Biliary Atresia and Cytomegalovirus Infection: A DNA Study

Abstract

The cause of extrahepatic biliary atresia (EHBA) is undetermined in most instances, but an infectious agent is widely suspected. Cytomegalovirus (CMV) infection has been associated with intrahepatic bile duct destruction and paucity, raising the question of its role in EHBA. We identified 12 children in the past 5 years with biliary atresia and examined the bile duct biopsy. These showed acute/chronic inflammation and epithelial degeneration. CMV inclusions were not identified. We used in situ hybridization and the polymerase chain reaction (PCR) for CMV-DNA on formalin-fixed, paraffin-embedded tissue. All samples showed the presence of amplifiable DNA using beta-globin primers. No biopsy tissue showed CMV DNA using specific probes and primers. The absence of demonstrable CMV DNA by in situ hybridization and PCR in EHBA biopsies implies that it is unlikely that this virus has any major role in the pathogenesis of this condition.

Cytomegalovirus frequency in neonatal intrahepatic cholestasis determined by serology, histology, immunohistochemistry and PCR

“…Lurie et al [35] , after studying four fatal cases of NIHC from CMV, described the presence of cytomegalic cells in the liver from two of them. None were detected in the present study or observed in cases of extrahepatic cholestasis (EHC) [36][37][38] . In CMV hepatitis following orthotopic liver transplantation (immunosuppressed patients), demonstration of cytomegalic inclusion bodies in hematoxylin and eosin sections is sufficient for a diagnosis of CMV hepatitis [39] .…”

Problems related to CMV infection and biliary atresia

“…De Tomasso et al 9 describe a low accuracy of serological tests for detecting active CMV infection, with no correlation between the CMV-positive qPCR and histopathological changes reported by others. 1,13,16 Our study, however, reinforces a probable correlation. Some information suggests a worse outcome in CMV-affected patients.…”

“…1,9,13,16 Serology, CMV quantitative polymerase chain reaction (qPCR), immunohistochemistry and histology have been unable to confirm a possible role of CMV in BA aetiology. De Tomasso et al 9 describe a low accuracy of serological tests for detecting active CMV infection, with no correlation between the CMV-positive qPCR and histopathological changes reported by others.…”

Biliary Atresia Is Associated with CD4+ Th1 Cell–Mediated Portal Tract Inflammation

“…Likewise, group C rotavirus was found in patients with biliary atresia by Riepenhoff-Talty et al (11); however, another study failed to identify this virus (12). Conflicting studies have also been reported for cytomegalovirus (13,14).…”