UNC researchers identify how hepatitis A virus causes liver injury

A new report in the journal Science describes how the virus can jump species, including to mice – a finding that has major implications for researching the disease and host immune responses to the virus. Jason Whitmire, PhD, and Stanley Lemon, MD, led the research team.

CHAPEL HILL, NC – Hepatitis researchers have long thought that immune cells – sent to attack virus-infected cells in the liver – cause the acute liver injury associated with hepatitis A virus (HAV) and other hepatitis viruses. Yet, investigators at the University of North Carolina at Chapel Hill School of Medicine discovered that it is an immediate, intrinsic response of the HAV-infected cell that results in liver inflammation. These results were published today in the journal Science.

“The virus evokes a response in the infected cell that activates a pre-programmed cell death pathway,” said Stanley Lemon, MD, one of the study’s authors, professor of medicine, and member of the UNC Institute for Global Health & Infectious Diseases. “In effect, the cell commits suicide, sacrificing itself along with the virus in an effort to save the host. This results in inflammation within the liver that we recognize as hepatitis.”

Hepatitis A virus is a vaccine-preventable form of infectious hepatitis found worldwide. It is transmitted through ingestion of food and water that is contaminated with the feces of an infected person. Frozen strawberries used in drinks at a smoothie chain led to a hepatitis A outbreak this summer in seven states.

Symptoms of hepatitis A include nausea, stomach pain, fever, sore throat, headache and diarrhea. People infected with HAV may not experience any symptoms, but shed the virus for two to four weeks. During this period, an infected person can pass the virus to others. HAV does not cause chronic liver disease like hepatitis B and C viruses. But in rare cases, it can cause acute liver failure, which is often fatal.

In addition to identifying how the virus causes acute liver injury, the UNC team, along with colleagues at North Carolina State University, established a new animal model of infection with the virus. For decades, researchers believed only primates – humans, chimpanzees and a few species of monkeys – could be infected by HAV. However, when the team interrupted the intrinsic cellular antiviral response in mice, they discovered the virus could jump species.

“The ability of the virus to jump into mice is dependent upon knocking out the mouse interferon system, which HAV cannot do on its own,” said Lemon. “Host species jumps are incredibly important for viral emergence, and the factors that control the odds of this happening are not well known. We have defined the host interferon system as a very important barrier to a host species jump.”

The UNC research team, led by Lemon and Jason Whitmire, PhD, associate professor in the department of genetics, is now poised to investigate the complicated interplay of nonspecific “innate” and specific “adaptive” immune responses that ultimately control the infection and eliminate HAV from the host, processes that are not well understood for any of the five human hepatitis viruses.

Funding from the National Institutes of Health (NIH) and a National Institute of Cancer Center Core Support Grant supported this research.

The mission of UNC’s Institute for Global Health & Infectious Diseases is to harness the full resources of the University and its partners to solve global health problems, reduce the burden of disease, and cultivate the next generation of global health leaders. Learn more at www.globalhealth.unc.edu. Twitter: @uncglobalhealth.