title: Analysis of full-length hepatitis A virus genome in sera from patients with fulminant and self-limited acute type A hepatitis.
abstract: OBJECTIVE
  Type A hepatitis still poses a considerable problem worldwide. Why some patients progress to fulminant type A hepatitis and others do not is still unknown. To examine whether genomic differences of hepatitis A virus (HAV) are responsible for the severity of the disease, we analyzed the whole HAV genomes from patients with fulminant and self-limited acute type A hepatitis.
  
  
  METHODS
  Sera from three patients with sporadic type A fulminant hepatitis (FH) and three patients with acute hepatitis (AH) were examined for HAV RNA. Full-length nucleotide sequences were determined using long reverse transcription polymerase chain reaction, 5' and 3' rapid amplification of cDNA ends methods, and direct sequencing. The amino acid sequences were deduced from the nucleotide sequences.
  
  
  RESULTS
  HAV RNA was detected in all six patients examined. From the sequence of viral protein 1/2A, all cases were revealed to be genotype IA. By comparing with genotype IA, wild-type HAV strain GBM, the analysis of whole genomes from the six cases showed no specific substitutions between FH and AH. Completely identical nucleotide sequences were observed at 3' non-translated region (NTR) in all six cases. In 5'NTR, less nucleotide substitutions were found in FH than in AH, and in the non-structural protein 2B region, a little more amino acid substitutions seemed to be found in FH than in AH.
  
  
  CONCLUSIONS
  This study showed that full-length HAV could be analyzed from serum samples. Although there were no unique nucleotide or amino acid substitutions, possible associations were suggested between the severity of type A hepatitis and the nucleotide substitutions in 5'NTR and the amino acid substitutions in 2B.
authors.affiliation: First Department of Internal Medicine, Chiba University School of Medicine, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Fujiwara
authors.forename: O
authors.initials: O
authors.lastname: Yokosuka
authors.forename: K
authors.initials: K
authors.lastname: Fukai
authors.forename: F
authors.initials: F
authors.lastname: Imazeki
authors.forename: H
authors.initials: H
authors.lastname: Saisho
authors.forename: M
authors.initials: M
authors.lastname: Omata
mesh_terms: D020413:3' Untranslated Regions / Q000235:genetics; D020121:5' Untranslated Regions / Q000235:genetics; D000328:Adult; D019943:Amino Acid Substitution; D001483:Base Sequence; D005260:Female; D016679:Genome, Viral; D005838:Genotype; D006506:Hepatitis A / Q000235:genetics* / Q000503:physiopathology / Q000821:virology*; D030041:Hepatitis A virus / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000235:genetics; D012720:Severity of Illness Index; D017361:Viral Nonstructural Proteins / Q000235:genetics; D015678:Viral Structural Proteins / Q000235:genetics
chemical_list: D020413:3' Untranslated Regions; D020121:5' Untranslated Regions; D012367:RNA, Viral; D017361:Viral Nonstructural Proteins; D015678:Viral Structural Proteins