by Sung Ying-Man, Mandy. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 112-125). / Abstracts in English and Chinese. / Acknowledgments --- p.I / List of Abbreviations --- p.II / Abstract --- p.IV / 摘要 --- p.VII / Chapter Chapter 1 --- Introduction / Chapter 1.1 --- Epidemiology --- p.1 / Chapter 1.2 --- Aetiological factors --- p.4 / Chapter 1.2.1 --- Hepatitis B infection --- p.4 / Chapter 1.2.2 --- Aflatoxin exposure --- p.5 / Chapter 1.2.3 --- Alcohol consumption --- p.5 / Chapter 1.2.4 --- Genetic risk factors --- p.6 / Chapter 1.3 --- Aims of the study --- p.7 / Chapter Chapter 2 --- Polymorphisms of candidate genes in Interleukin- signalling pathway in HCC --- p.6 / Chapter 2.1 --- Introduction --- p.9 / Chapter 2.2 --- Materials and Methods --- p.15 / Samples and Genomic DNA isolation --- p.15 / PCR-PFLP --- p.15 / dHPLC --- p.16 / Direct Sequencing --- p.17 / Stattistical Analysis --- p.17 / Chapter 2.3 --- Results --- p.25 / Chapter 2.3.1 --- Known IL6 polymorphisms --- p.25 / Chapter 2.3.2 --- IL-6R and gp130 polymorphisms --- p.28 / Chapter 2.3.3 --- Stat-3 polymorphisms --- p.29 / Chapter 2.3.4 --- SOCS-1 polymophisms --- p.32 / Chapter 2.3.5 --- Mutation screening of IL-6 gene --- p.34 / Chapter 2.3.6 --- Mutation screening of SOCS-1 gene --- p.39 / Chapter 2.4 --- Discussion --- p.40 / Chapter 2.4.1 --- Interleukin-6 --- p.40 / Chapter 2.4.2 --- Gp130 and IL6-R --- p.43 / Chapter 2.4.3 --- STAT-3 --- p.44 / Chapter 2.4.4 --- SOCS-l --- p.46 / Chapter Chapter 3 --- Methylation status of SOCS-1 gene in Chinese HCC patients / Chapter 3.1 --- Introduction --- p.49 / Chapter 3.2 --- Methods and Materials --- p.53 / Tissue Sampling --- p.53 / Methylation specific PCR (MSP) --- p.53 / Chapter 3.3 --- Results --- p.55 / Chapter 3.4 --- Discussion --- p.56 / Chapter Chapter 4 --- Polymorphisms of enzyme encoding genesin steroidogenesis in Chinese / Chapter 4.1 --- Introduction --- p.59 / Chapter 4.1.1 --- Steroid 5a reductases (SRD5A) --- p.62 / Chapter 4.1.1a --- Steroid 5a reductase type II (SRD5A2) --- p.63 / Chapter 4.1.1b --- Steroid 5a reductase type I (SRD5A1) --- p.65 / Chapter 4.1.2 --- Cytochrome P450al7 (CYP17) --- p.67 / Chapter 4.1.3 --- "Cytochrome P450, family 1，subfamily A polypeptide1 (CYP1A1)" --- p.69 / Chapter 4.1.4 --- "Cytochrome P450, subfamily IIIA (niphedipine oxidase) polypeptide 4 (CYP3A4)" --- p.71 / Chapter 4.2 --- Materials and Methods --- p.74 / Samples and Genomic DNA isolation --- p.74 / PCR-PFLP --- p.74 / Direct Sequencing --- p.74 / Statistical Analysis --- p.74 / Chapter 4.3 --- Results --- p.77 / Chapter 4.3.1 --- SRD5A2 --- p.77 / Chapter 4.3.2 --- Linkage Disequilibrium in SRD5A2 gene --- p.83 / Chapter 4.3.2 --- SRD5A1 --- p.84 / Chapter 4.3.3 --- CYP17 --- p.87 / Chapter 4.3.4 --- CYP1A1 --- p.89 / Chapter 4.3.5 --- CYP3A4 --- p.92 / Chapter 4.3.6 --- Logistic regression --- p.95 / Chapter 4.4 --- Discussion --- p.96 / Chapter 4.4.1 --- SRD5A2 --- p.96 / Chapter 4.4.2 --- SRD5A1 --- p.99 / Chapter 4.4.3 --- CYP17 --- p.101 / Chapter 4.4.4 --- CYP1A1 --- p.103 / Chapter 4.4.5 --- CYP3A4 --- p.106 / Chapter 4.4.6 --- Logistic Regression --- p.107 / Chapter Chapter 5 --- Conclusions and Future Prospect --- p.108 / Chapter 5.1 --- Conclusions --- p.108 / Chapter 5.2 --- Future works and prospect --- p.111 / References --- p.113

