Autoimmune liver disease serology in acute hepatitis E virus infection

Beretta‐Piccoli, Benedetta Terziroli; Ripellino, Paolo; Gobbi, Claudio; Cerny, Andreas; Baserga, Adriana; Bartolomeo, C. Di; Bihl, Florian; Deleonardi, Gaia; Melidona, Laura; Grondona, Ana Gabriela; Mieli‐Vergani, Giorgina; Vergani, Diego; Muratori, Luigi

doi:10.1016/j.jaut.2018.07.006

Cited by 39 publications

(22 citation statements)

References 41 publications

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“…Although no patient developed autoimmune liver disease in the further course, AIH-typical autoantibodies (except for anti-SLA) were found in over 50% of patients. 42 In line with the results from our study these findings strongly support the recommendation to exclude HEV infection in patients with suspected autoimmune liver disease, especially because immunosuppressive therapies can lead to chronic infections and potentially complicated courses.…”

Section: Con Clus Ionssupporting

confidence: 90%

High seroprevalence of anti‐Hepatitis E antibodies in Austrian patients with autoimmune hepatitis

Eder

Straßl

Beinhardt

et al. 2018

Liver International

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Background & Aims Increasing numbers of autochthonous hepatitis E virus infections have been reported in Europe. Chronic infections have been shown in immune‐compromised patients after solid organ transplantation. Hepatitis E virus might be a possible trigger for autoimmune hepatitis and might cause disease flares or relapses in the further course of disease. Aim of this study was to investigate the presence of hepatitis E virus antibodies and hepatitis E virus RNA, and to analyse their impact on immunosuppressive treatment in patients with autoimmune hepatitis. Methods Sera from 92 autoimmune hepatitis patients (73/79.3% female, age: 42.2 ± 16.3 years [mean ± SD]) were tested. Patients were scored according to the simplified and revised scoring systems of the International Autoimmune Hepatitis Group. The prevalence of anti‐ hepatitis E virus antibodies (Beijing Wantai Biological Pharmacy Enterprises Co., Ltd, Beijing, China) and hepatitis E virus RNA was determined. Results 19/20.7% autoimmune hepatitis patients tested positive for hepatitis E virus‐IgG, which was higher than in previous reports of healthy Austrian individuals (12.4%, P = 0.031); hepatitis E virus RNA was not detectable in any patient. Anti‐hepatitis E virus positive patients were older (49.5 ± 9.5 vs 40.4 ± 17.2 years [mean ± SD], P = 0.033) but did not differ in laboratory findings at diagnosis (AST: 14.6 [1.3‐70.6] vs 9.5 [0.7‐62.7] × ULN [median/range]; P = 0.387, alanine aminotransferase: 18.3 [1.6‐62.7] vs. 12.9 [0.8‐62.6] × ULN; P = 0.511; IgG: 1.4 [1.0‐2.5] vs 1.3 [0.6‐3.8] g/dL × ULN; P = 0.278) nor in alanine aminotransferase levels after six months (0.7 [0.5‐2.4] vs 1.0 U/L × ULN [0.1‐22.4]; P = 0.077). Conclusions No chronic hepatitis E virus infection was observed in our cohort of autoimmune hepatitis patients. Anti‐ hepatitis E virus‐IgG positive patients were older and the seroprevalence was nearly twice as high as reported previously in healthy Austrian individuals, suggesting that hepatitis E virus‐infection might act as trigger for the development of autoimmune hepatitis.

