• HEPATITIS E

We read with interest the recent work by Thornton et al, which described three cases of chronic hepatitis E in persons with cystic fibrosis (pwCF) after lung transplantation.1 Because most pwCF took porcine-derived pancreatic enzyme replacement therapy (PERT), the authors suspected PERT as a plausible source of transmitting hepatitis E virus (HEV) to these patients. Alarmingly, the authors found that 44% of PERT capsules were positive for HEV viral RNA.1 Although there remains a knowledge gap whether the viral components presented in PERT are actually infectious, which can be further assessed for example by using experimental models, the intriguing findings from this study do bear broad implications (figure 1).