In vivo and in vitro induction of MxA protein in peripheral blood mononuclear cells from patients chronically infected with hepatitis C virus

To test whether (HCV) persistence is related to interferon (IFN) hyporesponsiveness, peripheral blood monuclear cells from 29 patients and 11 controls were studied for MxA protein expression. In vitro, only IFN-alpha (P<.001) and interleukin-2 (P<.05) induced MxA protein expression above unstimulated levels. Forty patients were treated with IFN-alpha2b. Patients showed higher basal levels of MxA protein (P<.02) and 2',5'-oligoadenylate synthase (2-5A) activity (P<.05) than controls. During therapy, MxA protein levels (P<.001) and 2-5A activity (P<.05) increased; after 1 month, MxA levels remained high, whereas 2-5A activity declined to initial levels. Increases in MxA were inversely correlated with decreases in serum alanine aminotransferase levels, and MxA induction was greater among virological responders. Thus, the IFN system seems to be activated in chronic HCV infection, but HCV appears to modulate these two components of the IFN system differentially. These results suggest that an inefficient response may contribute to virus persistence and affect the therapeutic outcome.

Histological damage in chronic hepatitis C is not related to the extent of infection in the liver

It has not been completely elucidated whether the liver injury induced by the hepatitis C virus (HCV) is due to direct cytopathic damage or to an immune-mediated response against HCV-infected hepatocytes. In this work, we have determined the percentage of HCV-infected hepatocytes, the histological activity index, and the viremia levels in chronically HCV-infected patients with different grades of liver injury to investigate any possible correlation between them. For that purpose, liver biopsies from 27 patients with HCV chronic hepatitis were analyzed by in situ hybridization. This technique revealed that the percentage of infected hepatocytes ranged from 0.04% to 83.6%. Regarding the viremia levels, HCV RNA concentration ranged from 1.8 x 10(3) to 1.4 x 10(6) genome copies/ml. A significant correlation (r = 0.54; P = 0.003) between the percentage of infected hepatocytes and the viremia levels was found. In contrast, no correlation was observed between the percentage of HCV-infected hepatocytes or the viremia levels and the histological activity index. In conclusion, we have shown that the HCV viremia reflects the extent of the infection in the liver and that the liver injury in chronic HCV infection is not directly related to either the number of infected hepatocytes or the serum HCV RNA concentration.

In vitro effect of amantadine and interferon alpha-2a on hepatitis C virus markers in cultured peripheral blood mononuclear cells from hepatitis C virus-infected patients

The effects of amantadine (1-5 microM) and interferon alpha (IFNalpha)-2a alone (1000 IU/ml) and combined, have been studied in cultured peripheral blood mononuclear cells (PBMC) from 15 chronic hepatitis C patients and ten healthy donors. Amantadine itself did not affect cell viability and had minor effects on the response to mitogens by PBMC. Four patients (27%), but no donors, had hepatitis C virus (HCV) core and NS3-specific proliferative responses. Amantadine suppressed these responses in all cases and its antiproliferative effect was greater than that of IFNalpha (Mann-Whitney's U-test: P < 0.05 in both cases). All PBMC cultures from patients, but none from donors, were HCV RNA positive. Amantadine alone or combined with IFNalpha dose-dependently reduced HCV RNA content in individual PBMC (Wilcoxon's signed rank test: 1 microM, P < 0.05; 2 microM, P < 0.02; and 5 microM, P = 0.16) with respect to untreated cultures. In addition, 7, 13 and 20% of PBMC cultures became HCV RNA negative with 2 microM amantadine alone, IFNalpha alone and their combination, respectively. Finally, in contrast to IFNalpha, amantadine did not modify expression of 2',5'-oligoadenylate synthetase activity or the spontaneous or mitogen-stimulated IFNgamma and interleukin 10 production. In conclusion, these effects in PBMC from HCV patients suggest that the amantadine/IFNalpha combination might be considered a therapeutic option for treating chronic hepatitis C patients.

