Molecular biology of non-A, non-B hepatitis agents: hepatitis C and hepatitis E viruses

Impact of the novel hepatotropic viruslike agent NV-F during chronic hepatitis C virus infection

NV-F is a novel hepatotropic viruslike agent. To investigate the impact of the NV-F agent during chronic hepatitis C virus (HCV) infection, 101 consecutive patients with chronic HCV infection were evaluated. NV-F DNA in serum samples and NV-F antigen expression in liver tissues were assessed. All patients subsequently received a 6-month course of interferon-based antiviral therapy. Of the 101 patients, 30 (29.7%) were positive for serum NV-F DNA. Immunohistochemical analysis revealed positive NV-F antigen expression in the liver in 14 of these 30 patients. Patients positive for serum NV-F DNA had significantly higher serum aminotransferase levels (P < .001) and higher Knodell histology activity index values (P < .001). The sustained virological response rate for HCV clearance was not significantly different between patients with and those without detectable serum NV-F DNA. In conclusion, coinfection of the NV-F agent in chronic HCV infection is associated with more severe hepatitis activity.

Transmission in vitro of hepatitis C virus from persistently infected human B-cells to hepatoma cells by cell-to-cell contact

Virus cell-to-cell spread has been reported for many different viruses and may contribute to pathogenesis of viral disease. The role played by cell-to-cell contact in hepatitis C virus (HCV) transmission was studied in vitro by cell co-cultivation experiments. A human lymphoblastoid B-cell line, infected persistently with HCV in vitro (TO.FE(HCV)), was used as HCV donor [Serafino et al., 2003]; recipient cells were the human hepatoma HepG2 cell line. Both cell types were co-cultured for 48 hr to allow the cell-to-cell contacts. The hepatoma HepG2 cells are not permissive to free-virus infection, but they were infected successfully using TO.FE(HCV) cells as source of virus. The kinetics of viral RNA synthesis and the percentage of infected cells were compared in cell-mediated-and cell-free-viral infection. After co-cultivation, a consistent proportion of hepatoma cells replicated HCV and stably expressed viral antigens. Virus produced was infectious as demonstrated by the ability to reinfect fresh B-cells. This cell model shows that permissiveness to HCV infection can be achieved in vitro in non-permissive hepatoma cells by direct cell-to-cell contacts with infected human B-cells. This mechanism of virus spread may also play a pathogenic role in vivo.

Hepatitis E virus infection in Europe: regional situation regarding laboratory diagnosis and epidemiology

Hepatitis E virus (HEV) was first identified in the excreta of an experimentally infected human volunteer and further confirmed by similar findings in clinical specimens from patients with acute jaundice disease different from hepatitis A and B. The HEV is a 27- to 34-nm spherical non-enveloped virus obviously represented by a single serotype; however, its final taxonomic definition remains to be established. Studies on molecular biology of this virus revealed some peculiar characteristics showing no homologies in its nucleotide sequence to any entries in the Genbank database. The HEV infection was experimentally transmitted to non-human primates producing a disease in many features similar to that occurring in humans. Recently cell lines persistently infected with the HEV have also been obtained. These studies provided valuable virus-specific reagents which were used in diagnostic tests. Currently immune electron microscopy, fluorescent antibody technique, latex agglutination, cDNA hybridization, and Western blotting are employed to prove the etiological involvement of HEV in suspected hepatitis cases; serological tests with synthetic substances analogous to HEV antigens are expected to be available soon. Reliable diagnostic procedures can be carried out in a number of laboratories with the locally produced reagents. The HEV infection is common in many hot climate countries being responsible for more than 50% of jaundice cases among young adults. The European region is considered to be free of natural foci of this infection, however, several sporadic cases of HEV disease were reported to occur in Europeans who developed jaundice shortly after returning from endemic areas. It is suspected that in the Mediterranean countries (Italy and Spain) the cases of HEV infection could be causatively related to the consumption of shell-fish cultivated in sewage-polluted waters.

Influence of RNA secondary structure on HEV gene amplification using reverse-transcription and nested polymerase chain reaction

BACKGROUND

Single-stranded RNA has the potential to form secondary structures that may result in intrastrand misalignment of repeats and may be responsible for DNA mutation. Two amplicons obtained from amplification of hepatitis E virus (HEV) gene by reverse transcription and nested polymerase chain reaction (RT-nPCR) were of unexpected size and had the same misalignment. They did not contain the target region between the internal priming sites but contained two fragments flanking the target region joined by a 12-base sequence instead.

OBJECTIVES

To determine whether the unexpected amplicons obtained were due to secondary structures present in the HEV RNA.

