Retrovirus-like particles in hepatocytes of patients with transfusion-acquired non-A, non-B hepatitis

Ultrastructure characteristics of HCV infected human trophoblast cells in culture

AIM: To investigate whether the cultured trophoblastic cells can be infected with hepatitis C virus (HCV) and observe the ultrastructural features of infected cells.

METHODS: Human placentae were digested with trypsin and then centrifuged with percoll density gradient to obtain trophoblastic cells, and then incubated in HCV positive serum. The HCV RNA in HCV infected syncytiotroblasts was quantitated with RT-PCR. Ultrastructural characteristics of infected syncytiotroblasts were observed with transmission electron microscope.

RESULTS: HCV RNA was detected in supernatant of the cultured medium during 40 day periods of incubation. The antibody of HCV NS5 was observed around the nucleus with confocal microscope. The Ultrastructure of infected throphotoblast cells differed obviously from that of normal cells, and manifested with hyperplasia of lysosomes and rough endoplasmic, appearance of vacuoles and virus-like particles, and decreased lipid droplets.

CONCLUSION: Trophoblastic cells could be infected by HCV, and the cellular ultrastructure changed dramatically following infection of HCV.

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Viral hepatitis: new data on hepatitis C infection

Viral hepatitis (VH) is almost as old as human beings, at least as old as known human history. However, the natural history and the epidemiology of the disease has undergone changes during the centuries and even recently we have been facing several new aspects. The estimated global prevalence is around 3-5%, which means that approximately 400 million patients are infected with hepatitis B virus and that there are 170 million infections with hepatitis C virus. The mortality figures are projected to show a 2- to 3-fold increase over the next two decades as hepatitis C virus-infected patients develop cirrhosis, which makes this the leading indication for liver transplantation. These data point to the importance of VH being a significant public health problem worldwide. The list of hepatotropic viruses is well known, including hepatitis A (HAV), B (HBV), C (HCV), D (HDV), E (HEV), G (HGV) and F (HFV). HGV and HFV are excluded from the present review, mainly because they are questionable in relation to the causation of liver disease. Our knowledge of HAV, HBV, HDV and HEV has accumulated over the last decade, so the present discussion is focused on HCV, which is currently generating considerable concern and controversy, and is the leading cause of chronic liver disease worldwide. The main questions to be discussed, are: the characterization of the agents' viral genotypes/subtypes, the viral-cell interaction, the pathogenesis of VH, the extrahepatic manifestations of viral infection and hepatocarcinogenesis.

Fine structure of hepatocytes during the etiology of several common pathologies

Hepatocytes respond to injury by a few basic pathological reactions that are reflected in cell death, different types of degeneration, regeneration, or tumorous transformation. At the ultrastructural level, alterations of cell organelles can be observed in different combinations as a result of the injury, depending on the etiological agent(s) or pathological conditions developed. Nuclear bodies, dilation and fragmentation of rough endoplasmic reticulum (rer), swelling of mitochondria, and an increased number of lysosomes occur during acute viral hepatitis. The core and surface components of the hepatitis B virus can be localized in the liver cells in chronic hepatitis and in carriers. Close contact of hepatocytic and lymphocytic cell membranes were observed in chronic active hepatitis. Hepatocytes surrounded by an increased amount of collagen fibers are characteristic of cirrhosis. Loosely arranged, fine fibrils or condensed forms of Mallory bodies are pathognomic for alcoholic injury. A wide spectrum of alterations are noted after drug treatment: the proliferation of smooth endoplasmic reticulum (ser) as an adaptive phenomenon, focal or complete necrosis of the cell, inflammation, and the like. The fine structural analysis of hepatocytic inclusions in storage diseases has a differential diagnostic value. The storage of copper and other elements can be measured by x-ray microanalysis. The study of the hepatocytic differentiation in liver tumors is highly important in establishing the diagnosis and in proving the hepatocytic origin of the tumor.

