A vacina contra hepatite B tem sido implicada como um desencadeador de doenças auto-imunes, mas ainda não existem estudos prospectivos no lúpus. Assim, avaliamos prospectivamente a segurança e eficácia da imunização com a vacina recombinante contra hepatite B (Euvax B® - LG) em pacientes com diagnóstico de lúpus. Foram selecionadas 28 pacientes com a doença inativa (SLEDAI<4), com idade entre 18 e 50 anos e sorologia negativa para o vírus da hepatite B (VHB). Os critérios de exclusão foram o uso de prednisona >=20 mg/dia e drogas imunossupressoras, anti-dsDNA e anticardiolipina negativos. Os dados clínicos e laboratoriais foram coletados na entrada do estudo e um mês após cada dose da vacina. Além disso, obtivemos dados do ano anterior usando o prontuário eletrônico padronizado. A média de idade foi de 34 ± 7,7 anos e a média da duração da doença foi de 10,4 ± 6,7 anos. Soroconversão adequada foi atingida no final do estudo (93%), embora tenhamos observado uma baixa freqüência após a primeira dose (4%) e após a segunda dose (54%). Nenhuma alteração significativa na média de SLEDAI foi detectada após cada dose durante o estudo (0,14 ± 0,52 vs. 0 vs. 0,61 ± 1,66 vs. 0,36 ± 1,34, p=0,11). Reforçando estes achados, os 11% de atividade de doença durante o período de vacinação foi semelhante aos 21% observados no ano anterior (p=0,46). Além disso, a média da dose de prednisona na entrada foi comparável à dose do final do estudo (2,86 ± 3,06 vs. 4,64 ± 8,25 mg/d, p=0,32). A freqüência do uso de terapia imunossupressora no período da vacinação (11%) foi semelhante aos 14% observados no ano anterior (p=0,66). A vacinação contra hepatite B apresentou uma resposta de anticorpos protetores adequada e foi segura nos pacientes com lúpus inativo. / Hepatitis B vaccination has been implicated as a potential trigger for autoimmune diseases but there are no prospective studies in lupus. We therefore assessed prospectively the safety and efficacy of immunization with recombinant DNA hepatitis B vaccine (Euvax B® - LG) in SLE patients. Twenty-eight consecutive inactive SLE patients (SLEDAI<4), age between 18-50 years and negative serology for hepatitis B virus (HBV) were selected. Exclusion criteria were prednisone > 20mg/day and immunosuppressive drugs. Clinical and laboratorial assessments were obtained at study entry and one month after the three doses. In addition, a previous one year evaluation was performed using a standard electronic protocol. The mean age was 34 ± 7.7 years and disease duration was 10.4 ± 6.7 years. An adequate seroconversion was achieved at the end of the study (93%), although a lower frequency after the first (4%) and second dose (54%) was observed. No significant change in mean SLEDAI score was detected after each dose throughout the study (0.14 ± 0.52 vs. 0 vs. 0.61 ± 1.66 vs. 0.36 ± 1.34, p=0.11). Reinforcing these findings, the 11% flares during vaccination was similar to the 21% observed in the previous year (p=0.46). Furthermore, the mean prednisone dose at study entry was comparable to the end of the study (2.86 ± 3.06 vs. 4.64 ± 8.25 mg/d, p=0.32). In addition, the frequency of immunosuppressive therapy during the vaccination period (11%) was alike to the 14% observed in the previous year before entry (p=0.66). Hepatitis B vaccination was safe in inactive SLE patients with an adequate vaccine response rate.

Hepatitis B virus chronically infects 350-400 million people worldwide. It often leads to hepatocellular carcinoma, which causes >1 million deaths yearly. Current therapies prevent new viral genome formation but do not target pre-existing viral genomic DNA, thus curing only ~1/2 of patients. We targeted hepatitis B virus DNA for cleavage using zinc finger nucleases, which cleave as dimers. Co-transfection of our zinc finger nuclease pair with a target plasmid containing the hepatitis B virus genome resulted in specific cleavage. After three days in culture, 26% of the target remained linear, while ~10% was cleaved and mis-joined tail-to-tail. A portion of cleaved plasmids are repaired in cells, often with deletions and insertions. To track misrepair, we introduced an XbaI restriction site in the spacer between the zinc finger nuclease sites. Targeted cleavage and misrepair destroys the XbaI site. After three days in culture, ~6% of plasmids were XbaI resistant. 13 of 16 clones sequenced contained frameshift mutations that would lead to dramatic truncations of the viral core protein. These results demonstrate for the first time the feasibility of targeting episomal viral DNA genomes in cells using zinc finger nucleases. This strategy is broadly applicable toward inactivating other DNA viruses within cells. A major concern for the therapeutic use of zinc finger nucleases is off-target cleavage. To measure specificity, we employed in vitro assays and developed a bioinformatics method to find off-target cleavage sites in cultured cells. These sites can then be PCR amplified and tested using a mutation detection assay that we developed.