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Section: Con Clus Ionssupporting

confidence: 90%

High seroprevalence of anti‐Hepatitis E antibodies in Austrian patients with autoimmune hepatitis

Eder

Straßl

Beinhardt

et al. 2018

Liver International

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“…The rate of ANA positivity (>1:160) in our study population was more or less comparable to previously reported data. Terziroli Beretta-Piccoli and Wu et al reported ANA positivity rates ranging between 33% and 37% [11,12]. In contrast to our study, however, they only tested patients with acute hepatitis E, and not with chronic or asymptomatic HEV infection.…”

Section: Discussioncontrasting

confidence: 63%

“…The presence of autoantibodies has been described in HEV infections and in other viral diseases [11][12][13]. Using three cohorts of patients, we studied a possible link between the type of HEV infection and the immune phenomena, such as the presence of autoantibodies and cryoglobulins.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of autoantibodies has been described in HEV infection and in other viral diseases [11][12][13]. In contrast to true autoimmune diseases, there has been debate on the role of the immunological bystanders or the non-specific phenomena in HEV.…”

Section: Introductionmentioning

confidence: 99%

“…Whether or not the higher rate of seropositivity in AIH patients is merely due to false-positive testing because of higher levels of immunoglobulins has been debated [13]. In general, the presence of autoantibodies in sera from patients with active HEV infection is common [12,17]. This may result in a false AIH diagnosis when the underlying HEV infection is overlooked, and it may also result in unsuitable immunosuppressive treatment being used [12,13,15,16,[18][19][20][21][22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

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Significance of Anti-Nuclear Antibodies and Cryoglobulins in Patients with Acute and Chronic HEV Infection

et al. 2020

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Background: Hepatitis E virus (HEV) has been associated with immunological phenomena. Their clinical significance, however, still needs to be clarified, that is, whether cryoglobulins or autoantibodies impact overt disease in HEV-infected individuals. To better understand, we analyzed these different immune phenomena in three cohorts, each representing different types of HEV infection. Methods: The cohorts included: (i) immunocompetent patients with acute hepatitis E, (ii) immunosuppressed patients with chronic hepatitis E, and (iii) individuals with asymptomatic HEV infection. Together, they consisted of 57 individuals and were studied retrospectively for the presence of anti-nuclear antibodies (ANAs), cryoglobulins, and serum total IgG. They were then compared with a control cohort of 17 untreated patients with chronic hepatitis B virus (HBV) infection or hepatitis C virus (HCV) infection. Results: Thirteen (23%) were immunocompetent patients with acute hepatitis E (median alanine aminotransferase (ALT) = 872 U/L), 15 (26%) were immunosuppressed patients with chronic hepatitis E (median ALT = 137 U/L), and 29 (51%) were blood donors with asymptomatic HEV infection (median ALT = 35 U/L). Overall, 24% tested positive for elevated ANA titers of >1:160, and 11% presented with a specific ANA pattern. ANA detection was not associated with the type of HEV infection, IgG levels, sex, or age. All individuals tested negative for anti-mitochondrial antibodies, anti-neutrophil cytoplasmic antibodies, liver-kidney microsomal antibodies, anti-myeloperoxidase-, and anti-proteinase-3 antibodies. Five patients (9%) tested positive for cryoglobulins. Notably, cryoglobulinemia was present in overt hepatitis E (Groups (i) and (ii); one acute and four chronic HEV infections), but was not present in any of the asymptomatic blood donors (p = 0.02). The frequency of cryoglobulins and elevated ANAs did not differ significantly between HEV and HBV/HCV patients. Conclusion: In line with findings on HBV and HCV infections, we frequently observed detection of ANAs (24%) and cryoglobulins (9%) in association with HEV infections. The presence of cryoglobulins was limited to patients with overt hepatitis E. We add to the findings on the immune phenomena of hepatitis E.

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Diagnostic Liver Immunology

Beretta‐Piccoli

Bowlus

2020

Liver Immunology

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Autoimmune liver disease serology in acute hepatitis E virus infection

Cited by 39 publications

References 41 publications

High seroprevalence of anti‐Hepatitis E antibodies in Austrian patients with autoimmune hepatitis

High seroprevalence of anti‐Hepatitis E antibodies in Austrian patients with autoimmune hepatitis

Significance of Anti-Nuclear Antibodies and Cryoglobulins in Patients with Acute and Chronic HEV Infection

Diagnostic Liver Immunology

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