Toga-like virus as a cause of fulminant hepatitis attributed to sporadic non-A, non-B

Virus-like particles (60-70 nm) with spiked surfaces budding into cell vacuoles and rod-shaped inclusions were detected in nuclei of hepatocytes from a British patient transplanted for sporadic non-A, non-B fulminant hepatitis (NANB-FHF), probably contracted in Kenya. Identical particles were seen in two successive grafts (days 2 and 10) at regrafting for recurrent FHF. Ultrastructural features resembled those of the RNA-containing arbovirus, Rift Valley fever virus, but serological markers against a representative panel for arboviruses (Togaviruses) and transmission in mice proved negative. The particles shared features with the different arboviruses seen in the hepatectomy specimen of a second patient with NANB-FHF, and in both patients an insect vector was implicated in the clinical history. The particles were identical in size to those of a third patient with NANB-FHF, who had remained in the United Kingdom. These findings, together with the recent report of isolation of an RNA-containing virus resembling the Togaviridae, in parenteral NANB, suggest that several exotic virus-like agents resembling the arboviruses may be involved in the aetiology of NANB, including in the sporadic forms of FHF in the United Kingdom.

Viruslike particles in liver in sporadic non-A, non-B fulminant hepatitis

In a patient who followed the typical clinical course of fulminant hepatitis attributable to "sporadic" non-A,non-B (NANB) hepatitis and who finally received treatment by orthotopic liver grafting, three, apparently separate, virus-like agents (26, 45, and 80 nm) and cytoplasmic, reticular tubular structures (CTS) were identified in collapsed and regenerating areas of liver using electron microscopy. The 80-nm particles present within vacuoles, together with the finding of intranuclear rods in association with the smaller particles (26 nm), are similar to those found in the nuclei of cells infected with several different arboviruses. The third type of particle, existing as 45-nm spheres and rods, is similar in morphology only to some form of polyoma virus, which, hitherto, has not been reported as affecting the liver. Unlike typical polyoma virus, replication of the virus "cores" (25-26 nm) was extranuclear and appeared to be occurring in vacuoles. Although analysis for serological markers against a representative panel for arboviruses, flaviviruses, phleboviruses, arenavirus, and nairovirus was negative, an insect vector was implicated in the clinical history.

Non-A, non-B hepatitis

Diagnosis of non-A, non-B hepatitis (NANB) is made after exclusion of other known causes of hepatitis. Parenterally spread non-a, non-B hepatitis (PNANB) and enterally transmitted non-A, non-B hepatitis (ENANB) almost certainly appear to be two different diseases. The definite causative agents have not hitherto been identified. Much of our knowledge of NANB is based on (i) experimental studies on chimpanzees; and (ii) epidemiological studies. Parenterally spread non-A non-B hepatitis caused by whole blood transfusion and blood-product infusion has different incubation periods and may be caused by different agents. It is a mild disease clinically, and the majority of the patients are asymptomatic. It can be prevented only by judicious use of blood transfusion. Whenever possible, blood/blood products should be derived from individual volunteer donors who are anti-HBc sero-negative and have serum alanine transaminase of under 45 IU/l. Enterally-transmitted non-A non-B hepatitis is endemic in the Indian subcontinent, South-East Asia, North and East Africa and Latin America. Epidemic NANB is usually transmitted by water supply contaminated with feces. ENANB has a predilection for young adults. The disease is usually mild, except in pregnant women, who have a high case-fatality rate from fulminant hepatic failure. Control measures include provision of clean water supplies, safe disposal of human excreta and sound personal and food hygiene practices.

Transfusion transmitted non-A, non-B hepatitis

Non-A, non-B of hepatitis (NANBH) may occur following blood transfusions or administration of blood products. The causative agent(s) is still not identified and the symptoms are usually mild. The only indication of infection may be increased serum alanine transferase levels. The incidence of posttransfusion NANBH has been reported as high as 4-12% in the US (average 7%) while in Sweden it is according to recent studies on the average 2%. An estimated 2-3% of Swedish blood donors are probably carriers of the NANBH agent(s). Of patients acquiring posttransfusion NANBH, 40-60% will develop chronic hepatitis which in 15-20% will progrediate to cirrhosis.