Made available in DSpace on 2015-04-22T22:14:03Z (GMT). No. of bitstreams: 1 Myuki Alfaia Esashika Crispim.pdf: 2246402 bytes, checksum: d9773c605258310c1244020f1e5cb467 (MD5) Previous issue date: 2007-09-20 / Hepatitis B and D are endemic in the Western Brazilian Amazon region , but few studies have been conducted to investigate the genetic variability of both viruses. The hepatitis B virus (HBV) has a high genetic variability, with eight different genotypes defined (A-H). In present classification hepatitis D virus (HDV) is also supposed to present eight different genotypes (I-VIII). The aim of this study was to describe the genotypes of the virus B and D of the Western Brazilian Amazon region. We selected 190 samples of chronic carriers with HBV and 50 of them presented double infection with HDV. The serum samples of HBV were submitted to the genotyping through Polymerase Chain Reaction (PCR), with type-specific primers . In the reactive samples for HDV RNA by RT-PCR was used the genotyping by Restriction Fragment Lenght Polymorphism (RFLP). The genotype A of HBV was detected as the most frequent, in 91 participants (56,5%), following by genotype F, in 41 (25,5%), and genotype D, in 29 (18,0%). In the HDV genotyping, we found only the genotype III. This study showed that the genotypes A, D and F of VHB and the genotype III of HDV represented the predominant genotypes in the Western Brazilian Amazon. / As hepatites B e D são endêmicas na Amazônia Ocidental Brasileira, mas poucos estudos têm buscado investigar a variabilidade genética de ambos os vírus. O vírus da Hepatite B (VHB) tem uma alta variabilidade genética, sendo definidos oito genótipos distintos (A-H). O vírus da hepatite D (VHD), na atual classificação, também é sugerido apresentar oito genótipos (I-VIII). O presente estudo teve o objetivo de descrever os genótipos do vírus B e D na Amazônia Ocidental Brasileira. Selecionamos 190 amostras de portadores crônicos do vírus da hepatite B, sendo que, destas, 50 apresentavam infecção dupla com o VHD. As amostras de soro do VHB foram submetidas a genotipagem por meio da Reação em Cadeia da Polimerase (PCR), com iniciadores tipo específicos. Em amostras reativas para o VHD RNA por RT-PCR foi realizada a genotipagem por Análise do Polimorfismo do Tamanho de Fragmentos de Restrição (RFLP). Foi detectado o genótipo A como o mais freqüente em 91 participantes (56,5%), seguido pelo F em 41(25,5%), e o D em 29 (18,0%). Na genotipagem para o VHD encontramos somente o genótipo III. Este estudo mostrou que os genótipos A, D e F do VHB e o genótipo III do VHD, representam os genótipos predominantes na Amazônia Ocidental Brasileira.

