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Incidence of hepatotropic viruses in biliary atresia

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Biliary atresia (BA) is the most frequent indication for paediatric liver transplantation. We tested the hypothesis of a viral aetiology of this disease by screening liver samples of a large number of BA patients for the common human hepatotropic viruses. Moreover, we correlated our findings to the expression of Mx protein, which has been shown to be significantly up-regulated during viral infections. Seventy-four liver biopsies (taken during Kasai portoenterostomy) were tested by polymerase chain reaction (PCR) for DNA viruses (herpes simplex virus [HSV], Epstein-Barr virus [EBV], varicella zoster virus [VZV], cytomegalovirus [CMV], adenovirus, parvovirus B19 and polyoma BK) and RNA viruses (enteroviruses, rotavirus and reovirus 3). Mx protein expression was assessed by immunohistochemistry. Virus DNA/RNA was found in less than half of the biopsies (8/74 CMV, 1/74 adenovirus; 21/64 reovirus, 1/64 enterovirus). A limited number presented with double infection. Patients that had detectable viral RNA/DNA in their liver biopsies were significantly older than virus-free patients (P = 0.037). The majority (54/59) of the liver biopsies showed expression of Mx proteins in hepatocytes, bile ducts and epithelium. Our data suggest that the known hepatotropic viruses do not play a major role in the aetiology and progression of BA. Their incidence appears to be, rather, a secondary phenomenon. Nonetheless, the inflammatory response in the livers of BA patients mimics that observed during viral infections.

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This study was supported by grant Pe 622/2–3 (to Claus Petersen) from the Deutsche Forschungsgemeinschaft and the graduate research programme HILF1 (Hochschulinternes Leistungs Förderungs Programm) (to Johannes Leonhardt) of the Hannover Medical School.

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None declared.

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Correspondence to Claus Petersen.

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Rauschenfels, S., Krassmann, M., Al-Masri, A.N. et al. Incidence of hepatotropic viruses in biliary atresia. Eur J Pediatr 168, 469–476 (2009). https://doi.org/10.1007/s00431-008-0774-2

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  • Biliary atresia
  • Herpes viridae
  • Adenovirus
  • Enterovirus
  • Reovirus 3
  • RNA
  • DNA
  • Mx protein