Since May 2022, doctors in 35 countries have diagnosed a mysterious hepatitis in more than 1000 children: Several children died, others needed a liver transplant. Adenoviruses, among others, were suspected to be the cause. Two working groups from London and Glasgow are now confirming the assumption that adenoviruses triggered the liver inflammation, as reported on MedRxiv and the NHS server.
Both teams report that they have detected the complete genomes of the adeno-associated virus 2 (AAV2) in the liver and blood of most of the patients examined. In addition, they identified two helper viruses that could allow the adenovirus to enter the liver cells and thus increase susceptibility. On the other hand, the parties involved rule out the adenovirus subtype 41F, which was previously considered a potential trigger. The participants tracked down the AAV2 with the help of what is known as metagenomic sequencing. To do this, they sequenced all the genes in the tissue or blood samples of the affected children and then searched for viral genetic material.
Emma Thomson of the Glasgow Center for Virus Research and her team detected AAV2 in all nine blood plasma samples and each of the four liver biopsies examined, taken from some of the first patients admitted to Glasgow Children’s Hospital. In contrast, the tests in children with other infections or with hepatitis of other causes were consistently negative. Similar results were found by Sofia Morfopoulou, from the Institute of Child Health at University College London, and her team in the children they studied, five of whom needed a transplant.
AAV2 cannot replicate itself without external help, but both working groups also identified corresponding helpers: the HAdV and HHV6B, known as helper viruses. The latter in particular could pave the way for the adenovirus to enter the liver cells, Thomson suspects. The main virus can then multiply there and apparently triggers the liver inflammation.
However, it is still unclear why the virus causes this serious disease more frequently: AAV2 has been known to medicine for almost 60 years, and studies have shown that four out of five adults have already been infected with it. This usually happens in early childhood and is almost always without complications. In principle, adenoviruses only extremely rarely lead to hepatitis.
However, Thomson and Co point out that the virus has not yet been visualized with an electron microscope; moreover, there is no experimental evidence that it actually infects the liver and causes damage there. The physician Christina Pagel from the Clinical Operational Research Unit in London also emphasizes that although there is a strong correlation, it is not yet definitive evidence. Further studies are urgently needed.
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The original of this article “More than 1000 sufferers: Possible cause for mysterious hepatitis found in children” comes from Spektrum.de.