Chau, Kin Fan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 106-119). / Abstract also in Chinese. / Abstract --- p.II / 摘要 --- p.VI / Acknowledgements --- p.IX / List of figures --- p.X / List of Abbreviations --- p.XII / Table of Contents --- p.XV / Chapter Chapter 1: --- Introduction / Chapter 1.1 --- Incidence and etiology of hepatocellular carcinoma (HCC) --- p.1 / Chapter 1.2 --- Structure of Hepatitis B Virus (HBV) --- p.2 / Chapter 1.3 --- Hepatitis B X protein (HBx) and HCC --- p.5 / Chapter 1.4 --- HBx and Apoptosis --- p.8 / Chapter 1.5 --- The role of Bcl-2 family in apoptosis and cell survival --- p.10 / Chapter 1.6 --- "Bid, the BH3-domain only protein" --- p.14 / Chapter 1.7 --- Dual Functions of Bid --- p.16 / Chapter 1.8 --- The relationship between Bid and HBx --- p.19 / Chapter 1.9 --- Hypoxia and HCC --- p.21 / Chapter 1.10 --- Hypoxia and HBx --- p.25 / Chapter 1.11 --- Hypoxia and Bid --- p.28 / Chapter 1.12 --- Aim of study --- p.29 / Chapter Chapter 2: --- Methods and materials / Chapter 2.1 --- Confirmation of the culture of the stable cell lines --- p.30 / Chapter 2.2 --- Doxorubicin treatment to the cell lines --- p.34 / Chapter 2.3 --- Culture of the cell lines under hypoxic conditions --- p.35 / Chapter 2.4 --- Protein sample preparations --- p.37 / Chapter 2.5 --- Determination of protein samples --- p.38 / Chapter 2.6 --- Sodium dodecyl sulfate 226}0ؤ polyacrylamide gel electrophoresis (SDS- PAGE) --- p.39 / Chapter 2.7 --- Transfer of protein to nitrocellulose membranes --- p.39 / Chapter 2.8 --- Western blot analysis of proteins --- p.41 / Chapter 2.8.1. --- Antibodies --- p.41 / Chapter 2.8.2. --- Determination of expression profiles of desired proteins by immunoblotting --- p.45 / Chapter 2.9 --- "Measurement of cell viability by MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay" --- p.46 / Chapter 2.10 --- Determination of cell proliferation by BrdU proliferation assay --- p.47 / Chapter 2.11 --- Detection of apoptosis of the cell lines by TUNEL (Terminal deoxynucleotidyl transferase mediated dUTP Nick End Labeling) --- p.50 / Chapter 2.12 --- Determination of the involvement of p38 MAPK in the generation of truncated Bid by p38 MAPK inhibitor SB203580 --- p.52 / Chapter Chapter 3: --- Results / Chapter 3.1 --- Confirmation of plasmids and the stable cell lines --- p.53 / Chapter 3.2 --- Morphology and the basic parameters of the cells with full-length HBx or mutant HBx --- p.53 / Chapter 3.3 --- Cell viability under doxorubicin treatment with or without hypoxia --- p.59 / Chapter 3.4 --- Determination of cell proliferation under stress --- p.70 / Chapter 3.5 --- Expression profiles of various proteins in the stable cell lines under doxorubicin treatment with or without hypoxia --- p.74 / Chapter 3.5.1. --- Verification of hypoxia --- p.74 / Chapter 3.5.2. --- Pro-apoptotic proteins --- p.74 / Chapter 3.5.3. --- Anti-apoptotic proteins --- p.74 / Chapter 3.6 --- Determination of apoptosis of various cell lines under stress --- p.82 / Chapter 3.7 --- "p38 MAPK, but not Akt, was activated by doxorubicin" --- p.87 / Chapter 3.8 --- The p38 MAPK inhibitor SB203580 could attenuate the cleavage of Bid --- p.89 / Chapter Chapter 4: --- Discussion --- p.92 / Chapter Chapter 5: --- Conclusion and future prospective --- p.103 / Chapter Chapter 6: --- References --- p.106

Os vírus da hepatite B (HBV), C (HCV) e Delta (HDV) causam grande impacto para a saúde pública mundial. Noventa e duas, oito e quatro amostras para HBsAg, anti-HD e anti-HCV, respectivamente, foram identificadas em indivíduos no Maranhão. Cinquenta amostras positivas para HBV DNA foram classificadas em subgenótipo D4 (42/86%) e A1 (8/14%). Para o HDV, apenas quatro foram classificadas como HDV-8. As amostras positivas para anti-HCV não apresentaram RNA detectável. O HBV-D4 parece ser o principal vírus representante na região estudada. O estudo filogenético sugere que houve a introdução de uma única cepa do subgenótipo D4 no Maranhão, enquanto que para o subgenótipo A1 existiu introdução de diferentes cepas. A confirmação do achado do HDV-8 em coinfecção com HBV- D4 suporta a hipótese de origem desses vírus na África. A ausência de infecção ativa pelo HCV é provavelmente devido uma introdução recente desse vírus e/ou menor frequência de meios de transmissão eficientes. Mais estudos são necessários em regiões onde é desconhecido o perfil de infecção desses vírus. / Hepatitis B (HBV), C (HCV) and Delta (HDV) viruses cause a great universal public health concern. Ninety-two, eight and four positive individuals for HBsAg, anti-HD and anti-HCV were identified, respectively. Fifty samples for HBV were classified in. subgenotype D4 (42/86%) and A1 (8/14%). Concerning HDV, four samples were identified as HDV-8 genotype. Anti-HCV positive samples were negative for RNA. HBV-D4 seems to be the main representative in the studied region. The phylogenetic tree topology suggests there was the introduction of a single strain of D4 subgenotype in Maranhao, whereas subgenotype A1 had several introductions of different strains. The finding of HDV-8 in coinfection with HBV D4 confirms the hypothesis of origin of these viruses in Africa. The low number of HCV infection in this region may be due to the recent introduction of this virus and / or lower frequency of efficient means of transmission. More studies are necessary in other regions where the infection profile of these viruses is indefinite.