Two-dimensional gel electrophoresis as analytical tool for identifying Candida albicans immunogenic proteins

This paper reports the usefulness of two-dimensional gel electrophoresis followed by Western blotting with sera from patients with systemic candidiasis in the identification of the major Candida albicans antigens. In order to have different patterns of protein expression and subcellular localization, three types of protein preparations were obtained: cytoplasmic extracts, protoplast lysates and proteins secreted by protoplasts regenerating their cell wall. These proteins were separated by high-resolution two-dimensional electrophoresis using an immobilized pH gradient. Western blotting with sera from patients with systemic candidiasis allowed the detection of more than 18 immunoreactive proteins. Some of these proteins had different isoforms. All sera reacted with at least three C. albicans proteins and the most reactive serum detected up to eleven proteins. Some of these antigens, e.g., enolase and glyceraldehyde-3-phosphate dehydrogenase (GAPDH), have been identified on the 2-D map. The most reactive proteins were enolase and a 34 kDa protein in the acidic part of the gel (pI 4-4.4) that was only detected in regenerating protoplast-secreted proteins. The identification of all these antigens would be useful for the development of diagnostic strategies.

Two-dimensional analysis of proteins secreted by Saccharomyces cerevisiae regenerating protoplasts: a novel approach to study the cell wall

Protoplasts of Saccharomyces cerevisiae incubated in regenerating conditions secrete cell wall components in order to allow the biosynthesis of this structure. During the first hours of incubation, many of these are not retained in the forming cell wall but remain in the medium. We have developed a method for collecting the secreted proteins and have analysed these by two-dimensional electrophoresis to obtain a reference map of putative cell wall proteins. Several proteins were identified by microsequencing or immunoblotting; namely, cell wall hydrolytic enzymes, heat shock proteins, glycolytic enzymes and others. Some beta-1,3- and beta-1, 6-glucosylation was detected in the proteins secreted by regenerating protoplasts.

Modulation by biologic response modifiers of hepatitis C virus antigen-independent cytokine secretion in blood mononuclear cells

The systemic hepatitis C virus (HCV) antigen-non-specific cytokine responses were investigated in cultures of peripheral blood mononuclear cells. Cytokines of the T helper (Th) 1 [interferon (IFN)gamma and interleukin (IL)-2] and Th2 (IL-4 and IL-10) phenotype, and the pro-inflammatory cytokines tumour necrosis factor alphaIL-1beta and IL-6, were secreted by the cells activated by the HCV antigen-independent pathway. Furthermore, these cytokine responses were shifted towards a Th1 predominance by treatment with IFN-beta and with IL-2, whereas cytokine responses were selectively amplified towards a combined Th1-Th2 profile by granulocyte-macrophage- but not by macrophage colony-stimulating factor. Moreover, pro-inflammatory cytokine production was significantly enhanced by IFN-beta and augmented dose-dependently with GM-CSF and IL-2. Therefore, these immune mediators can promote unique-as well as overlapping-systemic cytokine responses that may be relevant for immunotherapeutic interventions to control HCV infection.

The efficacy and safety of clozapine versus chlorpromazine in geriatric schizophrenia

BACKGROUND

There has been an absence of controlled studies focusing specifically on neuroleptic treatment in the elderly schizophrenic population. Therefore, we conducted a 12-week double-blind comparison study to assess the efficacy and tolerability of clozapine and chlorpromazine in a group of elderly inpatients with chronic schizophrenia.

METHOD

Forty-two elderly DSM-IV schizophrenic veterans were randomly assigned to clozapine or chlorpromazine and assessed for efficacy at baseline and at termination with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impressions scale (CGI). Side effects were also monitored. Medications were titrated, on the basis of clinical response and side effects, to a maximum dose of 300 mg/day of clozapine or 600 mg/day of chlorpromazine.

RESULTS

The results suggest that both the chlorpromazine and clozapine groups improved their PANSS scores at termination compared with baseline, but the difference between the 2 groups was not statistically significant. The mean CGI scores reflecting severity of illness also demonstrated improvement in both groups over time. Both groups had similar incidences of side effects. One patient in each group had a life-threatening side effect. More patients taking clozapine had tachycardia and weight gain, while more chlorpromazine patients noted sedation.

CONCLUSION

We concluded that both clozapine and chlorpromazine are effective treatments for psychosis and behavioral disturbances in geriatric schizophrenia. Both agents had similar incidences of side effects. With careful monitoring and titration of dosage, both clozapine and chlorpromazine were fairly well tolerated in this population.