HINTERGRUND: Die Leber nimmt bei der Regulierung und Aufrechterhaltung des Uridinplasmaspiegels eine zentrale Rolle ein. Die Synthese von Uridin hängt dabei wesentlich von der intakten Funktion hepatozytärer Mitochondrien und des mitochondrialen Enzymes Dihydroorotatdehydrogenase (DHODH) ab. Bei Patienten unter HIV-Therapie zeigten sich in Studien verminderte Uridinplasmaspiegel, wobei die dafür verantwortlich gemachte therapieassoziierte mitochondriale Toxizität durch Uridinsupplementation reduziert werden konnte. Schädigungen von Leber und Mitochondrien im Rahmen chronischer Lebererkrankungen wie Hepatitis C (CHC), B (CHB), alkoholischer und nichtalkoholischer Fettleber (AFLD und NAFLD) könnten ebenfalls zu einem Abfall des Uridinplasmaspiegels führen. METHODIK: Nach Etablierung einer HPLC-Methodik zur Evaluation von Uridin im menschlichen Serum wurden Uridinplasmaspiegel von Patienten mit oben genannten Erkrankungen mit denjenigen einer gesunden Kontrollgruppe verglichen. Ferner wurden die Spiegel mit Demografie, Genotypen, Viruslasten, antiviraler Therapie und Therapiedauer sowie mit sonographischen wie histologischen Leberbefunden und Laborparametern korreliert. ERGEBNISSE: Sämtliche 130 Patienten zeigten einen signifikant niedrigeren Uridinplasmaspiegel als die aus 14 Probanden bestehende gesunde Kontrollgruppe, lagen jedoch noch im physiologischen Normbereich gesunder Erwachsener. In absteigender Reihenfolge zeigten die grössten Unterschiede die Gruppen mit chronischer Hepatits C (n = 69), Hepatitis B (n = 37) sowie AFLD/AFLD (n = 24). Demographische Faktoren, chronischer Alkoholkonsum, histologischer Grad der Leberentzündung und -fibrose, sowie Diabetes mellitus zeigten keinen Einfluss. Spezifika der Virushepatitiden zeigten, abgesehen von der Viruslast bei CHC mit Tendenz zu eher niedrigen Uridinplasmasppiegeln bei hohen Lasten ebenfalls keine Signifikanzen. Eine Leberverfettung zeigte hinsichtlich des Uridinplasmaspiegels lediglich im Vergleich der Gruppe AFLD/NAFLD zur Kontrollgruppe signifikant reduzierte Werte. In Bezug auf das absolute wie relative Vorliegen einer Leberzirrhose zeigten sich ebenfalls signifikant erniedrigte Spiegel, und auch bei Korrelation des Child-Pugh-Index sowie laborchemischen Lebersynthesemarkern zeigten sich mit Zunahme der Leberschädigung reduzierte Uridinspiegel. SCHLUSSFOLGERUNG: Der Uridinplasmaspiegel scheint bei chronischen Lebererkrankungen wie Hepatitis C und B sowie alkoholischer und nichtalkoholischer Fettleber relativ erniedrigt zu sein, ebenso bei der Leberzirrhose. Um den Einfluss einer Mitochondrienschädigung genauer einzuordnen wären zukünftige Untersuchungen unter Einbezug oxidativer Marker ebenso interessant wie Überlegungen, Uridin bei fortgeschrittenen chronischen Lebererkrankungen zu substituieren. / BACKGROUND: The liver plays a pivotal role in regulating and maintaining uridine levels in plasma. Synthesis of uridine is mainly depending on the intact function of mitochondria and the mitochondrial enzyme dihydroorotate dehydrogenase in liver cells. HIV therapy associated mitochondrial toxicity, affecting reduced uridine plasma levels could be diminished by uridine supplementation. Moreover, in cases of liver or mitochondrial damage induced by chronic liver diseases such as hepatitis C (CHC) and B (CHB), alcoholic and non-alcoholic induced fatty liver (AFLD and NAFLD) can result in reduced uridine levels in plasma. METHODS: An HPLC-based method for evaluating uridine levels in human serum was established and utilized to compare uridine levels in patients suffering from the aforementioned diseases with controls. Moreover, uridine levels were evaluated with regard to (a) demographic data, (b) genotypes, (c) viral load, (d) antiviral treatment, (e) treatment duration, (f) sonographic and histological findings, and (g) laboratory values. RESULTS: Uridine levels in plasma of all 130 patients were significantly reduced compared to those of the 14 healthy individuals, however, were still within the physiological range observed in healthy adults. Maximum deviations decreased in the following order: Hepatitis C (n=69), hepatitis B (n=37) and AFLD/NAFLD (n=24). Demographic factors, chronic alcoholic diseases, histological grade of liver inflammation and fibrosis, as well as diabetes mellitus; had no impact on uridine plasma levels. Apart from CHC, which tends to reduce levels of uridine in plasma with a high viral load; specifics of the infectious hepatitis indicated no significant change. In cases of fatty liver, only when comparing the AFLD/NAFLD group to controls, significantly reduced levels of uridine in plasma could be confirmed. Additionally, in the case of existent relative or absolute cirrhosis, as well as with an increasing Child-Pugh-Index and decreasing liver synthesis products, significant reduced uridine plasma levels could be detected. CONCLUSION: The present data indicates reduced levels of uridine in plasma in cases of chronic liver diseases (such as hepatitis C and B), alcoholic and non-alcoholic steatohepatitis, as well as cirrhosis. To assess the impact of mitochondrial damage, future investigations should include oxidative markers and evaluate the potential of substituting uridine in cases of advanced chronic liver diseases.