This thesis examines cancer and mortality rates among people diagnosed with hepatitis B (HBV) and C (HCV) infection in New South Wales (NSW) from 1990 through 2002, by linking hepatitis notifications with the NSW Central Cancer Registry (CCR) and National Death Index. Of the 39101 HBV, 75834 HCV and 2604 HBV/HCV co-infection notifications included 1052, 1761 and 85 were linked to cancer notifications and 1233, 4008 and 186 were linked to death notifications respectively. Of 2072 hepatocellular carcinoma (HCC) notifications to the CCR 323, 267 and 85 were linked to HBV, HCV and HBV/HCV co-infection notifications. Incidence of HCC was 6.5, 4.0 and 5.9 per 1000 person years for HBV, HCV and HBV/HCV co-infected groups. Risk of HCC in those diagnosed with hepatitis was 20 to 30 times greater than the standard population. There was a marginally statistically significant increased risk of immunoproliferative malignancies associated with HCV infection (SIR=5.6 95% CI 1.8 ???17.5). Risk of death for those with hepatitis was significantly greater, 1.5 to 5 fold, than the general population with the greatest risk among those with HBV/HCV co-infection. The primary cause of HBV deaths was liver related, particularly HCC, whereas in the HCV groups drug related deaths were most frequent. Among people with HCV, risk of dying from drug related causes was significantly greater than from liver related causes (p=0.012), with the greatest increased risk in females age 15- 24 years (SMR 56.9, 95%CI 39.2???79.9). Median age at diagnosis of HCC varied markedly by country of birth and hepatitis group: HBV 66, 63 and 57years ; HCV 51, 68 and 71 years; unlinked 69, 70 and 64 years for Australian, European, and Asian-born groups, respectively (P<0.0001 for all groups). While the risk of cancer, particularly HCC, is elevated among people with HBV and HCV infection, the absolute risk remains low. Young people with HCV face a higher mortality risk from continued drug use than from liver damage related to their HCV infection. The influence of IDU in the epidemiology of HCC in New South Wales was possibly reflected in the varying distributions of age and country of birth.

Hepatito B virusas (HBV) yra plačiai paplitęs žmogaus patogenas, bet iki šiol mažai ištirta jo šerdies baltymo (HBc), o ypač natūraliai aptinkamų mutantinių formų įtaka viruso dauginimuisi ir patogeniškumui. Šiame darbe mielių dviejų hibridų metodu atrinkti žmogaus kepenų baltymai, sąveikaujantys su laukinio tipo baltymu bei mutantais HBc1 ir HBc2. Su visomis tirtomis HBc atmainomis stipriausiai ir specifiškiausiai sąveikavo žmogaus baltymai GIPC1 ir GIPC2. Detaliau tiriant šias sąveikas nustatyta, kad HBc baltymo C-galas sąveikauja su GIPC1 ir GIPC2 baltymų PDZ domenais. HBc baltymo C-gale aptiktas PDZ domenų atpažįstamos sekos motyvas ir parodyta, kad šios sekos pokyčiai įtakoja HBc sąveiką su GIPC1 ir GIPC2. Vien su mutantais HBc1 ir HBc2 stipriausiai ir specifiškiausiai sąveikavo žmogaus baltymai FLJ20850 ir IKK (NEMO). Anksčiau netyrinėto nežinomos funkcijos žmogaus baltymo FLJ20850 raiška ir geno struktūra apibūdinta naudojantis bioinformatinėmis duomenų bazėmis. Detaliau tiriant mutantų sąveikas su FLJ20850 ir IKK buvo nustatytos baltymų sritys, apsprendžiančios tarpusavio sąveiką. IKK baltymas reguliuoja transkripcijos veiksnio NF-κB aktyvumą, todėl buvo tiriama ir mutanto HBc1 įtaka NF-κB aktyvumui žmogaus ląstelėse. Aptiktos baltymų sąveikos gali padėti geriau suprasti HBV dauginimosi ciklą bei patogeniškumą ir tapti naujų antivirusinių vaistų taikiniais. / Hepatitis B virus (HBV) is a major human pathogen, but up to now little is known about its core protein (HBc) interactions with host proteins. The role of mutated HBc proteins in enhanced pathogenicity of mutant viruses is also unclear. In this work, the yeast two-hybrid system was employed to find human proteins interacting with HBV core mutants HBc1 and