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Showing posts with label hepatitis. Show all posts
Showing posts with label hepatitis. Show all posts

Monday, December 2, 2013

Scientists achieve most detailed picture ever of key part of hepatitis C virus

Nov. 28, 2013 — Scientists at The Scripps Research Institute (TSRI) have determined the most detailed picture yet of a crucial part of the hepatitis C virus, which the virus uses to infect liver cells. The new data reveal unexpected structural features of this protein and should greatly speed efforts to make an effective hepatitis C vaccine.

The findings, which appear in the November 29, 2013 issue of the journal Science, focus on a protein known as E2 envelope glycoprotein.

"We're excited by this development," said Ian A. Wilson, the Hansen Professor of Structural Biology at TSRI and a senior author of the new research with TSRI Assistant Professors Mansun Law and Andrew B. Ward. "It has been very hard to get a high resolution structure of E2 and it took years of painstaking work to finally accomplish that."

Any successful hepatitis C vaccine is likely to target the E2 protein. Scientists already have isolated rare antibodies from patients that can bind E2 in ways that neutralize a broad range of viral strains.

"It took our team six years to crack this very difficult scientific problem, but we didn't give up," said Law. "Now that we can visualize the structural details of these binding sites, we can design vaccine molecules that mimic them."

A Silent Killer

There has long been an urgent need for an effective vaccine against hepatitis C virus. Once confined to isolated geographical regions, the virus spread globally during the 20th century, chiefly via blood transfusions, unsterilized medical instruments and re-used hypodermic needles. Although hospitals have screened blood products for hepatitis C virus (HCV) since the early 1990s, as many as 200 million people currently are thought to harbor the virus. These include more than 3 million people in the United States, where the virus is responsible for more deaths each year than HIV.

HCV was able to spread so widely because it typically causes few or no symptoms when it infects someone. In many cases it establishes a long-term infection of the liver, damaging it slowly for decades -- until liver cirrhosis and/or cancer develop. "It's known as a 'silent killer'," said Law. Expensive and risky liver transplantation is often the only way to save a patient's life. Some antiviral drugs are useful in treating and even curing chronic HCV infection, but the more effective ones are extremely expensive -- and most HCV-positive people don't even know that they're infected and need treatment.

An HCV vaccine could put an end to the global pandemic by preventing new infections. "It could be given to people when they're young and healthy, and they'd never have to worry about developing HCV-related liver diseases," said Ward.

However, like HIV and some other viruses, HCV uses several effective countermeasures to evade the immune system. These include fast-mutating regions on the E2 protein, which ensure that antibodies to one HCV strain typically are ineffective against other strains. The E2 protein also coats itself with relatively antibody-proof sugar molecules.

To defeat these viral countermeasures, scientists have wanted to "see" the high-resolution atomic structure of HCV, particularly E2 and its CD81 receptor binding site, which does not vary much from strain to strain. In recent years, Law's laboratory and others have isolated antibodies that manage to grab hold of this relatively conserved region of E2, thereby blocking the infectivity of a large fraction of HCV strains. In principle, a vaccine that prompts the body to make similar antibodies would effectively and cheaply immunize people against most of their risk of HCV infection.

Unruly E2

But precisely mimicking these antibody-binding sites in a vaccine means first determining their high-resolution structures, which has been difficult even to attempt. "Usually if you try to express the E2 protein in cultured cells, you either can't express it in useful quantities or you can but it aggregates and becomes a big mess," said Leopold Kong, a research associate in the Wilson laboratory who was the study's lead author.

Over the past several years, Kong and his colleagues have run dozens of experiments to find the right way to modify E2 -- enough that the protein doesn't aggregate so readily and also so that the antibody-binding sites are maintained. This would enable the protein to be soluble and pure enough to grow crystals to determine its structure by the technique known as X-ray crystallography. "It was a Herculean effort," said Ward. "This is one of the most difficult and unstable viral envelope proteins around."

In the end, the team succeeded, using a slightly altered version of E2 -- the E2 core -- with some of its glycans (sugar molecules) and outer variable and stalk segments removed. The scientists were then able to obtain the high-resolution structure of the protein while it was bound to a known broadly neutralizing antibody developed at TSRI. The scientists then followed up by imaging a more complete version of E2 using electron microscopy to extend the structural model.

When finally revealed, E2's structure surprised the researchers. "It had been thought that HCV's E2 belongs to a family of viral fusion proteins called class 2 fusion proteins, which includes envelope proteins for West Nile and dengue viruses, for example," said Kong. "But we showed that E2 is structurally distinct and probably works differently than what had been widely assumed."

Based on the new structural data, Law and colleagues at TSRI are already designing and testing novel antibody-stimulating components of a future HCV vaccine. "Having the E2 structure has certainly helped us," said Law.