acase@tulane.edu

Introduction: Chronic hepatitis B (CHB) is a viral infection that can lead to development of fibrosis and hepatocellular carcinoma (HCC). Several factors affecting disease progression have been reported, such as sex and region of origin. Liver stiffness and fibrosis can be evaluated using transient elastography. The degree of fibrosis is an important parameter when deciding if treatment and HCC surveillance is indicated. Aim1) To compare patients with CHB according to sex and region of origin regarding the parameters liver stiffness, presence of significant fibrosis, hepatitis B e antigen (HBeAg) positivity, frequency of elevated alanine aminotransferase (ALT) levels and HCC surveillance.2) To identify factors associated with significant liver fibrosis. Methods: 410 patients with a registered doctor’s visit 2015–2018 at the Department of Infectious Diseases at Örebro University Hospital were included. A systematic review of medical records was performed and groups (women-men, regions of origin) were compared. Multivariate logistic regression was used to identify factors associated with significant fibrosis. Results: Men had significantly higher liver stiffness values, higher presence of significant fibrosis, and were more frequently under HCC surveillance compared to women. No other significant differences were found regarding the studied parameters, neither related to sex, nor to region of origin. Factors associated with significant fibrosis were: male sex, elevated ALT levels and hepatitis D virus (HDV) co-infection. Conclusions: Men had a higher frequency of significant fibrosis compared to women. Factors associated with significant fibrosis were male sex, elevated ALT values and HDV co-infection.

