Absence of Persistent Hepatitis e Virus Infection in Antibody-Deficient Patients Is Associated with Transfer of Antigen-Neutralizing Antibodies from Immunoglobulin Products

Mike Ankcorn; Fernando Moreira; Samreen Ijaz; Andrew Symes; Matthew S. Buckland; Sarita Workman; Fiona Warburton; Richard Tedder; David M. Lowe

doi:10.1093/infdis/jiy504

Absence of Persistent Hepatitis e Virus Infection in Antibody-Deficient Patients Is Associated with Transfer of Antigen-Neutralizing Antibodies from Immunoglobulin Products

Mike Ankcorn^*, Fernando Moreira, Samreen Ijaz, Andrew Symes, Matthew S. Buckland, Sarita Workman, Fiona Warburton, Richard Tedder, David M. Lowe

^*Corresponding author for this work

Public Health England

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Background Persistent hepatitis E virus (HEV) infection is described in a number of immunosuppressive conditions. We aimed to determine the risk of persistent HEV infection in patients with primary or secondary antibody deficiency. Methods Two hundred forty-five antibody-deficient patients receiving regular immunoglobulin replacement therapy were tested for HEV RNA and anti-HEV immunoglobulin G (IgG). Immunoglobulin products and plasma specimens obtained from 9 antibody-deficient patients before and after intravenous immunoglobulin (IVIG) therapy, 5 recently treated patients with persistent HEV infection, and 5 healthy patients recovered from acute HEV infection were analyzed for anti-HEV IgG and for antibody reacting with HEV antigen. Results No antibody-deficient patient had detectable plasma HEV RNA. Anti-HEV IgG was detected in 38.8% of patients. All 10 immunoglobulin products tested contained anti-HEV capable of neutralizing HEV antigen. Plasma samples collected following IVIG infusion therapy demonstrated a higher anti-HEV IgG level and neutralizing activity, compared with samples collected before IVIG therapy. Neutralizing activity was similar to that in healthy patients with recent acute HEV infection. Conclusion The risk of persistent HEV infection in patients with antibody deficiency appears extremely low. This may be due to passive seroprotection afforded by the ubiquitous presence of anti-HEV in immunoglobulin replacement products.

Original language	English
Pages (from-to)	245-253
Number of pages	9
Journal	Journal of Infectious Diseases
Volume	219
Issue number	2
DOIs	https://doi.org/10.1093/infdis/jiy504
Publication status	Published - 7 Jan 2019

Bibliographical note

Funding Information:
Financial support. This work was supported by National Health Service Blood and Transplant and Public Health England. Potential conflicts of interest. D. M. L. has received grants from the UCL Biomedical Research Centre and the Rare Diseases Foundation and has received travel and subsistence grants for consultancy work from CSL Behring. S. W. has received travel and subsistence grants from CSL Behring, Octapharma, Grifols, Biotest, BPL, and LFB to attend educational meetings, an educational grant from CSL Behring, and honoraria from LFB and Biotest. M. B. has received consultancy and conference funding from Shire, Biotest, CSL Behring, and Octapharma. A. S. participated in an advisory board for Octapharma and has received conference funding from Grifols and CSL Behring. All other authors report no potential conflicts.

Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.

Keywords

Hepatitis E virus
IVIG
antibody deficiency
chronic infection
immunoglobulin

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/infdis/jiy504

Cite this

Ankcorn, M., Moreira, F., Ijaz, S., Symes, A., Buckland, M. S., Workman, S., Warburton, F., Tedder, R., & Lowe, D. M. (2019). Absence of Persistent Hepatitis e Virus Infection in Antibody-Deficient Patients Is Associated with Transfer of Antigen-Neutralizing Antibodies from Immunoglobulin Products. Journal of Infectious Diseases, 219(2), 245-253. https://doi.org/10.1093/infdis/jiy504

Ankcorn, Mike ; Moreira, Fernando ; Ijaz, Samreen ; Symes, Andrew ; Buckland, Matthew S. ; Workman, Sarita ; Warburton, Fiona ; Tedder, Richard ; Lowe, David M. / Absence of Persistent Hepatitis e Virus Infection in Antibody-Deficient Patients Is Associated with Transfer of Antigen-Neutralizing Antibodies from Immunoglobulin Products. In: Journal of Infectious Diseases. 2019 ; Vol. 219, No. 2. pp. 245-253.