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New Hampshire hospital worker to be sentenced for spreading hepatitis

(Reuters) - A former New Hampshire hospital technician who infected patients as old as 80 with hepatitis after injecting himself with stolen painkillers will learn on Monday how much of his life will be spent in prison.

The technician, David Kwiatkowski, 34, in August admitted to leaving dirty syringes for hospital use despite knowing that he was infected with hepatitis C. He pleaded guilty to obtaining controlled substances by fraud and tampering with a consumer product.

Kwiatkowski has asked U.S. District Judge Joseph Laplante to sentence him to 30 years in federal prison.

Prosecutors have requested a 40-year sentence, saying that he knowingly put patients in eight states in danger over about a decade of work as a traveling hospital technician.

Kwiatkowski admitted to injecting himself with pre-filled syringes of the painkiller fentanyl, which he would steal from hospital supply cabinets. He filled the empty syringes with saline solution, causing the syringes to become tainted by his infected blood. Hospital staff then injected patients with the needles, not realizing they had been tampered with.

"The defendant continued this reckless conduct with full knowledge that he had hepatitis C and that he was, by his own admission, 'going to kill a lot of people out of this,'" prosecutors argued in their sentencing memo, filed in U.S. district court in Concord, New Hampshire, where Kwiatkowski will be sentenced.

Kwiatkowski's crimes were discovered when several patients at Exeter Hospital in Exeter, New Hampshire, were infected with the disease. That prompted a review of all patients Kwiatkowski had worked with in his years in the field, in what prosecutors described as a "national public health crisis."

His attorneys argued for a shorter, 30-year-sentence, noting that Kwiatkowski confessed early in the legal process against him, sparing the state the expense of the trial.

"While Kwiatkowski initially denied involvement in the offense, he confessed to the crime before his first court appearance, when he admitted that he knew that he was infected with hepatitis C and did not try to blame anyone else for his conduct," his attorneys wrote in a court filing.

(Reporting by Scott Malone; Editing by Steve Orlofsky)


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Wednesday, September 25, 2013

FDA strengthens hepatitis B warning on 2 cancer drugs


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Tuesday, September 10, 2013

WHO urges governments to act on hepatitis threat

24 July 2013 | GENEVA - On World Hepatitis Day (28 July), WHO is urging governments to act against the five hepatitis viruses that can cause severe liver infections and lead to 1.4 million deaths every year. Some of these hepatitis viruses, most notably types B and C, can also lead to chronic and debilitating illnesses such as liver cancer and cirrhosis, and in addition to, loss of income and high medical expenses for hundreds of millions of people worldwide.

Viral hepatitis is referred to as a ‘silent epidemic’ because most persons do not realize that they are infected and, over decades, slowly progress to liver disease. Many countries are only now realizing the magnitude of the disease burden and devising ways to address it.

“The fact that many hepatitis B and C infections are silent, causing no symptoms until there is severe damage to the liver, points to the urgent need for universal access to immunization, screening, diagnosis and antiviral therapy,” says Dr Keiji Fukuda, WHO Assistant Director-General for Health Security and the Environment.

"Many of the measures needed to prevent the spread of viral hepatitis disease can be put in place right now, and doing so will offset the heavy economic costs of treating and hospitalizing patients in future."

Dr Sylvie Briand, Director, WHO Pandemic and Epidemic Diseases

This year, in the run up to World Hepatitis Day, the Organization is releasing its first-ever country hepatitis survey, covering 126 countries. The WHO "Global policy report on the prevention and control of viral hepatitis in WHO Member States" identifies successes as well as gaps at country level in the implementation of four priority areas. The priority areas are raising awareness, evidence-based data for action, prevention of transmission, and screening, care and treatment.

The findings show that 37% of the countries have national strategies for viral hepatitis, and more work is needed in treating hepatitis. It also highlights that while most of the countries (82%) have established hepatitis surveillance programmes, only half of them include the monitoring of chronic hepatitis B and C, which are responsible for most severe illnesses and deaths.

“Many of the measures needed to prevent the spread of viral hepatitis disease can be put in place right now, and doing so will offset the heavy economic costs of treating and hospitalizing patients in future,” says Dr Sylvie Briand, Director, Pandemic and Epidemic Diseases at WHO. “The findings underline the important work that is being done by governments to halt hepatitis through the implementation of WHO recommended policies and actions.”

The challenges posed by hepatitis were formally acknowledged by the World Health Assembly in 2010 when it adopted its first resolution on viral hepatitis, and called for a comprehensive approach to prevention and control. This has promoted a new era of awareness with more governments proactively working to address the disease. Reinforcing that call for action, WHO has been collaborating closely with countries and partners to build a strong global response. As a result, the new report notes, 38% of countries observe World Hepatitis Day (an annual event that began in 2010) with even more countries expected to mark the day this year.