Pharmacokinetics, antifolate activity and tissue distribution of PT523 in SCC VII tumor-bearing mice

PURPOSE

To monitor the pharmacokinetics of PT523 and methotrexate in C3H mice with transplanted SCC VII tumors; to compare the impact of PT523 and methotrexate on tumor and normal host 5,10-methylenetetrahydrofolate levels; and to synthesize [14C]PT523 and determine its time-dependent tissue distribution in tumor and host tissues.

METHODS

C3H mice bearing SCC VII tumors were given i.p. PT523 or methotrexate. Plasma drug levels and tumor, gut and marrow 5,10-methylenetetrahydrofolate were assayed. [14C]PT523 was synthesized and administered i.v. to tumor-bearing mice for tissue distribution analysis.

RESULTS

Areas under the curve, mean residence times, whole body clearances, apparent distribution volumes, and plasma protein binding of PT523 vs methotrexate were, respectively, 4311 vs 6472 microM x min(-1); 20 vs 16 min; 0.56 vs 0.36 ml min(-1); 532 vs 325 ml x kg(-1); and 70% vs 30%. Both PT523 and methotrexate caused time-dependent declines in 5,10-methylenetetrahydrofolate in tumor and marrow, but not in gut mucosa [corrected]. Gut levels began to recover within 4 h in the PT523-treated group only. [14C]PT523 distributed mainly into the liver, duodenum, kidneys, lungs, tumor, pancreas and muscle; less into the spleen, blood cells, heart, brain and testicles; and very little into gut [corrected. Only 35% of the dose was excreted, and 2.9-fold more in feces than urine.

CONCLUSIONS

Despite its more rapid clearance, accumulation of PT523 in extravascular tissues was greater than that of methotrexate. Consequently, less PT523 was recovered in feces and urine and its apparent volume of distribution was greater. PT523 selectively depleted 5,10-methylenetetrahydrofolate pools in tumor and, less persistently, in marrow, but spared the gut mucosa [corrected]. [14C]PT523 tissue distribution correlated with organ mass and blood supply.

Effects of the ribavirin-interferon alpha combination on cultured peripheral blood mononuclear cells from chronic hepatitis C patients

The effects of ribavirin and interferon (IFN) alpha have been investigated on cultured peripheral blood mononuclear cells, obtained from 15 patients with chronic hepatitis C virus (HCV) infection. At clinically relevant serum concentrations achieved during therapeutic administration, ribavirin did inhibit moderately the mitogen-stimulated mononuclear cell proliferation and growth of the CD4+ and CD8+ T cell subsets without apparent cytolysis. The ribavirin-IFN-alpha combination showed activity against HCV with disappearance of HCV RNA in 27% of cases, and a synergy in the inducibility of the intracellular enzyme 2',5'-oligoadenylate synthetase. Such ribavirin concentrations induced modest increases in the T helper 1-like cytokine production by mononuclear cells. Higher ribavirin concentrations markedly inhibited IFN-gamma production, but augmented interleukins (IL) 2, 4, and 12 secretion. Conversely, IFN-alpha tended to suppress IL 2, 4 and 12, but enhanced IFN-gamma and IL-10 secretion. Thus, ribavirin and IFN-alpha appear to cause diverse effects on immunoregulatory cytokine secretion, and when combined, counteracted for production of IL-2 and IL-12, while upregulated mononuclear cell secretion of IFN-gamma and that of the anti-inflammatory cytokine IL-10. These findings suggest a non-cytolytic modulation of inflammatory responses induced by the drug combination, that may be relevant in the pathophysiology of chronic HCV infection.

Quantitation of hepatitis C virus in liver and peripheral blood mononuclear cells from patients with chronic hepatitis C virus infection

Since the natural history of hepatitis C virus-associated liver disease and the therapeutic responsiveness might vary according to liver and blood mononuclear cells viral levels, it may be important to quantitate viral RNA in liver, blood mononuclear cells and serum, and to compare these data with genotype, biochemical and histologic data. A polymerase chain reaction-based assay available for serum hepatitis C virus RNA quantitation has been optimized to quantitate viral genomes in liver and peripheral blood mononuclear cells from 47 chronic hepatitis C patients. The procedure permitted hepatitis C virus RNA quantitation in freshly isolated mononuclear cells and in total RNA extracted from frozen mononuclear cells and liver tissue. The intrahepatic viral amount (median: 2.6 x 10(3) copies/microgram RNA; range: 0 to 3.6 x 10(4) copies/microgram RNA) correlated significantly with the hepatitis C virus RNA concentration in serum (r = 0.76, P < .001), but not in mononuclear cells. Viral RNA concentrations in liver (P < .001), serum (P < 0.01) and PBMC (P < 0.05) were significantly higher in hepatitis C virus genotype 1 patients (essentially type 1b) than in non-1 type cases, but were unrelated to biochemical or histologic indexes of disease activity. In conclusion, the optimized assay permit HCV RNA quantitation in liver and peripheral blood mononuclear cells, suggesting that serum viral level is an accurate measurement of intrahepatic viral burden.

A pilot study of recombinant interleukin-2 for treatment of chronic hepatitis C

The optimal and safer interleukin-2 (IL-2) dose for treatment of chronic hepatitis C virus (HCV) infection has been studied in 33 HCV-RNA positive patients with chronic hepatitis C. Patients were randomly allocated to receive 5 days per week during 12 weeks IL-2 doses of: 0.9 MIU (n = 10), 1.8 MIU (n = 10), or 3.6 MIU (n = 13). After 12 weeks, responder patients stopped treatment, whereas nonresponders received 12 additional weeks of IL-2 at the next higher dose: 1.8, 3.6, or 5.4 MIU. As a whole, after the first 12 weeks of IL-2 alanine aminotransferase (ALT) levels significantly decreased (P < .001) with respect to the baseline values (140 +/- 63 vs. 70 +/- 30 IU/L). At the end of treatment (24 weeks), the mean ALT level (80 +/- 50 IU/L) continued significantly lower (P < .001) than the baseline one, and 24% of patients normalized ALT levels; according to dosage, ALT normalization was: 0% for 0.9 MIU, 25% for 1.8 MIU, 5% for 3.6 MIU, and 18% for 5.4 MIU. HCV-RNA levels decreased during treatment, but in none of the patients became undetectable. All patients had a local reaction at the injection site with induration, erythema, and swelling, which was dose-related. The dose of 5.4 MIU was poorly tolerated and was reduced to 3.6 MIU in 4 of 11 patients. No changes in hematological parameters were observed. At the end of follow-up (6 months) four of eight responder patients continued with normal ALT. In conclusion, IL-2 treatment for chronic hepatitis C induced a biochemical response in 8 of 33 (24%) patients at the end of therapy while at the end of follow-up, 4 of 33 (8%) patients remained with normal ALT. The dose of 1.8 MIU is well tolerated and seems to be the most efficacious.

GB virus C RNA in serum, liver, and peripheral blood mononuclear cells from patients with chronic hepatitis B, C, and D

BACKGROUND & AIMS

No conclusive data about GB virus C (GBV-C) tropism are available. We have studied the presence of genomic and antigenomic GBV-C RNA in serum, liver, and peripheral blood cells of 56 patients with chronic hepatitis B, C, or D virus infection.

METHODS

Genomic and antigenomic GBV-C RNA were detected by reverse-transcription nested polymerase chain reaction. Specificity was confirmed by sequencing, by chemical modification of the RNA, and by using tagged primers.

RESULTS

Genomic GBV-C RNA was found in 10 of 56 (18%) of the sera. In contrast, antigenomic strand was not detected. The sequence of the amplified GBV-C RNA from 3 patients showed a 96% homology among them and from 83% to 88% with previously described isolates. Genomic GBV-C RNA was found in 7 of 7 liver samples of the patients with serum GBV-C RNA. In 6 of these 7 patients (85%), antigenomic strand was found. Genomic RNA was found in 7 of 7 of the peripheral blood cell samples of the same 7 patients. Antigenomic GBV-C RNA was not found in these cells.

CONCLUSIONS

These results suggest that GBV-C is a hepatotropic virus that replicates in the human liver. The data do not support a role for GBV-C in chronic liver disease.

Decreased nitric oxide production in chronic viral hepatitis B and C

Nitric oxide is a free radical gas molecule which may be implicated in antiviral defense. However, there is no information about its possible role in chronic viral hepatitis B and C. In this study we have analyzed the serum levels of NO2- (as an index of nitric oxide generation) from patients with chronic viral hepatitis B and C and relationship of same with the response to interferon therapy. Serum samples were analysed from 61 patients with chronic hepatitis B, 60 patients with chronic hepatitis C, 11 with chronic liver disease of nonviral origin, and 23 healthy controls. Levels of NO2- were statistically higher in healthy controls (P < 0.001) than in patients with chronic liver disease. No relation was found between NO2- and viremia or response to interferon therapy in patients with chronic hepatitis B. In contrast in chronic hepatitis C, responder patients had significantly higher NO2- than nonresponders (P < 0.01). With respect to the relation between NO2- levels and liver damage, patients with cirrhosis had lower NO2- levels than the rest of the patients (P < 0.001). In conclusion, patients with chronic viral hepatitis have low serum NO2- levels.

Line-focusing holographic mirrors for solar ultraviolet energy concentration

We report on the design and the construction of a 1.3-m(2) UV selective solar concentrator intended for photocatalytic water detoxification processes. This concentrator was made by assembling 30 cm x 30 cm line-focusing holographic mirrors. Holograms with an 80% diffraction efficiency concentrate ~40% of the incident solar energy, which is effective for exciting an aqueous suspension of the TiO(2) photocatalyst, and transmit unnecessary longwave radiation. Major problems, such as the low sensitivity of the dichromated gelatin used for recording the holograms and wavelength dispersion, are discussed.

Impaired interferon induction of human MxA protein in chronic hepatitis B virus infection

MxA protein is interferon inducible, and its role as an antiviral mediator is being studied in various viral diseases. Several cytokines, including type 1 interferons (alpha and beta), interleukins 2 and 12, and granulocyte, macrophage, and granulocyte-macrophage colony-stimulating factors, were tested for their ability to induce human MxA protein synthesis in peripheral blood mononuclear cells from 15 chronic hepatitis B virus-infected patients and 6 healthy subjects as controls. Constitutive MxA expression was scarce in patients and controls but increased significantly in response to type I interferons. MxA responsiveness to interferon alpha was diminished significantly in chronic hepatitis B patients, compared with healthy donors (P < 0.05); this effect was more marked in patients with high viremia levels. Interleukins 2 and 12, and none of the colony-stimulating factors tested, induced low, but detectable, MxA protein levels. These results indicate that chronic infection by hepatitis B virus may impair activation of the immune cells and their capacity to respond to type 1 interferons.

Decreased nitric oxide production in chronic viral hepatitis B and C

Nitric oxide is a free radical gas molecule which may be implicated in antiviral defense. However, there is no information about its possible role in chronic viral hepatitis B and C. In this study we have analyzed the serum levels of NO2- (as an index of nitric oxide generation) from patients with chronic viral hepatitis B and C and relationship of same with the response to interferon therapy. Serum samples were analysed from 61 patients with chronic hepatitis B, 60 patients with chronic hepatitis C, 11 with chronic liver disease of nonviral origin, and 23 healthy controls. Levels of NO2- were statistically higher in healthy controls (P < 0.001) than in patients with chronic liver disease. No relation was found between NO2- and viremia or response to interferon therapy in patients with chronic hepatitis B. In contrast in chronic hepatitis C, responder patients had significantly higher NO2- than nonresponders (P < 0.01). With respect to the relation between NO2- levels and liver damage, patients with cirrhosis had lower NO2- levels than the rest of the patients (P < 0.001). In conclusion, patients with chronic viral hepatitis have low serum NO2- levels.

Symptom change and extrapyramidal side effects during acute haloperidol treatment in chronic geriatric schizophrenics

Haloperidol (HAL) has been widely used in the elderly. Little is known about the phenomenology of schizophrenia in late life or the response to antipsychotic treatment. We prospectively studied 19 elderly patients treated with HAL for 25 days. They ranged in age from 55 to 83 (mean age = 67.5 +/- 6.4 years). After a washout period in 15 patients (4 patients had been noncompliant with medication for at least 1 month), patients were rated before treatment and at the end of the assessment period with the Positive and Negative Syndrome Scale (PANSS) and Simpson-Angus extrapyramidal side effects rating scale (SA). Baseline PANSS scores were associated with change in SA scores (r = .52, p = .02) and with SA baseline score (r = .45, p = .05). Age was negatively associated with baseline positive subscale (r = -.42, p = .07) and endpoint positive subscale scores of PANSS (r = -.48, p = .04). Age was positively associated with improvement in negative symptoms (r = .53, p = .02). Haloperidol dose was negatively associated with improvement in positive symptoms (r = -.46, p = .04). Although studies with larger samples sizes are needed, these findings may indicate that elderly schizophrenics do not respond to treatment in the same manner as do younger schizophrenics.

