Hepatitis E is a fairly underestimated disease with increasing prevalence worldwide. About 20 million infections result in more than 70,000 deaths per year1. The underlying agent, the Hepatitis E virus (HEV), was reassigned recently and is now classified within the family Hepeviridae including the genera Orthohepevirus and Piscihepevirus. HEV of various origins are classed within the species Orthohepevirus A-D including isolates from humans, swine, rabbits, rats, birds and other mammals2. At present, eight different genotypes (GT) of the positive-orientated, single-stranded RNA virus have been identified2. Although they differ in their sequence identity, routes of transmission and geographical distribution, their genomic structure is highly conserved. More specific, the 7.2 kbp HEV genome is divided into 3 major open reading frames (ORF1-3). While ORF1 encodes all enzymes needed for a successful replication within the host cell, ORF2 encodes the capsid protein, and the ORF3 protein operates as a functional ion channel required for assembly and release of infectious particles3. Once released into the basal or apical lumen HEV exists in both, quasienveloped and non-enveloped/naked species depending on whether the virus originates from blood or feces, respectively4,5.
While GT1 and GT2 are mainly found in developing countries solely infecting humans6 via the fecal-oral route, GT3, GT4 and GT7 predominantly occur in developed countries1,7 with a variety of species serving as reservoirs, e.g., swine8, rat9, chicken10,11, deer12, mongoose13, bat14, rabbit15,16, wild boar17 and many more7,18,19, providing evidence of zoonosis7,20,21,22. In addition to inadequate sanitary conditions23 and contaminated food products12,24,25,26, transmission via blood transfusion and organ transplantations is also possible27,28. HEV is a common cause of liver cirrhosis and liver failure29 especially in patients with pre-existing liver disease, immunocompromised individuals (genotype 3, 4 and 7) and pregnant women (genotype 1). Of note, there are also extrahepatic manifestations such as hematopoietic disease30,31,32, neurological disorders33 and renal injury34.
To date, the off-label drug ribavirin (RBV) is the treatment of choice for many infected patients35,36. However, cases of treatment failure and poor clinical long-term outcomes have been reported. Treatment failure has been linked to viral mutagenesis and increased viral heterogeneity in chronically infected patients37,38,39. On the contrary, a recent European retrospective multicenter study was not able to correlate polymerase mutations to RBV treatment failure40. In clinical observations and in vitro experiments, interferon41,42,43, sofosbuvir44,45, zinc salts46 and silvestrol47,48 have also shown antiviral effects. Nonetheless, a specific HEV treatment remains to be found, hampered by the lack of knowledge about the HEV life cycle and its pathogenesis. Therefore, a robust cell culture system for virological studies and the development of new antiviral drugs is urgently needed49.
Unfortunately, like other hepatitis viruses, HEV is difficult to propagate in conventional cell lines and usually progresses very slowly leading to low viral loads. Nevertheless, some groups were able to boost viral loads by the generation of cell line subclones50 or the adjustment of media supplements51. Recently the generation of cDNA clones52 and the adaption of primary patient isolates by passaging53,54 further improved HEV propagation in cell culture55. In this protocol, we used the genome of a cell culture adapted Kernow-C1 strain (referred to as p6_WT)54 and a mutant strain harboring a replication-enhancing mutation (referred to as p6_G1634R)37. Kernow-C1 is the most frequently used strain in HEV cell culture and is capable to produce high viral loads. By assessing viral RNA copy numbers, HEV replication can be monitored in vitro. Nevertheless, these techniques do not allow assessment of the number of infectious particles being produced. Therefore, we have established an immunofluorescence staining to determine Focus Forming Units (FFU/mL).
The here described method56 can be used to produce full-length infectious viral particles that are capable to infect a variety of cell types from diverse origins including primary cells and mammalian cell lines. This is a fundamental prerequisite to decipher important aspects of HEV infection and tropism. There is no need for inoculation with usually limited patient isolates. The production of infectious HEV particles from plasmids poses an infinite source, which makes this protocol comparably efficient. In addition, this system can be used for reverse genetics enabling the study of in vivo identified genome alteration and their impact on HEV replication and fitness. This technique overcomes many limitations and, can path the way for drug development, mutagenesis studies and the evaluation of virus-host interactions such as restriction or entry factors.