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dc.contributor.authorMorfopoulou, Sofia
dc.contributor.authorBuddle, Sarah
dc.contributor.authorMontaguth, Oscar Enrique Torres
dc.contributor.authorAtkinson, Laura
dc.contributor.authorGuerra-Assunção, José Afonso
dc.contributor.authorMarjaneh, Mahdi Moradi
dc.contributor.authorChiozzi, Riccardo Zenezini
dc.contributor.authorStorey, Nathaniel
dc.contributor.authorCampos, Luis
dc.contributor.authorHutchinson, J. Ciaran
dc.contributor.authorCounsell, John R.
dc.contributor.authorPollara, Gabriele
dc.contributor.authorRoy, Sunando
dc.contributor.authorVenturini, Cristina
dc.contributor.authorAntinao Diaz, Juan F.
dc.contributor.authorSiam, Ala’a
dc.contributor.authorTappouni, Luke J.
dc.contributor.authorAsgarian, Zeinab
dc.contributor.authorNg, Joanne
dc.contributor.authorHanlon, Killian S.
dc.contributor.authorLennon, Alexander
dc.contributor.authorMcArdle, Andrew
dc.contributor.authorCzap, Agata
dc.contributor.authorRosenheim, Joshua
dc.contributor.authorAndrade, Catarina
dc.contributor.authorAnderson, Glenn
dc.contributor.authorLee, Jack C. D.
dc.contributor.authorWilliams, Rachel
dc.contributor.authorWilliams, Charlotte A.
dc.contributor.authorTutill, Helena
dc.contributor.authorBayzid, Nadua
dc.contributor.authorBernal, Luz Marina Martin
dc.contributor.authorMacpherson, Hannah
dc.contributor.authorMontgomery, Kylie-Ann
dc.contributor.authorMoore, Catherine
dc.contributor.authorTempleton, Kate
dc.contributor.authorNeill, Claire
dc.contributor.authorHolden, Matt
dc.contributor.authorGunson, Rory
dc.contributor.authorShepherd, Samantha J.
dc.contributor.authorShah, Priyen
dc.contributor.authorCooray, Samantha
dc.contributor.authorVoice, Marie
dc.contributor.authorSteele, Michael
dc.contributor.authorFink, Colin
dc.contributor.authorWhittaker, Thomas E.
dc.contributor.authorSantilli, Giorgia
dc.contributor.authorGissen, Paul
dc.contributor.authorKaufer, Benedikt B.
dc.contributor.authorReich, Jana
dc.contributor.authorDIAMONDS consortium
dc.contributor.authorISARIC 4C Investigators
dc.contributor.authorPERFORM Consortium
dc.contributor.authorBreuer, Judith
dc.date.accessioned2023-05-10T14:30:03Z
dc.date.available2023-05-10T14:30:03Z
dc.date.issued2023-05-18
dc.identifier.citationMorfopoulou , S , Buddle , S , Montaguth , O E T , Atkinson , L , Guerra-Assunção , J A , Marjaneh , M M , Chiozzi , R Z , Storey , N , Campos , L , Hutchinson , J C , Counsell , J R , Pollara , G , Roy , S , Venturini , C , Antinao Diaz , J F , Siam , A , Tappouni , L J , Asgarian , Z , Ng , J , Hanlon , K S , Lennon , A , McArdle , A , Czap , A , Rosenheim , J , Andrade , C , Anderson , G , Lee , J C D , Williams , R , Williams , C A , Tutill , H , Bayzid , N , Bernal , L M M , Macpherson , H , Montgomery , K-A , Moore , C , Templeton , K , Neill , C , Holden , M , Gunson , R , Shepherd , S J , Shah , P , Cooray , S , Voice , M , Steele , M , Fink , C , Whittaker , T E , Santilli , G , Gissen , P , Kaufer , B B , Reich , J , DIAMONDS consortium , ISARIC 4C Investigators , PERFORM Consortium & Breuer , J 2023 , ' Genomic investigations of unexplained acute hepatitis in children ' , Nature , vol. 617 , pp. 564-592 . https://doi.org/10.1038/s41586-023-06003-wen
dc.identifier.issn0028-0836
dc.identifier.otherPURE: 283996624
dc.identifier.otherPURE UUID: e7f39ea9-30cb-4464-9913-4eef08c05704
dc.identifier.otherPubMed: 36996872
dc.identifier.otherORCID: /0000-0002-4958-2166/work/134056254
dc.identifier.otherRIS: urn:C77FAD47DB8421E150338ACF50B70E8D
dc.identifier.otherRIS: Morfopoulou2023
dc.identifier.otherScopus: 85151469478
dc.identifier.urihttps://hdl.handle.net/10023/27561
dc.descriptionFunding: UKHSA funded the metagenomics and HAdV sequencing. The work was part funded by the NIHR Blood and Transplant Research Unit in Genomics to Enhance Microbiology Screening (GEMS), the National Institute for Health and Care Research (CO-CIN-01) or jointly by NIHR and UK Research and Innovation (CV220-169, MC_PC_19059). S. Morfopoulou is funded by a W.T. Henry Wellcome fellowship (206478/Z/17/Z). S.B. and O.E.T.M. are funded by the NIHR Blood and Transplant Research Unit (GEMS). M.M.M. and M.L. are supported in part by the NIHR Biomedical Research Centre of Imperial College NHS Trust. J.B. receives NIHR Senior Investigator Funding. M.N. and J.B. are supported by the Wellcome Trust (207511/Z/17/Z and 203268/Z/16/Z). M.N., J.B. and G.P. are supported by the NIHR University College London Hospitals Biomedical Research Centre. P. Simmonds is supported by the NIHR (NIHR203338). T.S.J. is grateful for funding from the Brain Tumour Charity, Children with Cancer UK, GOSH Children’s Charity, Olivia Hodson Cancer Fund, Cancer Research UK and the NIHR. DIAMONDS is funded by the European Union (Horizon 2020; grant 848196). PERFORM was funded by the European Union (Horizon 2020; grant 668303).en
dc.description.abstractSince its first identification in Scotland, over 1000 cases of unexplained pediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator subjects, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in liver, blood, plasma or stool from 27/28 cases. We found low levels of Adenovirus (HAdV) and Human Herpesvirus 6B (HHV-6B), in 23/31 and 16/23 respectively of the cases tested. In contrast, AAV2 was infrequently detected at low titre in blood or liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T-cells and B-lineage cells. Proteomic comparison of liver tissue from cases and healthy controls, identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and in severe cases HHV-6B, may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children.
dc.format.extent29
dc.language.isoeng
dc.relation.ispartofNatureen
dc.rightsCopyright © 2023, The Author(s). This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.en
dc.subjectRJ Pediatricsen
dc.subjectQH426 Geneticsen
dc.subjectDASen
dc.subjectSDG 3 - Good Health and Well-beingen
dc.subjectMCCen
dc.subject.lccRJen
dc.subject.lccQH426en
dc.titleGenomic investigations of unexplained acute hepatitis in childrenen
dc.typeJournal articleen
dc.description.versionPublisher PDFen
dc.contributor.institutionUniversity of St Andrews. St Andrews Bioinformatics Uniten
dc.contributor.institutionUniversity of St Andrews. Infection and Global Health Divisionen
dc.contributor.institutionUniversity of St Andrews. Biomedical Sciences Research Complexen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.identifier.doihttps://doi.org/10.1038/s41586-023-06003-w
dc.description.statusPeer revieweden


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