UNCPBA-CICPBA-CONICET), Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Tandil, Argentina
| | - Julia Analia Silva
- Centro de Investigación Veterinaria de Tandil (UNCPBA-CICPBA-CONICET), Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Tandil, Argentina
| | - Ayelén Barón Prato
- Facultad de Ciencias Humanas, CIG- IGEHCS- CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Tandil, Argentina
| | - Florencia Sánchez
- Centro de Investigación Veterinaria de Tandil (UNCPBA-CICPBA-CONICET), Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Tandil, Argentina
| | - Julia Matias Brancher
- Laboratorio de Ciencias Básicas Or. Genética, Facultad de Medicina de la Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Silvia Marcela Estein
- Centro de Investigación Veterinaria de Tandil (UNCPBA-CICPBA-CONICET), Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Tandil, Argentina
| | - María Guadalupe Vizoso-Pinto
- Laboratorio de Biología de las Infecciones, Instituto Superior de Investigaciones Biológicas (INSIBIO), CONICET-UNT, Tucumán, Argentina
- Laboratorio de Ciencias Básicas Or. Genética, Facultad de Medicina de la Universidad Nacional de Tucumán, Tucumán, Argentina
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Liu R, Tan C, Wu J, Xu Y, Li X, Zhong Z, Li S, Qiu Y, Feng B. Characterization of genotype IV hepatitis E virus-like particles expressed in E.coli. Heliyon 2023; 9:e15284. [PMID: 37095953 PMCID: PMC10122030 DOI: 10.1016/j.heliyon.2023.e15284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 03/05/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023] Open
Abstract
HEV (Hepatitis E virus) is an infectious disease transmitted between humans and animals, which poses a severe threat to the biological safety and property throughout the world. The disease is especially severe in patients with potential liver cirrhosis and women during pregnancy. There is no specific and thorough HEV treatment at present. The development of hepatitis E virus vaccine is vital to the prevention of viral hepatitis worldwide. Since HEV cannot grow adequately in vitro, vaccine developed by devitalized virus particles does not work. Exploration of HEV-like structures is essential for the development of functional vaccines against HEV infection. ORF2 encodes the structural proteins of HEV, some of which can automatically assemble into virus-like particles (VLP) in this experiment, the recombinant capsid protein p27 was expressed in E. coli and the VLP formed by p27 was used to immunize mice. The results showed that the VLP formed by recombinant P27 had similar particle size to that of HEV; the immune dose produced by p27 was positively correlated with the immune effect. Compared with other genetic engineering subunit vaccines, P27 protein has a better application prospect.
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Affiliation(s)
- Rushi Liu
- Laboratory of Medical Molecular and Immunological Diagnostics, School of Medicine, Hunan Normal University, Changsha, 410013, China
| | - Chufan Tan
- Laboratory of Medical Molecular and Immunological Diagnostics, School of Medicine, Hunan Normal University, Changsha, 410013, China
| | - Junwen Wu
- Nanya Middle School of Changsha, Changsha, 410129, China
| | - Ye Xu
- Laboratory of Medical Molecular and Immunological Diagnostics, School of Medicine, Hunan Normal University, Changsha, 410013, China
| | - Xiaofeng Li
- Laboratory of Medical Molecular and Immunological Diagnostics, School of Medicine, Hunan Normal University, Changsha, 410013, China
| | - Zhihong Zhong
- Laboratory of Medical Molecular and Immunological Diagnostics, School of Medicine, Hunan Normal University, Changsha, 410013, China
| | - Sang Li
- Laboratory of Medical Molecular and Immunological Diagnostics, School of Medicine, Hunan Normal University, Changsha, 410013, China
| | - Yilan Qiu
- School of Life Science, Hunan Normal University, Changsha, 410081, China
- Corresponding author.
| | - Bo Feng
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 410008, China
- Corresponding author.
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Yang J, Yuan X, Hao Y, Shi X, Yang X, Yan W, Chen L, Zhang D, Shen C, Li D, Zhu Z, Liu X, Zheng H, Zhang K. Proteins in pregnant swine serum promote the African swine fever virus replication: an iTRAQ-based quantitative proteomic analysis. Virol J 2023; 20:54. [PMID: 36978180 PMCID: PMC10043535 DOI: 10.1186/s12985-023-02004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
African swine fever (ASF) is a severe infectious disease caused by the African swine fever virus (ASFV), seriously endangering the global pig industry. ASFV possesses a large genome, strong mutation ability, and complex immune escape mechanisms. Since the first case of ASF was reported in China in August 2018, it has had a significant impact on social economy and food safety. In the present study, pregnant swine serum (PSS) was found to promote viral replication; differentially expressed proteins (DEPs) in PSS were screened and identified using the isobaric tags for relative and absolute quantitation technology and compared with those in non-pregnant swine serum (NPSS). The DEPs were analyzed using Gene Ontology functional annotation, Kyoto Protocol Encyclopedia of Genes and Genome pathway enrichment, and protein-protein interaction networks. In addition, the DEPs were validated via western blot and RT-qPCR experiments. And the 342 of DEPs were identified in bone marrow-derived macrophages cultured with PSS compared with the NPSS. The 256 were upregulated and 86 of DEPs were downregulated. The primary biological functions of these DEPs involved signaling pathways that regulate cellular immune responses, growth cycles, and metabolism-related pathways. An overexpression experiment showed that the PCNA could promote ASFV replication whereas MASP1 and BST2 could inhibit it. These results further indicated that some protein molecules in PSS were involved in the regulation of ASFV replication. In the present study, the role of PSS in ASFV replication was analyzed using proteomics, and the study will be provided a basis for future detailed research on the pathogenic mechanism and host interactions of ASFV as well as new insights for the development of small-molecule compounds to inhibit ASFV.
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Affiliation(s)
- Jinke Yang
- State Key Laboratory for Animal Disease Control and Prevention, College of Veterinary Medicine, Lanzhou University, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China
| | - Xingguo Yuan
- State Key Laboratory for Animal Disease Control and Prevention, College of Veterinary Medicine, Lanzhou University, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China
| | - Yu Hao
- State Key Laboratory for Animal Disease Control and Prevention, College of Veterinary Medicine, Lanzhou University, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China
| | - Xijuan Shi
- State Key Laboratory for Animal Disease Control and Prevention, College of Veterinary Medicine, Lanzhou University, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China
| | - Xing Yang
- State Key Laboratory for Animal Disease Control and Prevention, College of Veterinary Medicine, Lanzhou University, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China
| | - Wenqian Yan
- State Key Laboratory for Animal Disease Control and Prevention, College of Veterinary Medicine, Lanzhou University, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China
| | - Lingling Chen
- State Key Laboratory for Animal Disease Control and Prevention, College of Veterinary Medicine, Lanzhou University, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China
| | - Dajun Zhang
- State Key Laboratory for Animal Disease Control and Prevention, College of Veterinary Medicine, Lanzhou University, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China
| | - Chaochao Shen
- State Key Laboratory for Animal Disease Control and Prevention, College of Veterinary Medicine, Lanzhou University, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China
| | - Dan Li
- State Key Laboratory for Animal Disease Control and Prevention, College of Veterinary Medicine, Lanzhou University, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China
| | - Zixiang Zhu
- State Key Laboratory for Animal Disease Control and Prevention, College of Veterinary Medicine, Lanzhou University, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China
| | - Xiangtao Liu
- State Key Laboratory for Animal Disease Control and Prevention, College of Veterinary Medicine, Lanzhou University, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China
| | - Haixue Zheng
- State Key Laboratory for Animal Disease Control and Prevention, College of Veterinary Medicine, Lanzhou University, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China.
| | - Keshan Zhang
- State Key Laboratory for Animal Disease Control and Prevention, College of Veterinary Medicine, Lanzhou University, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730000, China.
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Detection of Hepatitis E Virus Genotype 3 in Feces of Capybaras (Hydrochoeris hydrochaeris) in Brazil. Viruses 2023; 15:v15020335. [PMID: 36851548 PMCID: PMC9959927 DOI: 10.3390/v15020335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Hepatitis E virus (HEV) is an emerging zoonotic pathogen associated with relevant public health issues. The aim of this study was to investigate HEV presence in free-living capybaras inhabiting urban parks in São Paulo state, Brazil. Molecular characterization of HEV positive samples was undertaken to elucidate the genetic diversity of the virus in these animals. A total of 337 fecal samples were screened for HEV using RT-qPCR and further confirmed by conventional nested RT-PCR. HEV genotype and subtype were determined using Sanger and next-generation sequencing. HEV was detected in one specimen (0.3%) and assigned as HEV-3f. The IAL-HEV_921 HEV-3f strain showed a close relationship to European swine, wild boar and human strains (90.7-93.2% nt), suggesting an interspecies transmission. Molecular epidemiology of HEV is poorly investigated in Brazil; subtype 3f has been reported in swine. This is the first report of HEV detected in capybara stool samples worldwide.
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Hepatitis E Virus Seroprevalence Indicated a Significantly Increased Risk Selectively in Patients with Gastric Cancer among 17 Common Malignancies. J Clin Med 2023; 12:jcm12020437. [PMID: 36675366 PMCID: PMC9861101 DOI: 10.3390/jcm12020437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/24/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
Background: The impact of hepatitis E virus (HEV) infection on cancer development has been poorly investigated. This study aimed to explore the relationship between HEV seroprevalence and cancer risks and to identify high cancer risk subgroups in HEV-exposed populations. Methods: HEV seroprevalence status was determined in cancer and non-cancer subjects. Logistic regression and sensitivity analyses were used to assess the relationship between HEV antibody seropositivity and cancer risk for 17 cancer types. Additionally, interaction analyses were applied to interpret the association of HEV seroprevalence and other cancer risk factors. Results: Of the enrolled 4948 cancer and 4948 non-cancer subjects, cancer subjects had a higher anti-HEV seropositivity than non-cancer subjects (46.36% vs. 32.50%, p < 0.01). However, this divergency varied in degrees across different cancer types. Additionally, HEV seroprevalence was associated with cancer risk in young males (OR: 1.64, 95% CI: 1.19−2.27, p < 0.01). Remarkably, a significant association between HEV seroprevalence and cancer risk was observed only in gastric cancer patients (OR: 1.82, 95% CI: 1.07−3.09, p = 0.03). Conclusions: HEV seroprevalence was associated with cancer risk selectively in gastric cancer patients and young males, suggesting that cancer screening, particularly gastric cancer, should be regularly performed in young males with a history of HEV exposure.
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10
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Prevalence of hepatitis E virus and its association with adverse pregnancy outcomes in pregnant women in China. J Clin Virol 2023; 158:105353. [PMID: 36527809 DOI: 10.1016/j.jcv.2022.105353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/12/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatitis E virus (HEV) infection has become a global concern, especially in pregnant women. However, the association between HEV prevalence and age, gravidity and parity of pregnant women remains unclear. METHODS Pregnant women (n=19,762) were enrolled for HEV prevalence and associated adverse pregnancy outcomes investigation in Qujing City, Yunnan Province of China from May 2019 to December 2020. RESULTS The seroprevalence of HEV was 11.6% (2,297/19,762; 95% CI:11.2%-12.1%). About 11.4% (2,247/19,762; 95% CI:10.9%-11.8%) were positive for anti-HEV IgG antibody, 0.1% (22/19,762; 95% CI:0.1%-0.2%) were positive for anti-HEV IgM antibody, and 0.1% (28/19,762; 95% CI:0.1%-0.2%) were positive for both anti-HEV IgM and IgG antibodies. Sixty-one out of 2,297 anti-HEV-antibodies-positive pregnant women were positive for HEV RNA. Phylogenetic analysis revealed that all HEV isolates from pregnant women belong to genotype 4. Age, gravidity and parity are associated with increased prevalence of HEV. Pregnant women positive for HEV-IgG antibody bear a higher risk for an adverse pregnancy history and liver injury with elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels than anti-HEV-negative pregnant women. Furthermore, seropositive pregnant women suffered a higher adverse maternal outcomes risk (crude odds ratio [cOR]=1.29; 95% CI: 1.16-1.43; adjusted odds ratio [aOR]=1.40, 95% CI: 1.25-1.55 for anti-HEV-IgG-positive pregnant women and cOR=1.38, 95% CI: 1.02-1.86; aOR=1.43, 95% CI: 1.05-1.95 for anti-HEV-IgM-positive pregnant women) and fetal outcomes risk (cOR=1.80, 95% CI: 1.61-2.01; aOR=1.77, 95% CI: 1.57-1.99) than anti-HEV-negative pregnant women. Adverse pregnancy outcomes of HEV infection are aggravated by age, gravidity and parity. CONCLUSION In this study, we demonstrated high prevalence of HEV in pregnancy women in China, and HEV infection can cause various adverse maternal and neonatal outcomes.