Patterns of immune responses to the host-encoded GOR and hepatitis C virus core-derived epitopes with relation to hepatitis C viremia, genotypes, and liver disease severity

Antibody responses to the GOR epitope and hepatitis C virus (HCV) core were investigated in 136 patients with chronic HCV infection. Patient age (P = .011) and necroinflammatory activity (P < .001) were significantly greater in 92 (67.6%) patients with anti-GOR than in 44 (32.4%) patients without anti-GOR. HCV RNA concentration was significantly higher in patients with anti-GOR (P = .031). HCV 1a or 1b genotypes were also found according to anti-GOR status. GOR and HCV core (amino acids 5-19) antibody responses correlated significantly (rs = .615, P < .001). Anti-HCV core(5-19) was detected in 67 (73%) of 92 patients with and in 14 (32%) of 44 without anti-GOR (P < .001). Patients with concurrent anti-GOR and anti-HCV core(5-19) had significantly greater necroinflammatory activity (P = .003). By multivariate analysis, anti-HCV core(5-19), patient age, and necroinflammatory activity were correlated with anti-GOR response (P < .001). Reactivity to the GOR autoepitope correlates with HCV core response and liver necroinflammatory activity, thus suggesting an immunopathogenic role in chronic hepatitis C.

Evaluation of PCR and indirect enzyme-linked immunosorbent assay on milk samples for diagnosis of brucellosis in dairy cattle

A study was performed to evaluate the previously described PCR (C. Romero, C. Gamazo, M. Pardo, and I. López-Goñi, J. Clin. Microbiol. 33:615-617, 1995) for the diagnosis of brucellosis in dairy cattle. Milk samples from 56 Brucella milk culture-positive cattle and from 37 cattle from Brucella-free herds were examined for Brucella DNA by PCR and for specific antibodies by an indirect enzyme-linked immunosorbent assay (ELISA). The specificities of both tests were 100% when testing the milk samples from Brucella-free cattle. The milk samples from 49 infected cattle were positive by PCR (87.5% sensitivity), and 55 were positive by ELISA (98.2% sensitivity). A PCR-positive sample was negative by ELISA, and 7 ELISA-positive samples were PCR negative, yielding an observed proportion of agreement of 0.91 for the two tests. Although the results suggest that ELISA is a better screening test than PCR, the combined sensitivity of the two assays was 100%, and their simultaneous application could be more useful than one test alone for a rapid screening of brucellosis in dairy cattle.

Immunoglobulin M antibody to hepatitis C virus core antigen: correlations with viral replication, histological activity, and liver disease outcome

Immunoglobulin M (IgM) antibody to hepatitis C core antigen (anti-HCV-core) was tested by enzyme immunoassay against a synthetic peptide representing amino acids 1 to 62 of the core protein. Of 214 patients with different categories of histological activity, 193 (90%) showed positive results for IgM anti-HCV-core, and 207 (97%) had HCV RNA; most cases (186, 87%) had both markers detectable simultaneously. No differences in the frequency of IgM anti-HCV-core were observed with respect to epidemiological, biochemical, or histological parameters. In 175 interferon alfa (IFN-alpha) recipients, and in 39 untreated controls, pretreatment IgM anti-HCV-core frequencies were similar: 28 of 32 (88%) in sustained responders; 55 of 61 (90%) in responders with relapse; 72 of 82 (88%) in nonresponders; and 38 of 39 (97%) in untreated controls. After IFN-alpha therapy, IgM anti-HCV-core levels became undetectable with significantly greater frequency in sustained responders (P = .014); a similar trend was observed for HCV RNA (P < .0001). IgM anti-HCV-core levels decreased after therapy in responders (P < .001) but increased in nonresponders. Fifty-one cases were longitudinally tested in relation to long-term disease outcome. Both markers remained detectable in most nonresponders with persistent liver disease, in most responders before relapse, and in all but one case at the time of biochemical relapse. IgM anti-HCV-core and HCV RNA became undetectable in most sustained responders, but reappeared despite a long-lasting transaminase normalization, behaving as asymptomatic HCV carriers; the possibility that disease reactivation may take place years afterwards cannot be excluded.(ABSTRACT TRUNCATED AT 250 WORDS)

