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Saruuldalai E, Lee HH, Lee YS, Hong EK, Ro S, Kim Y, Ahn T, Park JL, Kim SY, Shin SP, Im WR, Cho E, Choi BK, Jang JJ, Choi BH, Jung YS, Kim IH, Lee SJ, Lee YS. Adenovirus expressing nc886, an anti-interferon and anti-apoptotic non-coding RNA, is an improved gene delivery vector. MOLECULAR THERAPY. NUCLEIC ACIDS 2024; 35:102270. [PMID: 39171141 PMCID: PMC11338102 DOI: 10.1016/j.omtn.2024.102270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/12/2024] [Indexed: 08/23/2024]
Abstract
Recombinant adenovirus (rAdV) vector is the most promising vehicle to deliver an exogenous gene into target cells and is preferred for gene therapy. Exogenous gene expression from rAdV is often too inefficient to induce phenotypic changes and the amount of administered rAdV must be very high to achieve a therapeutic dose. However, it is often hampered because a high dose of rAdV is likely to induce cytotoxicity by activating immune responses. nc886, a 102-nucleotide non-coding RNA that is transcribed by RNA polymerase III, acts as an immune suppressor and a facilitator of AdV entry into the nucleus. Therefore, in this study, we have constructed an rAdV expressing nc886 (AdV:nc886) to explore whether AdV:nc886 overcomes the aforementioned drawbacks of conventional rAdV vectors. When infected into mouse cell lines and mice, AdV:nc886 expresses a sufficient amount of nc886, which suppresses the induction of interferon-stimulated genes and apoptotic pathways triggered by AdV infection. As a result, AdV:nc886 is less cytotoxic and produces more rAdV-delivered gene products, compared with the parental rAdV vector lacking nc886. In conclusion, this study demonstrates that the nc886-expressing rAdV could become a superior gene delivery vehicle with greater safety and higher efficiency for in vivo gene therapy.
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Affiliation(s)
- Enkhjin Saruuldalai
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
| | - Hwi-Ho Lee
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
| | - Yeon-Su Lee
- Division of Rare Cancer, Research Institute, National Cancer Center, Goyang 10408, Korea
| | - Eun Kyung Hong
- Research Institute and Hospital, National Cancer Center, Goyang 10408, Korea
| | - Soyoun Ro
- Division of Immuno-Oncology, Research Institute, National Cancer Center, Goyang 10408, Korea
| | - Yeochan Kim
- Department of Life Science, Handong Global University, Pohang 37554, Korea
| | - TaeJin Ahn
- Department of Life Science, Handong Global University, Pohang 37554, Korea
| | - Jong-Lyul Park
- Personalized Genomic Medicine Research Center, KRIBB, Daejeon 34141, Korea
- Department of Functional Genomics, University of Science and Technology, Daejeon 34113, Korea
| | - Seon-Young Kim
- Personalized Genomic Medicine Research Center, KRIBB, Daejeon 34141, Korea
- Department of Functional Genomics, University of Science and Technology, Daejeon 34113, Korea
| | - Seung-Phil Shin
- Division of Immuno-Oncology, Research Institute, National Cancer Center, Goyang 10408, Korea
| | - Wonkyun Ronny Im
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
| | - Eunjung Cho
- Division of Immuno-Oncology, Research Institute, National Cancer Center, Goyang 10408, Korea
| | - Beom K. Choi
- Division of Immuno-Oncology, Research Institute, National Cancer Center, Goyang 10408, Korea
| | - Jiyoung Joan Jang
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
| | - Byung-Han Choi
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
| | - Yuh-Seog Jung
- Division of Immuno-Oncology, Research Institute, National Cancer Center, Goyang 10408, Korea
| | - In-Hoo Kim
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
| | - Sang-Jin Lee
- Division of Immuno-Oncology, Research Institute, National Cancer Center, Goyang 10408, Korea
| | - Yong Sun Lee
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Korea
