Review of clinical characteristics, immune responses and regulatory mechanisms of hepatitis E-associated liver failure

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.

The burden of HEV related acute liver failure in the developing world: a systematic review and meta-analysis

“…Luckily, many studies were trying to conquer these issues. Elevating in ammatory cytokines, alternation of innate and adaptive immunity in these patients indicated that host immune response, rather than HEV virus itself, is a key factor for the occurrence of HEV-ALF [21] . Gut microbiota and its metabolites was recently found to be involved in the change of immune system, may participating in the development of HEV-ALF [24] .…”

“…Our study found that HEV was the causative agent of ALF among about 65.0% of pregnant females in India, in contrast to 40.0% among non-pregnant individuals in the same country. Pregnancy is a unique situation, due to the alternation of immune system, hormone change (progesterone and oestrogen), pregnant females are more susceptible for progressing to HEV-ALF [19][20][21] , especially in the 2nd and the 3rd trimester or when infection is blamed for HEV GT1 [22] . Pooled incidence in our study also revealed that, in India, about 28.0% HEV infected non-pregnant individuals progressed to HEV-ALF, while this incidence was approximately 34.0% in pregnant individuals.…”