[Non-A-E acute and chronic hepatitis in Japan]

It has been clarified that hepatitis C virus(HCV) is the major cause of acute and chronic non-A, non-B hepatitis. However, it is also clear that there still exist a group of patients with viral hepatitis who are seronegative for hepatitis A, B, C, D or E virus infections. In this article, epidemiological studies on such non-A-E hepatitis in Japan are reported. Since the introduction of blood screening with hepatitis B virus(HBV) core antibody and HCV antibody in addition to HBV surface antigen, incidence of posttransfusion hepatitis decreased remarkably to a level less than 1%. Therefore, occurrence of non-A-E posttransfusion is rare in Japan. As for acute sporadic hepatitis, about 20% of the patients were diagnosed as type non-A-E. Those patients with non-A-E acute sporadic hepatitis showed relatively mild hepatitis. About 5% of patients with chronic hepatitis was negative for both markers of HBV and HCV infections. Hepatitis G virus, a newly discovered hepatitis virus, accounted for only a minor part of acute and chronic non-A-E hepatitis.

Detection of antibodies to a putative hepatitis G virus envelope protein

BACKGROUND

A flavivirus designated hepatitis G virus (HGV) has been isolated from the serum of patients with non-A-E hepatitis. Hitherto, the presence of HGV RNA in serum has been detected with the reverse transcription-polymerase chain reaction (RT-PCR) amplification method. We have now developed an immunoassay for antibodies against an HGV protein.

METHODS

Recombinant HGV envelope protein E2 was used as antigen in an ELISA. 80 blood donors, 99 intravenous-drug users, and 11 patients with acute post-transfusion hepatitis were tested for antibodies to E2. The HGV-RNA status was assessed by RT-PCR.

FINDINGS

Anti-E2 seroprevalence was 9% among the blood donors and 41% among the drug users; HGV-RNA prevalence was 2.5% and 38%, respectively. Whereas anti-E2 prevalence increased with the duration of drug use, HGV-RNA prevalence declined in parallel. In each group, the presence of anti-E2 and HGV RNA was almost mutually exclusive: none of the blood donors and only 4% of the drug users were positive for both markers at the same time. Of the 11 post-transfusion patients--who were all HGV-RNA positive and anti-E2 negative at the onset of disease--four developed antibodies to E2 during the following year, and two of the four subsequently became HGV-RNA negative.

INTERPRETATION

We conclude that a humoral immune response to E2 is associated with loss of detectable HGV viraemia. Thus, E2-specific antibodies might serve as a useful marker for diagnosing recovery from HGV infections. The immunoassay we describe should facilitate investigation of suspected infections and may be helpful in the elucidation of the clinical significance of HGV.

Antibody response to E2/NS1 hepatitis C virus protein in patients with acute hepatitis C

Antibody response to the E2/NS1 protein of the hepatitis C virus (HCV) was studied in 26 patients with post-transfusion acute hepatitis C. Second-generation HCV (HCV-2) antibody, E2/NS1 antibody and HCV-RNA were measured in serial serum samples taken within 1 month and 3, 6 and 12 months after the onset of acute hepatitis C. The HCV genotype was also tested to study its clinical significance. Of 26 patients, eight showed normalization of alanine aminotransferase (ALT) and clearance of HCV-RNA (resolved group). In the remaining 18 patients, HCV viraemia and ALT abnormality (except one patient) continued for more than 3 years (unresolved group). Both HCV-2 and E2/NS1 antibodies were positive at least once in all patients. The prevalence of E2/NS1 antibody was significantly (P < 0.05) higher in the resolved group (88%) than in the unresolved group (39%) in the period within 1 month of onset; the prevalence was similar between the two groups thereafter. The prevalence of HCV-2 antibody did not differ between the two groups at any point. The HCV genotype was not related to the chronicity of acute hepatitis C. In conclusion, the E2/NS1 antibody appeared in all patients with acute hepatitis C and was associated with the clearance of HCV.