HBc2, as well as with the wild-type core protein. All HBc variants strongly and specifically interacted with human proteins GIPC1 and GIPC2. Common protein interaction domain PDZ in both GIPC1 and GIPC2 was identified as the region interacting with the C-end of HBc. A putative PDZ-interacting motif was identified at the C-end of the HBc protein, and variation of this sequence influenced determined interactions. Human proteins FLJ20850 and IKKγ (NEMO) strongly and specifically interacted with mutants HBc1 and HBc2 only. Gene structure and expression FLJ20850 protein, which was never before described in scientific literature, were analyzed bioinformatically. Detailed analysis of interacting protein pairs revealed regions, responsible for discovered interactions. IKKγ is known as an important regulator of transcription factor NF-kB, therefore HBc1 influence on NF-kB activity in human cells was evaluated experimentally. Determined protein interactions potentially add to understanding of HBV replication and pathogenicity and could serve as targets for developing of new antivirals.

Hepatitis B virus (HBV) is a major human pathogen, but up to now little is known about its core protein (HBc) interactions with host proteins. The role of mutated HBc proteins in enhanced pathogenicity of mutant viruses is also unclear. In this work, the yeast two-hybrid system was employed to find human proteins interacting with HBV core mutants HBc1 and HBc2, as well as with the wild-type core protein. All HBc variants strongly and specifically interacted with human proteins GIPC1 and GIPC2. Common protein interaction domain PDZ in both GIPC1 and GIPC2 was identified as the region interacting with the C-end of HBc. A putative PDZ-interacting motif was identified at the C-end of the HBc protein, and variation of this sequence influenced determined interactions. Human proteins FLJ20850 and IKKγ (NEMO) strongly and specifically interacted with mutants HBc1 and HBc2 only. Gene structure and expression FLJ20850 protein, which was never before described in scientific literature, were analyzed bioinformatically. Detailed analysis of interacting protein pairs revealed regions, responsible for discovered interactions. IKKγ is known as an important regulator of transcription factor NF-kB, therefore HBc1 influence on NF-kB activity in human cells was evaluated experimentally. Determined protein interactions potentially add to understanding of HBV replication and pathogenicity and could serve as targets for developing of new antivirals. / Hepatito B virusas (HBV) yra plačiai paplitęs žmogaus patogenas, bet iki šiol mažai ištirta jo šerdies baltymo (HBc), o ypač natūraliai aptinkamų mutantinių formų įtaka viruso dauginimuisi ir patogeniškumui. Šiame darbe mielių dviejų hibridų metodu atrinkti žmogaus kepenų baltymai, sąveikaujantys su laukinio tipo baltymu bei mutantais HBc1 ir HBc2. Su visomis tirtomis HBc atmainomis stipriausiai ir specifiškiausiai sąveikavo žmogaus baltymai GIPC1 ir GIPC2. Detaliau tiriant šias sąveikas nustatyta, kad HBc baltymo C-galas sąveikauja su GIPC1 ir GIPC2 baltymų PDZ domenais. HBc baltymo C-gale aptiktas PDZ domenų atpažįstamos sekos motyvas ir parodyta, kad šios sekos pokyčiai įtakoja HBc sąveiką su GIPC1 ir GIPC2. Vien su mutantais HBc1 ir HBc2 stipriausiai ir specifiškiausiai sąveikavo žmogaus baltymai FLJ20850 ir IKK (NEMO). Anksčiau netyrinėto nežinomos funkcijos žmogaus baltymo FLJ20850 raiška ir geno struktūra apibūdinta naudojantis bioinformatinėmis duomenų bazėmis. Detaliau tiriant mutantų sąveikas su FLJ20850 ir IKK buvo nustatytos baltymų sritys, apsprendžiančios tarpusavio sąveiką. IKK baltymas reguliuoja transkripcijos veiksnio NF-κB aktyvumą, todėl buvo tiriama ir mutanto HBc1 įtaka NF-κB aktyvumui žmogaus ląstelėse. Aptiktos baltymų sąveikos gali padėti geriau suprasti HBV dauginimosi ciklą bei patogeniškumą ir tapti naujų antivirusinių vaistų taikiniais.

