Porcine-derived pancreatic enzyme replacement therapy may be linked to chronic hepatitis E virus infection in cystic fibrosis lung transplant recipients.

Autor:	Thornton CS; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.; Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada., Waddell BJ; Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada., Congly SE; Department of Medicine, University of Calgary, Calgary, Alberta, Canada., Svishchuk J; Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada., Somayaji R; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.; Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada., Fatovich L; Department of Medicine, University of Calgary, Calgary, Alberta, Canada., Isaac D; Department of Medicine, University of Calgary, Calgary, Alberta, Canada., Doucette K; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada., Fonseca K; Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada., Drews SJ; Canadian Blood Services, Edmonton, Alberta, Canada.; Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada., Borlang J; Public Health Agency of Canada, Winnipeg, Manitoba, Canada., Osiowy C; Public Health Agency of Canada, Winnipeg, Manitoba, Canada., Parkins MD; Department of Medicine, University of Calgary, Calgary, Alberta, Canada mdparkin@ucalgary.ca.; Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada.
Jazyk:	angličtina
Zdroj:	Gut [Gut] 2024 Sep 09; Vol. 73 (10), pp. 1702-1711. Date of Electronic Publication: 2024 Sep 09.
DOI:	10.1136/gutjnl-2023-330602
Abstrakt:	Objectives: In high-income countries hepatitis E virus (HEV) is an uncommonly diagnosed porcine-derived zoonoses. After identifying disproportionate chronic HEV infections in persons with cystic fibrosis (pwCF) postlung transplant, we sought to understand its epidemiology and potential drivers. Design: All pwCF post-transplant attending our regional CF centre were screened for HEV. HEV prevalence was compared against non-transplanted pwCF and with all persons screened for suspected HEV infection from 2016 to 2022 in Alberta, Canada. Those with chronic HEV infection underwent genomic sequencing and phylogenetic analysis. Owing to their swine derivation, independently sourced pancreatic enzyme replacement therapy (PERT) capsules were screened for HEV. Results: HEV seropositivity was similar between transplanted and non-transplanted pwCF (6/29 (21%) vs 16/83 (19%); p=0.89). Relative to all other Albertans investigated for HEV as a cause of hepatitis (n=115/1079, 10.7%), pwCF had a twofold higher seropositivity relative risk and this was four times higher than the Canadian average. Only three chronic HEV infection cases were identified in all of Alberta, all in CF lung transplant recipients (n=3/29, 10.3%). Phylogenetics confirmed cases were unrelated porcine-derived HEV genotype 3a. Ninety-one per cent of pwCF were taking PERT (median 8760 capsules/person/year). HEV RNA was detected by RT-qPCR in 44% (47/107) of PERT capsules, and sequences clustered with chronic HEV cases. Conclusion: PwCF had disproportionate rates of HEV seropositivity, regardless of transplant status. Chronic HEV infection was evident only in CF transplant recipients. HEV may represent a significant risk for pwCF, particularly post-transplant. Studies to assess HEV incidence and prevalence in pwCF, and potential role of PERT are required. Competing Interests: Competing interests: SEC: reports grants from Bristol-Myers Squibb Canada, Gilead Sciences, Genfit, Allergan, Axcella Health, and Sequana Medical and personal fees from Intercept Pharmaceuticals, Eisai, Paladin Labs, AstraZeneca and Novo Nordisk outside the submitted work. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu