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Recently a new Flavivirus, GB Virus C also referred to as Hepatitis G virus (GBV-C/HGV) was identified in humans with indeterminate hepatitis . Whilst in non-African countries this discovery led to an enormous enthusiasm to elucidate an association with liver disease, very little was known about the prevalence and pathogenicity of GBV-C/HGV infection in KwaZulu Natal, South Africa, where Hepatitis B Virus (HBV) infection is endemic and infection with the Human immunodeficiency virus (HIV) is a catastropic health problem. Sera from patients with liver disease (chronic liver disease [n = 98]; alcoholic liver disease [n = 50]); high risk groups (haemodialysis patients [n = 70]; HIV positive mothers and their babies [n = 75]) and control groups (alcoholics without liver disease [n = 35] and blood donors from the four racial groups [n = 232]) were screened for GBV-C/HGV RNA and Anti-E2 antibodies by reverse transcription polymerase chain reaction (RT-PCR) and an enzyme linked immunosorbent assay (ELISA), respectively. Overall 43.9% (43/98) of patients with chronic liver disease; 60 % (30/50) of patients with alcoholic liver disease; 47.1% (33/70) of haemodialysis patients; 60% (21/35) of alcoholics without liver disease and 31.9% (74/232) of blood donors (Africans] 44/76; 5.9%); Asians (5/52; 9.6%); Whites (15/49; 30.6%) and "Coloureds" [mixed origin] (9/54; 16.6%)]) were exposed to GBV-C/HGV infection as determined by the detection of Anti-E2 &/or RNA in serum. There was a significant difference in the prevalence of GBV-C/HGV infection (RNA &/or anti E2) between African blood donors and the other racial groups (p < 0.001), between blood donors and haemodialysis patients (p = 0.02) and or patients with chronic liver disease (p =0.04). There was no significant difference in the prevalence of GBV-C/HGV between African blood donors (45/76, 59.2%) and alcoholics with and without liver disease (30/50, 60% and 21/35, 60%, respectively). Anti-E2 antibodies and GBV-C/HGV RNA were almost mutually exclusive. GBV-C/HGV infected dialysis patients tended to have had more transfusions (p = 0.03) and had a longer duration of dialysis than non infected patients, indicating that the majority of patients on maintenance haemodialysis acquire their GBV-C/HGV infection through the transfusions they receive. There was no evidence for in utero and/or intrapartum transmission of GBV-C/HGY. However, there is some mother-to-infant transmission of GBV-C/HGV, though it is very probable that in KZN GBV-C/HGV is transmitted by as yet undefined non-parenteral routes. Sequence and phylogenetic analysis of the 5' non-coding region (5' NCR) and E2 gene segments of the GBV-C/HGV genome identified an additional "genotype" (Group 5) of GBV-C/HGV that is distinct from all other known GBV-C/HGV sequences (Groups 1-4). Although there is a high prevalence of Group 5 GBV-C/HGV isolates in KZN, there was no significant difference in liver biochemistry between GBV-C/HGV infected and noninfected patients with liver disease or between blood donors in each of the four racial groups. There was no significant differences in CD4 (461.12 ± 163.28 vs 478.42 ± 181.22) and CD8 (680.83 ± 320.36 vs 862.52 ± 354.48) absolute cell counts between HIV positive patients co-infected with GBV-C/HGV and those not infected with GBV-C/HGV, respectively. However, significantly higher relative CD3 [80.0 ± 4.17% vs 70.99 ± 19.79%] (p = 0.015), gamma delta T cells (yLT) [3.22± 1.30% vs 2.15 ± 29.12%] (p = 0.052) and lower CD 30 [35.45 ± 17.86% vs 50.59 ± 9.20%] (p = 0.041) status were observed in GBV-C/HGV positive compared to GBV-C/HGV negative HIV infected patients, respectively. Although there is a high prevalence of novel Group isolates of GBV-C/HGV in KZN, the lack of elevated liver enzymes and clinical hepatitis in blood donors and haemodialysis patients suggests that GBV-C/HGV is not associated with liver disease. HBV and not GBV-C/HGV modifies the course of alcoholic liver disease. The relatively higher number of CD3 cells and increased yLT expression, together with a decrease in CD 30 cells tends to suggest an association with protection and or delayed progression of HIV disease in GBV-C/HGV infected patients. Whilst GBV-C/HGV is not associated with liver disease, it may be an important commensal in HIV infected patients. / Thesis (Ph.D.)-University of Natal, 2003.

