Significance of Anti-Nuclear Antibodies and Cryoglobulins in Patients with Acute and Chronic HEV Infection
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 differen...
Main Authors: | , , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
MDPI AG
2020-09-01
|
Series: | Pathogens |
Subjects: | |
Online Access: | https://www.mdpi.com/2076-0817/9/9/755 |
id |
doaj-9d61bb3a6a9344bd8d2240ab1b4e1577 |
---|---|
record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Thomas Horvatits Julian Schulze zur Wiesch Susanne Polywka Gustav Buescher Marc Lütgehetmann Elaine Hussey Karoline Horvatits Sven Peine Friedrich Haag Marylyn M. Addo Ansgar W. Lohse Christina Weiler-Normann Sven Pischke |
spellingShingle |
Thomas Horvatits Julian Schulze zur Wiesch Susanne Polywka Gustav Buescher Marc Lütgehetmann Elaine Hussey Karoline Horvatits Sven Peine Friedrich Haag Marylyn M. Addo Ansgar W. Lohse Christina Weiler-Normann Sven Pischke Significance of Anti-Nuclear Antibodies and Cryoglobulins in Patients with Acute and Chronic HEV Infection Pathogens hepatitis E HEV autoimmune response antibodies cryoglobulins |
author_facet |
Thomas Horvatits Julian Schulze zur Wiesch Susanne Polywka Gustav Buescher Marc Lütgehetmann Elaine Hussey Karoline Horvatits Sven Peine Friedrich Haag Marylyn M. Addo Ansgar W. Lohse Christina Weiler-Normann Sven Pischke |
author_sort |
Thomas Horvatits |
title |
Significance of Anti-Nuclear Antibodies and Cryoglobulins in Patients with Acute and Chronic HEV Infection |
title_short |
Significance of Anti-Nuclear Antibodies and Cryoglobulins in Patients with Acute and Chronic HEV Infection |
title_full |
Significance of Anti-Nuclear Antibodies and Cryoglobulins in Patients with Acute and Chronic HEV Infection |
title_fullStr |
Significance of Anti-Nuclear Antibodies and Cryoglobulins in Patients with Acute and Chronic HEV Infection |
title_full_unstemmed |
Significance of Anti-Nuclear Antibodies and Cryoglobulins in Patients with Acute and Chronic HEV Infection |
title_sort |
significance of anti-nuclear antibodies and cryoglobulins in patients with acute and chronic hev infection |
publisher |
MDPI AG |
series |
Pathogens |
issn |
2076-0817 |
publishDate |
2020-09-01 |
description |
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 (<i>p</i> = 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. |
topic |
hepatitis E HEV autoimmune response antibodies cryoglobulins |
url |
https://www.mdpi.com/2076-0817/9/9/755 |
work_keys_str_mv |
AT thomashorvatits significanceofantinuclearantibodiesandcryoglobulinsinpatientswithacuteandchronichevinfection AT julianschulzezurwiesch significanceofantinuclearantibodiesandcryoglobulinsinpatientswithacuteandchronichevinfection AT susannepolywka significanceofantinuclearantibodiesandcryoglobulinsinpatientswithacuteandchronichevinfection AT gustavbuescher significanceofantinuclearantibodiesandcryoglobulinsinpatientswithacuteandchronichevinfection AT marclutgehetmann significanceofantinuclearantibodiesandcryoglobulinsinpatientswithacuteandchronichevinfection AT elainehussey significanceofantinuclearantibodiesandcryoglobulinsinpatientswithacuteandchronichevinfection AT karolinehorvatits significanceofantinuclearantibodiesandcryoglobulinsinpatientswithacuteandchronichevinfection AT svenpeine significanceofantinuclearantibodiesandcryoglobulinsinpatientswithacuteandchronichevinfection AT friedrichhaag significanceofantinuclearantibodiesandcryoglobulinsinpatientswithacuteandchronichevinfection AT marylynmaddo significanceofantinuclearantibodiesandcryoglobulinsinpatientswithacuteandchronichevinfection AT ansgarwlohse significanceofantinuclearantibodiesandcryoglobulinsinpatientswithacuteandchronichevinfection AT christinaweilernormann significanceofantinuclearantibodiesandcryoglobulinsinpatientswithacuteandchronichevinfection AT svenpischke significanceofantinuclearantibodiesandcryoglobulinsinpatientswithacuteandchronichevinfection |
_version_ |
1724830542450393088 |
spelling |
doaj-9d61bb3a6a9344bd8d2240ab1b4e15772020-11-25T02:29:59ZengMDPI AGPathogens2076-08172020-09-01975575510.3390/pathogens9090755Significance of Anti-Nuclear Antibodies and Cryoglobulins in Patients with Acute and Chronic HEV InfectionThomas Horvatits0Julian Schulze zur Wiesch1Susanne Polywka2Gustav Buescher3Marc Lütgehetmann4Elaine Hussey5Karoline Horvatits6Sven Peine7Friedrich Haag8Marylyn M. Addo9Ansgar W. Lohse10Christina Weiler-Normann11Sven Pischke12I. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, GermanyI. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, GermanyInstitute of Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, GermanyI. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, GermanyGerman Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, 20359 Hamburg, GermanyI. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, GermanyI. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, GermanyInstitute of Transfusion Medicine, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, GermanyInstitute of Immunology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, GermanyI. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, GermanyI. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, GermanyI. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, GermanyI. Department of Medicine, Gastroenterology and Hepatology, with the Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, GermanyBackground: 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 (<i>p</i> = 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.https://www.mdpi.com/2076-0817/9/9/755hepatitis EHEVautoimmune responseantibodiescryoglobulins |