In addition to collaborating closely with countries, WHO has been working on developing networks and mechanisms that can deliver results. The Organization is exploring with international funding agencies avenues that could allow hepatitis to be included in their current programme of activities. In June 2013, WHO launched the Global Hepatitis Network. One of its aims is to support countries with planning and implementation of viral hepatitis plans and programmes.

WHO is currently developing new hepatitis C screening, care and treatment guidelines, which will provide recommendations on seven key areas such as testing approaches; behavioural interventions (alcohol reduction); non-invasive assessment of liver fibrosis; and the selection of hepatitis C drug combinations.

”New, more effective medicines to prevent the progression of chronic hepatitis B and C are in the pipeline. However, these will be expensive and therapy will require monitoring with sophisticated laboratory tests. To cure and reduce the spread of these viruses, medicines must become more accessible,” says Dr Stefan Wiktor, Team lead of WHO’s Global Hepatitis Programme.

The complexity of hepatitis disease lies in the existence of different types of viruses. Hepatitis A and E are foodborne and waterborne infections which cause millions of cases of acute illness every year, sometimes with several months needed for a person to fully recover.

Hepatitis B, C, and D are spread by infected body fluids including blood, by sexual contact, mother-to-child transmission during birth, or by contaminated medical equipment. Hepatitis B and C have a greater health burden in terms of death because they can cause life-long infection (called chronic infection), which can lead to liver cirrhosis and cancer. In fact, chronic hepatitis is the leading cause of liver cirrhosis and cancer.

WHO-approved vaccines are available to prevent hepatitis A and B, while screening of blood donors, assuring clean needle and syringes, and condom use can prevent bloodborne and sexual transmission.

Hepatitis B can be prevented by reaching every child with immunization programmes that include hepatitis B vaccine. There is no vaccine for hepatitis C. In addition, infections can be prevented by protecting against mother-to-child transmission of the virus and ensuring the safety of blood, transfusion services, organ donation and injection practice (treatment can include antiviral medications if needed).Hepatitis A and E can be prevented by avoiding contaminated food and water; in addition, there is an effective WHO approved vaccine for hepatitis A. Hepatitis medicines are now included in the WHO Essential Medicines List, which Member States are encouraged to adopt. Essential medicines are selected based on disease prevalence, safety, efficacy, and comparative cost-effectiveness. The WHO Model List can be used by countries as a guide for the development of their own national list.

Mr Glenn Thomas
Communications Officer
WHO, Geneva
Telephone: +41 22 791 3983
Mobile: +41 79 509 0677
E-mail: thomasg@who.int


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Sunday, July 1, 2012

All baby boomers should get hepatitis C test -CDC

AppId is over the quota
AppId is over the quota

(Reuters) - All baby boomers should be tested at least once for the liver-destroying hepatitis C virus, according to proposed guidelines from U.S. health officials released on Friday.

The often-undiagnosed virus is transmitted through contaminated blood. While infection rates have dropped dramatically since the early 1990s - due in part to the introduction of blood and organ screening - many older adults are still at risk, according to the U.S. Centers for Disease Control and Prevention, which released the draft guidelines.

According to the CDC, one in 30 baby boomers - the generation born from 1945 through 1965 - has been infected with hepatitis C, and most do not know it.

A one-time, cost-effective blood test would "identify hundreds of thousands of hidden infections," said Dr John Ward, director of CDC's division of viral hepatitis.

He likened the proposal to existing age-related guidelines on screening for diseases including breast cancer, cervical cancer and high cholesterol.

Hepatitis C causes serious liver diseases, including liver cancer - the fastest-rising cause of cancer-related deaths - and is the leading cause of liver transplants in the United States.

The CDC said it believes routine blood tests will address the largely preventable consequences of the disease, especially in light of newly available therapies that can cure around 75 percent of infections.

The field has attracted broad interest with two new hepatitis C drugs - Incivek from Vertex Pharmaceuticals Inc and Merck & Co's Victrelis - reaching the U.S. market in the past year.

Companies including Gilead Sciences Inc and Bristol-Myers Squibb Co aim to improve on those medicines with pills that do not need to be combined with injections of immune system boosters, which have side effects that can deter patients.

More than 15,000 Americans, most of them baby boomers, die each year from hepatitis C-related illness, such as cirrhosis and liver cancer.

Current U.S. guidelines call for testing only individuals with certain known risk factors for hepatitis C infection.

The CDC said it will accept public comment on the draft recommendations from May 22 to June 8.

Final recommendations will be issued later this year.

(Reporting By Deena Beasley in Los Angeles; editing by John Wallace and Matthew Lewis)