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Li M, Jiang L, Liu S, Xu P, Wei H, Li Y, Guo C, Zhu L, Zhao B, Liu Y, Zhang M, Zhao J. Clinicopathological characteristics of 3 probable pediatric cases with acute severe hepatitis of unknown aetiology. New Microbes New Infect 2024; 56:101203. [PMID: 38146348 PMCID: PMC10749268 DOI: 10.1016/j.nmni.2023.101203] [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: 08/18/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 12/27/2023] Open
Abstract
Background Acute severe hepatitis with unknown aetiology in children (ASHep-UA) has become a global health alert. This article reported clinicopathological characteristics of 3 probable ASHep-UA cases. Methods We respectively collected serological data and liver biopsies of 3 suspected cases of ASHep-UA. Neutralizing antibodies titer for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variants were determined by virus neutralization test (VNT). Histological assessment, immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) for cytomegalovirus (CMV), Epstein-Barr virus (EBV), human adenoviruses (HAdV), adeno-associated virus (AAV2), human herpes virus type 6 (HHV-6) were performed to identify possible aetiologies. Results Remarkable elevation of transaminase (median ALT level, 1100 IU/liter; median AST level, 500 IU/liter) were revealed with undetectable hepatitis A-E and non-hepatotropic virus in both sera and tissues. Weakness, jaundice, pale stools and splenomegaly were observed. Interestingly, two individuals had SARS-CoV-2 Omicron variants infection. Histologically, moderate or severe lobular necroinflammation, active interface hepatitis and portal inflammatory infiltrate with lymphocytic, plasma cells, neutrophils and eosinophilic cells were noted. Conclusions The exact aetiology of ASHep-UA was still unknown. By reporting the 3 probable cases, we expect to enrich the clinical experience in diagnosis and treatment of ASHep-UA as well as the pathological characteristics.
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Affiliation(s)
- Meiling Li
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lina Jiang
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shuhong Liu
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Pengfei Xu
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Haiyan Wei
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yu Li
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chaonan Guo
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Li Zhu
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bokang Zhao
- Department of Hepatology, Center of Infectious Diseases and PathogenBiology, The First Hospital of Jilin University, Changchun, China
| | - Yisi Liu
- First Department of Liver Disease Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Min Zhang
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jingmin Zhao
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
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3
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Ahamed R, Ahmed I, Bari LF, Dewan SMR. An observation: Could the spread of Adenovirus in South Asia pose a hazard to global public health? Health Sci Rep 2023; 6:e1567. [PMID: 37711675 PMCID: PMC10497803 DOI: 10.1002/hsr2.1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/15/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
Background One of the most pressing issues in healthcare today is the prevention of Adenovirus (AdV) infections. Children and the elderly, both of whom have weaker immune systems than healthy adults, are more vulnerable to infection. Discussion India has been the epicenter of a recent AdV epidemic in the South Asian area. Most of the nations, bordering India are still developing and have very low per capita incomes, yet their citizens often cross into India for trade, medical care, and vacation. Conclusion We are concerned that an epidemic of the AdV might occur in the Indian subcontinent, spread to other nations, and eventually affect the whole world if effective preventative and diagnostic measures are not taken.