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11
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Lynch JA, Lim JK, Asaga PEP, Wartel TA, Marti M, Yakubu B, Rees H, Talaat K, Kmush B, Aggarwal R, Ciglenecki I, Gurley E, Labrique AB. Hepatitis E vaccine-Illuminating the barriers to use. PLoS Negl Trop Dis 2023; 17:e0010969. [PMID: 36602994 DOI: 10.1371/journal.pntd.0010969] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
| | | | | | | | - Melanie Marti
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Beno Yakubu
- National Agency for Food and Drug Administration and Control (NAFDAC), Nigeria
| | - Helen Rees
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Kawsar Talaat
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Brittany Kmush
- Department of Public Health, Syracuse University, Syracuse, New York, United States of America
| | - Rakesh Aggarwal
- Department of Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Emily Gurley
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Alain B Labrique
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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12
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Murison KR, Grima AA, Simmons AE, Tuite AR, Fisman DN. Severity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Pregnancy in Ontario: A Matched Cohort Analysis. Clin Infect Dis 2022; 76:e200-e206. [PMID: 35792660 PMCID: PMC9907552 DOI: 10.1093/cid/ciac544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pregnancy represents a physiological state associated with increased vulnerability to severe outcomes from infectious diseases, both for the pregnant person and developing infant. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic may have important health consequences for pregnant individuals, who may also be more reluctant than nonpregnant people to accept vaccination. METHODS We sought to estimate the degree to which increased severity of SARS-CoV-2 outcomes can be attributed to pregnancy using a population-based SARS-CoV-2 case file from Ontario, Canada. Because of varying propensity to receive vaccination, and changes in dominant circulating viral strains over time, a time-matched cohort study was performed to evaluate the relative risk of severe illness in pregnant women with SARS-CoV-2 compared to other SARS-CoV-2 infected women of childbearing age (10-49 years old). Risk of severe SARS-CoV-2 outcomes was evaluated in pregnant women and time-matched nonpregnant controls using multivariable conditional logistic regression. RESULTS Compared with the rest of the population, nonpregnant women of childbearing age had an elevated risk of infection (standardized morbidity ratio, 1.28), whereas risk of infection was reduced among pregnant women (standardized morbidity ratio, 0.43). After adjustment for confounding, pregnant women had a markedly elevated risk of hospitalization (adjusted odds ratio, 4.96; 95% confidence interval, 3.86-6.37) and intensive care unit admission (adjusted odds ratio, 6.58; 95% confidence interval, 3.29-13.18). The relative increase in hospitalization risk associated with pregnancy was greater in women without comorbidities than in those with comorbidities (P for heterogeneity, .004). CONCLUSIONS Given the safety of SARS-CoV-2 vaccines in pregnancy, risk-benefit calculus strongly favors SARS-CoV-2 vaccination in pregnant women.
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Affiliation(s)
- Kiera R Murison
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alicia A Grima
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alison E Simmons
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ashleigh R Tuite
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - David N Fisman
- Correspondence: D. Fisman, Room 686, 155 College St, Toronto, Ontario, Canada, M5T 3M7 ()
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13
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Hepatitis E Virus Infection in Cancer Patients. Transplant Cell Ther 2022; 28:788.e1-788.e5. [DOI: 10.1016/j.jtct.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/06/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022]
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14
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Chowdhury SR, Bhoumik A, Gupta VK, Majumder HK. Type II DNA Topoisomerases in trypanosomatid and apicomplexan parasites. Acta Trop 2022; 234:106613. [PMID: 35905776 DOI: 10.1016/j.actatropica.2022.106613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/01/2022]
Abstract
Diseases caused by trypanosomatid parasites have no commercially available vaccines for human application. Treatment modalities completely rely on chemotherapeutics strategies that often exhibit clinical drawbacks, like host toxicity, side effects and treatment failure for drug resistance. These, in many instances, are costly, making them unaffordable for certain groups of beneficiaries. To find reasonable solutions, researchers are attempting to identify and validate new drug targets that would offer parasite specificity. DNA topoisomerases in parasites present a consolidated class of drug targets due to their multiple structural and functional differences with host homologs. Type II DNA topoisomerases in these parasites, in particular, have been attracting interest of scientific community attributable to their pivotal role in the replication of the atypical DNA. In this article, we present a detailed review of structural and functional features of type II DNA topoisomerases of clinically-relevant trypanosomatid and apicomplexan parasites. Also, we provide up-to-date information on different molecules that target these enzymes. Altogether, the review will largely help in understanding the rationale for exploiting type II DNA topoisomerases in these groups of parasites as drug targets.
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Affiliation(s)
- Somenath Roy Chowdhury
- Institut für Physikalische Chemie, Westfälische Wilhelms-Universität Münster, Correnstrasse 28, 48149, Münster.
| | - Arpita Bhoumik
- Infectious Diseases & Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata, 700 032
| | - Vivek Kumar Gupta
- Organic and Medicinal Chemistry Division, CSIR-Indian Institute of Chemical Biology, Kolkata 700 032
| | - Hemanta K Majumder
- Infectious Diseases & Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata, 700 032
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15
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Chen C, Zhang SY, Chen L. Review of clinical characteristics, immune responses and regulatory mechanisms of hepatitis E-associated liver failure. World J Clin Cases 2022; 10:6341-6348. [PMID: 35979284 PMCID: PMC9294909 DOI: 10.12998/wjcc.v10.i19.6341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/17/2022] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatitis E virus (HEV) is the most common cause of acute liver failure (LF) and one of the most common factors causing acute injury in acute-on-chronic LF (ACLF). When HEV-related LF occurs, a series of changes take place in both the intrahepatic environment and extrahepatic microenvironment. The changed types and distribution of immune cells (infiltrating macrophages and increased lymphocytes) in liver tissue, as well the increased proinflammatory cytokines and chemokines in the blood, indicate that the occurrence and progression of HEV-related LF are closely related to immune imbalance. The clinical features and immune reaction in the body during HEV-related acute LF (ALF) and ACLF are complicated. This review highlights recent progress in elucidating the clinical manifestations of HEV-associated ALF and ACLF and discusses the corresponding systemic immune changes and possible regulatory mechanisms.
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Affiliation(s)
- Chong Chen
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Shu-Ye Zhang
- Department of Hepatology, Shanghai Public Health Clinical Center, Shanghai 201508, China
| | - Liang Chen
- Department of Hepatology, Shanghai Public Health Clinical Center, Shanghai 201508, China
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16
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Marascio N, Rotundo S, Quirino A, Matera G, Liberto MC, Costa C, Russo A, Trecarichi EM, Torti C. Similarities, differences, and possible interactions between hepatitis E and hepatitis C viruses: Relevance for research and clinical practice. World J Gastroenterol 2022; 28:1226-1238. [PMID: 35431515 PMCID: PMC8968488 DOI: 10.3748/wjg.v28.i12.1226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/06/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatitis E virus (HEV) and hepatitis C virus (HCV) are both RNA viruses with a tropism for liver parenchyma but are also capable of extrahepatic manifestations. Hepatitis E is usually a viral acute fecal-oral transmitted and self-limiting disease presenting with malaise, jaundice, nausea and vomiting. Rarely, HEV causes a chronic infection in immunocompromised persons and severe fulminant hepatitis in pregnant women. Parenteral HCV infection is typically asymptomatic for decades until chronic complications, such as cirrhosis and cancer, occur. Despite being two very different viruses in terms of phylogenetic and clinical presentations, HEV and HCV show many similarities regarding possible transmission through organ transplantation and blood transfusion, pathogenesis (production of antinuclear antibodies and cryoglobulins) and response to treatment with some direct-acting antiviral drugs. Although both HEV and HCV are well studied individually, there is a lack of knowledge about coinfection and its consequences. The aim of this review is to analyze current literature by evaluating original articles and case reports and to hypothesize some interactions that can be useful for research and clinical practice.
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Affiliation(s)
- Nadia Marascio
- Department of Health Sciences, Unit of Microbiology, University “Magna Graecia” of Catanzaro, Catanzaro 88100, Italy
| | - Salvatore Rotundo
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, "Magna Graecia" University of Catanzaro, Catanzaro 88100, Italy
| | - Angela Quirino
- Department of Health Sciences, Unit of Microbiology, University “Magna Graecia” of Catanzaro, Catanzaro 88100, Italy
| | - Giovanni Matera
- Department of Health Sciences, Unit of Microbiology, University “Magna Graecia” of Catanzaro, Catanzaro 88100, Italy
| | - Maria Carla Liberto
- Department of Health Sciences, Unit of Microbiology, University “Magna Graecia” of Catanzaro, Catanzaro 88100, Italy
| | - Chiara Costa
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, "Magna Graecia" University of Catanzaro, Catanzaro 88100, Italy
| | - Alessandro Russo
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, "Magna Graecia" University of Catanzaro, Catanzaro 88100, Italy
| | - Enrico Maria Trecarichi
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, "Magna Graecia" University of Catanzaro, Catanzaro 88100, Italy
| | - Carlo Torti
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, "Magna Graecia" University of Catanzaro, Catanzaro 88100, Italy
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17
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Heemelaar S, Hangula AL, Chipeio ML, Josef M, Stekelenburg J, van den Akker TH, Pischke S, Mackenzie SBP. Maternal and fetal outcomes of pregnancies complicated by acute hepatitis E and the impact of HIV status: A cross-sectional study in Namibia. Liver Int 2022; 42:50-58. [PMID: 34623734 PMCID: PMC9298024 DOI: 10.1111/liv.15076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/26/2021] [Accepted: 09/27/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Namibia has been suffering from an outbreak of hepatitis E genotype 2 since 2017. As nearly half of hepatitis E-related deaths were among pregnant and postpartum women, we analysed maternal and fetal outcomes of pregnancies complicated by acute hepatitis E and assessed whether HIV-status impacted on outcome. METHODS A retrospective cross-sectional study was performed at Windhoek Hospital Complex. Pregnant and postpartum women, admitted between 13 October 2017 and 31 May 2019 with reactive IgM for Hepatitis E, were included. Outcomes were acute liver failure (ALF), maternal death, miscarriage, intra-uterine fetal death and neonatal death. Odds ratios (OR) and 95% confidence interval (CI) were calculated. RESULTS Seventy women were included. ALF occurred in 28 (40.0%) of whom 13 died amounting to a case fatality rate of 18.6%. Sixteen women (22.9%) were HIV infected, compared to 16.8% among the general pregnant population (OR 1.47, 95% CI 0.84-2.57, P = .17). ALF occurred in 4/5 (80%) HIV infected women not adherent to antiretroviral therapy compared to 1/8 (12.5%) women adherent to antiretroviral therapy (OR 28.0, 95% CI 1.4-580.6). There were 10 miscarriages (14.3%), five intra-uterine fetal deaths (7.1%) and four neonatal deaths (5.7%). CONCLUSIONS One in five pregnant women with Hepatitis E genotype 2 died, which is comparable to genotype 1 outbreaks. Despite small numbers, HIV infected women receiving antiretroviral therapy appear to be less likely to develop ALF in contrast with HIV infected women not on treatment. As there is currently no curative treatment, this phenomenon needs to be assessed in larger cohorts.