Glomerulonephritis as an extra hepatic manifestation of chronic HBV infection has now been well documented [1,2,3,4,5]. HBV-associated nephropathy has been described in areas of both high and low endemicity [6]. In Africa HBV-associated nephropathy has been reported from the southern, central and northern regions [7,8,9,10,11]. In the southern African continent the prevalence of HBV-associated nephropathy appears to be higher than the rest of the continent [12]. In KwaZulu/Natal, South Africa, the prevalence of hepatitis B surface antigenaemia (HbsAg) in urban, rural and institutionalised children was reported to be 6.3%, 18.5% and 35.4% and the HBV exposure rates, as shown by the presence of any marker of HBV infection, 19.5%, 65.1% and 70.1% respectively amongst black children [13]. Prior experience of nephrotic syndrome (NS) and its association with HBV in black children, already published in a series of reports, showed HBV-associated nephropathy to be the commonest form of nephrotic syndrome among black patients in KwaZulu/Natal; membranous nephropathy (MN) being the commonest histological type reported [7,14]. The only other large series of HBV-associated nephropathy in southern Africa was from Cape Town of a large cohort of children, mainly of mixed ancestory (coloured), with a small number of black children [8]. There have been no other large studies of this condition amongst black children in Africa. We therefore undertook a series of studies to delineate the spectrum of this disease in black children with regard to the following: clinical presentation, laboratory findings, natural history, biosocial background, genetics (using HLA Class I and II antigens) as well as the impact of treatment and prevention by immunisation. We commenced these studies by reviewing our 20-year experience of 636 children with NS in Durban, South Africa for the period 1976- - 1995. Three hundred and six (48.2%) were blacks, 307 (48.2%) Indians and 23 (3.6%) were a mixed group (coloured); 91 (14.3%) could not be categorised and were excluded from the analysis. In black children, membranous nephropathy accounted for 43% of all cases of NS; 86.2% of these 306 children were associated with hepatitis B virus antigens [15]. This contrasts with the 2% - 5% prevalence of idiopathic membranous nephropathy reported in western countries [16]. We then proceeded to document the clinical features of this disease in black children. One hundred and thirty-three children with NS positive for HBV carriage were studied. In 70 patients the histological type was membranous; 46 of these 70 patients were followed up for a mean of 3.4 years (range 1-11). Spontaneous elimination of both HBsAg and HBeAg occurred in 10 (21.7%) of the 46 patients; 16 (34.8%) cleared HBeAg alone. Co-existing liver disease occurred in 18 (25.7%); hypocomplementaemia (low C3 and C4) in 22 (47.8%) and 5 (10.9%) of these 46 children respectively. Sixty-five (92.9%) of the 70 patients had normal renal function; 1(1.4%) impaired renal function; 3 (4.3%) chronic renal insufficiency and 1(1.4%) end stage renal disease at last hospital visit. Twelve (17.1%) of the 70 patients were in remission; all having cleared HBeAg. HBVMN was clinically indistinguishable from 24 children with idiopathic MN although biochemical characteristics were different. There were 23 patients with histological lesions other than MN. Forty patients with clinical, biochemical and serological findings similar to those with HBVMN and the other histological types, were unbiopsied. This report delineates the natural history of HBV infection in black South African children with NS, the majority of whom have MN. Disease remission in HBVMN parallels elimination of HBV antigens, particularly HBeAg. Comparison of HBVMN with idiopathic MN revealed clinically indistinguishable characteristics but unexplained biochemical differences [14]. Little is understood of the biosocial context in which HBV-associated nephropathy (particularly MN) develops. In the next two studies we evaluated HBV status and proteinuria in family members and household contacts of index children with HBVMN to test the hypothesis that HBV carriage and asymptomatic proteinuria are closely linked and may be causally associated. In the first of these two studies, thirty-one black children with biopsy-proven HBVMN were the index cases. One hundred and fifty-two family members and 43 black household contacts were the subjects of this study. We assessed HBV carrier status by testing for HBV antigens and antibodies using enzyme-linked immunosorbent assays (ELISA) and for HBV DNA by using slot-blot hybridisation and nested polymerase chain reaction. Sequencing of the precore HBV region of HBV was done in a subset of both index cases and subjects. Proteinuria was assessed by measuring