Introduktion: Hepatit B är ett virus med hög smittsamhet som är orsak till den vanligaste leversjukdomen globalt. I Vietnam är prevalensen av hepatit B hög.Syfte: Att undersöka vietnamesiska universitetsstudenters kunskap om hepatit B och attityder till hepatit B vaccination, samt att undersöka om det fanns någon skillnad mellan könen.Metod: En kvantitativ tvärsnittsstudie med hjälp av en enkät. Studien genomfördes på University of Medicine and Pharmacy i Ho Chi Minh City. Förstaårsstudenter på sjuksköterske- och medicinsk teknikprogrammet valdes ut och 233 studenter fyllde i enkäten korrekt och inkluderades i studien.Resultat: Majoriteten av studenterna (95,3%) hade hört om hepatit B viruset (HBV) innan studien ägde rum. Fler än hälften av studenterna (55,4%) visste att HBV inte sprids genom att dela mat med en infekterad person, och 58,4% visste att HBV kan orsaka levercancer. Endast 47,6% visste att HBV är sexuellt överförbart och 39,5% visste att HBV kan smitta från mor till barn perinatalt. Fler manliga studenter än kvinnliga visste att HBV kan överföras genom att dela tandborste med en infekterad person (p= 0,026). Majoriteten av studenterna (93,1%) trodde att de skulle vaccineras mot HBV i framtiden.Slutsats: Studenterna visade att de hade kunskap i ämnet, men studien visar också på en viss brist på kunskap, som är allvarlig. Förbättrad utbildning om HBV är nödvändigt för att vietnamesiska universitetsstudenter ska utöka sin kunskap om HBV. / Introduction: The hepatitis B virus is highly contagious and causes the world’s most common liver infection. Vietnam is a country where the endemicity of hepatitis B is high.Aim: To investigate Vietnamese university students’ knowledge about hepatitis B infection and attitudes towards hepatitis B virus vaccination and to examine if there is a difference between genders.Method: A cross-sectional study with quantitative method using a questionnaire. The study was carried out at the University of Medicine and Pharmacy in Ho Chi Minh City. First year students from the nursing and medical technician programme were selected and 233 students completed the questionnaire and were included in the study.Result: The majority of the university students (95.3%) had heard about hepatitis B virus (HBV). More than half (55.4%) knew correctly that HBV can not be transmitted by sharing food with an infected person, and 58.4% knew that HBV can cause liver cancer. Only 47.6% knew that HBV can be sexually transmitted and 39.5% knew that HBV can be transmitted from mother to child at birth. More male than female students answered correctly that HBV can be transmitted by sharing a toothbrush with an infected person (p= 0.026). Almost all students (93.1%) thought that they would receive HBV vaccination.Conclusion: The students showed insight into the subject, but the result also showed some gaps of knowledge among the university students considered as serious. Improved education about HBV is necessary for university students to increase their knowledge about HBV.

Hepatitis B virus (HBV), which belongs to the family Hepadnaviridae, is responsible for acute and chronic hepatitis. The vaccines presently used to immunize patients against HBV are recombinant subunit vaccines consisting of viral surface antigens (S protein). However, they are expensive and their use is limited in poor countries. For that reason, HBV remains an important worldwide health problem. Of the 2 billion people who have been infected with the HBV, more than 350 million have chronic (lifelong) infections, who face increased risk of developing cirrhosis and hepatocellular carcinoma. In this study, high-level expression of recombinant Hepatitis B surface Antigen (rHBsAg), PreS2-S was achieved in the methylotrophic yeast, Pichia pastoris. For this aim, a single copy of HBV M gene (PreS2-S) was inserted at the downstream of the alcohol oxidase (AOX1) promoter of the pPICZA vector. rHBsAg protein could then be expressed intracellularly by induction with methanol. High cell density fermentation was followed by chromatographic separation to obtain pure rHBsAg. Humoral response after immunization with the purified protein was observed in mice using commercial Hepatitis B surface antigen kits. It was verified by the atomic force microscopy that rHBsAg has been produced in the desired conformation.

No description available.

Se estudiaron 236 historias clínicas de pacientes atendidos en el Hospital Edgardo Rebagliati Martins, desde el año 2000 hasta julio del 2004.con fibrosis o cirrosis hepática por hepatitis viral B y C con el objetivo de evaluar el valor de diagnóstico de la ultrasonografía en comparación con el diagnóstico histopatológico. Se aplicó un sistema de puntaje ultrasonográfico a cada paciente de acuerdo a los signos US clasificándolos en una escala de 4-11. Se transcribieron los puntajes histopatológicos según el sistema METAVIR y se evaluó la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo para la puntuación US, compuesta de superficie, parénquima, borde hepático y pared porta. A partir del punto óptimo se hallaron gráficos de curvas ROC lo que permitió tener una mejor visión de las pruebas de diagnostico. Se halló que una puntuación US 6 fue el mejor punto de corte para la predicción de Cirrosis y fibrosis grado III relacionados a HBV y HCV, con sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo de 97.2%, 71.4%, 89.9%, 90.95 respectivamente. Las puntuaciones US están altamente y significativamente correlacionado 0.73(P<0.01) con la histopatología. La ultrasonografía en el diagnostico de la fibrosis y cirrosis por hepatitis B y C, muestra un mayor valor en la sensibilidad (85.39), la especificidad (85.71) y exactitud (85.59) en relación a la superficie del hígado. Los resultados demuestran que la ultrasonografía es un examen confiable para el diagnostico de la cirrosis y la fibrosis hepática tanto para la hepatitis viral B y C, aunque con mayor predicción para la hepatitis viral B. Los datos permiten concluir que la fibrosis y la cirrosis por hepatitis B y C, pueden ser correctamente diagnosticadas con un 85.59% de exactitud empleando un solo signo ultrasonográfico (superficie del hígado).

published_or_final_version / Medicine / Doctoral / Doctor of Philosophy