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Affiliation(s)
- Steffie Heemelaar
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia,Present address:
Department of Obstetrics and GynaecologyLeiden University Medical CenterLeidenThe Netherlands
| | - Anna L. Hangula
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia
| | - Melody L. Chipeio
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia
| | - Mirjam Josef
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia
| | - Jelle Stekelenburg
- Department of Health SciencesGlobal Health UnitUniversity Medical Center GroningenGroningenThe Netherlands,Department of Obstetrics and GynaecologyMedical Center LeeuwardenLeeuwardenThe Netherlands
| | - Thomas H. van den Akker
- Department of Obstetrics and GynaecologyLeiden University Medical CenterLeidenThe Netherlands,Faculty of ScienceVU UniversityAthena InstituteAmsterdamThe Netherlands
| | - Sven Pischke
- Department of MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Shonag B. P. Mackenzie
- Department of Obstetrics and GynaecologyKatutura State HospitalWindhoekNamibia,Present address:
Department of Obstetrics and GynaecologyBorders General HospitalMelroseUnited Kingdom
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18
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Serological Evidence of Hepatitis E Virus Infection in Semi-Domesticated Eurasian Tundra Reindeer ( Rangifer tarandus tarandus) in Norway. Pathogens 2021; 10:pathogens10121542. [PMID: 34959497 PMCID: PMC8709481 DOI: 10.3390/pathogens10121542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 01/23/2023] Open
Abstract
Hepatitis E virus (HEV) is a common cause of viral hepatitis in humans. In developing countries, HEV-infections seem to be mainly associated with pigs, but other animal species may be involved in viral transmission. Recently, anti-HEV antibodies were detected in Norwegian wild reindeer. Here, we investigated anti-HEV seroprevalence in Norwegian semi-domesticated reindeer, animals in closer contact with humans than their wild counterparts. Blood samples (n = 516) were obtained from eight reindeer herds during the period 2013–2017 and analysed with a commercial enzyme-linked immunosorbent assay designed for detecting anti-HEV antibodies in livestock. Antibodies were found in all herds and for all sampling seasons. The overall seroprevalence was 15.7% (81/516), with adults showing a slightly higher seroprevalence (18.0%, 46/256) than calves (13.5%, 35/260, p = 0.11). The seroprevalence was not influenced by gender or latitude, and there was no temporal trend (p > 0.15). A positive association between the presence of anti-HEV antibodies and antibodies against alphaherpesvirus and pestivirus, detected in a previous screening, was found (p < 0.05). We conclude that Norwegian semi-domesticated reindeer are exposed to HEV or an antigenically similar virus. Whether the virus is affecting reindeer health or infects humans and poses a threat for human health remains unknown and warrants further investigations.
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19
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Wu J, Ling B, Guo N, Zhai G, Li M, Guo Y. Immunological Manifestations of Hepatitis E-Associated Acute and Chronic Liver Failure and Its Regulatory Mechanisms. Front Med (Lausanne) 2021; 8:725993. [PMID: 34434948 PMCID: PMC8380956 DOI: 10.3389/fmed.2021.725993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022] Open
Abstract
Hepatitis E virus (HEV) is a common cause of viral hepatitis in developing countries, most commonly transmitted through the fecal-oral route. The virus is mainly of genotypes (GT) 1 and GT2 genotypes, and patients usually show symptoms of acute hepatitis. Due to the rising trend of HEV serological prevalence in global population, HEV has become an important public health problem in developed countries. Severe hepatitis caused by HEV includes acute and chronic liver failure (ACLF). ACLF frequently occurs in developed countries and is caused by overlapping chronic liver diseases of HEV with genotypes GT3 and GT4. Because the onset of hepatitis E is closely associated with immunity, it is critical to understand the immunological mechanism of hepatitis E associated with acute and chronic liver failure (HEV-ACLF). This review discusses the immunological manifestations and mechanisms of HEV-ACLF, intrahepatic immune microenvironment and treatment, and raises outstanding questions about the immunological mechanism and treatment of the disease.
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Affiliation(s)
- Jian Wu
- Department of Clinical Laboratory, Gusu School, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, China
| | - Bai Ling
- Department of Pharmacy, The First People's Hospital of Yancheng City, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, China
| | - Naizhou Guo
- Department of Clinical Laboratory, The First People's Hospital of Yancheng City, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, China
| | - Guanghua Zhai
- Department of Clinical Laboratory, Gusu School, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, China
| | - Meifen Li
- Department of Clinical Laboratory, Gusu School, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, China
| | - Yurong Guo
- Department of Laboratory Medicine, Yancheng Hospital of Traditional Chinese Medicine, Affiliated to Nanjing University of Traditional Chinese Medicine, Yancheng, China
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20
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Velavan TP, Pallerla SR, Johne R, Todt D, Steinmann E, Schemmerer M, Wenzel JJ, Hofmann J, Shih JWK, Wedemeyer H, Bock CT. Hepatitis E: An update on One Health and clinical medicine. Liver Int 2021; 41:1462-1473. [PMID: 33960603 DOI: 10.1111/liv.14912] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 03/09/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
The hepatitis E virus (HEV) is one of the main causes of acute hepatitis and the de facto global burden is underestimated. HEV-related clinical complications are often undetected and are not considered in the differential diagnosis. Convincing findings from studies suggest that HEV is clinically relevant not only in developing countries but also in industrialized countries. Eight HEV genotypes (HEV-1 to HEV-8) with different human and animal hosts and other HEV-related viruses are in circulation. Transmission routes vary by genotype and location, with large waterborne outbreaks in developing countries and zoonotic food-borne infections in developed countries. An acute infection can be aggravated in pregnant women, organ transplant recipients, patients with pre-existing liver disease and immunosuppressed patients. HEV during pregnancy affects the fetus and newborn with an increased risk of vertical transmission, preterm and stillbirth, neonatal jaundice and miscarriage. Hepatitis E is associated with extrahepatic manifestations that include neurological disorders such as neuralgic amyotrophy, Guillain-Barré syndrome and encephalitis, renal injury and haematological disorders. The risk of transfusion-transmitted HEV is increasingly recognized in Western countries where the risk may be because of a zoonosis. RNA testing of blood components is essential to determine the risk of transfusion-transmitted HEV. There are currently no approved drugs or vaccines for HEV infections. This review focuses on updating the latest developments in zoonoses, screening and diagnostics, drugs in use and under development, and vaccines.
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Affiliation(s)
- Thirumalaisamy P Velavan
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Vietnamese-German Center for Medical Research, VG-CARE, Hanoi, Vietnam.,Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Srinivas R Pallerla
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Vietnamese-German Center for Medical Research, VG-CARE, Hanoi, Vietnam
| | - Reimar Johne
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - Daniel Todt
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany.,European Virus Bioinformatics Center (EVBC), Jena, Germany
| | - Eike Steinmann
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Mathias Schemmerer
- Institute of Clinical Microbiology and Hygiene, National Consultant Laboratory for HAV and HEV, University Medical Center Regensburg, Regensburg, Germany
| | - Jürgen J Wenzel
- Institute of Clinical Microbiology and Hygiene, National Consultant Laboratory for HAV and HEV, University Medical Center Regensburg, Regensburg, Germany
| | - Jörg Hofmann
- Institute of Virology, Charité Universitätsmedizin Berlin, Labor Berlin-Charité-Vivantes GmbH, Berlin, Germany
| | | | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research, Partner Hannover-Braunschweig, Braunschweig, Germany
| | - Claus-Thomas Bock
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
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21
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Zorzetto R, Klein RL, Erpen LMS, Klein BD, Giacobbo I, da Silveira RA, Frandoloso R, Kreutz LC. Unusual high prevalence of antibodies to hepatitis E virus in South Brazil. FEMS Microbiol Lett 2021; 368:6312495. [PMID: 34196363 DOI: 10.1093/femsle/fnab076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/15/2021] [Indexed: 01/16/2023] Open
Abstract
Hepatitis E virus (HEV) is worldwide distributed and might cause acute or chronic hepatitis mainly in immunocompromised individuals. In previous studies we found a high prevalence of antibodies to HEV within blood donors in south Brazil and also within backyard-raised pigs. Here, we aimed to investigate the prevalence of anti-HEV antibody and HEV RNA within the general population from three major municipalities (Caxias do Sul, Passo Fundo and Santa Maria) in south Brazil. A total of 3000 blood samples were randomly obtained from clinical laboratories at each of the three municipality (n = 1000 each) to determine the presence of anti-HEV antibodies and HEV RNA. Overall, anti-HEV antibodies were detected in 574/1000 (57,4%) samples in Caxias do Sul, 655/1000 (65.5%) samples in Passo Fundo and 554/1000 (55.4%) samples in Santa Maria. The prevalence of HEV-positive samples increased steadily and significantly (P < 0,001) with age and was unusually higher within individual over 40 years. Despite of this, none of the pooled serum samples had detectable levels of HEV RNA. The high anti-HEV antibody prevalence suggests that the virus might be present on the environment and/or foodstuff and poses a permanent threat to immune-compromised individuals.
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Affiliation(s)
- Renata Zorzetto
- Laboratório de Microbiologia e Imunologia Avançada, Faculdade de Agronomia e Medicina Veterinária, Universidade de Passo Fundo, BR 285, Km 292 - Campus I, Bairro São José, Passo Fundo, 99052-900, Brazil
| | - Rafaela Luiza Klein
- Laboratório de Microbiologia e Imunologia Avançada, Faculdade de Agronomia e Medicina Veterinária, Universidade de Passo Fundo, BR 285, Km 292 - Campus I, Bairro São José, Passo Fundo, 99052-900, Brazil
| | - Luana Marina Sheer Erpen
- Laboratório de Microbiologia e Imunologia Avançada, Faculdade de Agronomia e Medicina Veterinária, Universidade de Passo Fundo, BR 285, Km 292 - Campus I, Bairro São José, Passo Fundo, 99052-900, Brazil
| | - Bárbara Diel Klein
- Laboratório de Microbiologia e Imunologia Avançada, Faculdade de Agronomia e Medicina Veterinária, Universidade de Passo Fundo, BR 285, Km 292 - Campus I, Bairro São José, Passo Fundo, 99052-900, Brazil
| | - Igor Giacobbo
- Laboratório de Microbiologia e Imunologia Avançada, Faculdade de Agronomia e Medicina Veterinária, Universidade de Passo Fundo, BR 285, Km 292 - Campus I, Bairro São José, Passo Fundo, 99052-900, Brazil
| | - Rafael Arrua da Silveira
- Scientia Cursos. Rua Carlos Brenner, 220, Bairro Nossa Senhora de Lourdes, 97050-100, Santa Maria, RS, Brazil
| | - Rafael Frandoloso
- Laboratório de Microbiologia e Imunologia Avançada, Faculdade de Agronomia e Medicina Veterinária, Universidade de Passo Fundo, BR 285, Km 292 - Campus I, Bairro São José, Passo Fundo, 99052-900, Brazil
| | - Luiz Carlos Kreutz
- Laboratório de Microbiologia e Imunologia Avançada, Faculdade de Agronomia e Medicina Veterinária, Universidade de Passo Fundo, BR 285, Km 292 - Campus I, Bairro São José, Passo Fundo, 99052-900, Brazil
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22
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Almeida PH, Matielo CEL, Curvelo LA, Rocco RA, Felga G, Della Guardia B, Boteon YL. Update on the management and treatment of viral hepatitis. World J Gastroenterol 2021; 27:3249-3261. [PMID: 34163109 PMCID: PMC8218370 DOI: 10.3748/wjg.v27.i23.3249] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/11/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
This review aims to summarize the current evidence on the treatment of viral hepatitis, focusing on its clinical management. Also, future treatment options and areas of potential research interest are detailed. PubMed and Scopus databases were searched for primary studies published within the last ten years. Keywords included hepatitis A virus, hepatitis B virus (HBV), hepatitis C virus, hepatitis D virus (HDV), hepatitis E virus, and treatment. Outcomes reported in the studies were summarized, tabulated, and synthesized. Significant advances in viral hepatitis treatment were accomplished, such as the advent of curative therapies for hepatitis C and the development and improvement of hepatitis A, hepatitis B, and hepatitis E vaccination. Drugs that cure hepatitis B, going beyond viral suppression, are so far unavailable; however, targeted antiviral drugs against HBV (immunomodulatory therapies and gene silencing technologies) are promising approaches to eradicating the virus. Ultimately, high vaccination coverage and large-scale test-and-treat programmes with high screening rates may eliminate viral hepatitis and mitigate their burden on health systems. The development of curative hepatitis C treatment renewed the enthusiasm for curing hepatitis B, albeit further investigation is required. Novel therapeutic options targeting HDV life cycle are currently under clinical investigation.