Risks and benefits of interferon-alpha in the treatment of hepatitis

The high worldwide prevalence of chronic viral hepatitis, as well as its progressive course, have led to the performance of multiple clinical studies. The natural history of the disease is different depending on the infecting virus; thus, the evolution to liver cirrhosis and/or hepatocellular carcinoma for the hepatitis B, C and delta (D) viruses in chronic hepatitis is 15, 20 and 75%, respectively. Different therapeutic agents have been used in attempts to modify the natural course of these diseases, interferon-alpha (IFN alpha) having proved to be the most effective. In 30 to 50% of patients, treatment with IFN alpha has achieved inhibition of viral replication, as well as normalisation of aminotransferase levels. Moreover, in a majority of patients, histological improvement is observed, principally in piece-meal necrosis and portal inflammation. The dosage currently recommended for treatment of chronic hepatitis B is 30 to 35MU weekly for a minimum of 4 months; when there is a co-existing delta virus infection, the total dosage employed should be greater. For hepatitis C, the minimum effective dosage is 9MU weekly, and a treatment duration of 12 months is recommended. The administration of IFN alpha produces a series of dose-dependent adverse effects, which are reversible on suspension of the medication. The most frequent of these adverse reactions is the 'flu-like' syndrome, which is self-limited and generally well tolerated. Secondary haematological alterations (leucopenia and thrombocytopenia) are the most frequent cause of reduction in dosage or suspension of treatment, although the latter is not normally necessary. The proportion of patients requiring dosage modification or suspension of treatment fluctuates between 5 and 15%. Taking the evolution of chronic hepatitis into account, there can be no doubt that all patients with this disease should be offered treatment. At present, the drug of choice is IFN alpha, as it slows disease progression and it is generally well tolerated.

Treatment of chronic hepatitis C with cirrhosis with recombinant human granulocyte colony-stimulating factor plus recombinant interferon-alpha

Interferon therapy in cirrhotic patients with hepatitis C virus infection is not efficient. In an attempt to improve the response rate, a pilot study using recombinant human granulocyte colony-stimulating factor (rhG-CSF) alone, and in combination with recombinant interferon-alpha (rIFN), was carried out. Fifteen cirrhotic patients with hepatitis C virus infection were randomly allocated into 3 groups to receive treatment: 0.5, 1, or 1.5 micrograms/kg of rhG-CSF daily for 4 weeks, followed by a 4 week resting period, and by the same dose of rhG-CSF daily, plus 6 MU of rIFN 3 times weekly for 4 weeks. They then continued to receive 6 MU of rIFN alone for 4 weeks, followed by 3 MU of rIFN for 16 weeks. After the 4 weeks of treatment with rhG-CSF alone, no changes in alanine aminotransferase (ALT) levels were observed. No changes occurred during the resting period. Three of 10 patients who ended the rhG-CSF plus rIFN treatment period had normal ALT values. During the treatment with rIFN alone, two responders suffered a relapse. The other responder had normal ALT until the first month of follow-up. In summary, the combination of rhG-CSF and rIFN seems promising for the treatment of patients with chronic hepatitis C and liver cirrhosis.

Specific detection of Brucella DNA by PCR

A PCR assay with primers derived from the 16S rRNA sequence of Brucella abortus was developed. Nine different combinations between six primers were tested. One pair of primers, which amplified a 905-bp fragment, was selected. As little as 80 fg of Brucella DNA was detected by this method. DNAs from all of the representative strains of the species and biovars of Brucella and from 23 different Brucella isolates were analyzed and yielded exclusively the 905-bp fragment. No amplification was detected with DNAs from 10 strains phylogenetically related to Brucella spp., 5 gram-negative bacteria showing serological cross-reactions with Brucella spp., and 36 different clinical isolates of non-Brucella species. Only Ochrobactrum anthropi biotype D yielded a PCR product of 905 bp, suggesting a closer relationship between Brucella spp. and O. anthropi biotype D. The specificity and high sensitivity of the PCR assay may provide a valuable tool for the diagnosis of brucellosis.