Review of clinical characteristics, immune responses and regulatory mechanisms of hepatitis E-associated liver failure

doi:10.12998/wjcc.v10.i19.6341

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World Journal of Clinical Cases

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World J Clin Cases. Jul 6, 2022; 10(19): 6341-6348
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6341

Review of clinical characteristics, immune responses and regulatory mechanisms of hepatitis E-associated liver failure

Chong Chen, Shu-Ye Zhang, Liang Chen

Chong Chen, Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China

Shu-Ye Zhang, Liang Chen, Department of Hepatology, Shanghai Public Health Clinical Center, Shanghai 201508, China

Author contributions: Chen C, Zhang SY and Chen L contributed equally to all aspects of the work.

Supported by Shanghai Shenkang Hospital Development Center, No. SHDC12020109; Shanghai Association for Science and Technology, No. 21S11905600; and Plan of the Research Project Funded by Shanghai Public Health Clinical Centre, No. KY-GW-2022-22.

Conflict-of-interest statement: All the authors declare no conflict of interest related to the manuscript.

Corresponding author: Liang Chen, MD, Chief Physician, Department of Hepatology, Shanghai Public Health Clinical Center, No. 2901 Caolang Road, Jin-Shan District, Shanghai 201508, China. chenliang@shphc.org.cn

Received: January 8, 2022
Peer-review started: January 8, 2022
First decision: March 9, 2022
Revised: March 17, 2022
Accepted: May 5, 2022
Article in press: May 5, 2022
Published online: July 6, 2022
Processing time: 166 Days and 21.9 Hours

Abstract

Hepatitis E virus (HEV) is the most common cause of acute liver failure (LF) and one of the most common factors causing acute injury in acute-on-chronic LF (ACLF). When HEV-related LF occurs, a series of changes take place in both the intrahepatic environment and extrahepatic microenvironment. The changed types and distribution of immune cells (infiltrating macrophages and increased lymphocytes) in liver tissue, as well the increased proinflammatory cytokines and chemokines in the blood, indicate that the occurrence and progression of HEV-related LF are closely related to immune imbalance. The clinical features and immune reaction in the body during HEV-related acute LF (ALF) and ACLF are complicated. This review highlights recent progress in elucidating the clinical manifestations of HEV-associated ALF and ACLF and discusses the corresponding systemic immune changes and possible regulatory mechanisms.

Keywords: Hepatitis E virus; Acute liver failure; Acute-on-chronic liver failure; Immune cells; Cytokines; Mechanism

Core Tip: Hepatitis E virus (HEV) is the most common cause of acute liver failure (LF) and a common factor causing acute injury in acute-on-chronic LF (ACLF). The whole immune environment in the body during HEV-related LF is complicated. This review highlights recent progress in elucidating the clinical manifestations of HEV-associated acute LF and ACLF and discusses the corresponding systemic immune changes and possible regulatory mechanisms.