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Affiliation(s)
- Rayhan Ahamed
- Department of Pharmacy, School of MedicineUniversity of Asia PacificDhakaBangladesh
| | - Iftekhar Ahmed
- Department of Pharmacy, School of MedicineUniversity of Asia PacificDhakaBangladesh
| | - Lazima Faiah Bari
- Department of Pharmacy, School of MedicineUniversity of Asia PacificDhakaBangladesh
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García-Bañuelos J, Oceguera-Contreras E, Sandoval-Rodríguez A, Bastidas-Ramírez BE, Lucano-Landeros S, Gordillo-Bastidas D, Gómez-Meda BC, Santos A, Cerda-Reyes E, Armendariz-Borunda J. AdhMMP8 Vector Administration in Muscle: An Alternate Strategy to Regress Hepatic Fibrosis. Cells 2023; 12:2127. [PMID: 37681859 PMCID: PMC10486800 DOI: 10.3390/cells12172127] [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: 05/26/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023] Open
Abstract
The development of several vaccines against the SARS-CoV2 virus and their application in millions of people have shown efficacy and safety in the transfer of genes to muscle turning this tissue into a protein-producing factory. Established advanced liver fibrosis, is characterized by replacement of hepatic parenchyma by tissue scar, mostly collagen type I, with increased profibrogenic and proinflammatory molecules gene expression. Matrix metalloproteinase 8 (MMP-8) is an interstitial collagen-degrading proenzyme acting preferentially on collagen type I when activated. This study was carried out to elucidate the effect of an intramuscularly delivered adenoviral vector containing proMMP-8 gene cDNA (AdhMMP8) in male Wistar rats with experimental advanced liver fibrosis induced by thioacetamide. Therapeutic effects were monitored after 1, 2, or 3 weeks of a single dose (3 × 1011 vp/kg) of AdhMMP8. Circulating and liver concentration of MMP-8 protein remained constant; hepatic fibrosis decreased up to 48%; proinflammatory and profibrogenic genes expression diminished: TNF-α 2.28-fold, IL-1 1.95-fold, Col 1A1 4-fold, TGF-β1 3-fold and CTGF 2-fold; and antifibrogenic genes expression raised, MMP-9 2.8-fold and MMP-1 10-fold. Our data proposes that the administration of AdhMMP8 in muscle is safe and effective in achieving liver fibrosis regression at a comparable extent as when the adenoviral vector is delivered systemically to reach the liver, using a minimally invasive procedure.
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Affiliation(s)
- Jesús García-Bañuelos
- Institute for Molecular Biology in Medicine and Gene Therapy, Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Edén Oceguera-Contreras
- Laboratorio de Sistemas Biológicos, Centro Universitario de los Valles, Universidad de Guadalajara, Carretera Guadalajara-Ameca km. 45.5, Ameca 46600, Jalisco, Mexico
| | - Ana Sandoval-Rodríguez
- Institute for Molecular Biology in Medicine and Gene Therapy, Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Blanca Estela Bastidas-Ramírez
- Instituto de Investigación en Enfermedades Crónico Degenerativas, Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Silvia Lucano-Landeros
- Institute for Molecular Biology in Medicine and Gene Therapy, Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Daniela Gordillo-Bastidas
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 64849, Nuevo Leon, Mexico
| | - Belinda C. Gómez-Meda
- Instituto de Genética Humana “Dr. Enrique Corona Rivera”, Department of Molecular Biology and Genomics, Health Sciences University Center, Guadalajara 44340, Jalisco, Mexico
| | - Arturo Santos
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 64849, Nuevo Leon, Mexico
| | | | - Juan Armendariz-Borunda
- Institute for Molecular Biology in Medicine and Gene Therapy, Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 64849, Nuevo Leon, Mexico
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Wu M, Xiao H, Xiao Y, Chen T, Wang X, Xiao X, Wang Y, Wang J, Ren L, Liu G. Pathogenesis diagnosis of a pediatric patient suffering from multi-organ abscesses. Diagn Pathol 2023; 18:85. [PMID: 37516858 PMCID: PMC10386630 DOI: 10.1186/s13000-023-01360-6] [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: 03/20/2023] [Accepted: 05/24/2023] [Indexed: 07/31/2023] Open
Abstract
A pediatric patient suffered from renal and hepatic abscesses (through hepatorenal space) and recovered by antibiotics and other therapies. By clinical analysis, the multi-organ abscesses might be caused by bloodstream-disseminated infection. In order to identify the pathogen, we collected kidney biopsy tissue, swabs, and plasma samples, and used metagenomics next-generation sequencing (mNGS) and some traditional methods. The results revealed that polymicrobial especially anaerobic bacteremia (Bacteroides fragilis, et al.) contributed to the abscess formation. What is more, systematic human adenovirus C (HAdV-C) infection was shown, and the virus was isolated. The titer of HAdV-2 neutralizing antibodies was 1/4 in the plasma after symptoms onset. Although the exact mechanism of HAdV-2 infection in multiple abscess formation has not been clarified, the case of multi-organ abscesses in the context of polymicrobial especially anaerobic bacteremia and HAdV infection in healthy children is infrequent.