A case of acute myocardial infarction with reentrant sustained ventricular tachycardia developing in the prehospital phase

A case of development of monomorphic sustained ventricular tachycardia in the prehospital phase of acute myocardial infarction is reported. By performing pacing from the right ventricular outflow tract during ventricular tachycardia, constant fusion and progressive fusion were documented without constant and progressive fusion from the right ventricular apex pacing, and it was terminated by pacing from the right ventricular outflow tract. Thus, reentry was considered to be the mechanism of this ventricular tachycardia occurring in the prehospital phase. Direct angioplasty successfully recanalized the totally occluded coronary artery, but late potential was present probably because of late reperfusion. In an electrophysiologic study in the chronic phase, slow conduction areas were found at the interventricular septum and the exit of this ventricular tachycardia was at the mid-septum of the right ventricle. A review of the literature failed to reveal any report of a similar case.

Vitamin D analogues up-regulate p21 and p27 during growth inhibition of pancreatic cancer cell lines

To obtain information regarding the growth-inhibitory effect of 1,25-dihydroxyvitamin D3 and its non-calcaemic analogue 22-oxa-1,25-dihydroxyvitamin D3 on pancreatic cancer cell lines, differences in the effects of G1-phase cell cycle-regulating factors were studied in vitamin D-responsive and non-responsive cell lines. Levels of expression of cyclins (D1, E and A), cyclin-dependent kinases (2 and 4) and cyclin-dependent kinase inhibitors (p21 and p27) were analysed by Western blotting after treatment with these compounds. In the responsive cells (BxPC-3, Hs 700T and SUP-1), our observations were: (1) marked up-regulation of p21 and p27 after 24 h treatment with 10(-7) mol l(-1) 1,25-dihydroxyvitamin D3 and 22-oxa-1,25-dihydroxyvitamin D3; and (2) marked down-regulation of cyclins, cyclin-dependent kinases and cyclin-dependent kinase inhibitors after 7 days' treatment. In non-responsive cells (Hs 766T and Capan-1), no such changes were observed. In conclusion, vitamin D analogues up-regulate p21 and p27 as an early event, which in turn could block the G1/S transition and induce growth inhibition in responsive cells.

Susceptibility of Helicobacter pylori isolates against agents commonly administered for eradication therapy and the efficacy of chemotherapy

Although chemotherapy has been documented to be effective in the treatment of Helicobacter pylori-associated gastritis and gastroduodenal ulcers, some cases are known to have been unsuccessful in the attempt to eradicate this species. In this study, we examined the relation between the susceptibility of H. pylori isolates and the efficacy of chemotherapy. We utilized the modified agar plate dilution method to determine the minimum inhibitory concentrations (MICs) of 63 H. pylori strains isolated before treatment with several drugs routinely used during eradication chemotherapy. Among the drugs tested, amoxicillin (AMPC) and clarithromycin (CAM) demonstrated high degrees of activity with MIC99, 0.39 and 0.2 micrograms/ml, respectively. No highly resistant strain against AMPC was detected among the strains examined, while for CAM and metronidazole (MTZ), 9.5% and 7.9% of the strains, respectively, were resistant before treatment. It should be noted that all of the MICs of the strains from patients with successful therapy were lower than those from patients with unsuccessful therapy. These findings indicate that susceptibility tests should be carried out prior to the commencement of drug administration in order to provide safer and more effective chemotherapy.

Autoimmune chronic pancreatitis simulating pancreatic lymphoma

A 51-yr-old man, who presented with diabetes mellitus, abdominal pain, inguinal lymphadenopathy, and diffuse enlargement of the whole pancreas on ultrasonography, was at first thought to have pancreatic lymphoma. Chemotherapy including steroid was carried out successfully, although the definitive diagnosis of lymphoma was not made. However, on follow-up, we realized that both laboratory findings, such as hyperglobulinemia and autoantibody-positive results, and radiographic features in this case were very similar to those of a case of autoimmune pancreatitis recently reported by Yoshida et al. (Dig Dis Sci 1995;40:1561-8). When the disease recurred, therefore, treatment with steroid alone was performed with an excellent result. We report a case of autoimmune pancreatitis simulating primary pancreatic lymphoma.

Effect of hepatitis G virus infection on chronic hepatitis C

OBJECTIVE

To clarify the effect of hepatitis G virus (HGV) infection on chronic hepatitis C.