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Affiliation(s)
| | - Celso E L Matielo
- Liver Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
| | - Lilian A Curvelo
- Liver Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
| | - Rodrigo A Rocco
- Liver Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
| | - Guilherme Felga
- Liver Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
| | | | - Yuri L Boteon
- Liver Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo 05652-900, Brazil
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Dichtl K, Zimmermann J, Koeppel MB, Böhm S, Osterman A. Evaluation of a Novel CLIA Monotest Assay for the Detection of Anti-Hepatitis E Virus-IgG and IgM: A Retrospective Comparison with a Line Blot and an ELISA. Pathogens 2021; 10:pathogens10060689. [PMID: 34206114 PMCID: PMC8228023 DOI: 10.3390/pathogens10060689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 12/27/2022] Open
Abstract
Despite the increasing relevance of Hepatitis E, an emerging disease endemic in developing and with increasing numbers of sporadic cases in industrialized countries, commercial tests are mainly based on batch oriented serological assays. In this retrospective study, we compared a line immunoassay (LIA; recomLine HEV, Mikrogen) and an ELISA (EIA; Anti-Hepatitis E Virus ELISA, Euroimmun) with a novel chemoluminescence immunoassay in a monotest format (CLIA; Hepatitis E VirClia, Vircell). Twenty sera of PCR proven cases of hepatitis E and 68 blood samples serologically pre-characterized were included. Applying the WHO reference standard, the CLIA demonstrated the highest analytical sensitivity for IgG and IgM. The combinations of CLIA/EIA (IgG and IgM) and CLIA/LIA (IgG) measurements showed substantial correlation. Compared to overall antibody detection (seropositivity in ≥2 assays), CLIA correlation was excellent, outperforming LIA (IgM) and EIA (IgG and IgM). Minor IgM cross reactivity in samples of patients with acute EBV infection was observed in all three assays. The CLIA showed good performance in diagnostic samples compared to established LIA and EIA assays. Due to its ready-to-use monotest format, the CLIA allows simple, time- and cost-effective handling of single samples. These qualities make the assay suitable for diagnostics, especially in the emergency setting and for low-throughput laboratories.
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Affiliation(s)
- Karl Dichtl
- Chair of Medical Microbiology and Hospital Epidemiology, Faculty of Medicine, Max von Pettenkofer-Institute, LMU Munich, D-80336 München, Germany; (K.D.); (J.Z.)
| | - Julia Zimmermann
- Chair of Medical Microbiology and Hospital Epidemiology, Faculty of Medicine, Max von Pettenkofer-Institute, LMU Munich, D-80336 München, Germany; (K.D.); (J.Z.)
- Chair of Virology, National Reference Center for Retroviruses, Faculty of Medicine, Max von Pettenkofer Institut, LMU München, D-80336 München, Germany;
- German Center for Infection Research (DZIF), Partner Site Munich, D-80539 Munich, Germany
| | | | - Stephan Böhm
- Chair of Virology, National Reference Center for Retroviruses, Faculty of Medicine, Max von Pettenkofer Institut, LMU München, D-80336 München, Germany;
- German Center for Infection Research (DZIF), Partner Site Munich, D-80539 Munich, Germany
| | - Andreas Osterman
- Chair of Virology, National Reference Center for Retroviruses, Faculty of Medicine, Max von Pettenkofer Institut, LMU München, D-80336 München, Germany;
- German Center for Infection Research (DZIF), Partner Site Munich, D-80539 Munich, Germany
- Correspondence:
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24
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Molecular Characterization and Seroprevalence of Hepatitis E Virus in Inflammatory Bowel Disease Patients and Solid Organ Transplant Recipients. Viruses 2021; 13:v13040670. [PMID: 33924409 PMCID: PMC8070591 DOI: 10.3390/v13040670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/13/2022] Open
Abstract
Seroprevalence rates and molecular characterization of hepatitis E virus (HEV) prevalent in the Lithuanian human population has not yet been evaluated. Immunosuppressed individuals have been recognized as a risk group for chronic hepatitis due to HEV genotype 3 (HEV-3) infections. The objectives of the present study were to determine prevalence rates of anti-HEV antibodies among inflammatory bowel disease (IBD) patients and solid organ transplant (SOT) recipients, to isolate and characterize HEV strain present in the Lithuanian human population, and to investigate its capacity to infect non-human primate (MARC-145 and Vero), swine (PK-15) and murine (Neuro-2a) cells in vitro. In the present study, the significant difference of anti-HEV IgG prevalence between healthy (3.0% (95% CI 0–6.3)) and immunosuppressed individuals (12.0% [95% CI 8.1–15.9]) was described. Moreover, our findings showed that anti-HEV IgG seropositivity can be significantly predicted by increasing age (OR = 1.032, p < 0.01), diagnosis of IBD (OR = 4.541, p < 0.01) and reception of SOT (OR = 4.042, <0.05). Locally isolated HEV strain clustered within genotype 3i subtype of genotype 3 and was capable of infecting MARC-145 cells. This study demonstrates higher HEV seroprevalence in the risk group compared to healthy control individuals without confidence interval overlap. The high level of genetic homology between human and animal strains in Lithuania and the capacity of locally isolated strains to infect cells of non-human origin suggests its potential for zoonotic transmission.
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25
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El Costa H, Gouilly J, Abravanel F, Bahraoui E, Peron JM, Kamar N, Jabrane-Ferrat N, Izopet J. Effector memory CD8 T cell response elicits Hepatitis E Virus genotype 3 pathogenesis in the elderly. PLoS Pathog 2021; 17:e1009367. [PMID: 33617602 PMCID: PMC7932504 DOI: 10.1371/journal.ppat.1009367] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 03/04/2021] [Accepted: 02/09/2021] [Indexed: 12/17/2022] Open
Abstract
Genotype 3 Hepatitis E virus (HEV-3) is an emerging threat for aging population. More than one third of older infected patients develops clinical symptoms with severe liver damage, while others remain asymptomatic. The origin of this discrepancy is still elusive although HEV-3 pathogenesis appears to be immune-mediated. Therefore, we investigated the role of CD8 T cells in the outcome of the infection in immunocompetent elderly subjects. We enrolled twenty two HEV-3-infected patients displaying similar viral determinants and fifteen healthy donors. Among the infected group, sixteen patients experienced clinical symptoms related to liver disease while six remained asymptomatic. Here we report that symptomatic infection is characterized by an expansion of highly activated effector memory CD8 T (EM) cells, regardless of antigen specificity. This robust activation is associated with key features of early T cell exhaustion including a loss in polyfunctional type-1 cytokine production and partial commitment to type-2 cells. In addition, we show that bystander activation of EM cells seems to be dependent on the inflammatory cytokines IL-15 and IL-18, and is supported by an upregulation of the activating receptor NKG2D and an exuberant expression of T-Bet and T-Bet-regulated genes including granzyme B and CXCR3. We also show that the inflammatory chemokines CXCL9-10 are increased in symptomatic patients thereby fostering the recruitment of highly cytotoxic EM cells into the liver in a CXCR3-dependent manner. Finally, we find that the EM-biased immune response returns to homeostasis following viral clearance and disease resolution, further linking the EM cells response to viral burden. Conversely, asymptomatic patients are endowed with low-to-moderate EM cell response. In summary, our findings define immune correlates that contribute to HEV-3 pathogenesis and emphasize the central role of EM cells in governing the outcome of the infection. The outcome of Genotype 3 Hepatitis E virus (HEV-3) infection differs among the elderly. Some patients develop severe forms of Hepatitis E while others remain asymptomatic. Nonetheless, parameters which can lead to severe versus silent infection are largely unknown. Therefore, we investigated immunological features of CD8 T cells in infected patients (aged ≥55) with similar viral determinants but distinct clinical outcomes. We show that drastic phenotypic changes were specifically observed within the effector memory (EM) compartment. Compared to asymptomatic patients, symptomatic ones display a strong activation of both HEV-3-specific and -nonspecific EM CD8 T cells associated with qualitative and quantitative alterations in cytokine production. In addition, EM cells are endowed with high cytotoxic capacity and have the ability to rapidly migrate to the liver. Finally, we report that the inflammatory response to HEV-3 infection shape EM cell activation and function in symptomatic elderly patients. In summary, our results present the first report demonstrating that the nature and the magnitude of EM CD8 T cell response play an important role in the outcome of HEV-3 infection in the elderly.
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Affiliation(s)
- Hicham El Costa
- Infinity—Université Toulouse, CNRS, Inserm, Toulouse, France
- Laboratoire de Virologie, Centre National de référence HEV, Institut Fédératif de Biologie, CHU Toulouse, Toulouse, France
- * E-mail:
| | - Jordi Gouilly
- Infinity—Université Toulouse, CNRS, Inserm, Toulouse, France
| | - Florence Abravanel
- Infinity—Université Toulouse, CNRS, Inserm, Toulouse, France
- Laboratoire de Virologie, Centre National de référence HEV, Institut Fédératif de Biologie, CHU Toulouse, Toulouse, France
| | | | - Jean-Marie Peron
- Département de Gastroentérologie, CHU Toulouse, Toulouse, France
| | - Nassim Kamar
- Infinity—Université Toulouse, CNRS, Inserm, Toulouse, France
| | | | - Jacques Izopet
- Infinity—Université Toulouse, CNRS, Inserm, Toulouse, France
- Laboratoire de Virologie, Centre National de référence HEV, Institut Fédératif de Biologie, CHU Toulouse, Toulouse, France
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26
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Advances in Hepatitis E Virus Biology and Pathogenesis. Viruses 2021; 13:v13020267. [PMID: 33572257 PMCID: PMC7915517 DOI: 10.3390/v13020267] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/21/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023] Open
Abstract
Hepatitis E virus (HEV) is one of the causative agents for liver inflammation across the world. HEV is a positive-sense single-stranded RNA virus. Human HEV strains mainly belong to four major genotypes in the genus Orthohepevirus A, family Hepeviridae. Among the four genotypes, genotype 1 and 2 are obligate human pathogens, and genotype 3 and 4 cause zoonotic infections. HEV infection with genotype 1 and 2 mainly presents as acute and self-limiting hepatitis in young adults. However, HEV infection of pregnant women with genotype 1 strains can be exacerbated to fulminant hepatitis, resulting in a high rate of case fatality. As pregnant women maintain the balance of maternal-fetal tolerance and effective immunity against invading pathogens, HEV infection with genotype 1 might dysregulate the balance and cause the adverse outcome. Furthermore, HEV infection with genotype 3 can be chronic in immunocompromised patients, with rapid progression, which has been a challenge since it was reported years ago. The virus has a complex interaction with the host cells in downregulating antiviral factors and recruiting elements to generate a conducive environment of replication. The virus-cell interactions at an early stage might determine the consequence of the infection. In this review, advances in HEV virology, viral life cycle, viral interference with the immune response, and the pathogenesis in pregnant women are discussed, and perspectives on these aspects are presented.
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27
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Kirkwood CD, Dobscha KR, Steele AD. Hepatitis E should be a global public health priority: recommendations for improving surveillance and prevention. Expert Rev Vaccines 2021; 19:1129-1140. [PMID: 33441054 DOI: 10.1080/14760584.2020.1874930] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Hepatitis E virus (HEV) is an important cause of enterically transmitted viral hepatitis and a significant contributor to maternal mortality in endemic regions around the world, yet the global response has been limited. HEV is a disease of poverty, and the populations experiencing the greatest burden of HEV-associated illness are not benefitting from existing interventions, including WASH strategies and immunization. AREAS COVERED Though a vaccine exists (HEV 239, Hecolin®, Xiamen Innovax Biotech, China), it is only licensed and available in the private market in China and has yet to be prequalified by the WHO for use in endemic settings and outbreaks. This review of the current state of HEV disease and subsequent recommendations for a coordinated public health response are intended to guide the global health community towards breaking the current 'vicious cycle,' in which a lack of data prevents actions that would improve health outcomes. EXPERT OPINION Vaccine implementation in future outbreaks, targeted studies assessing vaccine effectiveness and immunogenicity in endemic regions and populations, improved understanding of the global burden, and improvements in diagnostic and epidemiologic tools are urgently needed. Strategies for implementing routine vaccination programs, improving water, sanitation, and hygiene in endemic regions.