Lack of reverse transcriptase activity in serum in sporadic post-transfusional and presumed epidemic or water-borne forms of severe non-A, non-B hepatitis

Reverse transcriptase (RT) activity was not detected in any serum sample taken from 22 patients with mainly severe non-A, non-B hepatitis (NANBH), using two assays selected to cover the range of known human and animal retroviruses. The study included patients with fulminant and sub-acute hepatic failure, which was was attributed to sporadic, post-transfusional, and presumed epidemic or water-borne epidemiological forms of NANBH. Although we cannot exclude the possibility that some of the agents implicated in NANBH are retroviruses, our negative findings suggest that other agents may be involved at least in the severe forms of NANBH.

Microbial structures in a patient with sporadic non-A, non-B fulminant hepatitis treated by liver transplantation

Double-shelled virus-like particles (60 nm) and long cytoplasmic tubular structures were found in the cytoplasm of hepatocytes from areas of collapsed and regenerating areas of hepatectomised liver in a 13-year-old boy who received a liver graft for fulminant hepatitis attributed to sporadic non-A, non-B hepatitis. The patient died on the ninth postoperative day from acute graft failure. Although virus-like particles were not found, instead, gram-negative rods were identified in the necrotic graft and the most likely cause of death was a gram-negative septicaemia with a Shwartzman-like reaction localized to the liver.

Studies on transmission of human non-A, non-B hepatitis to marmosets

Two sera obtained from four healthy blood donors, which caused non-A, non-B post-transfusion hepatitis in two recipients, were experimentally inoculated into nine marmosets. Three of seven marmosets developed acute hepatitis characterized by the elevation of serum concentrations of glutamic pyruvic transaminase (GPT) and/or isocitric dehydrogenase (ICD) 8-11 weeks after inoculation. Four of seven showed histopathological changes of acute hepatitis in liver biopsy specimens during the biochemically acute phase. In electron microscopic examination, attached membrane-like structures, which consisted of two-unit membranes of two neighboring endoplasmic reticula with electron-dense material between them, were noted in cytoplasm of hepatocytes during the acute phase of hepatitis. Furthermore, acute-phase sera obtained from two animals were inoculated into four additional marmosets, and non-A, non-B hepatitis was successfully passaged in two of them. The results of this study indicate that certain species of marmoset monkeys are susceptible to human non-A, non-B hepatitis agents and provide a useful animal model for non-A, non-B hepatitis.

Non-A, non-B hepatitis: an update

The definition of non-A, non-B hepatitis (NANB) is improved by further characterization of what it is not (like the delta agent or non-A epidemic hepatitis) rather than by providing convincing evidence of isolation of the agent responsible for blood transfusion- or blood product-related NANB or specific markers thereof. Yet, NANB research is in disquieting movement. Modern biotechnology yielded its blessings to the field. However, monoclonal antibodies and molecular probes will have to be evaluated with the same scrutiny that unmasked so many test systems and viral agents thus far. Recent victims appear to be published reports on NANB being identified as a retroviral agent and NANB virus being propagated in primary cultures of chimpanzee hepatocytes. Yet the application of these powerful new tools, together with the availability of cultured human and chimpanzee hepatocytes for propagation of the agent may improve the chances for substantial progress. Our finding of involvement of lymphocytes in transmission of the disease may add another approach to reach the ultimate goal of characterization of the causative agent and development of diagnostic methods to detect it in patients and biological materials derived from carriers of the disease.

A glycoprotein associated with the non-A, non-B hepatitis agent(s): isolation and immunoreactivity

A glycoprotein was isolated and purified to homogeneity from the serum of a patient with chronic non-A, non-B hepatitis. NaDodSO4/PAGE of the glycoprotein revealed a single major band at Mr approximately 77,000. Antibodies to this glycoprotein were shown to possess the following immunoreactivity: (i) they reacted by radioimmunoassay with sera obtained at the time of diagnosis from 17 of 42 patients with non-A, non-B hepatitis and with only 2 of 58 sera from either matched controls or patients with hepatitis A or hepatitis B, (ii) they reacted with sucrose gradient fractions from a proven infectious non-A, non-B hepatitis serum at a peak density of 1.14 g/ml and in the soluble protein fractions on top of the gradient, and (iii) they reacted in ELISA with disrupted human T-cell lymphocytotropic virus type III (HTLV-III), and (iv) they reacted in immunoblots with a protein of Mr 74,000 derived from HTLV-III.