STUDY DESIGN

HEV RNA sequences were obtained from the GenBank database and the software DNASIS was used to predict the presence of secondary structures within the amplification target regions. The free energy barriers of the secondary structures, which indicate their stability, were also calculated. Conventional RT-nPCR protocol was subsequently modified to eliminate RNA secondary structures.

RESULTS

An extensive stem-loop structure was predicted to exist between the two internal priming sites of the HEV RNA by the DNASIS software. Its free energy barrier was found to be significant and might have resulted in the deletion of the target region located between the internal priming sites. Increased temperature and addition of dimethyl sulphoxide (DMSO) in the reverse transcription step gave the expected amplicon after the nested polymerase chain reaction.

CONCLUSION

Spontaneous secondary structure formation can influence the outcome of RNA gene amplification and should be considered an important factor when designing primers and adopting protocols for RNA gene amplification.

The unique riverine ecology of hepatitis E virus transmission in South-East Asia

The ecology of hepatitis E virus (HEV) transmission in South-East Asia was assessed from a review of 6 published and 3 unpublished NAMRU-2 reports of hepatitis outbreak investigations, cross-sectional prevalence studies, and hospital-based case-control studies. Findings from Indonesia and Viet Nam show epidemic foci centred in jungle, riverine environments. In contrast, few cases of acute, clinical hepatitis from cities in Indonesia, Viet Nam and Laos could be attributed to HEV. When communities in Indonesia were grouped into areas of low (< 40%), medium (40-60%), and high (> 60%) prevalence of anti-HEV antibodies, uses of river water for drinking and cooking, personal washing, and human excreta disposal were all significantly associated with high prevalence of infection. Conversely, boiling of river drinking water was negatively associated with higher prevalence (P < 0.01). The protective value of boiling river water was also shown in sporadic HEV transmission in Indonesia and in epidemic and sporadic spread in Viet Nam. Evidence from Indonesia indicated that the decreased dilution of HEV in river water due to unusually dry weather contributed to risk of epidemic HEV transmission. But river flooding conditions and contamination added to the risk of HEV infection in Viet Nam. These findings attest to a unique combination of ecological and environmental conditions predisposing to epidemic HEV spread in South-East Asia.

Hepatitis C virus infection of a Vero cell clone displaying efficient virus-cell binding

The susceptibility of Vero cells and derivative cell clones to hepatitis C virus (HCV) infection was assayed by qualitative and quantitative polymerase chain reaction (PCR)-based methods. Cell extracts from Vero cells inoculated with HCV were tested for the presence of both positive and negative strands of HCV RNA; in parallel, cell-free HCV genomes were assayed in culture supernatant fluids. Quantitation of genomic HCV RNA molecules in infected cells by competitive reverse transcription PCR (cRT-PCR) indicated that HCV replication was more efficient in a derivative clone (named clone 10) than in parental Vero cells or other clones under study. Analysis of HCV-binding to cell receptors, performed by cRT-PCR quantitation of viral particles adsorbed to the cell surface, demonstrated a 10-fold higher virus-binding level of clone 10 than that of parental Vero cells. The results shown here indicate that the Vero clone 10 may constitute an efficient model system for analysing early events in HCV infection as well as a source of virus for diagnostic and biotechnological applications.

Possible aetiological role of hepatitis E virus in acute non-A, non-B, non-C hepatitis in Saudi Arabia

During a period of 10 months, 69 Saudi Arabian patients (14 children and 55 adults) were diagnosed as having acute non-A, non-B, non-C (NA, B, C) hepatitis at King Khalid University Hospital, Riyadh, Saudi Arabia. Seven of the paediatric patients had anti-hepatitis E virus (HEV) immunoglobulin (Ig) M and anti-HEV IgG; 26 adults (47.3%) had anti-HEV IgM and 30 (54.5%) had anti-HEV IgG. These results, together with the fact that none of the 40 patients with acute hepatitis A virus infection, none of the 24 with hepatitis B virus, and none of the 30 with acute hepatitis C virus, had anti-HEV IgM, indicates that HEV is an important aetiological agent for acute NA, B, C hepatitis in Saudi Arabia, and that there are still other unidentified agent(s) responsible for acute hepatitis in Saudi Arabia.