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title = "Absence of Persistent Hepatitis e Virus Infection in Antibody-Deficient Patients Is Associated with Transfer of Antigen-Neutralizing Antibodies from Immunoglobulin Products",

abstract = "Background Persistent hepatitis E virus (HEV) infection is described in a number of immunosuppressive conditions. We aimed to determine the risk of persistent HEV infection in patients with primary or secondary antibody deficiency. Methods Two hundred forty-five antibody-deficient patients receiving regular immunoglobulin replacement therapy were tested for HEV RNA and anti-HEV immunoglobulin G (IgG). Immunoglobulin products and plasma specimens obtained from 9 antibody-deficient patients before and after intravenous immunoglobulin (IVIG) therapy, 5 recently treated patients with persistent HEV infection, and 5 healthy patients recovered from acute HEV infection were analyzed for anti-HEV IgG and for antibody reacting with HEV antigen. Results No antibody-deficient patient had detectable plasma HEV RNA. Anti-HEV IgG was detected in 38.8% of patients. All 10 immunoglobulin products tested contained anti-HEV capable of neutralizing HEV antigen. Plasma samples collected following IVIG infusion therapy demonstrated a higher anti-HEV IgG level and neutralizing activity, compared with samples collected before IVIG therapy. Neutralizing activity was similar to that in healthy patients with recent acute HEV infection. Conclusion The risk of persistent HEV infection in patients with antibody deficiency appears extremely low. This may be due to passive seroprotection afforded by the ubiquitous presence of anti-HEV in immunoglobulin replacement products.",

keywords = "Hepatitis E virus, IVIG, antibody deficiency, chronic infection, immunoglobulin",

author = "Mike Ankcorn and Fernando Moreira and Samreen Ijaz and Andrew Symes and Buckland, {Matthew S.} and Sarita Workman and Fiona Warburton and Richard Tedder and Lowe, {David M.}",

note = "Funding Information: Financial support. This work was supported by National Health Service Blood and Transplant and Public Health England. Potential conflicts of interest. D. M. L. has received grants from the UCL Biomedical Research Centre and the Rare Diseases Foundation and has received travel and subsistence grants for consultancy work from CSL Behring. S. W. has received travel and subsistence grants from CSL Behring, Octapharma, Grifols, Biotest, BPL, and LFB to attend educational meetings, an educational grant from CSL Behring, and honoraria from LFB and Biotest. M. B. has received consultancy and conference funding from Shire, Biotest, CSL Behring, and Octapharma. A. S. participated in an advisory board for Octapharma and has received conference funding from Grifols and CSL Behring. All other authors report no potential conflicts. Publisher Copyright: {\textcopyright} The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.",

year = "2019",

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doi = "10.1093/infdis/jiy504",

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Ankcorn, M, Moreira, F, Ijaz, S, Symes, A, Buckland, MS, Workman, S, Warburton, F, Tedder, R & Lowe, DM 2019, 'Absence of Persistent Hepatitis e Virus Infection in Antibody-Deficient Patients Is Associated with Transfer of Antigen-Neutralizing Antibodies from Immunoglobulin Products', Journal of Infectious Diseases, vol. 219, no. 2, pp. 245-253. https://doi.org/10.1093/infdis/jiy504

Absence of Persistent Hepatitis e Virus Infection in Antibody-Deficient Patients Is Associated with Transfer of Antigen-Neutralizing Antibodies from Immunoglobulin Products. / Ankcorn, Mike; Moreira, Fernando; Ijaz, Samreen; Symes, Andrew; Buckland, Matthew S.; Workman, Sarita; Warburton, Fiona; Tedder, Richard; Lowe, David M.

In: Journal of Infectious Diseases, Vol. 219, No. 2, 07.01.2019, p. 245-253.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Absence of Persistent Hepatitis e Virus Infection in Antibody-Deficient Patients Is Associated with Transfer of Antigen-Neutralizing Antibodies from Immunoglobulin Products

AU - Ankcorn, Mike

AU - Moreira, Fernando

AU - Ijaz, Samreen

AU - Symes, Andrew

AU - Buckland, Matthew S.