Woodchucks are the preferred animal model to study chronic viral hepatitis and the development of hepatocellular carcinoma (HCC), which occurs as a result of infection with woodchuck hepatitis virus. Significant elevations in the phosphomonoester peak in 31P-MRS spectrum correlated to the presence of HCC. Ex vivo 31P-NMR determined that HCC tissue had significantly elevated concentrations of PC compared to uninfected control tissues, confirming that PME is specific to the tumour’s growth. Finally, a recombinant vaccinia virus was constructed to stimulate the immune systems of infected woodchucks against cells expressing core antigens. Despite reductions in surface antigen expression and viral load, elevations in serum GGT and the PME in 31P-MRS indicated that there was tumour growth in treated woodchucks. In conclusion, the PME peak represents a potential biomarker of cancerous growth when used in conjunction with serological tests to detect HCC in the liver due to chronic hepatitis virus infection.

Hepatitis C Virus (HCV) infects 170 million people worldwide. The current treatment regimen, which is combination therapy with pegylated interferon (PegIFN) and Ribavirin (Rib), cures only 50% of the patients infected with the most prevalent HCV genotype. Therefore, there is a pressing need to understand the molecular mechanism of interferon resistance and to develop a prognostic tool to predict who will respond to treatment before initiation of therapy. It has been firmly established that the virus-host interaction plays an important role in determining treatment outcomes. My thesis investigated the host factors that are involved in interferon resistance with an aim to provide insights into the molecular mechanism of IFN resistance. cDNA microarray analysis identified 18 differentially expressed hepatic genes from pretreatment liver tissues of responders (Rs) and non-responders (NRs). Based on the differential expression levels of these 18 genes, a prognostic tool was developed to predict who will respond to therapy, with a positive predicting value (PPV) of 96%. Most of these 18 genes are interferon stimulated genes (ISGs) and they are more highly expressed in NR livers, indicating that preactivation of interferon signaling in the pre-treatment liver tissues contributes to NR. 3 out of the 18 genes are involved in an ubiquitin-like ISG15/USP18 signaling pathway that plays an important role in interferon response. Over-expression of USP18 and ISG15 in the pretreatment liver tissues of NR promotes HCV production and blunts interferon anti-HCV activity. There exists a distinct cell-type specific ISG activation in the pretreatment liver tissues of Rs and NRs. Up-regulation of the two ISGs that I tested (ISG15 and MxA) was found mainly in hepatocytes in NRs while ISG activation was preferentially observed in macrophages in Rs. Taking all these data together, pre-activation of interferon signaling and cell-type specific gene activation in the pretreatment liver tissues of patients infected with HCV are associated with treatment non-response. HCV exploits the host interferon system to favour its persistence by enhanced replication /secretion stimulated by a few ISGs (ISG15, USP18) in response to IFN. The developed prognostic tool can be used to stratify patients for treatment and the novel insights of the molecular mechanism of IFN resistance in HCV patients offer potential drug targets for future development.

Hepatitis B virus (HBV) is a life-threatening pathogen with major economic significance. Acute infection in adults is common, albeit usually self-limiting. Importantly, infection in infants typically results in chronic infection and increased incidence of hepatocellular carcinoma (HCC). Furthermore, the infectious carrier state is perpetuated in chronically infected individuals. Successful immuno-therapeutic vaccination would reduce the incidence of chronic infection and of HCC as well as reduce transmission of the disease. Recovery from acute and chronic HBV infection typically occurs in the presence of robust antigen-specific humoral and cellular immune responses (CMI), whereas these responses are low or absent in chronically HBV-infected individuals. Therefore, it was hypothesised that effective stimulation of both humoral and CMI responses, in conjunction with currently available antiviral therapies, may contribute significantly to development of vaccines for treatment of chronic HBV infection. The duck hepatitis B virus (DHBV) model of HBV infection was used to test novel vaccine strategies that could complement existing antiviral therapeutic approaches to treat chronically HBV-infected humans. To this end, three separate vaccine studies were conducted to investigate potential therapeutic regimes. Methods to assess the efficacies of the vaccine strategies included immunoperoxidase detection of viral antigen and immune cell markers within the liver and development of sensitive assays to monitor levels of DHBV DNA, duck hepatitis B virus surface antigen (DHBsAg), antibodies to duck hepatitis B core (anti-DHBc) and surface antigens (anti-DHBs) in serum were developed and validated which allowed monitoring of the kinetics of the humoral immune response following vaccination and the course and outcome of experimental DHBV infection. The first vaccine study tested the protective efficacy of DNA vaccines encoding either the small form of DHBsAg (DHBs) protein or the larger antigen (DHBpre-S/S), These were administered to ducks at day 4 and 14 of age. On the same day as the second vaccination, ducks were challenged intravenously with DHBV. Immunoperoxidase