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Affiliation(s)
- Carl D Kirkwood
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation , Seattle, WA, USA
| | - Katherine R Dobscha
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation , Seattle, WA, USA
| | - A Duncan Steele
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation , Seattle, WA, USA
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28
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Hepatitis E Virus Capsid Antigen (HEV-Ag) - A practical diagnostic biomarker in the HEV outbreak scenario. J Clin Virol 2020; 134:104692. [PMID: 33316568 DOI: 10.1016/j.jcv.2020.104692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The increased global incidence of hepatitis E virus (HEV) infections, warrants accurate and affordable diagnostics across different geographical regions. The soluble and highly conserved HEV open reading frame 2 (ORF2) capsid antigen (HEV-Ag) is detectable in self-limited acute enteric hepatitis by HEV-Ag ELISA which is a promising serological assay in settings where HEV-RNA testing is not feasible. Our aim was to assess the HEV-Ag biomarker in an HEV outbreak in a low income country. METHODS A prospective single center longitudinal study during HEV outbreaks in the Chittagong, Bangladesh region between October 2018 and October 2019 was conducted based on recruitment of acute jaundice cases with clinical signs and symptoms of suspect HEV infections. Acute HEV infection was defined as a positive test result for anti-HEV IgM antibodies. RESULTS Forty four of the 51 enrolled enteric hepatitis cases (86 %) were confirmed HEV by anti-HEV IgM ELISA at day 0 hospital entry. The anti-HEV-IgM and IgG were positive in all patients and did not reveal significant differences; neither between the time points day 0 and follow-up hospitalization on day 2-6 or day 7-10 nor between RNA-positive (n = 36) versus RNAnegative (n = 8) HEV groups. The HEV-Ag positivity was higher in viral RNA-positive (29/36, 81 %) than the viral RNA-negative (1/8, 12 %) group, p < 0.001 and the HEV-Ag levels positively correlated with viremia, r = 0.77, p < 0.0001. All non-HEV cases; n = 7 tested negative anti-HEV IgM and HEV-Ag and 5 of 7 (71 %) tested anti-HAV IgM positive. CONCLUSIONS The HEV-Ag ELISA is a reliable and practical diagnostic tool in this acute HEV outbreak.
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29
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Kofman A, Linderman S, Su K, Purpura LJ, Ervin E, Brown S, Morales-Betoulle M, Graziano J, Cannon DL, Klena JD, Desamu-Thorpe R, Fankhauser J, Orone R, Soka M, Glaybo U, Massaquoi M, Nysenswah T, Nichol ST, Kollie J, Kiawu A, Freeman E, Giah G, Tony H, Faikai M, Jawara M, Kamara K, Kamara S, Flowers B, Mohammed K, Chiriboga D, Williams DE, Hinrichs SH, Ahmed R, Vonhm B, Rollin PE, Choi MJ. Characteristics of Ebola Virus Disease Survivor Blood and Semen in Liberia: Serology and RT-PCR. Clin Infect Dis 2020; 73:e3641-e3646. [PMID: 32894277 DOI: 10.1093/cid/ciaa1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Ebola virus (EBOV), species Zaire ebolavirus, may persist in the semen of male survivors of Ebola Virus Disease (EVD). We conducted a study of male survivors of the 2014-2016 EVD outbreak in Liberia and evaluated their immune responses to EBOV. We report here findings from the serologic testing of blood for EBOV-specific antibodies, molecular testing for EBOV in blood and semen, and serologic testing of peripheral blood mononuclear cells (PBMCs) in a subset of study participants. METHODS We tested for EBOV RNA in blood by qRT-PCR, and for anti-EBOV-specific IgM and IgG antibodies by enzyme-linked immunosorbent assay (ELISA) for 126 study participants. We performed peripheral blood mononuclear cell (PBMC) analysis on a subgroup of 26 IgG-negative participants. RESULTS All 126 participants tested negative for EBOV RNA in blood by qRT-PCR. The blood of 26 participants tested negative for EBOV-specific IgG antibodies by ELISA. PBMCs were collected from 23/26 EBOV IgG-negative participants. Of these, 1/23 participants had PBMCs which produced anti-EBOV-specific IgG antibodies upon stimulation with EBOV-specific GP and NP antigens. DISCUSSION The blood of EVD survivors, collected when they did not have symptoms meeting the case definition for acute or relapsed EVD, is unlikely to pose a risk for EBOV transmission. We identified one IgM/IgG negative participant who had PBMCs which produced anti-EBOV-specific antibodies upon stimulation. Immunogenicity following acute EBOV infection may exist along a spectrum and absence of antibody response should not be exclusionary in determining an individual's status as a survivor of EVD.
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Affiliation(s)
- Aaron Kofman
- Epidemic Intelligence Service, CDC.,Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | | | - Kaihong Su
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Lawrence J Purpura
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Elizabeth Ervin
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Shelley Brown
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Maria Morales-Betoulle
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | | | - Deborah L Cannon
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - John D Klena
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Rodel Desamu-Thorpe
- Office of, Public Health Preparedness and Response, Center for Preparedness and Response, CDC
| | - John Fankhauser
- ELWA Hospital, Samaritan's Purse.,Ventura County Medical Center, Ventura, CA', CA
| | | | - Moses Soka
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | | | - Moses Massaquoi
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | | | - Stuart T Nichol
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jomah Kollie
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | - Armah Kiawu
- University of Massachusetts Medical School, Worcester, MA
| | - Edna Freeman
- University of Massachusetts Medical School, Worcester, MA
| | - Giovanni Giah
- University of Massachusetts Medical School, Worcester, MA
| | - Henry Tony
- University of Massachusetts Medical School, Worcester, MA
| | - Mylene Faikai
- University of Massachusetts Medical School, Worcester, MA
| | - Mary Jawara
- University of Massachusetts Medical School, Worcester, MA
| | - Kuku Kamara
- University of Massachusetts Medical School, Worcester, MA
| | - Samuel Kamara
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | - Benjamin Flowers
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | - Kromah Mohammed
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | | | | | - Steven H Hinrichs
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Rafi Ahmed
- Emory Vaccine Center, Emory University, Atlanta, GA
| | | | - Pierre E Rollin
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Mary J Choi
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
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Elhendawy M, Abo-Ali L, Abd-Elsalam S, Hagras MM, Kabbash I, Mansour L, Atia S, Esmat G, Abo-ElAzm AR, El-Kalla F, Kobtan A. HCV and HEV: two players in an Egyptian village, a study of prevalence, incidence, and co-infection. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:33659-33667. [PMID: 32533486 PMCID: PMC7292573 DOI: 10.1007/s11356-020-09591-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/01/2020] [Indexed: 05/04/2023]
Abstract
The highest recorded hepatitis C virus (HCV) prevalence worldwide is in Egypt. A high prevalence of hepatitis E virus (HEV) in chronic liver disease has been reported. The aim of this study was to study prevalence, incidence, and outcome of HCV infection in an Egyptian Nile Delta village and the relation between HEV infection and HCV-related chronic hepatic affection. This prospective cohort study included 2085 Nagreej village residents. Mass HCV screening was conducted and testing for HEV antibodies among HCV-infected patients performed. The annual incidence of HCV was recorded. Five hundred five (24.22%) of the tested villagers were positive for HCV RNA. Prevalence escalated with age and male sex. The main recorded risk factors were a history of surgery, dental procedures, hospitalization, blood transfusion, and antischistosomal treatment. HEV IgG antibody was positive in 71.4% of individuals with chronic HCV and 96.1% with advanced liver disease (cirrhosis ± hepatocellular carcinoma (HCC)). After 1 year, 29 of the 1390 HCV Ab negative villagers had a positive HCV PCR, placing an annual incidence of new HCV infections at 2.09%. The Egyptian HCV prevalence remains high with infection particularly among the elderly. The annual incidence in a small Nile Delta village is 2.086%. HCV-HEV co-infection may lead to a worse prognosis among Egyptians with chronic liver disease.
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Affiliation(s)
- Mohammed Elhendawy
- Tropical Medicine Department, Faculty of Medicine, Tanta University Hospital, Tanta University, El Geish Street, Tanta, Gharbia Governorate, Egypt
| | - Lobna Abo-Ali
- Tropical Medicine Department, Faculty of Medicine, Tanta University Hospital, Tanta University, El Geish Street, Tanta, Gharbia Governorate, Egypt
| | - Sherief Abd-Elsalam
- Tropical Medicine Department, Faculty of Medicine, Tanta University Hospital, Tanta University, El Geish Street, Tanta, Gharbia Governorate, Egypt.
| | - Maha M Hagras
- Clinical Pathology Department, Tanta University, Tanta, Egypt
| | - Ibrahim Kabbash
- Public Health and Community Medicine, Tanta University, Tanta, Egypt
| | - Loai Mansour
- Tropical Medicine Department, Faculty of Medicine, Tanta University Hospital, Tanta University, El Geish Street, Tanta, Gharbia Governorate, Egypt
| | - Sherief Atia
- Kafr El Sheikh Liver Institute, Kafr El Sheikh, Egypt
| | - Gamal Esmat
- Tropical Medicine Department, Cairo University, Cairo, Egypt
| | - Abdel-Raouf Abo-ElAzm
- Tropical Medicine Department, Faculty of Medicine, Tanta University Hospital, Tanta University, El Geish Street, Tanta, Gharbia Governorate, Egypt
| | - Ferial El-Kalla
- Tropical Medicine Department, Faculty of Medicine, Tanta University Hospital, Tanta University, El Geish Street, Tanta, Gharbia Governorate, Egypt
| | - Abdelrahman Kobtan
- Tropical Medicine Department, Faculty of Medicine, Tanta University Hospital, Tanta University, El Geish Street, Tanta, Gharbia Governorate, Egypt
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Akyüz F, Çavuş B, Pınarbaşı B, Bozacı M, Baran B, Akyuz U, Uyanıkoglu A, Demir K, Beşışık F, Özdil S, Boztaş G, Mungan Z, Badur S, Yenen S, Kaymakoglu S. Cryptogenic liver cirrhosis and hepatitis E virus (HEV): Are they related? Ann Hepatol 2020; 18:585-589. [PMID: 31130469 DOI: 10.1016/j.aohep.2019.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Hepatitis E virus (HEV) is one of the most common causes of acute hepatitis. In recent years, its role in the development of chronic hepatitis and cirrhosis especially in immunosuppressed patients and its wide range of extrahepatic involvement have increased the amount of research on HEV. In this study we aimed to investigate the presence of HEV infection in individuals with cryptogenic cirrhosis. MATERIALS AND METHODS HEV antibodies were analysed using the Anti HEV enzyme-linked immunosorbent assay (ELISA) kit (anti-HEV ELISA; Diapro Prodiagnostic Bioprobes, Milan, Italy). HEV RNA was isolated with using QIAMP Viral RNA mini kit (QIAGEN, Hilden, Germany). The HEV RNA titre was detected with the Rotor Gene 3000 real time polymerase chain reaction (PCR) system using GenoSen's HEV (Rotor Gene) Quantitative Real Time PCR Kit (Genome Diagnostics Private Limited, the Netherlands). RESULTS Our study included 21 healthy volunteers (12 males) and 35 cryptogenic cirrhosis patients (19 males). The ages of the patients and the controls were similar (46±12.1 vs. 37.5±9.7years). The mean Child-Pugh score was 8±2.5. The anti HEV immunoglobulin G(IgG) positivity rate was 9.5% and 25.7% in the control and patient groups respectively (p>0.05). HEV RNA positivity was not detected in the control group, but 3 cases (8.6%) in the patient group were positive (p>0.05). The HEV RNA, aspartate aminotransferase (AST) and alanine aminotransferase(ALT) levels for these 3 cases were 326.461copies/mL, 91IU/L and 67IU/L; 480copies/mL, 68IU/L and 36IU/L and 72copies/mL, 42IU/L and 24IU/L respectively. There were positive correlations between HEV RNA levels and AST and ALT levels (p<0.05). CONCLUSIONS Anti HEVIgG and HEV RNA positivity rates are high in cryptogenic cirrhosis although it is not statistically significant and there is a positive correlation between HEV RNA and aminotransferases.