Purification and characterization of a recombinant hepatitis E protein vaccine candidate by liquid chromatography-mass spectrometry

A protein with a molecular mass of approximately 62.10(3), derived from open reading frame 2 (ORF-2) of the hepatitis E virus (HEV: Burma strain), was expressed in a baculovirus expression vector and purified to homogeneity. The recombinant 62 kDa protein appeared to be a doublet, as determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Tryptic digestion in conjunction with laser desorption mass spectrometry (LD-MS) and sequence analysis of the tryptic peptides indicated that the amino terminus was blocked, although no proteolytic degradation occurred. The determined internal sequences of peptides were in agreement with the predicted ORF-2 protein. Reversed-phase liquid chromatography coupled to electrospray mass spectrometry (LC-MS) resolved the doublet proteins into two major components with molecular masses of 56548.5 and 58161.4. Confirmation of the amino terminus of the molecule by LD-MS post-ion decay enabled us to tentatively assign the carboxyl terminus of each species at residues 540 and 525. Sequencing of the intact protein by automated carboxyl terminal sequencing confirmed that the carboxyl terminus was truncated and that the sequence assignment predicted by LC-MS was correct.

Detection of a 5' UTR variation in the HCV genome after a long-term in vitro infection

The TOFE lymphoid cell line from normal human bone marrow is susceptible to infection by a hepatitis C virus (HCV) serum strain. A sequence analysis of the 5' untranslated region (UTR) of HCV before and after long-term in vitro infection revealed one base substitution at position -158 (C > T) of the 5' UTR. We performed the direct sequencing of 5' UTR polymerase chain reaction-amplified sequences of the HCV genome: a) from the original serum-derived strain; b) from TOFE cell extracts 6 months post infection. This base substitution in the regulatory elements of the 5' UTR might be related to the ability of the virus to grow in cell culture.

Two years' investigation of epidemic hepatitis E virus transmission in West Kalimantan (Borneo), Indonesia

Two years' follow-up investigation of a hepatitis E virus (HEV) outbreak in West Kalimantan, Indonesia in 1991 was carried out to investigate the epidemiology of epidemic HEV transmission and the persistence of the immunoglobulin G (IgG) antibody response. Sixty cases identified as anti-HEV IgG positive during the outbreak in 1991 were matched with 67 controls and examined, together with 318 members of their families. Overall, the prevalence of anti-HEV IgG among the 445 subjects (representing 127 households) was 59%. There was no significant difference in anti-HEV prevalence between cases (72%) and controls (61%). Loss of detectable anti-HEV IgG after 2 years was demonstrated in 17 of 60 subjects (28%) who were originally positive for anti-HEV in 1991. The mean number of anti-HEV positive subjects per household was 2.04. Cross-sectional prevalence of anti-HEV IgG increased significantly with age (P = 0.01). When communities were grouped into areas of low (< 40%), medium (40-59%) and high (> or = 60%) anti-HEV prevalence, use of river water for drinking and cooking (P < 0.001), personal washing (P < 0.0001), and human excreta disposal (P < 0.001) were associated with high prevalence communities. Conversely, boiling drinking water was negatively associated with increased prevalence (P = 0.02). Subnormal rainfall during the month (August) leading up to the 1991 outbreak (19 cm compared to the monthly mean of 209 cm in 1985-1993) may have contributed to favourable epidemic conditions.

Serological survey on hepatitis E virus infection in an endemic area: diagnosis potential of enzyme immunoassay for detection of IgG antibody

BACKGROUND

Hepatitis E is a major cause of acute icteric disease widespread in tropical and sub-tropical regions but rarely occurring in industrialized countries. Recently solid-phase enzyme immunoassays with recombinant antigens have been introduced for diagnosis of this infection.

OBJECTIVES

The aim of this study was to evaluate the diagnostic potential of a newly developed Abbott test for the detection of IgG class antibodies to hepatitis E virus (anti-HEV IgG) in hepatitis patients and 'normal' individuals.

STUDY DESIGN

Sera taken from hepatitis patients and individuals without liver disorders in endemic (Kirghizstan and Uzkbekistan) versus non-endemic (Moscow) areas were investigated. In parallel IgG class antibodies to hepatitis A virus (anti-HAV IgG) were determined by an enzyme immunoassay with native HAV antigen.

RESULTS

In five groups comprising altogether 86 suspected hepatitis E patients from endemic area the rate of anti-HEV IgG seropositivity varied from 85% to 17%. In Moscow anti-HEV IgG was found in one patient (who also had acute hepatitis B) out of 19. Anti-HEV IgG persisted in an experimentally infected volunteer for at least 12 years after the acute disease. Among the individuals without liver disorders eight out of 173 (4.6%) showed anti-HEV IgG seropositivity in Kirghizstan while there was only one seropositive out of 165 (0.6%) in Moscow. In contrast, anti-HAV IgG were frequently present in the residents of both areas: in Kirghizstan over 90% of individuals from young age groups already had these antibodies; in Moscow the rate of anti-HAV IgG seropositivity constantly increased from 31% in the youngest age group to almost 85% in the oldest one.