staining of biopsy tissue collected at day 4 p.i. showed significant decreases in the number of DHBV infected hepatocytes in ducks receiving the DNA vaccines compared to the mock-vaccinated control ducks. Significant protection against development of chronic DHBV infection was observed in ducks vaccinated with DNA vaccines expressing either pre-S/S or S protein. Although anti-DHBs antibodies were not detected prior to DHBV challenge, the decrease in the percentages of DHBV-infected hepatocytes at day 4 p.i is suggestive that neutralisation of the inoculum by low-level anti-DHBs antibodies in cohort with CMI responses induced by vaccination were the most probable mechanisms of action. The second vaccine study examined the protective efficacy of a novel whole-cell vaccine that expressed the DHBV core antigen (DHBcAg). Ducks were vaccinated on day 4 and 14 of age and DHBV challenge was administered 4 days later. Detectable anti-DHBc antibodies were generated as soon as 4 days after the initial vaccination suggesting that this regimen elicited increased immunogenicity than vaccination with DNA vaccines alone. In contrast to the first vaccine study with DNA vaccines expressing DHBsAg, no significant differences in the percentage of DHBV-infected hepatocytes were observed in biopsy tissue collected at day 4 p.i.This finding is confirmation that anti-DHBc antibodies were not neutralising to the initial DHBV inoculum. However, significant protection against development of chronic DHBV infection was observed in the whole-cell vaccinated ducks suggesting that the mechanism of protection was consistent immune-mediated killing of DHBV-infected hepatocytes following CMI responses to determinants of DHBcAg. The final vaccine study involved a combination strategy of antiviral drug Entecavir (ETV) and prime-boost vaccination with DNA vaccines and recombinant fowlpoxvirus (rFPV) expressing DHBV antigens. Immediately following DHBV infection, ducks were dosed by oral gavage with the antiviral drug Entecavir (ETV) and at the same time received the priming DNA vaccines encoding DHBV antigens. Seven days later the boosting vaccination consisting of recombinant fowlpox viruses (rFPV) also expressing DHBV antigens was administered. Extraordinary protection was observed, with 100% of ducks given combination therapy rapidly resolved their DHBV infection while 100% of non-treated ducks developed chronic infection. It was concluded that protection resulted from a combination of at least three factors. First, reduction and control of DHBV levels with the aid of ETV; secondly, stimulation of surface antigen-specific humoral immune responses resulting in neutralisation of newly produced virions; and finally, the combined up-regulation of CMI responses against DHBV core and surface antigens, resulting in elimination of infected hepatocytes. The four manuscripts that comprise this thesis provide insights into the viral kinetics and immune responses that follow DHBV infection and/or vaccination of ducks. The results provide new directions for future vaccine studies aimed at developing effective treatments for chronic HBV infection. / Thesis (Ph.D.) -- University of Adelaide, School of Molecular and Biomedical Science, 2008

Hepatitis B virus (HBV) is a life-threatening pathogen with major economic significance. Acute infection in adults is common, albeit usually self-limiting. Importantly, infection in infants typically results in chronic infection and increased incidence of hepatocellular carcinoma (HCC). Furthermore, the infectious carrier state is perpetuated in chronically infected individuals. Successful immuno-therapeutic vaccination would reduce the incidence of chronic infection and of HCC as well as reduce transmission of the disease. Recovery from acute and chronic HBV infection typically occurs in the presence of robust antigen-specific humoral and cellular immune responses (CMI), whereas these responses are low or absent in chronically HBV-infected individuals. Therefore, it was hypothesised that effective stimulation of both humoral and CMI responses, in conjunction with currently available antiviral therapies, may contribute significantly to development of vaccines for treatment of chronic HBV infection. The duck hepatitis B virus (DHBV) model of HBV infection was used to test novel vaccine strategies that could complement existing antiviral therapeutic approaches to treat chronically HBV-infected humans. To this end, three separate vaccine studies were conducted to investigate potential therapeutic regimes. Methods to assess the efficacies of the vaccine strategies included immunoperoxidase detection of viral antigen and immune cell markers within the liver and development of sensitive assays to monitor levels of DHBV DNA, duck hepatitis B virus surface antigen (DHBsAg), antibodies to duck hepatitis B core (anti-DHBc) and surface antigens (anti-DHBs) in serum were developed and validated which allowed monitoring of the kinetics of the humoral immune response following vaccination and the course and outcome of experimental DHBV infection. The first vaccine study tested the protective efficacy of DNA vaccines encoding either the small form of DHBsAg (DHBs) protein or the larger antigen (DHBpre-S/S), These were administered to ducks at day 4 and 14 of age. On the same day as the second vaccination, ducks were challenged intravenously with DHBV. Immunoperoxidase staining of biopsy tissue collected at day 4 p.i. showed significant decreases in the number of DHBV infected hepatocytes in ducks receiving the DNA vaccines compared to the mock-vaccinated control