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Porcine-derived pancreatic enzyme replacement therapy: a cause of hepatitis E virus transmission?
  1. Nassim Kamar1,2,
  2. Olivier Marion3,4,
  3. Florence Abravanel5,
  4. Laure Esposito6,
  5. Arnaud Del Bello6,
  6. Jacques Izopet7
  1. 1Department of Nephrology and Organ Transplantation, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
  2. 2INFINITY, Toulouse, France
  3. 3Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
  4. 4Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France
  5. 5Virology, CHU toulouse Purpan, Toulouse, France
  6. 6Department of Nephrology and Organ Transplantation, CHu Rangueil, Toulouse cedex 4, France
  7. 7Centre Hospitalier Universitaire de Toulouse, Toulouse, France
  1. Correspondence to Professor Nassim Kamar, Department of Nephrology and Organ Transplantation, Centre Hospitalier Universitaire de Toulouse, Toulouse, Occitanie, France; kamar.n{at}chu-toulouse.fr

https://doi.org/10.1136/gutjnl-2024-332744

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    Recently, in Canada, Thornton et al observed a higher proportion of anti-hepatitis E virus (HEV) IgG among persons with cystic fibrosis having received (20.7%) or not (19.3%) a lung transplantation compared with a non-cystic fibrosis population (10.7%).1 In order to understand the difference in the seropositivity rate between these populations, they focused their research on the use of pancreatic enzyme replacement therapy (PERT).1 Indeed, pancreatic insufficiency is quite common in patients with cystic fibrosis, requiring PERT. PERT is porcine derived. Pork is one of the main reservoirs of HEV.2 Zoonotic transmission of viruses through PERT was previously recognised.3 Thornton et al detected HEV RNA in 44% of PERT capsules obtained from different formulations and produced by four different manufacturers.1 In their study, 3 out of 29 lung transplant patients with cystic fibrosis have detectable HEV RNA and developed chronic HEV infection. …

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    Footnotes

    • Contributors NK analysed the data and wrote the paper. OM, LE and ADB did the patients’ follow-up. FA did the virological workup. JI revised the paper.

    • 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; externally peer reviewed.