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Affiliation(s)
- Mingkun Wu
- National Health Commission of the People's Republic of China Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, No.9 Dong Dan San Tiao, Dongcheng District, 100730, Beijing, P. R. China
| | - Haijuan Xiao
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, No.56 NanLiShi Road, Xicheng District, 100045, Beijing, P. R. China
| | - Yan Xiao
- National Health Commission of the People's Republic of China Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, No.9 Dong Dan San Tiao, Dongcheng District, 100730, Beijing, P. R. China
- Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, P. R. China
| | - Tianming Chen
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, No.56 NanLiShi Road, Xicheng District, 100045, Beijing, P. R. China
| | - Xinming Wang
- National Health Commission of the People's Republic of China Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, No.9 Dong Dan San Tiao, Dongcheng District, 100730, Beijing, P. R. China
| | - Xia Xiao
- National Health Commission of the People's Republic of China Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, No.9 Dong Dan San Tiao, Dongcheng District, 100730, Beijing, P. R. China
| | - Ying Wang
- National Health Commission of the People's Republic of China Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, No.9 Dong Dan San Tiao, Dongcheng District, 100730, Beijing, P. R. China
| | - Jianwei Wang
- National Health Commission of the People's Republic of China Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, No.9 Dong Dan San Tiao, Dongcheng District, 100730, Beijing, P. R. China.
- Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, P. R. China.
| | - Lili Ren
- National Health Commission of the People's Republic of China Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, No.9 Dong Dan San Tiao, Dongcheng District, 100730, Beijing, P. R. China.
- Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, P. R. China.
| | - Gang Liu
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, No.56 NanLiShi Road, Xicheng District, 100045, Beijing, P. R. China.
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6
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Sun K, Yang X, Wang Y, Guan Q, Fu W, Zhang C, Liu Q, An W, Zhao Y, Xing W, Xu D. A Novel Sample-to-Answer Visual Nucleic Acid Detection System for Adenovirus Detection. Microbiol Spectr 2023; 11:e0517022. [PMID: 37022182 PMCID: PMC10269611 DOI: 10.1128/spectrum.05170-22] [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: 12/19/2022] [Accepted: 03/10/2023] [Indexed: 04/07/2023] Open
Abstract
Human adenoviruses (HAdVs) are common viruses that can cause local outbreaks in schools, communities and military camps, posing a huge threat to public health. An ideal POCT device for adenovirus detection in resource-limited settings is critical to control the spread of the virus. In this study, we developed an integrated and electricity-independent sample-to-answer system that can complete nucleic acid extraction, amplification, and detection at room temperature. This system is suitable for field and on-site detection because of its rapidity, sensitivity, lack of contamination, and lack of requirements of high-precision instruments and skilled technicians. It consists of two separate modules, ALP FINA (alkaline lysis with the paper-based filtration isolation of nucleic acid) and SV RPA (sealed and visual recombinase polymerase amplification). The extraction efficiency of ALP FINA can reach 48 to 84%, which is close to that of the conventional centrifuge column. The detection sensitivity of SV RPA is close to 10 copies/μL of AdvB and AdvE without aerosol contamination after repeated operations. When SV RPA was applied to the detection of nasopharyngeal swab samples of 19 patients who were infected with AdvB or AdvE as well as 10 healthy volunteers, its sensitivity and specificity reached 100%, respectively. IMPORTANCE HAdV infections are readily transmittable and, in some instances, highly contagious. Early and rapid diagnosis is essential for disease control. In this work, we developed a portable, disposable, and modularized sample-to-answer detection system for AdvB and AdvE, which rendered the entire test to be completely independent of electricity and other laboratory infrastructure. Thus, this detection system can be applied in resource-limited settings, and it has the potential to be further developed as an early diagnosis method in the field.
