Author/Authors :
Horvatits ، Thomas Department of Medicine I - University Medical Center Hamburg-Eppendorf , Behrendt ، Patrick Department of Gastroenterology, Hepatology and Endocrinology - Hanover Medical School , Schuebel ، Niels Klinikum Osnabrück - Infectious Diseases Center , Guthoff ، Martina Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension - University of Tuebingen , Wiegand ، Johannes Department of Medicine II, Division of Hepatology - Medical Center - Leipzig University , Harth ، Anna Medical Center Cologne-Merheim , Mersi ، Julia Department of Oncology - University Hospital Wurzburg , Luetgehetmann ، Marc Institute of Microbiology, Virology and Hygiene - University Medical Center Hamburg-Eppendorf , Gallon ، Clemence Hepatology Service - Public Assistance-Hospitals of Paris, Cochin Hospital-Port Royal - University of Paris , Rybczynski ، Meike University Heart Center - University Medical Center Hamburg-Eppendorf , Liang ، Zhaochao Department of Microbiology - Infectious Disease Center, Health Science Center, School of Basic Medical Sciences - Peking University , Maasoumy ، Benjamin Department of Gastroenterology, Hepatology and Endocrinology - Hanover Medical School , Mallet ، Vincent Hepatology Service - Public Assistance-Hospitals of Paris, Cochin Hospital-Port Royal - University of Paris , Wang ، Lin Department of Microbiology - Infectious Disease Center, Health Science Center, School of Basic Medical Sciences - Peking University , Pischke ، Sven Department of Medicine I - University Medical Center Hamburg-Eppendorf
Abstract :
Background: Chronic hepatitis E virus (HEV) infection may progress to end-stage liver disease in immunosuppressed individuals. Ribavirin therapy is efficient in most chronic HEV patients, but 10% remain without a sustained virological response (SVR). Objectives: We aimed to study whether zinc supplementation could represent a therapeutic approach in these patients. Methods: Antiviral properties of zinc salts were studied in vitro (subgenomic-replicon system), in vivo (rabbit model), and retrospectively in patients with chronic hepatitis E who did not achieve SVR under ribavirin monotherapy. Results: Zinc inhibited HEV genotype 3 replication in vitro. In a model of acute HEV infection in immunocompetent rabbits, zinc + ribavirin did not improve viral clearance compared to ribavirin monotherapy. In chronically HEV-infected patients not responding to ribavirin (n = 12), viral clearance was observed in 4/12 (33%) patients receiving additional zinc supplementation. Conclusions: Oral zinc, an inexpensive, harmless dietary supplement, could potentially represent a rescue treatment option for a few patients with chronic hepatitis E without SVR under ribavirin monotherapy. Further studies are needed to elucidate the role of zinc in HEV.
Keywords :
Hepatitis E , HEV , Antiviral , Zinc
