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Reaction: three studies link cases of childhood hepatitis of unknown origin to adeno-associated virus

Three studies published today in Nature explore the link between the cases of childhood hepatitis of unknown origin that have occurred since 2022 mainly in the UK and the US and an adeno-associated virus. The papers do not settle the question and further studies will be needed to confirm or exclude the hypothesis.

30/03/2023 - 17:00 CEST
Expert reactions

Marina Berenguer - hepatitis Nature EN

Marina Berenguer Haym

Head of the Hepatology and Liver Transplant Group, IIS La Fe. Coordinator of the Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) group. President of the International Liver Transplant Society. Member of AMIT

Science Media Centre Spain

The press release has some things in it that are not true: 

It says: "This virus is known to replicate in the liver, but not known to cause hepatitis and cannot replicate without a 'helper' virus". Everything after the comma is not true. These viruses replicate without a helper and cause hepatitis, but it has only been seen in immunocompromised children. 

It says: "That suggests some children may be genetically more susceptible to some forms of hepatitis". This is not true. What this genetic polymorphism indicates is that the immune response to viral infection may be different in these people. 

The studies in Nature are credible, but the limitations are well put by Tacke [the author of the News & views article accompanying the three studies]. They are retrospective studies. At the moment there is no confirmation in in vitro studies (with organoids, for example, to confirm the potential direct effect of the virus on the hepatocyte), nor prospective studies showing that hepatitis is caused by the interaction between a generally low pathogenic virus with an altered or deficient immune system (both because of the genetic polymorphism and because it is not adequately developed by the measures taken against covid-19).

The author has not responded to our request to declare conflicts of interest
EN
Publications
Childhood hepatitis outbreak under scrutiny
  • Comment
  • Non-peer-reviewed
Journal
Nature
Publication date
Authors

Frank Tacke

Study types:
  • Comment
  • Non-peer-reviewed
Adeno-associated virus 2 infection in children with non-A-E hepatitis
  • Research article
  • Peer reviewed
  • People
Journal
Nature
Publication date
Authors

Antonia Ho et al.

Study types:
  • Research article
  • Peer reviewed
  • People
Adeno-associated virus type 2 in US children with acute severe hepatitis
  • Research article
  • Peer reviewed
Journal
Nature
Publication date
Authors

Venice Servellita et al.

Study types:
  • Research article
  • Peer reviewed
Genomic investigations of acute hepatitis of unknown aetiology in children
  • Research article
  • Peer reviewed
Journal
Nature
Publication date
Authors

Sofia Morfopoulou et al.

Study types:
  • Research article
  • Peer reviewed
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