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Affiliation(s)
- Filiz Akyüz
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
| | - Bilger Çavuş
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Binnur Pınarbaşı
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mürvet Bozacı
- Department of Virology and Microbiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Bülent Baran
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Umit Akyuz
- Department of Internal Medicine, Division of Gastroenterohepatology SağlıkBilimleri University, Fatih Sultan Mehmet Educational and Research Center, Istanbul, Turkey
| | - Ahmet Uyanıkoglu
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Kadir Demir
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Fatih Beşışık
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sadakat Özdil
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Güngör Boztaş
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Zeynel Mungan
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Selim Badur
- Department of Virology and Microbiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sadi Yenen
- Department of Virology and Microbiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sabahattin Kaymakoglu
- Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Li K, Dong F, Gao F, Bian L, Sun S, Du R, Hu Y, Mao Q, Zheng H, Wu X, Liang Z. Effect of freezing on recombinant hepatitis E vaccine. Hum Vaccin Immunother 2020; 16:1545-1553. [PMID: 31809644 PMCID: PMC7482780 DOI: 10.1080/21645515.2019.1694327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022] Open
Abstract
Studies have revealed that vaccines are more often exposed to sub-zero temperatures during cold chain transportation than what was previously known. Such exposure might be detrimental to the potency of temperature-sensitive vaccines. The aim of this study was to evaluate the impact of exposure to freezing on the physicochemical properties and biological activities of recombinant hepatitis E (rHE) vaccine. Changes in rHE vaccine due to freezing temperatures were analyzed with regard to sedimentation rate, antigenicity, and antibody affinity and potency. The freezing temperature of rHE was measured, then rHE vaccine was exposed to freezing temperatures below -10°C.Significant increase of sedimentation rate was noted, according to shake test and massed precipitates. In addition, the binding affinity of rHE vaccine to six specific monoclonal antibodies was significantly reduced and the in vivo potency for eliciting a protective IgG response was also partially lost, especially for anti-HEV neutralizing antibodies. Altogether, our work indicates that exposure of rHE vaccine to a temperature below -10°C results in the loss of structural integrity and biological potency of rHE vaccine.
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Affiliation(s)
- Kelei Li
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
- Research and Development Center, Minhai Biotechnology Co. Ltd, Beijing, China
| | - Fangyu Dong
- The Second Department of Research, Lanzhou Institute of Biological Products Co. Ltd, Lanzhou, China
| | - Fan Gao
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
| | - Lianlian Bian
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
| | - Shiyang Sun
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
| | - Ruixiao Du
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
| | - Yalin Hu
- Quality Assurance Department, Hualan Biological Engineering Inc, Xinxiang, China
| | - Qunying Mao
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
| | - Haifa Zheng
- Research and Development Center, Minhai Biotechnology Co. Ltd, Beijing, China
| | - Xing Wu
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
| | - Zhenglun Liang
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
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Janahi EM, Parkar SFD, Mustafa S, Eisa ZM. Implications of Hepatitis E Virus in Blood Transfusions, Hemodialysis, and Solid Organ Transplants. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E206. [PMID: 32344807 PMCID: PMC7279256 DOI: 10.3390/medicina56050206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 01/05/2023]
Abstract
Hepatitis E Virus (HEV) is emerging as the primary cause of acute viral hepatitis in humans. The virus is commonly transmitted by the fecal-oral route via contaminated water in endemic regions or through the consumption of inadequately cooked swine products or game meats in industrialized regions. HEV genotypes 1 and 2 are predominantly associated with waterborne transmission in developing countries, whereas HEV3 and HEV4 are mainly zoonotically transmitted in industrialized countries. Seroprevalence in populations determined by detecting anti-HEV antibodies and serum HEV RNA is commonly used to analyze the presence of HEV. Although HEV RNA-based detection is now standardized, there is a lack of agreement between the assaying methods used for gathering seroprevalence data. Since 2004, HEV has been considered as a transmissible infectious agent through blood transfusion. Recent seroprevalence studies in European countries indicate an underestimated risk for blood transfusion and hence warrant testing the blood supply. HEV infection is usually self-limiting and spontaneously cleared. However, in about 60% of recipients of solid organ transplants, HEV progresses to chronic hepatitis. Immunosuppressive drugs such as tacrolimus are a major cause of chronic hepatitis and reducing its dosage results in viral clearance in about 30% of patients. In hemodialysis patients, the parenteral route is implicated as an important mechanism of transmission. In this review, we explore the clinical and epidemiological characteristics of various HEV genotypes in blood donors, hemodialysis patients, and transplant recipients.
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Affiliation(s)
- Essam M. Janahi
- Department of Biology, College of Science, University of Bahrain, Sakhir 32038, Bahrain; (S.F.D.P.); (S.M.)
| | - Saba F. D. Parkar
- Department of Biology, College of Science, University of Bahrain, Sakhir 32038, Bahrain; (S.F.D.P.); (S.M.)
| | - Sakina Mustafa
- Department of Biology, College of Science, University of Bahrain, Sakhir 32038, Bahrain; (S.F.D.P.); (S.M.)
| | - Zaki M. Eisa
- The National Center for Disease Prevention and Control, Jazan 82722-2476, Saudi Arabia;
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De Sabato L, Di Bartolo I, Lapa D, Capobianchi MR, Garbuglia AR. Molecular Characterization of HEV Genotype 3 in Italy at Human/Animal Interface. Front Microbiol 2020; 11:137. [PMID: 32117156 PMCID: PMC7014918 DOI: 10.3389/fmicb.2020.00137] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/21/2020] [Indexed: 12/17/2022] Open
Abstract
Hepatitis E virus (HEV) is an emerging public health issue in industrialized countries. In the last decade the number of autochthonous human infections has increased in Europe. Genotype 3 (HEV-3) is typically zoonotic, being foodborne the main route of transmission to humans, and is the most frequently detected in Europe in both humans and animals (mainly pigs and wild boars). In Italy, the first autochthonous human case was reported in 1999; since then, HEV-3 has been widely detected in both humans and animals. Despite the zoonotic characteristic of HEV-3 is well established, the correlation between animal and human strains has been poorly investigated in Italy. In the present study, we compared the subtype distribution of HEV-3 in humans and animals (swine and wild boar) in the period 2000-2018 from Italy. The dataset for this analysis included a total of 96 Italian ORF2 sequences (300 nt long), including both NCBI database-derived (n = 64) and recent sequences (2016-2018, n = 32) obtained in this study. The results show that subtype 3f is the most frequent in humans and pigs, followed by the HEV-3e, HEV-3c and other unassignable HEV-3 strains. Diversely, in wild boar a wider group of HEV-3 subtypes have been detected, including HEV-3a, which has also been detected for the first time in a human patient in Central Italy in 2017, and a wide group of unassignable HEV-3 strains. The phylogenetic analysis including, besides Italian strains, also sequences from other countries retrieved from the NCBI database, indicated that human Italian sequences, in particular those of HEV-3f and HEV-3e, form significant clusters mainly with sequences of animal origin from the same country. Nevertheless, for HEV-3c, rarely detected in Italian pigs, human sequences from Italy are more correlated to human sequences from other European countries. Furthermore, clusters of near-identical human strains identified in a short time interval in Lazio Region (Central Italy) can be recognized in the phylogenetic tree, suggesting that multiple infections originating from a common source have occurred, and confirming the importance of sequencing support to HEV surveillance.
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Affiliation(s)
- Luca De Sabato
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, Italy
| | - Ilaria Di Bartolo
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, Italy
| | - Daniele Lapa
- Laboratory of Virology, “L. Spallanzani” National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, “L. Spallanzani” National Institute for Infectious Diseases, IRCCS, Rome, Italy
| | - Anna Rosa Garbuglia
- Laboratory of Virology, “L. Spallanzani” National Institute for Infectious Diseases, IRCCS, Rome, Italy
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Human Immunodeficiency Virus Infected Patients are Not at Higher Risk for Hepatitis E Virus Infection: A Systematic Review and Meta-Analysis. Microorganisms 2019; 7:microorganisms7120618. [PMID: 31779204 PMCID: PMC6955890 DOI: 10.3390/microorganisms7120618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 12/15/2022] Open
Abstract
Hepatitis E virus (HEV) infection is the most common cause of acute hepatitis in the world. It is not well established whether people infected with the human immunodeficiency virus (HIV) are more susceptible to infection with HEV than people not infected with HIV. Many studies have evaluated this relationship, although none are conclusive. The aim of this systematic review and meta-analysis was to assess whether patients with HIV infection constitute a risk group for HEV infection. A systematic review and meta-analysis was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), to find publications comparing HEV seroprevalences among HIV infected and uninfected populations. The analysis was matched by sex, age and geographical area, and compared patients who live with HIV and HIV-negative individuals. The odds ratio (OR) for patients with HIV was 0.87 (95% CI: 0.74-1.03) in the fixed effects meta-analysis and 0.88 (95% CI: 0.70-1.11) in random effects, with I2 = 47%. This study did not show that HIV infection was a risk factor for HEV infection when compared with those who are HIV-negative.
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36
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Hepatitis E in Pregnant Women and the Potential Use of HEV Vaccine to Prevent Maternal Infection and Mortality. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-00193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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López-López P, Rivero-Juarez A, Frias M, Machuca I, Caballero-Gómez J, Olivas I, Camacho A, Risalde MDLA, García-Bocanegra I, Rivero A. Mutations in the Progesterone Receptor (PROGINS) May Reduce the Symptoms of Acute Hepatitis E and Protect Against Infection. Front Microbiol 2019; 10:2617. [PMID: 31787965 PMCID: PMC6854998 DOI: 10.3389/fmicb.2019.02617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/28/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Mutations in the progesterone receptor (PR) gene, PROGINS, have been studied in relation to hepatitis E virus (HEV) infection. Patients with the PROGINS gene may develop a worse clinical course of hepatitis E. The aim of our study was to evaluate the influence of PROGINS on the susceptibility to and the clinical course of HEV infection in HIV patients. METHODS This study included patients with HIV who were evaluated in previous prospective studies for the prevalence and incidence of HEV. The following three groups of patients were studied: (i) never infected, (ii) past infections, and (iii) recently infected. We determined the PR genotype to evaluate the proportion of patients who were homozygous for PROGINS according to HEV infection. We also compared the proportion of PROGINS carriers with a recent HEV infection according to their symptomatology. RESULTS In this study, 311 patients infected with HIV were included. Of those patients, 198 were homozygous wild type (63.7%), 91 were heterozygous (29.3%), and 22 were homozygous PROGINS (7.1%). We found that the homozygous PROGINS genotype in women was associated with a lower HEV seroprevalence. In addition, in patients with a recent HEV infection, none of those homozygous for PROGINS presented symptoms. CONCLUSION The PROGINS mutation plays a protective role against HEV infection and is associated with subclinical infection in HIV-infected patients, particularly women.
