High prevalence of anti-hepatitis E virus antibodies in outpatients with chronic liver disease in a university medical center in Germany.

AIM/OBJECTIVES/BACKGROUND: Hepatitis E virus (HEV) is an emerging disease in developed countries. HEV seroprevalence ranges from 3.2 to 10% in Europe, but is higher in endemic areas such as southern France. In Germany, an increasing incidence of HEV infections has been reported recently. Risk factors for the acquisition of HEV are incompletely understood. METHODS: We screened 295 consecutive patients with chronic liver disease attending the outpatient department at Charité University Hospital for HEV seroprevalence. Epidemiological characteristics were analyzed and patients were questioned for risk factors using a standardized questionnaire. A total of 78 patients without known liver disease were also tested for HEV IgG. RESULTS: Out of 295 screened patients, 62 tested positive for HEV-IgG. Overall, 50% of the HEV-positive patients were women and 23.8% had underlying liver cirrhosis. HEV-positive patients were older than HEV-negative patients (mean age 56 vs. 48.6 years). Seroprevalence increased with age from 13% in patients 30-39 years of age to 36.4% in patients 70-79 years of age. Of the total, 46.7% of HEV-IgG-positive patients had contact with domestic animals and 38.3% had received blood transfusions. A total of 50% of the HEV-IgG-positive patients had regularly consumed uncooked meat and 45% had regularly consumed wild game or wild boar, which was significantly more frequent than in HEV-IgG-negative patients. CONCLUSION: HEV-IgG seroprevalence was 21% in a cohort of patients with chronic liver disease and 24.4% in a cohort of patients without known liver disease. The higher seroprevalence found among elderly patients suggests a lifetime accumulation of risk of exposure to HEV. The results from this study imply that regular testing should be performed for HEV in developed countries in case of liver disease of unknown etiology.

Rituximab in two cases of Goodpasture's syndrome.

We describe the effects of rituximab in two patients with refractory Goodpasture's syndrome. After one single 1000 mg dose administration, rituximab did not appear to improve renal function in either of our cases. Polyoma virus-negative leukoencephalopathy, a probable toxic side effect of rituximab, was seen in our first patient.

Export of beta-lactamase is independent of the signal recognition particle.

In Escherichia coli, three different types of proteins engage the SecY translocon of the inner bacterial membrane for translocation or insertion: 1) polytopic membrane proteins that prior to their insertion into the membrane are targeted to the translocon using the bacterial signal recognition particle (SRP) and its receptor; 2) secretory proteins that are targeted to and translocated across the SecY translocon in a SecA- and SecB-dependent reaction; and 3) membrane proteins with large periplasmic domains, requiring SRP for targeting and SecA for the translocation of the periplasmic moiety. In addition to its role as a targeting device for membrane proteins, a function of the bacterial SRP in the export of SecB-independent secretory proteins has also been postulated. In particular, beta-lactamase, a hydrolytic enzyme responsible for cleavage of the beta-lactam ring containing antibiotics, is considered to be recognized and targeted by SRP. To examine the role of the SRP pathway in beta-lactamase targeting and export, we performed a detailed in vitro analysis. Chemical cross-linking and membrane binding assays did not reveal any significant interaction between SRP and beta-lactamase nascent chains. More importantly, membrane vesicles prepared from mutants lacking a functional SRP pathway did block the integration of SRP-dependent membrane proteins but supported the export of beta-lactamase in the same way as that of the SRP-independent protein OmpA. These data demonstrate that in contrast to previous results, the bacterial SRP is not involved in the export of beta-lactamase and further suggest that secretory proteins of Gram-negative bacteria in general are not substrates of SRP.