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Affiliation(s)
- Kui Sun
- Beijing Institute of Basic Medical Sciences, Beijing, China
- Energy Laboratory of 970 Hospital of the PLA Joint Logistic Support Force, Beijing, China
| | - Xiaodong Yang
- Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanan Wang
- Beijing Institute of Basic Medical Sciences, Beijing, China
- Academy of Medical Laboratory, Hebei North University, Zhangjiakou, China
| | - Qun Guan
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wenliang Fu
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Chao Zhang
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Qin Liu
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Wenzheng An
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yongqi Zhao
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Weiwei Xing
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Donggang Xu
- Beijing Institute of Basic Medical Sciences, Beijing, China
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7
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Elbeltagi R, Al-Beltagi M, Saeed NK, Bediwy AS, Toema O. May 2022 acute hepatitis outbreak, is there a role for COVID-19 and other viruses? World J Hepatol 2023; 15:364-376. [PMID: 37034240 PMCID: PMC10075009 DOI: 10.4254/wjh.v15.i3.364] [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: 10/21/2022] [Revised: 01/06/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023] Open
Abstract
There has been an increasing number of reported cases of acute hepatitis of unknown origin in previously healthy children since first reported on March 31, 2022. This clinical syndrome is identified by jaundice and markedly elevated liver enzymes with increased aspartate transaminase and/or alanine aminotransaminase (greater than 500 IU/L). We conducted an inclusive literature review with respect to acute hepatitis outbreaks in children using the search terms acute hepatitis, outbreak, children, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), coronavirus disease 2019 (COVID-19), and adenovirus. According to the cumulative data presented in four main studies, the median age is 4 years, with a male predominance (1.3:1). Jaundice was the most common clinical manifestation (69%), followed by vomiting (63%), anorexia (52.9%), diarrhea (47.2%), abdominal pain (39%), pyrexia (33.3%), pale stool (30%), and dark urine (30%). Coryza and lethargy were reported in 16.6%, while pruritus was reported in 2% of cases. Acute liver failure was observed in 25% of cases. The exact mechanism of this acute hepatitis outbreak is still not entirely clear. Adenoviruses and SARS-CoV-2 were detected in a significant number of patients. Coinfection with adenovirus and SARS-CoV-2 could be a possible underlying mechanism. However, other possible infections and mechanisms must be considered in the pathogenesis of this condition. Acute hepatitis of unknown origin in children has been a serious problem since the start of the COVID-19 pandemic but has not yet been sufficiently addressed. Many questions remain regarding the underlying mechanisms leading to acute liver failure in children, and it is likely that extensive future research is needed.
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Affiliation(s)
- Reem Elbeltagi
- Department of Medicine, The Royal College of Surgeons in Ireland - Bahrain, Busiateen 15503, Muharraq, Bahrain
| | - Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Al Gharbia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Department of Pathology, Microbiology Section, Salmaniya Medical Complex, Manama 12, Bahrain
- Department of Microbiology, Royal College of Surgeons in Ireland - Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Diseases, Faculty of Medicine, Tanta University, Tanta 31527, Al Gharbia, Egypt
- Department of Chest Diseases, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Osama Toema
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Al Gharbia, Egypt
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8
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Pan LX, Wang GY, Zhong JH, Fan XH. Current knowledge about the outbreak of acute severe hepatitis of unknown origin among children. J Clin Transl Res 2022; 8:470-475. [PMID: 36457899 PMCID: PMC9709525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 01/27/2023] Open
Abstract
Background and Aim A recent outbreak of acute severe hepatitis of unknown etiology (ASHep-UA) among children 16 years old and younger has aroused global concern. Initially reported in central Scotland, the disease has been notified in 35 countries and linked to 22 deaths as of 25 September 2022. This review aimed to provide current knowledge about the outbreak of ASHep-UA. Methods and Results The websites of the World Health Organization, the UK Health Security Agency, the European Center for Disease Prevention and Control, the Centers for Disease Control and Prevention, and the PubMed database were searched, based on the search term "acute severe hepatitis of unknown etiology." The corresponding reports or literature previously released by the mentioned websites and database were integrated to obtain current information about ASHep-UA. Conclusion Even though the potential relevance between ASHep-UA and adenovirus, adeno-associated virus 2, and human herpes viruses was revealed, the etiology of ASHep-UA is still unknown. More effort should be made to explore whether ASHep-UA is caused by a novel virus or other environmental factors, to generate appropriate treatment strategies. Relevance to Patients ASHep-UA has aroused global concern recently, which may lead to adverse outcomes such as liver transplants and death. The present review shares current development and information about the outbreak of acute severe hepatitis of unknown origin among children.