DESIGN

Retrospective study.

SETTING

University hospital in Matsumoto, Japan.

PATIENTS

189 randomly selected patients with histologically proven chronic hepatitis C, including 101 patients receiving interferon-alpha.

MEASUREMENTS

Serum levels of HGV RNA were measured by reverse-transcription polymerase chain reaction. Clinical features, including liver histologic findings, hepatitis C virus (HCV) markers, and response of HCV to interferon-alpha were compared between HGV RNA-positive and HGV RNA-negative patients.

RESULTS

21 of 189 (11%) patients with chronic hepatitis C were positive for HGV RNA. On average, patients with HGV RNA were younger than those without HGV RNA (mean age +/- SD, 46.6 +/- 13.0 years and 51.7 +/- 10.7 years, respectively); other demographic and clinical features were similar. The HCV genotype and HCV RNA level were distributed similarly between patients with and those without HGV infection. Ten of 101 patients with chronic hepatitis C who received interferon-alpha were positive for HGV RNA. The rate of sustained HCV response to interferon-alpha in patients with HGV infection (30%) was similar to that in patients without HGV infection (36%). The HGV RNA level decreased during therapy in all 9 patients in whom this value was measured. However, only 2 of these patients had a sustained HGV response after discontinuation of therapy.

CONCLUSIONS

Patients who only had HCV infection did not differ from patients with HCV and HGV co-infection in clinical presentation, HCV RNA level, or response of HCV to interferon-alpha therapy. Thus, HGV infection had no apparent influence on the clinical or virologic course of HCV infection. Hepatitis G virus was uniformly sensitive to interferon-alpha therapy, but only a few patients had a sustained virologic response.

Budd-Chiari syndrome caused by hepatic vein thrombosis in a patient with myeloproliferative disorder

We report a 24-year-old Japanese female hospitalized with jaundice and ascites. She exhibited hepatosplenomegaly, severe liver dysfunction, and slight polycythemia with an increase in serum levels of beta-thromboglobin and platelet factor 4. Bone marrow was hypercellular with an increase in progenitor cells. The aggregation response of platelets to ADP and to collagen was markedly increased. Venography revealed narrowed hepatic veins with "spider web' sign. Liver biopsy revealed hepatic congestion. Budd-Chiari syndrome was diagnosed, and was thought to be due to thrombosis related to myeloproliferative disorder. Liver transplant was successful in relieving symptoms.

[Survey for hepatitis in an isolated endemic area]

Mass health screening for liver disease was conducted in A.H areas in N Town which is known to be an endemic area for hepatitis since 1985. Subjects were about 1,000 inhabitants in A.H areas and 1795 inhabitants in non-endemic areas (control) 6 years or older in age. Informed consent was obtained from all inhabitants. All subjects were interviewed for demographic data including age, sex, occupation past medical history, surgical operation daily intake of alcohol, folk use of remedies such as acupuncture and family history of liver disease. Body weight and height were also recorded. Blood obtained from all individuals was analyzed for liver function enzyme and hepatitis virus markers including anti-HCV and HBV markers. Furthermore, health education on how to prevent hepatitis and how to treat liver diseases was provided. The results were as follows. 1. Overall, the prevalence of anti-HCV was 24.1% in A.H areas, and increased in older individuals over 50 years old. To the contrary, it was 2.3% in control areas. The prevalence of HBsAg was the same in both areas. 2. Prevalence of history of surgical operations, blood transfusion and acupuncture were similar in A.H. area sand control area. 3. Risk factors for HCV infection were blood transfusion, acupuncture, history of liver diseases and anti-HBs positive. 4. Death rate due to liver cirrhosis and hepatocellular carcinoma has been increasing year by year during recent years.

Prevalence and disease association of hepatitis G virus infection in Japan

A reverse transcriptase-polymerase chain reaction procedure (RT-PCR) for the detection of hepatitis G virus (HGV) RNA was used to examine the prevalence of HGV infection and HGV-related disease in Japan. Among 48 patients with acute non-A, B, C, D, E (non-A-E) hepatitis (five transfusion-associated cases and 43 sporadic cases), only one patient (2%), a transfusion recipient, was HGV RNA positive. Similarly, among 50 patients with established chronic non-A-E hepatitis, only two (4%) were positive for HGV RNA. These frequencies were not significantly different from those in 129 voluntary blood donors (0.8%). By contrast, HGV infection was relatively common among patients who were also infected with other hepatitis viruses. HGV co-infection or superinfection was found in seven of 53 (13%) patients with acute hepatitis C, in 15 of 126 (12%) patients with chronic hepatitis C, in three of 21 (14%) patients with acute hepatitis B and in four of 81 (5%) patients with chronic hepatitis B. Among the 29 dually infected patients, 15 (52%) had a history of blood transfusion. HGV was also detected in seven (10%) of 69 haemodialysis patients, of whom only one had a dual infection with hepatitis C virus (HCV) and an elevated aminotransferase level.

IN CONCLUSION

HGV RNA was found in only a low percentage of patients with either acute or chronic non-A-E hepatitis: HGV appears to co-infect or superinfect in 10-15% of HCV infections and in 5-15% of HBV infections; the prevalence of HGV infection (0.8%) among voluntary blood donors in Japan is similar to that for HCV infection; a history of blood transfusion was obtained in 22 (55%) of the total 40 HGV-positive subjects; and isolated HGV infection appears to have a low disease burden.

Seroepidemiological studies on Silk Road ethnic groups

To clarify the origin of the Japanese, the Jomom and/or Yayol, we screened for HTLV-1 and -II antibodies among inhabitants of the Silk Road, the Han, Uygur and Kazaks. We also screened for HIV, HBV, and HCV. The HTLV-I, -II, HIV, and HCV antibody tests were uniformly negative in all the studied groups. In contrast, a significantly higher incidence of HBs antigen was observed in all the groups tested (Northern Han: 11.9%, Uygur: 6.0%, Kazak: 9.1%). These results indicate that these ethnic groups are not the origin of the indigenous Japanese (the Jomon), and that HBV is prevalent in the various groups along the Silk Road.

Serum thrombopoietin (c-Mpl ligand) levels in patients with liver cirrhosis

To clarify the role of c-Mpl ligand (thrombopoietin: TPO) in liver cirrhosis (LC), we examined serum TPO levels (sTPO) in patients with LC (N = 44), chronic hepatitis (CH; N = 13) and healthy controls (N = 41) by an enzyme-linked immunosorbent assay. Although platelet counts of all LC patients (89 +/- 59 x 10(9)/l; mean +/- SD) were lower than those of controls and CH patients, sTPO levels in LC patients (1.23 +/- 0.51 fmol/ml) were the same as those in controls (1.22 +/- 0.37) and CH patients (1.18 +/- 0.36). Platelet counts were significantly higher in splenectomized patients than in unsplenectomized patients, but the sTPO level did not differ between these two groups. In LC patients, the sTPO level was not correlated with the platelet count, but was correlated with prothrombin time, activated partial thromboplastin time, and total bilirubin, indicating that production of TPO in the liver decreases slightly with the development of liver dysfunction. Our findings suggest that production of TPO is maintained in LC patients and their thrombocytopenia is not due to a defect in platelet production.

The largest isoform of platelet membrane glycoprotein Ib alpha is commonly distributed in eastern Asian populations

Platelet membrane glycoprotein Ib alpha has at least two polymorphisms which affect phenotype. One is the dimorphism at codon 145, and the other is a molecular weight polymorphism due to variable numbers of tandem repeats (TR) in the macroglycopeptide region. These two polymorphisms are in linkage disequilibrium. The frequencies of these polymorphisms differ considerably depending on race, and the largest variant with four TR is almost exclusively present in the Japanese population. We examined the genotypes of HPA-2 and TR polymorphism in three different races from Eastern Asia; the Japanese (n = 103), Korean (n = 101) and Chinese population (n = 177). The gene frequency of HPA-2 differed significantly among these three populations. Among HPA-2b-positive individuals, the A isoform with four TR and B with three TR were present in all three populations and A dominated over B. Individuals homozygous for the A isoform were found in both Japanese and Korean populations. These findings indicate that the largest haplotype is common in the Eastern Asian region.

Lymphocyte proliferative responses to recombinant hepatitis C virus antigens in patients with chronic hepatitis C

The purpose of the present study was to analyse lymphocyte proliferative responses to recombinant hepatitis C virus (HCV) antigens in chronic hepatitis C. Four recombinant peptides derived from the NS3, core, E1 and E2/NS1 regions of the HCV genome were used as antigens in lymphocyte proliferative responses. Forty-two patients, classified into various sub-groups, and 17 healthy control subjects were tested and the specific response was expressed as a stimulation index. Responses were analysed with alanine aminotransferase (ALT) level and histological diagnosis. NS3- and core-antigen specific responses in all patient groups were significantly higher than in the healthy control group. E1- and E2/NS1-antigen-specific responses in the patient group with ALT levels exceeding 100 IU/L were significantly higher than those in other patient groups. Histological diagnosis was not correlated to the intensity of the core- and NS3-specific responses. E1- and E2/NS1-antigens induced significantly elevated responses in patients with chronic active hepatitis and liver cirrhosis compared with results in the healthy control group and in patients with chronic persistent hepatitis. In conclusion, the significantly elevated responses to core- and NS3-antigens may be related to HCV infection and such responses to E1- and E2/NS1-antigens could be related to the severity and activity of the disease.

Association between the extent of sclerotic changes in iliac arteries and long-term prognosis in patients with ischemic heart disease

Peripheral vascular disease is often complicated with ischemic heart disease and is associated with increased cardiac mortality. Latent progression of sclerotic changes in the arteries supplying the lower extremities is often present but undiagnosed. We examined the influence of sclerotic changes of the iliac arteries on the late outcome in 79 patients with ischemic heart disease. Lower abdominal aortography was performed at the time of cardiac catheterization between December 1989 and January 1991. The degree of sclerotic change in the iliac arteries was assessed according to aortography findings such as stenosis, dilatation or bend, with higher scores representing more advanced sclerosis (aortography score). The mean aortography score of all patients was 5.8 +/- 4.6. The patients were followed up for 4.4 +/- 1.2 years to monitor the occurrence of cardiac events (cardiac death, acute myocardial infarction, coronary bypass surgery, or coronary angioplasty for new lesion). The cardiac event-free rate at 5 years was 76.6% in the high score group (32 patients with scores of 6 or more) and 92.9% in the low score group (47 patients with scores of 5 or less). The difference was significant (p = 0.007) by log-rank test. The hazard rate of the aortography score for predicting risk of cardiac event was 1.11 by the Cox proportional hazards model (95% confidence intervals: 1.01-1.23, p = 0.039). When the analysis was adjusted for coronary bypass surgery as primary therapy, the number of diseased coronary arteries, or the presence of peripheral vascular disease, similar results were obtained. In conclusion, more severe sclerotic change in iliac arteries is associated with a higher incidence of cardiac events in patients with ischemic heart disease.

Serum levels of hepatitis C virus core protein in patients with chronic hepatitis C treated with interferon alfa

The quantitation of hepatitis C virus (HCV) viremia can be helpful in the diagnosis, therapy, and monitoring of patients with chronic hepatitis C. A sensitive and quantitative fluorescence enzyme immunoassay (FEIA) has recently been developed for assaying HCV core protein in serum. To assess the utility of measurements of serum HCV core protein during the course of treatment of chronic hepatitis C, we studied 27 patients who were treated with a single schedule of interferon alfa (IFN-alpha) (9 million units per dose for 24 weeks; total dose, 720 million units). Eleven of the 27 patients responded with clearance of HCV RNA and fall of aminotransferase to normal; 16 patients did not respond to treatment. Before therapy, HCV core antigen was detectable in 25 of the 27 patients (93%). The initial serum concentration of HCV core protein was significantly (P < .01) higher in the nonresponders versus the responders. Two weeks after initiating IFN-alpha therapy, HCV core protein was not detectable in any of the 11 responders, but was detected in 8 of 16 nonresponders (P < .01). All responders, but none of the nonresponders, remained negative for core protein after IFN-alpha therapy. The measurement of HCV core protein by FEIA may be useful for predicting the response to IFN-alpha and for monitoring its therapeutic efficacy.

Elevated serum levels of manganese superoxide dismutase in polymyositis and dermatomyositis

We studied serum concentrations of manganese superoxide dismutase (Mn SOD) and copper-zinc superoxide dismutase (Cu/Zn SOD) in 22 patients with polymyositis and dermatomyositis (PM/DM), 87 patients with four types of muscular dystrophy, 20 patients with amyotrophic lateral sclerosis, and 15 patients with collagen vascular diseases (CVD). Serum levels of Mn SOD were increased only in the patients with PM/DM and CVD, and the elevation was more prominent in those with PM/DM. Levels of Cu/Zn SOD were slightly elevated in some patients with PM/DM and Duchenne muscular dystrophy. In patients with PM/DM, the change in Mn SOD levels corresponded to disease activity as closely as or more closely than those of creatine kinase. The results indicate that serum Mn SOD may be a useful clinical marker for PM/DM.

[Early detection of hepatobiliary cancer in mass health screening]

Mass health screening (MHS) for detecting early cancer of hepatobiliary diseases is not common. However, as high risk factors for developing hepatocellular carcinoma (HCC) has been established in Japan, MHS for HCC is available, especially in high endemic areas of hepatitis C. Intrahepatic bile duct cancer often occur in patients with Thorotrastosis. Cohort study for detection of early cancer of intrahepatic bile duct has been conducting by the Japanese Government. Early detection of bile duct cancer in health screening is very rare. It will be helpful for perform MHS to clarify the high risk factors for bile duct cancers.

Inhibitory effect of 220-oxa-1,25-dihydroxyvitamin D3 on the proliferation of pancreatic cancer cell lines

BACKGROUND & AIMS

Effective chemotherapy for pancreatic cancer is urgently needed. The aim of this study was to compare the anti-proliferative activity of a new vitamin D3 analogue, 22-oxa-1,25-dihydroxyvitamin D3 (22-oxa-calcitriol), on pancreatic cancer cells lines with that of 1,25-dihydroxyvitamin D3 (calcitriol) with analysis of vitamin D receptor status.

METHODS

Antiproliferative effects of both agents were compared using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide method and by measuring the tumor size of xenograft inoculated into athymic mice. Vitamin D receptor contents by Scatchard analysis and mutational analysis of receptor complementary DNA were performed.

RESULTS

In vitro, 22-oxa-calcitriol and calcitriol markedly inhibited the proliferation (3 of 9 cell lines) and caused a G1 phase cell cycle arrest by appearance of numerous domes. In vivo, 22-oxa-calcitriol inhibited the growth of BxPC-3 xenografts more significantly than calcitriol without including hypercalcemia. Hs 766T, showing no response to either agent, had the second highest receptor contents with no abnormalities in its primary structure deduced by receptor complementary DNA.

CONCLUSIONS

22-oxa-calcitriol may provide a more useful tool for the chemotherapy of pancreatic cancer than calcitriol. Also, the susceptibility of the cell lines to both agents is not well determined by evaluating either the contents or the mutation of vitamin D receptor.

The natural course of chronic hepatitis C: a comparison between patients with genotypes 1 and 2 hepatitis C viruses

This study was conducted to clarify if the long-term histological outcome among patients with chronic hepatitis C differs according to whether they are infected with genotype 1 or 2 hepatitis C virus (HCV). We examined 140 patients with chronic hepatitis C. The HCV genotype was determined by the enzyme-linked immunosorbent assay (ELISA) based on genotypes 1 and 2 specific recombinant proteins; genotype 1 was found in 100 patients (96 were 1b and 4 were indeterminate) and genotype 2 in 36. The two groups showed no significant difference for any clinical background features. Deterioration of the grade of liver histology during the follow-up period was seen in 68.0 percent of the patients with genotype 1 as compared with 41.7 percent of those with genotype 2 (P < .01). Similarly, the deterioration of the stage of liver histology was more common in the former group than in the latter (63.0 percent and 38.9 percent respectively; P < .05). The mean serum HCV-RNA titer was significantly higher in the patients with genotype 1 than in those with genotype 2 (P < .001), and multivariate analysis showed the titer was one of the independent factors of the deterioration of the stage (P = .0044). This phenomenon may be related in part to the difference in pathogenicity between the two HCV genotypes. In conclusion, our results suggest that more severe progression of chronic hepatitis C is seen in patients showing genotype 1b compared with those with genotype 2.

The natural course of chronic hepatitis C: a comparison between patients with genotypes 1 and 2 hepatitis C viruses

This study was conducted to clarify if the long-term histological outcome among patients with chronic hepatitis C differs according to whether they are infected with genotype 1 or 2 hepatitis C virus (HCV). We examined 140 patients with chronic hepatitis C. The HCV genotype was determined by the enzyme-linked immunosorbent assay (ELISA) based on genotypes 1 and 2 specific recombinant proteins; genotype 1 was found in 100 patients (96 were 1b and 4 were indeterminate) and genotype 2 in 36. The two groups showed no significant difference for any clinical background features. Deterioration of the grade of liver histology during the follow-up period was seen in 68.0 percent of the patients with genotype 1 as compared with 41.7 percent of those with genotype 2 (P < .01). Similarly, the deterioration of the stage of liver histology was more common in the former group than in the latter (63.0 percent and 38.9 percent respectively; P < .05). The mean serum HCV-RNA titer was significantly higher in the patients with genotype 1 than in those with genotype 2 (P < .001), and multivariate analysis showed the titer was one of the independent factors of the deterioration of the stage (P = .0044). This phenomenon may be related in part to the difference in pathogenicity between the two HCV genotypes. In conclusion, our results suggest that more severe progression of chronic hepatitis C is seen in patients showing genotype 1b compared with those with genotype 2.

Detection of hepatitis C virus specific core protein in serum of patients by a sensitive fluorescence enzyme immunoassay (FEIA)

A protein-capture fluorescence enzyme immunoassay (FEIA) was developed using monoclonal antibodies (mAbs) against recombinant hepatitis C virus (HCV) core protein. Four hybridoma cell lines (5E3, 5F11, 515S, 1080S) were established and characterized. These monoclonal antibodies (mAbs) each had IgG1 and OgG2 isotypes, and recognized major B cell epitopes within the immunodominant nucleoprotein amino terminal subregion. Using mAb 5F11 as the first antibody to the solid phase and beta-D-galactosidase-conjugated mAb 5E3 as the second antibody to the protein, we established a specific HCV core protein capturing FEIA capable of detecting as little as 20 pg/ml of recombinant HCV core protein. HCV core protein in serum was detectable after treatment with 4.0% polyethyleneglycol, 0.5 NaOH, and 5% Triton X-100. The results of a peptide inhibition assay indicated that this FEIA is specific for HCV RNA positive sera. The quantity of HCV core protein detected in serum was significantly correlated to the level of HCV RNA. The detection limit for HCV core proteins was an HCV RNA per titer of approximately 10(4)/ml. Using this FEIA system, the detection ratio of HCV core protein in patients with chronic HCV infection was 92.3% (70/76).

Bronchoalveolar lavage fluid findings in patients with chronic hepatitis C virus infection

BACKGROUND

Hepatitis C virus (HCV) infection has recently been incriminated as an aetiological agent in idiopathic pulmonary fibrosis. This study was performed to determine the cellularity and lymphocyte phenotypes of bronchoalveolar lavage (BAL) fluid in patients with chronic hepatitis C.

METHODS

BAL fluid and lavage lymphocyte subsets from 13 patients (10 men) with active chronic hepatitis C, diagnosed by sustained elevated serum glutamic pyruvic transaminase and typical histological findings in the liver, were analysed. Lavage findings in these patients were compared with those from 13 healthy volunteers (eight men) as controls.

RESULTS

There was no difference in total cell counts in lavage fluid between the two groups. Lavage lymphocyte and eosinophil numbers were increased in patients with chronic hepatitis C. Surface marker analysis of the lymphocyte populations showed increases in CD2, CD3, CD4, and HLA-DR. CD4/CD8 ratios were not different.

CONCLUSIONS

The numbers of lymphocytes and eosinophils in BAL fluid are increased in patients with chronic hepatitis C. These findings suggest that HCV infection may trigger alveolitis.