ducks. Significant protection against development of chronic DHBV infection was observed in ducks vaccinated with DNA vaccines expressing either pre-S/S or S protein. Although anti-DHBs antibodies were not detected prior to DHBV challenge, the decrease in the percentages of DHBV-infected hepatocytes at day 4 p.i is suggestive that neutralisation of the inoculum by low-level anti-DHBs antibodies in cohort with CMI responses induced by vaccination were the most probable mechanisms of action. The second vaccine study examined the protective efficacy of a novel whole-cell vaccine that expressed the DHBV core antigen (DHBcAg). Ducks were vaccinated on day 4 and 14 of age and DHBV challenge was administered 4 days later. Detectable anti-DHBc antibodies were generated as soon as 4 days after the initial vaccination suggesting that this regimen elicited increased immunogenicity than vaccination with DNA vaccines alone. In contrast to the first vaccine study with DNA vaccines expressing DHBsAg, no significant differences in the percentage of DHBV-infected hepatocytes were observed in biopsy tissue collected at day 4 p.i.This finding is confirmation that anti-DHBc antibodies were not neutralising to the initial DHBV inoculum. However, significant protection against development of chronic DHBV infection was observed in the whole-cell vaccinated ducks suggesting that the mechanism of protection was consistent immune-mediated killing of DHBV-infected hepatocytes following CMI responses to determinants of DHBcAg. The final vaccine study involved a combination strategy of antiviral drug Entecavir (ETV) and prime-boost vaccination with DNA vaccines and recombinant fowlpoxvirus (rFPV) expressing DHBV antigens. Immediately following DHBV infection, ducks were dosed by oral gavage with the antiviral drug Entecavir (ETV) and at the same time received the priming DNA vaccines encoding DHBV antigens. Seven days later the boosting vaccination consisting of recombinant fowlpox viruses (rFPV) also expressing DHBV antigens was administered. Extraordinary protection was observed, with 100% of ducks given combination therapy rapidly resolved their DHBV infection while 100% of non-treated ducks developed chronic infection. It was concluded that protection resulted from a combination of at least three factors. First, reduction and control of DHBV levels with the aid of ETV; secondly, stimulation of surface antigen-specific humoral immune responses resulting in neutralisation of newly produced virions; and finally, the combined up-regulation of CMI responses against DHBV core and surface antigens, resulting in elimination of infected hepatocytes. The four manuscripts that comprise this thesis provide insights into the viral kinetics and immune responses that follow DHBV infection and/or vaccination of ducks. The results provide new directions for future vaccine studies aimed at developing effective treatments for chronic HBV infection. / Thesis (Ph.D.) -- University of Adelaide, School of Molecular and Biomedical Science, 2008

[Truncated abstract] The hepatitis C virus (HCV) is a significant human pathogen for which there are limited post-infection therapies and no effective vaccine. Research into HCV is notoriously difficult due to the absence of suitable in vitro and in vivo model systems with which to study the virus. Furthermore, our understanding of HCV host interaction is limited and the mechanisms by which it subverts the host immune system remains largely unknown. Due to the difficult nature associated with studying HCV, the work presented in this thesis was designed to addresses a broad range of issues relating to both clinical and molecular aspects of HCV. Chronic HCV infection is often associated with the development of cirrhosis, end stage liver disease and hepatocellular carcinoma. To date, histological examination of liver biopsies provides the only approved method with which to assess the level of liver damage. While clinically informative, liver biopsies are highly invasive and may be contraindicative for patients such as haemophiliacs. Cytokine specific ELISPOT assays were used to determine whether cytokine secretion from PBMCs isolated from chronically infected HCV patients could be used as a non-invasive method to assess liver damage. Chronically infected patients with sever liver fibrosis demonstrated a significantly reduced ability to produce IFN-γ in response to HCV Core, but not other unrelated antigens, indicating that decreased IFN-γ secretion by PBMCs in response to HCV antigen could be used as a non-invasive marker for the development of liver fibrosis ... A series of HCV expression vectors covering the full length of the HCV ORF were constructed and their expression extensively tested before being used to assess the ability of HCV proteins to interact with Jak/STAT mediated Type I IFN signalling. Additionally, an alternative set of HCV IRES-EGFP reporter vectors were developed and used to access HCV IRES functionality between different eukaryotic cell lines. HCV Core protein expressed alone or in concert with E1-P7 and non-structural protein NS5B were shown to significantly reduce Jak/STAT mediated IFN expression. While the influence of HCV Core on Type I IFN signalling is consistent with previous reports in the literature, these results identify a new role for NS5B as a possible candidate protein involved in inhibition of Type I IFN signalling.

Thesis (Ph.D.)--Edith Cowan University, 2006. / Submitted to the Faculty of Education and Arts. Includes bibliographical references.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2007. / Härtill 4 uppsatser.