title: Rotavirus and biliary atresia:  can causation be proven?
abstract: OBJECTIVE
  New knowledge on rotavirus infection in children and well established mouse models has renewed interest in whether rotavirus could cause biliary atresia, an idiopathic, obliterative infantile disease of bile ducts that is the primary indication for liver transplant in children.
  
  
  RESULTS
  Studies in the rotavirus mouse model of biliary atresia indicate that infection of biliary epithelium is an inaugural event leading to biliary inflammation and obstruction, which is preceded by systemic spread of rotavirus, which also occurs during human rotavirus enteric infections. Viral factors, including rotavirus gene 4, are important for biliary infection and biliary atresia in mice. Specific host factors related to inflammatory processes (natural killer and T cells, interferon) are also critical, and a paucity of regulatory T cells in neonates may play a key role in pathogenesis in experimental biliary atresia. Rotavirus vaccination has substantially decreased rotavirus diarrheal disease worldwide and might enable demonstration of a cause-effect relationship between rotavirus infection and biliary atresia in humans.
  
  
  CONCLUSIONS
  Rotavirus can be detected in the serum of mice and children and causes biliary atresia in neonatal mice. Approaches to re-examine whether rotavirus causes biliary atresia in children are discussed based on concepts from the mouse model of biliary atresia and rotavirus vaccination programs.
authors: Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. phertel@bcm.edu
authors: Paula M
authors: PM
authors: Hertel
authors: Mary K
authors: MK
authors: Estes
mesh_terms: D000818:Animals; D001652:Bile Ducts / Q000821:virology*; D001656:Biliary Atresia / Q000453:epidemiology / Q000209:etiology / Q000821:virology; D014943:Global Health; D006801:Humans; D015994:Incidence; D007223:Infant; D012307:Risk Factors; D012401:Rotavirus / Q000302:isolation & purification*; D012400:Rotavirus Infections / Q000150:complications / Q000453:epidemiology / Q000821:virology