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Affiliation(s)
- Li-Xin Pan
- Hepatobiliary Surgery Department, Guangxi Medical University Cancer Hospital, Nanning, China
- Department of Microbiology, School of Preclinical Medicine, Guangxi Medical University, Nanning, China
| | - Guan-Yu Wang
- Center for Genomics and Personalized Medicine, Guangxi Key Laboratory for Genomics and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomics and Personalized Medicine, Guangxi Medical University, Nanning, China
| | - Jian-Hong Zhong
- Hepatobiliary Surgery Department, Guangxi Medical University Cancer Hospital, Nanning, China
- Guangxi Key Laboratory for Early Prevention and Treatment of Regional High Frequency Tumors, Guangxi Medical University, Nanning, China
| | - Xiao-Hui Fan
- Department of Microbiology, School of Preclinical Medicine, Guangxi Medical University, Nanning, China
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9
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Cheema HA, Shahid A, Aziz H. Severe acute pediatric hepatitis: The undue emphasis on adenovirus needs to be reassessed. J Med Virol 2022; 94:5088-5089. [PMID: 35859036 DOI: 10.1002/jmv.28014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Huzaifa A Cheema
- Department of Paediatrics, King Edward Medical University, Lahore, Pakistan
| | - Abia Shahid
- Department of Paediatrics, King Edward Medical University, Lahore, Pakistan
| | - Hassan Aziz
- Division of Transplant and Hepatobiliary Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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10
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Kajon AE, George KS. Mysterious Cases of Acute Hepatitis in Children: is adenovirus still a lead suspect? Emerg Microbes Infect 2022; 11:1787-1789. [PMID: 35763594 PMCID: PMC9295815 DOI: 10.1080/22221751.2022.2095933] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Kirsten St George
- Wadsworth Center, New York State Department of Health.,Department of Biomedical Science, University at Albany
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Diagnosis, treatment, and prevention of severe acute hepatitis of unknown etiology in children. World J Pediatr 2022; 18:538-544. [PMID: 35771382 PMCID: PMC9244883 DOI: 10.1007/s12519-022-00581-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/06/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Severe acute hepatitis of unknown etiology in children has recently exhibited a global trend of concentrated occurrence. This review aimed to summarize the current available information regarding the outbreak of severe acute hepatitis and introduce our hospital's previous experiences with the diagnosis and treatment of severe acute hepatitis for reference. DATA SOURCES Websites including the UK Health Security Agency, European Centre for Disease Prevention and Control, CDC, WHO, and databases including PubMed/Medline, Cochrane Library, Embase and Web of Science were searched for articles on severe acute hepatitis in children. RESULTS As of May 26, 2022, a total of 650 cases have been reported in 33 countries; at least 38 (6%) children required liver transplantation, and nine (1%) died. Cases are predominantly aged between 3 and 5 years old, and there are no epidemiological links among them. The common manifestations are jaundice, vomiting and pale stools. Adenovirus tested positive in most cases, and SARS-CoV-2 and other viruses were detected in a few cases, but virus particles were not found in liver tissue. Adenovirus immunohistochemistry showed immunoreactivity in the intrasinusoidal lumen from some liver samples. The hierarchical treatment includes symptomatic and supportive therapy, management of coagulation disorders and hepatic encephalopathy, artificial liver support, and liver transplantation (approximately 6%-10% of cases require liver transplant). CONCLUSIONS The etiology of this severe acute hepatitis in children is not clear. The clinical features are severe acute hepatitis with significantly elevated liver enzymes. Clinicians need to be alert to children with hepatitis.
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