the urinary protein: creatinine ratio. Seventy-two (37%) of the 197 family members and household contacts were HBV carriers, and 53 (27%) had a protein: creatinine ratio greater than the physiological limit (protein: creatinine ratio <0.2). Abnormal proteinuria was defined by a protein: creatinine ratio 0.2. Continuous data was compared using analysis of variance. Categorical data were compared using Chi-square test or Fisher’s exact test where appropriate. A probability of <0.05 was considered significant. The frequency of abnormal proteinuria was not significantly different in those with [22 (30.5%) of 72] or without [33 (32%) of 104] HBV carriage. This lack of association remained when carriers were classified into those who were HBsAg positive only and those with active viral replication (HBsAg and/or HBeAg and/or HBV DNA; p = 0.01). Family members were more predisposed to HBV carriage than household contacts, but abnormal proteinuria was present with equal frequency (p = 0.48). Age had a significant impact on proteinuria, with children less than five years being more likely to have abnormal proteinuria (p = 0.008). The prevalence of abnormal proteinuria in family members and household contacts of the index cases was more than in community-based controls. The 10 index HBVMN cases and 14 family members and household contacts that were tested all had HBV of genotype A. The results suggest that the family members and household contacts of children with HBVMN are at very high risk of HBV carriage; they also have asymptomatic proteinuria at a significantly higher rate than community-based controls. The HBV carrier status was not associated with proteinuria. This lack of association was a finding supported by peak prevalences of proteinuria in those under five years but no corresponding peak of HBV carriage. Proteinuria may indicate glomerular basement membrane dysfunction. Environmental and social factors may underpin development of these two disorders, but are insufficient to account for the index cases of HBVMN. The emergence of children with HBVMN from such households additionally depends on unidentified and possibly genetic factors [17]. In the second study of the biosocial background in which the HBV carrier-state with MN develops, we used the same subjects. One hundred and twenty-three unrelated individuals from the communities of the index cases, negative for HBV, served as controls. In this study, proteinuria was assessed using sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and protein: creatinine ratios. Patterns of proteinuria on SDS-PAGE were classified as glomerular, tubular or mixed; IgG and haptoglobulin were suggestive of MN. Seventy-two (36.9%) of the 195 family members and household contacts were HBV carriers; 21 (29.2%) of these carriers had evidence of proteinuria using SDS-PAGE. Twenty-eight (41.2%) of the sixty-eight members of the study group who were HBV negative and 26.8% of the controls also showed proteinuria on SDS-PAGE. This lack of association between HBV carriage and proteinuria remained when controlled for gender and family relationship. Also, HBV was not protective against the development of proteinuria. Age was associated directly with a glomerular pattern of proteinuria (p = 0.007). Those having a pattern of proteinuria suggestive of MN were more likely to have an abnormal protein: creatinine ratio (p = 0.001). Ten (59%) subjects with a membranous pattern of proteinuria and 19 (47.5%) with a non-membranous pattern of proteinuria had microscopic haematuria. Such a pattern of proteinuria was not significantly different between subjects and community based controls (8.7% vs. 6.5%, p = 0.5). Environmental exposures in these subjects may be responsible for the proteinuria, which probably reflects underlying glomerular basement membrane damage. Discordance between the HBV carrier-state and patterns of proteinuria in the study group suggest that interaction between specifically vulnerable individuals and HBV group suggest HBV and MN may not be causally related or that it reflects exceptional interaction between specifically vulnerable individuals and HBV [18]. From the above two studies we inferred that the pathogenetic mechanisms by which individuals with chronic HBV infection develop MN are probably dependent on interactions between viral, host and environmental factors; some evidence suggests a genetic predisposition. We therefore undertook another two studies to explore HLA associations in black children with HBVMN. In the first of these two studies, thirty black children, age range 2 to 16 years, with biospy-proven HBVMN, were the subjects of this study. HLA A, B and C antigens were determined using a two-stage lymphocytotoxic test. HLA DRB1* and DQB1* typing was done using sequence-specific primers. HLA