AU - Workman, Sarita

AU - Warburton, Fiona

AU - Tedder, Richard

AU - Lowe, David M.

N1 - Funding Information: Financial support. This work was supported by National Health Service Blood and Transplant and Public Health England. Potential conflicts of interest. D. M. L. has received grants from the UCL Biomedical Research Centre and the Rare Diseases Foundation and has received travel and subsistence grants for consultancy work from CSL Behring. S. W. has received travel and subsistence grants from CSL Behring, Octapharma, Grifols, Biotest, BPL, and LFB to attend educational meetings, an educational grant from CSL Behring, and honoraria from LFB and Biotest. M. B. has received consultancy and conference funding from Shire, Biotest, CSL Behring, and Octapharma. A. S. participated in an advisory board for Octapharma and has received conference funding from Grifols and CSL Behring. All other authors report no potential conflicts. Publisher Copyright: © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.

PY - 2019/1/7

Y1 - 2019/1/7

N2 - Background Persistent hepatitis E virus (HEV) infection is described in a number of immunosuppressive conditions. We aimed to determine the risk of persistent HEV infection in patients with primary or secondary antibody deficiency. Methods Two hundred forty-five antibody-deficient patients receiving regular immunoglobulin replacement therapy were tested for HEV RNA and anti-HEV immunoglobulin G (IgG). Immunoglobulin products and plasma specimens obtained from 9 antibody-deficient patients before and after intravenous immunoglobulin (IVIG) therapy, 5 recently treated patients with persistent HEV infection, and 5 healthy patients recovered from acute HEV infection were analyzed for anti-HEV IgG and for antibody reacting with HEV antigen. Results No antibody-deficient patient had detectable plasma HEV RNA. Anti-HEV IgG was detected in 38.8% of patients. All 10 immunoglobulin products tested contained anti-HEV capable of neutralizing HEV antigen. Plasma samples collected following IVIG infusion therapy demonstrated a higher anti-HEV IgG level and neutralizing activity, compared with samples collected before IVIG therapy. Neutralizing activity was similar to that in healthy patients with recent acute HEV infection. Conclusion The risk of persistent HEV infection in patients with antibody deficiency appears extremely low. This may be due to passive seroprotection afforded by the ubiquitous presence of anti-HEV in immunoglobulin replacement products.

AB - Background Persistent hepatitis E virus (HEV) infection is described in a number of immunosuppressive conditions. We aimed to determine the risk of persistent HEV infection in patients with primary or secondary antibody deficiency. Methods Two hundred forty-five antibody-deficient patients receiving regular immunoglobulin replacement therapy were tested for HEV RNA and anti-HEV immunoglobulin G (IgG). Immunoglobulin products and plasma specimens obtained from 9 antibody-deficient patients before and after intravenous immunoglobulin (IVIG) therapy, 5 recently treated patients with persistent HEV infection, and 5 healthy patients recovered from acute HEV infection were analyzed for anti-HEV IgG and for antibody reacting with HEV antigen. Results No antibody-deficient patient had detectable plasma HEV RNA. Anti-HEV IgG was detected in 38.8% of patients. All 10 immunoglobulin products tested contained anti-HEV capable of neutralizing HEV antigen. Plasma samples collected following IVIG infusion therapy demonstrated a higher anti-HEV IgG level and neutralizing activity, compared with samples collected before IVIG therapy. Neutralizing activity was similar to that in healthy patients with recent acute HEV infection. Conclusion The risk of persistent HEV infection in patients with antibody deficiency appears extremely low. This may be due to passive seroprotection afforded by the ubiquitous presence of anti-HEV in immunoglobulin replacement products.

KW - Hepatitis E virus

KW - IVIG

KW - antibody deficiency

KW - chronic infection

KW - immunoglobulin

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U2 - 10.1093/infdis/jiy504

DO - 10.1093/infdis/jiy504

M3 - Article

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AN - SCOPUS:85059232471

VL - 219

SP - 245

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JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

SN - 0022-1899

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ER -

Absence of Persistent Hepatitis e Virus Infection in Antibody-Deficient Patients Is Associated with Transfer of Antigen-Neutralizing Antibodies from Immunoglobulin Products

Abstract

Bibliographical note

Keywords

UN SDGs

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