To the Editor. —
Studies to date have shown that the pre-S2-region encoded peptide is found in the serum early in the course of uncomplicated acute type B hepatitis and is correlated well with the presence of markers of active viral replication (hepatitis B e antigen and hepatitis B virus [HBV] DNA),1 while the appearance of antibodies to pre-S2 (anti—pre-S2) is followed by clearance of hepatitis B surface antigen (HBsAg) and recovery.1,2 In this context, anti—pre-S2 antibodies seem to play no role in the pathogenesis of HBV-related liver damage.2 Fulminant type B heptitis (FH-B) is characterized by rapid clearance of HBsAg and early appearance of anti-HBs; this enhanced immune response has been implicated in the pathogenesis of FH-B.3 We studied the presence of pre-S2/anti—pre-S2 in 16 serum samples from seven adults (four men and three women) with FH-B. Their age ranged from 27 to 62 years
Tassopoulos NC, Budkowska A, Hadziyannis S. Pre-S2 and Its Antibody in Fulminant Type B Hepatitis. JAMA. 1989;261(7):991–992. doi:10.1001/jama.1989.03420070041020
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