CONCLUSION

Prevalence of anti-HEV antibodies was unexpectedly low in endemic area; in Moscow anti-HEV IgG was found only in single cases. Anti-HEV IgG seropositivity in a single serum sample could be of certain diagnostic value in non-endemic areas.

Epigenesis: the missing beat in biotechnology?

The range of human phenotypes/diseases for which our burgeoning bio-molecular data base is sufficient to provide understanding, diagnosis, and therapy is small. Only 2 percent of our total disease load is related to monogenic causality, and even here the final phenotype is modulated by many factors. Monogenic logic cannot, moreover, be applied to the 98 percent of our most important sources of premature disability and death. This article provides an analysis of the limits of genetic thinking in biotechnology and describes the outline for another approach to understanding complex cellular/physiological systems. In this outline, rules governing physiological regulation and cellular and higher levels of organization are located not in the genome, but in interactive epigenetic networks which themselves organize genomic response to environmental signaling.

Detection of IgA class antibody to hepatitis E virus in serum samples from patients with hepatitis E virus infection

A newly developed assay for IgA class antibody to hepatitis E virus (IgA anti-HEV) was used to study 145 serum samples collected during an outbreak of an enterically transmitted hepatitis that occurred in 3 villages in the lower Shebeli region of Southern Somalia between January, 1988 and November, 1989. A total of 52.4% of the afflicted patients were found positive for IgA anti-HEV, and 73.1% of these were also positive for IgM. Both antibodies disappeared during the convalescence period. Similar results were also seen in serum obtained from sporadic cases of acute waterborne hepatitis in Pakistan.

Replication and multiplication of hepatitis C virus genome in human foetal liver cells

The ability to obtain primary long-term cultures of human foetal hepatocytes maintaining liver differentiation characteristics in serum-free medium prompted us to test their susceptibility to hepatitis C virus infection. Using PCR, we detected the presence of the HCV RNA-positive strand in the supernatants and in the cells of the virus-infected hepatocyte cultures, at various times post-infection. Evidence of effective virus genome replication and multiplication was also based on the time-dependent appearance of the putative HCV RNA-negative strand, the detection of virus replicative intermediates and an increase in HCV genomic templates in the HCV-infected cells.

Routine laboratory diagnosis of hepatitis C virus infection

Hepatitis C virus (HCV) is the major cause of parenterally transmitted non-A, non-B hepatitis. The analysis of the genomic sequence of HCV has facilitated the development of a number of diagnostic assays for testing circulating antibodies in serum from patients with HCV infection. Besides the first-generation ELISA and RIBA, which employed the C100-3 non-structural polypeptide, second-generation tests employing both structural and non-structural polypeptides are being rapidly introduced. Several coded panels were employed in a comparative study of HCV-SP ELISA (utilizing a new synthetic peptide whose sequence was derived from the structural region) along with first- and second-generation tests. On the basis of the results, evidently antigens corresponding to the structural components of the virus are more sensitive and specific for the early detection of HCV antibodies than tests using non-structural epitopes. Additionally epitopes of the structural region elicit a very strong antibody response in laboratory animals. An example of one such application is the detection of HCV specific antigens in semen from patients diagnosed with non-A, non-B (NANB) hepatitis. Semen samples from 9 patients clinically diagnosed as having NANB hepatitis were tested by an ELISA using antibodies against HCV-specific structural antigens. The semen from all 9 patients had HCV-specific structural antigens in comparison to semen from 5 healthy donors. Semen from 5 of the 9 patients had significant levels of the HCV-specific antigen. This approach to detecting HCV antigens could, if rigorously tested, evolve into promising new assays for detecting HCV.

Virus infection of polarized epithelial cells

This chapter focuses on the interaction of viruses with epithelial cells. The role of specific pathways of virus entry and release in the pathogenesis of viral infection is examined together with the mechanisms utilized by viruses to circumvent the epithelial barrier. Polarized epithelial cells in culture, which can be grown on permeable supports, provide excellent systems for investigating the events in virus entry and release at the cellular level, and much information is being obtained using such systems. Much remains to be learned about the precise routes by which many viruses traverse the epithelial barrier to initiate their natural infection processes, although important information has been obtained in some systems. Another area of great interest for future investigation is the process of virus entry and release from other polarized cell types, including neuronal cells.