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Porcine-derived pancreatic enzyme replacement therapy linking to chronic hepatitis E: broad implications
  1. Jiahua Zhou1,
  2. Kuan Liu1,2,
  3. Qiuwei Pan1
  1. 1Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
  2. 2Department of Surgery, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Dr Qiuwei Pan, Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands; q.pan{at}erasmusmc.nl

https://doi.org/10.1136/gutjnl-2024-332975

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    We read with interest the recent work by Thornton et al, which described three cases of chronic hepatitis E in persons with cystic fibrosis (pwCF) after lung transplantation.1 Because most pwCF took porcine-derived pancreatic enzyme replacement therapy (PERT), the authors suspected PERT as a plausible source of transmitting hepatitis E virus (HEV) to these patients. Alarmingly, the authors found that 44% of PERT capsules were positive for HEV viral RNA.1 Although there remains a knowledge gap whether the viral components presented in PERT are actually infectious, which can be further assessed for example by using experimental models, the intriguing findings from this study do bear broad implications (figure 1).

    Figure 1

    The potential risk of transmitting hepatitis E virus (HEV) to humans through porcine-derived medicinal products such as heparin or pancreatic enzyme (PE), and through xenotransplantation …

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    Footnotes

    • Correction notice This article has been corrected since it published Online First. The last author's affiliation details have been updated.

    • Contributors JZ, KL and QP contributed to the concept and writing.

    • 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 Not commissioned; internally peer reviewed.