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Affiliation(s)
- Pedro López-López
- Infectious Diseases Unit, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba, University of Córdoba, Córdoba, Spain
| | - Antonio Rivero-Juarez
- Infectious Diseases Unit, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba, University of Córdoba, Córdoba, Spain
| | - Mario Frias
- Infectious Diseases Unit, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba, University of Córdoba, Córdoba, Spain
| | - Isabel Machuca
- Infectious Diseases Unit, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba, University of Córdoba, Córdoba, Spain
| | - Javier Caballero-Gómez
- Infectious Diseases Unit, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba, University of Córdoba, Córdoba, Spain
- Department of Animal Health, University of Córdoba, Córdoba, Spain
| | - Israel Olivas
- Infectious Diseases Unit, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba, University of Córdoba, Córdoba, Spain
| | - Angela Camacho
- Infectious Diseases Unit, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba, University of Córdoba, Córdoba, Spain
| | - María de los Angeles Risalde
- Infectious Diseases Unit, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba, University of Córdoba, Córdoba, Spain
| | | | - Antonio Rivero
- Infectious Diseases Unit, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba, University of Córdoba, Córdoba, Spain
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Arce LP, Müller MF, Martinez A, Baiker A, Marranzino G, Agote F, Vizoso-Pinto MG. A Novel In-House Enzyme-Linked Immunosorbent Assay for Genotype 3 Hepatitis E Virus Reveals High Seroprevalence in Blood Donors in Northern Argentina. Front Microbiol 2019; 10:2481. [PMID: 31736916 PMCID: PMC6838658 DOI: 10.3389/fmicb.2019.02481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/15/2019] [Indexed: 12/19/2022] Open
Abstract
The Hepatitis E virus (HEV) is an emergent virus that causes acute hepatitis in immunocompetent hosts and chronic hepatitis in immunocompromised hosts. In Latin America, the main circulating genotype HEV-3 is usually of zoonotic origin. Diagnosis and seroprevalence studies mainly rely on the detection of specific antibodies. There are scarce data on the seroprevalence of HEV infection in Latin America mainly due to the lack of awareness of HEV circulation. Furthermore, in some countries, like Argentina, HEV testing is not included in routine assays. In order to provide tools to deepen the knowledge on HEV epidemiology in South America, we designed a new in-house ELISA based on the native recombinant protein ORF2 aa112–608 and demonstrated its potential for detecting anti-HEV immunoglobulin G (IgG) in human serum samples. The following conditions were determined: an optimal antigen concentration of 0.25 μg/ml, a serum dilution of 1:80, gelatin as a blocking agent, and a secondary antibody dilution of 1:2000. A relative sensitivity of 93.33% (95% CI: 77.9–99.2%) and a relative specificity of 99.4% (95% CI: 96.7–100%) were determined using a panel of previously characterized sera and a gold standard (HEV IgG ELISA, DIA.PRO, Italy). Further, we obtained a very good agreement (κ index = 0.94, 95% CI: 0.87–1.00) with the gold standard. We screened 813 blood donor samples with this newly developed ELISA and found a seroprevalence of 9.23% (95% confidence interval, 7.33–11.43%). We show for the first time evidence of past HEV infection in Tucuman, the most populated city in northern Argentina. We expect that this study will raise the interest of health decision makers who should intercede to include indirect testing of HEV in regular diagnostic protocols. In conclusion, the in-house ELISA developed in this work shows a very good agreement with an already licensed commercial HEV IgG ELISA (DIA.PRO, ITALY), which can be used as an epidemiologic tool for HEV surveillance.
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Affiliation(s)
- Lorena Paola Arce
- Infection Biology Laboratory, Instituto de Investigaciones en Medicina Molecular y Celular Aplicada (IMMCA), SIPROSA, CONICET, UNT, San Miguel de Tucumán, Argentina.,Laboratorio de Ciencias Básicas and Or. Genética, Facultad de Medicina de la Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Melisa Florencia Müller
- Infection Biology Laboratory, Instituto de Investigaciones en Medicina Molecular y Celular Aplicada (IMMCA), SIPROSA, CONICET, UNT, San Miguel de Tucumán, Argentina.,Laboratorio de Ciencias Básicas and Or. Genética, Facultad de Medicina de la Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Alfredo Martinez
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Armin Baiker
- Bavarian Health and Food Safety Authority (LGL), Oberschleissheim, Germany
| | - Gabriela Marranzino
- Banco Central de Sangre de Tucumán "Dr. César Guerra," PRIS-Si.PRO.SA, San Miguel de Tucumán, Argentina
| | - Felicitas Agote
- Banco Central de Sangre de Tucumán "Dr. César Guerra," PRIS-Si.PRO.SA, San Miguel de Tucumán, Argentina
| | - Maria Guadalupe Vizoso-Pinto
- Infection Biology Laboratory, Instituto de Investigaciones en Medicina Molecular y Celular Aplicada (IMMCA), SIPROSA, CONICET, UNT, San Miguel de Tucumán, Argentina.,Laboratorio de Ciencias Básicas and Or. Genética, Facultad de Medicina de la Universidad Nacional de Tucumán, Tucumán, Argentina
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Walker CM. Adaptive Immune Responses in Hepatitis A Virus and Hepatitis E Virus Infections. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a033472. [PMID: 29844218 DOI: 10.1101/cshperspect.a033472] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Both hepatitis A virus (HAV) and hepatitis E virus (HEV) cause self-limited infections in humans that are preventable by vaccination. Progress in characterizing adaptive immune responses against these enteric hepatitis viruses, and how they contribute to resolution of infection or liver injury, has therefore remained largely frozen for the past two decades. How HAV and HEV infections are so effectively controlled by B- and T-cell immunity, and why they do not have the same propensity to persist as HBV and HCV infections, cannot yet be adequately explained. The objective of this review is to summarize our understanding of the relationship between patterns of virus replication, adaptive immune responses, and acute liver injury in HAV and HEV infections. Gaps in knowledge, and recent studies that challenge long-held concepts of how antibodies and T cells contribute to control and pathogenesis of HAV and HEV infections, are highlighted.
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Affiliation(s)
- Christopher M Walker
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's, Columbus, Ohio 43004
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40
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Parisi F, Mazzei M, Verin R, Forzan M, Rocchigiani G, Roper C, Bertelloni G, Poli A. Hepatitis E virus infection in wild rabbit (Oryctolagus cuniculus) in Italy and in the UK: a serological, molecular, and pathological study. EUR J WILDLIFE RES 2019. [DOI: 10.1007/s10344-019-1314-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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41
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Rogers E, Todd SM, Pierson FW, Kenney SP, Heffron CL, Yugo DM, Matzinger SR, Mircoff E, Ngo I, Kirby C, Jones M, Siegel P, Jobst P, Hall K, Etches RJ, Meng XJ, LeRoith T. CD8 + lymphocytes but not B lymphocytes are required for protection against chronic hepatitis E virus infection in chickens. J Med Virol 2019; 91:1960-1969. [PMID: 31317546 DOI: 10.1002/jmv.25548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/09/2019] [Indexed: 12/12/2022]
Abstract
Hepatitis E is an important global disease, causing outbreaks of acute hepatitis in many developing countries and sporadic cases in industrialized countries. Hepatitis E virus (HEV) infection typically causes self-limiting acute hepatitis but can also progress to chronic disease in immunocompromised individuals. The immune response necessary for the prevention of chronic infection is T cell-dependent; however, the arm of cellular immunity responsible for this protection is not currently known. To investigate the contribution of humoral immunity in control of HEV infection and prevention of chronicity, we experimentally infected 20 wild-type (WT) and 18 immunoglobulin knockout (JH-KO) chickens with a chicken strain of HEV (avian HEV). Four weeks postinfection (wpi) with avian HEV, JH-KO chickens were unable to elicit anti-HEV antibody but had statistically significantly lower liver lesion scores than the WT chickens. At 16 wpi, viral RNA in fecal material and liver, and severe liver lesions were undetectable in both groups. To determine the role of cytotoxic lymphocytes in the prevention of chronicity, we infected 20 WT and 20 cyclosporine and CD8+ antibody-treated chickens with the same strain of avian HEV. The CD8 + lymphocyte-depleted, HEV-infected chickens had higher incidences of prolonged fecal viral shedding and statistically significantly higher liver lesion scores than the untreated, HEV-infected birds at 16 wpi. The results indicate that CD8 + lymphocytes are required for viral clearance and reduction of liver lesions in HEV infection while antibodies are not necessary for viral clearance but may contribute to the development of liver lesions in acute HEV infection.
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Affiliation(s)
- Eda Rogers
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Stephanie Michelle Todd
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Frank William Pierson
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Scott P Kenney
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Connie Lynn Heffron
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Danielle M Yugo
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Shannon R Matzinger
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Elena Mircoff
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Irene Ngo
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Charles Kirby
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Michaela Jones
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Paul Siegel
- Department of Animal and Poultry Sciences, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Peter Jobst
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Karen Hall
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | | | - Xiang-Jin Meng
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Tanya LeRoith
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
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42
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Detection and characterization of hepatitis E virus genotype 3 in HIV-infected patients and blood donors from southern Brazil. Int J Infect Dis 2019; 86:114-121. [PMID: 31279609 DOI: 10.1016/j.ijid.2019.06.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/21/2019] [Accepted: 06/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hepatitis E virus genotype 3 (HEV-3) infection usually causes self-limited acute hepatitis. In immunosuppressed patients, HEV-3 infection can rapidly progress to chronic hepatitis and cirrhosis. In southern Brazil, data on HEV seroprevalence are scarce. METHODS Testing for HEV RNA and antibodies (anti-HEV) was performed for 320 HIV-infected patients followed at the HIV/AIDS Service of the Federal University of Rio Grande between 2012 and 2013, as well as 281 blood donor samples obtained in 2015. Variables associated with anti-HEV positivity were assessed by multivariable logistic regression analysis. RESULTS HIV and blood donor groups showed similar HEV seroprevalence (6.7% and 7.1%, respectively). Risk factors associated with anti-HEV detection were older age, marital status, a higher number of sexual partners, poor sanitation, and alcohol use (HIV group), and living in a rural area (blood donors). HEV RNA was detected in eight serum samples from HIV-infected patients and in one blood donor, who was also positive for anti-HEV IgM and IgG. CONCLUSIONS The prevalence rates of HEV infection were comparable between HIV-seropositive patients who were not severely immunocompromised and blood donors. The blood donor's HEV isolate showed high similarity with swine HEV strains from Brazilian herds in the same region, thus indicating a potential risk of foodborne and parenteral transmission via blood transfusion.
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43
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Nelson KE, Labrique AB, Kmush BL. Epidemiology of Genotype 1 and 2 Hepatitis E Virus Infections. Cold Spring Harb Perspect Med 2019; 9:a031732. [PMID: 29735579 PMCID: PMC6546036 DOI: 10.1101/cshperspect.a031732] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Hepatitis E virus (HEV) genotypes 1 and 2 are responsible for the majority of acute viral hepatitis infections in endemic areas in South Asia and sub-Saharan Africa. In addition to frequent sporadic illnesses throughout the year, these viruses often cause large epidemics in association with monsoon rains in Asia or during humanitarian crises in Africa. Clinical hepatitis commonly involves adults more often than young children, with an overall mortality of ∼1%. However, the mortality among pregnant women is often 30% or higher. HEV infection in pregnant women frequently leads to infant mortality or premature delivery. Hepatitis E is an important, yet largely neglected, global public health problem.
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Affiliation(s)
- Kenrad E Nelson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205
| | - Alain B Labrique
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205
| | - Brittany L Kmush
- Department of Public Health, Food Studies, and Nutrition, Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, New York 13244
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44
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Ouoba JB, Traore KA, Rouamba H, Setondji KVM, Minoungou GL, Ouoba BL, Ouedraogo A, Moctar S, M'Bengue AK, Kakou SN, Doumbia M, Traore AS, Roques P, Barro N. Prevalence of anti-hepatitis E virus antibodies in domestic animal from three representative provinces of Burkina Faso. Vet Anim Sci 2019; 7:100059. [PMID: 32734080 PMCID: PMC7386747 DOI: 10.1016/j.vas.2019.100059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/19/2019] [Accepted: 05/29/2019] [Indexed: 12/17/2022] Open
Abstract
Four major genotypes of Hepatitis E virus (HEV) have been documented worldwide (1-4) with genotypes 1 and 2 found in human in Sub-Saharan Africa. Human Hepatitis cases due to HEV genotype 3 and 4 are zoonotic with various animal identified as possible reservoirs. Recently, HEV genotype 3 was found in pigs and human beings in West Africa, which may change the epidemic in human. Here, we assessed the prevalence of HEV antibodies in various domestic and wild mammalians in Burkina Faso. Random sampling was performed between 2015 and 2017 to collect serum from 100 rabbits (Oryctolagus cuniculus), 19 hares (Lepus africana), 72 cattle (Bos taurus), 75 sheep (Ovis aries) and 81 goats (Capra aegagrus) in three provinces in Burkina Faso. A multi-species ELISA was performed on serum samples from 328 domestic animals and 19 hunting hares. HEV total antibodies were identified in 121 out of 347 specimens (34.9% CI95% [29.9-39.9]). Sera from rabbits (60% CI95% [50.4-69.6]), hares (52.6% CI95% [30.2-75.1]), cattle (26.4% CI95% [16.2-36.6]), sheep (12.0% CI95% [4.6-19.4]), and goats (28.4% CI95% [18.6-38.2]) tested positive for antibodies anti-HEV. In this study we evidence presence of HEV antibodies in various mammalians and highlight the importance of these species in the epidemiology of HEV infection in Burkina Faso.
