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Is HBx protein the X factor in the pathogenesis of IBD?
  1. Indrani Mukhopadhya
  1. Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Indrani Mukhopadhya, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK; indrani.mukhopadhya{at}

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The role of viruses in the aetiopathogenesis of inflammatory bowel disease (IBD) has been a topic of conjecture for decades. Initial focus on specific viral agents in IBD like norovirus, rotaviruses and measles virus did not gain ground. The advent of metagenomics and detailed assessment of the ‘whole gut virome’ has now shown that the gastrointestinal tract harbours nearly 109 virus like particles per gram, with the majority comprised of prokaryotic viruses (bacteriophages infecting bacteria) and a minority of eukaryotic viruses.1 In IBD, the bacteriophages as apex predators in the gut ecosystem can alter their bacterial prey resulting in ‘dysbiosis’ of the bacterial population whereas eukaryotic viruses can interact directly with the host innate immune system and lead to chronic inflammation.1 This leaves us with the intriguing prospect that ‘viral dysbiosis’ could very well be the initiating event triggering the inflammatory cascade in patients with IBD.2

In Gut, Massimino et al have reported a novel association of viral infection and IBD.3 The authors have previously reported an upregulation of the HBx protein belonging to the Orthohepadnavirus genus, in the gut virome of early diagnosed, treatment naïve ‘paediatric’ subjects with ulcerative colitis (UC), but not in those with Crohn’s disease (CD) or normal subjects.4 In the current study, they confirmed HBx positivity in …

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  • Contributors IM has drafted this commentary.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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