Science translational medicine · 6 authors, 5 centres
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Using antibody profiling, this study found that children with severe acute hepatitis of unknown etiology showed a strong and conserved immune response to adeno-associated virus 2 (AAV-2), which was not observed in pediatric or adult controls. The results suggest AAV-2 is a likely causative agent for this condition.
This case-control study used VirScan, a high-throughput antibody profiling technology, to analyze the antibody repertoires of nine pediatric patients with severe acute hepatitis of unknown etiology treated at a single institution. The antibody responses were compared to those of 38 pediatric and 470 adult controls. The central finding was a significantly increased breadth of antibodies against adeno-associated dependoparvovirus A (AAV-A) in cases, with conserved responses to specific AAV-2 peptides in seven of the nine cases, a pattern rarely seen in controls. This indicates a recent, strong AAV-2 infection. The study also notes immunity to helper viruses (adenovirus and herpesvirus) in all AAV-2 positive cases, supporting the plausibility of AAV-2 replication. Limitations include the small sample size and the fact that pediatric controls were not from the same geographic area or matched on demographics. The authors conclude these findings implicate AAV-2 as a likely etiologic agent, but further research is needed to confirm this association and understand the mechanism.