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Affiliation(s)
- Jean Bienvenue Ouoba
- Laboratoire d'Epidémiologie et de Surveillance des Agents transmissibles par les aliments et l'eau (LaBESTA) Centre de Recherche en Sciences Biologique Alimentaire Nutritionnelles (CRSBAN), Université Ouaga I, Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso.,Unité de sérologie bactérienne et virale, Institut Pasteur, Côte D'Ivoire
| | - Kuan Abdoulaye Traore
- Laboratoire d'Epidémiologie et de Surveillance des Agents transmissibles par les aliments et l'eau (LaBESTA) Centre de Recherche en Sciences Biologique Alimentaire Nutritionnelles (CRSBAN), Université Ouaga I, Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso.,Université Norbert ZONGO de Koudougou, Burkina Faso
| | - Hortense Rouamba
- Laboratoire d'Epidémiologie et de Surveillance des Agents transmissibles par les aliments et l'eau (LaBESTA) Centre de Recherche en Sciences Biologique Alimentaire Nutritionnelles (CRSBAN), Université Ouaga I, Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso.,Centre Médical de Samandin, Ouagadougou, Burkina Faso
| | - Komi Victor-Mari Setondji
- Laboratoire d'Epidémiologie et de Surveillance des Agents transmissibles par les aliments et l'eau (LaBESTA) Centre de Recherche en Sciences Biologique Alimentaire Nutritionnelles (CRSBAN), Université Ouaga I, Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | | | | | | | - Sidi Moctar
- Laboratoire National d'Elevage (LNE), Burkina Faso
| | | | | | - Moussa Doumbia
- Unité de sérologie bactérienne et virale, Institut Pasteur, Côte D'Ivoire
| | - Alfred S Traore
- Laboratoire d'Epidémiologie et de Surveillance des Agents transmissibles par les aliments et l'eau (LaBESTA) Centre de Recherche en Sciences Biologique Alimentaire Nutritionnelles (CRSBAN), Université Ouaga I, Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Pierre Roques
- IDMIT Département / IBFJ, CEA, Fontenay-aux-Roses, France.,Immunology of Viral Infections and Autoimmune Diseases (IMVA), U1184, INSERM, Fontenay-aux-Roses, France.,IMVA, Univ Paris-Sud, UMR1184, Saclay, France
| | - Nicolas Barro
- Laboratoire d'Epidémiologie et de Surveillance des Agents transmissibles par les aliments et l'eau (LaBESTA) Centre de Recherche en Sciences Biologique Alimentaire Nutritionnelles (CRSBAN), Université Ouaga I, Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso
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The Current Host Range of Hepatitis E Viruses. Viruses 2019; 11:v11050452. [PMID: 31108942 PMCID: PMC6563279 DOI: 10.3390/v11050452] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 01/01/2023] Open
Abstract
Hepatitis E virus (HEV) is an emerging zoonotic pathogen transmitting both human to human via the fecal oral route and from animals to humans through feces, direct contact, and consumption of contaminated meat products. Understanding the host range of the virus is critical for determining where potential threats to human health may be emerging from and where potential reservoirs for viral persistence in the environment may be hiding. Initially thought to be a human specific disease endemic to developing countries, the identification of swine as a primary host for genotypes 3 and 4 HEV in industrialized countries has begun a long journey of discovering novel strains of HEV and their animal hosts. As we continue identifying new strains of HEV in disparate animal species, it is becoming abundantly clear that HEV has a broad host range and many of these HEV strains can cross between differing animal species. These cross-species transmitting strains pose many unique challenges to human health as they are often unrecognized as sources of viral transmission.
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46
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Souza AJSD, Malheiros AP, Sarmento VP, Resende FDS, Alves MM, Nunes HM, Soares MDCP, Sá LRMD. Serological and molecular retrospective analysis of hepatitis E suspected cases from the Eastern Brazilian Amazon 1993-2014. Rev Soc Bras Med Trop 2019; 52:e20180465. [PMID: 31038622 DOI: 10.1590/0037-8682-0465-2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/18/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We evaluated the anti-hepatitis E virus (HEV) antibody prevalence and HEV-RNA in archived serum samples of non-A-C hepatitis, or suspected cases of HEV infection from the Eastern Brazilian Amazon from 1993 to 2014. METHODS Serum samples (n = 318) were tested using ELISA and immunoblotting, and screened for HEV-RNA by RT-qPCR. RESULTS Anti-HEV IgM and IgG were detected in 3.4% (11/318) and 5.9% (19/318) of the samples, respectively. All samples were HEV-RNA negative. CONCLUSIONS HEV was detected at a low prevalence. Broader serological and molecular evaluation of HEV infection in the Amazon region should be carried out.
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Affiliation(s)
- Alex Junior Souza de Souza
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil.,Seção de Hepatologia, Instituto Evandro Chagas, Belém, PA, Brasil
| | | | | | | | | | | | | | - Lilian Rose Marques de Sá
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brasil
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47
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Seroprevalence of hepatitis E virus (HEV) in a general adult population in Northern Norway: the Tromsø study. Med Microbiol Immunol 2019; 208:715-725. [PMID: 30903372 DOI: 10.1007/s00430-019-00599-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/13/2019] [Indexed: 02/07/2023]
Abstract
Hepatitis E virus (HEV) is a major cause of acute viral hepatitis in many parts of the world but only a few cases have been diagnosed in Norway. To investigate the HEV exposure rate in a presumed low-risk area, we have conducted a population-based study of anti-HEV IgG seroprevalence in Northern Norway. A total of 1800 serum samples from 900 women and 900 men, age 40-79 years, were randomly selected from the 21,083 participants in the 7th Tromsø Study, representing the 32,591 inhabitants of the Tromsø municipality that were ≥ 40 years. All samples were analyzed by ELISA-1 (recomWell HEV IgG). Samples testing positive or borderline, as well as a 1.5-fold excess of negative samples, were retested by ELISA-2 (DiaPro HEV IgG). If still borderline or a result discordant from ELISA-1, the sample was retested by ELISA-3 (Wantai HEV IgG) and strip-immunoassay (recomLine HEV IgG). Anti-HEV IgG was detected in 205 individuals (11.4%), yielding an estimated seroprevalence of 10.4% in the age-matched population of Tromsø. Using logistic regression analysis followed by multivariable backward elimination analysis, increasing age (OR 1.036 per year; p < 0.001) and higher education (OR 2.167; p < 0.001) were found as potential risk factors, whereas travel abroad or eating of red meat were not. Our results indicate that HEV-infection is common in Northern Norway and suggest that HEV testing should be included in the evaluation of elevated liver enzymes.
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Choudhary MC, Bajpai V, Anand L, Gupta E. Guillain-Barré syndrome in a patient of acute Hepatitis E virus infection associated with genotype 1: Case report and literature review. Intractable Rare Dis Res 2019; 8:43-47. [PMID: 30881857 PMCID: PMC6409121 DOI: 10.5582/irdr.2018.01099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Hepatitis E is a serious public health problem in developing countries. Most of the patients with Hepatitis E virus (HEV) infection present with typical acute hepatitis symptoms. However, in few patients it may lead to complications such as liver failure and extrahepatic symptoms. One of the rare extrahepatic presentations of this infection is neurological complications such as Guillain-Barré syndrome (GBS) which is observed in 5.5% of HEV infected patients (mainly in developed countries). Moreover, only genotype (gt) 3 HEV was found in association with GBS among patients in developed countries whereas molecular characterisation of HEV cases detected from developing countries have not been reported till now. Here, we are reporting a case of GBS as an extrahepatic complication of HEV associated with gt1 identified by molecular characterization by performing PCR of open-reading frame 2 (ORF2) region of HEV. Phylogenetic analysis by maximum likelihood method revealed that HEV gt1 case reported in this paper rooted closely with other HEV gt1 samples from South-Asian countries with high bootstrap values indicative of fully resolved tree.
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Affiliation(s)
- Manish Chandra Choudhary
- Department of Virology, Institute of Liver and Biliary Sciences, New Delhi, India
- Molecular and Cellular Medicine department, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vijeta Bajpai
- Department of Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Lovkesh Anand
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ekta Gupta
- Department of Virology, Institute of Liver and Biliary Sciences, New Delhi, India
- Address correspondence to:Dr. Ekta Gupta, Department of Virology, Institute of Liver and Biliary Sciences, New Delhi 110070, India. E-mail:
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49
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Tripathy AS, Puranik S, Sharma M, Chakraborty S, Devakate UR. Hepatitis E virus seroprevalence among blood donors in Pune, India. J Med Virol 2018; 91:813-819. [PMID: 30489644 DOI: 10.1002/jmv.25370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 11/24/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Blood transfusion is a recently reported route of hepatitis E virus (HEV) transmission. It is a bigger concern in regions where large-scale HEV genotype 1 infections occur causing more severe disease. The present study aims to assess the prevalence and rate of HEV infection in the blood donors of Pune, India. MATERIALS AND METHODS A total of 2447 healthy blood donors were screened for anti-HEV IgG and IgM antibodies. Anti-HEV IgM antibody positives were further subjected to alanine aminotransferase measurement, HEV RNA detection, viral load quantification and phylogenetic analysis. RESULTS Anti-HEV seroprevalence rate was 17.70%, while IgM prevalence rate was 0.20%. An age dependent increase in IgG seropositive rate was observed. Two of five IgM-positives tested positive for HEV RNA. The viral load ranged from 3.5 × 104 to 4.6 × 105 copies/mL and belonged to HEV genotype 1. CONCLUSIONS HEV prevalence rate of 17.70% in the blood donors of Pune, India, a developing country, goes at par with the developed countries. Current data of 0.20% (5 of 2447) blood donors positive for anti-HEV IgM and two of them being HEV RNA positive suggest a need for consideration of cost-effective evaluation towards pooled HEV RNA testing in blood banks.
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Affiliation(s)
| | - Shaila Puranik
- Department of Pathology, B.J. Medical College and Sassoon General Hospitals, Pune, India
| | - Meenal Sharma
- Hepatitis Group, National Institute of Virology, Pune, Maharashtra, India
| | | | - Ujwal R Devakate
- Department of Pathology, B.J. Medical College and Sassoon General Hospitals, Pune, India
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50
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Bochud M, Schäfer W, Roth NJ, Ros C. Characterization of a quasi-enveloped, fast replicating hepevirus from fish and its use as hepatitis E virus surrogate. J Virol Methods 2018; 263:111-119. [PMID: 30399394 DOI: 10.1016/j.jviromet.2018.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/23/2018] [Accepted: 11/02/2018] [Indexed: 02/06/2023]
Abstract
Hepatitis E virus (HEV) is an emerging concern for the safety of plasma-derived medicinal products. The lack of an efficient cell culture system hampers the studies on HEV biology as well as validation studies to test the capacity of virus reduction steps to clear HEV. Hence, a surrogate hepevirus that can efficiently replicate in cell culture is needed. Cutthroat trout virus (CTV) is a non-pathogenic fish hepevirus, which can replicate in cell culture to high titers. Under interferon inhibition, CTV replication reached up to 5 × 107 genome equivalents per μL in 4-5 days. The intracellular CTV progeny was already lipid-associated, suggesting that the envelope is acquired from intracellular membranes. Transmission electron microscopy of purified quasi-enveloped virus revealed exosome-like structures with an average size of 40 nm, in contrast to 27-34 nm for the non-enveloped virus. The quasi-enveloped virus was significantly less infectious than the non-enveloped virus. Assays based on quantitative RT-PCR, immunofluorescence and immunocytochemistry were established to evaluate virus inactivation. Cold ethanol fractionation removed 3.0 log of CTV and pasteurization of human albumin inactivated more than 3.7 log to below the limit of detection. Similar to HEV, virus replication was promoted in the presence of 17β-estradiol, an effect that can contribute to the understanding of the exacerbated virulence of HEV in pregnant women. These results together reveal substantial similarities between the human and fish HEV and validate CTV as a practical virus model to use in some applications for evaluating the HEV reduction capacity of biological manufacturing process steps.
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Affiliation(s)
- Maëlle Bochud
- Department of Chemistry and Biochemistry, University of Bern, Freiestrasse 3, 3012 Bern, Switzerland
| | - Wolfram Schäfer
- CSL Behring GmbH, Emil-von-Behring-Strasse 76, 35041, Marburg, Germany
| | - Nathan J Roth
- CSL Behring AG, Wankdorfstrasse 10, 3000, Bern 22, Switzerland
| | - Carlos Ros
- Department of Chemistry and Biochemistry, University of Bern, Freiestrasse 3, 3012 Bern, Switzerland.
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