class I and II antigen frequencies of the study subjects were compared to controls that were randomly chosen healthy blood donors from the same population. HLA DQB1*0603 was increased in patients with HBVMN compared to controls (chi-square 13.65, RR 4.3). DRB1*07 and DQB1*02 were increased in frequency in the study subjects but failed to reach statistical significance. There was no significant difference in the frequencies of class I antigens in the study group compared to controls. This study is the first report of HLA associations in black patients with HBVMN in whom Class I and II antigens were determined using molecular methodology. It shows a high frequency of DQB1*0603 in black children with HBVMN compared to controls suggesting a possible genetic predisposition to the development of HBVMN [19]. Following our findings of an HLA Class II association in black children with HBVMN, we proceeded to determine if HLA DQB1*0603 predisposes to HBV carriage and development of abnormal proteinuria in the second study. We studied 70 family members of 14 children with HBVMN positive for HLA DQB1*0603 selected from the first study. Associations of HLA DQB1*0603 to HBV carriage and abnormal proteinuria were determined using the mean probability ratio (LOD scores). Forty-seven of the 70 (67%) family members were positive for HBV infection. Nineteen (27%) had abnormal range proteinuria. LOD scores in the study subjects with DQB1*0603 who were HBV negative vs. those with DQB1*0603 who were HBV positive was not significant (anti-log sum = 2.0559 and average 0.23). When a similar calculation was done for abnormal proteinuria, there were no significant findings (anti-log sum = 3.8587 and average 0.43). This lack of association between HLA DQB1*0603 with either HBV carriage or abnormal proteinuria in family members suggests that additional factors may play a role in predisposing children to chronic HBV carriage and the development of MN. We therefore conclude that the main effect of HLA DQB1*0603 which distinguishes HBVMN from family members is the degree of proteinuria which is a reflection of the severity of glomerular basement membrane damage in the latter [20]. In the next study we proceed to investigate the efficacy of Interferon alpha 2b (INTRON A ®) in the treatment of HBV-associated nephropathy in black children. Twenty-four black children with biopsy-proven HBV-associated nephropathy were recruited into the study during the period April 1997 to June 1999. Five defaulted treatment and were excluded from the primary analysis. IFN 2b was administered for 16 weeks. Response to treatment was defined as loss of HBeAg, decrease in proteinuria, and prevention of deterioration in renal and liver function. A control group of 20 patients was followed up for the same period. Ten (52.6%) of the treated children responded with clearance of HBeAg by 40 weeks. None cleared HBsAg. All responders showed remission of proteinuria, 90% maintained normal renal function and 1 (10%) showed improvement of renal function. HBV DNA levels decreased in this group. Nine patients did not clear HBeAg; none showed remission of proteinuria, 2 showed deterioration of renal function. Liver enzymes rose during treatment but subsequently declined irrespective of response to therapy. No serious side effects were encountered. Only 5% of controls showed spontaneous clearance of HBeAg, and none had remission of proteinuria. Black children with HBV-associated nephropathy show accelerated clearance of HBeAg with remission of proteinuria following treatment with IFN 2b. IFN 2b was well-tolerated [21]. We then went on to investigate the impact of HBV vaccination in South Africa over 6 years on HBV-associated MN. HBV vaccine has resulted in a decline in the incidence of HBV carriage and hepatocellular carcinoma in South East Asia. Vaccine efficacy in Africa has not been adequately assessed. King Edward VIII Hospital, Durban, South Africa, is the only tertiary referral centre for the province of KwaZulu/Natal for children with renal diseases. HBV vaccine was introduced into the Extended Programme on Immunisation (EPI) in April 1995; vaccine coverage rates between 1995-2001 for children for the first, second and third doses were 85.4%, 78.2% and 62.0% respectively. HBV status was determined using radioimmunoassay (1984 – 1991) or ELISA. MN was confirmed on renal biopsy. The hospital average annual incidence of HBVMN was compared pre and post-vaccination, and according to age groups. Between 1984 and 2001 there were 119 children with HBVMN; the mean age was 7 years (range 1 to 14 years) and 101(85%) were males. The average annual rate ratio (aRR) per 105 child population was 0.25. The aRR of 0.03 for the years 2000-2001, was significantly lower than the aRR of 0.22 during the pre-immunisation period (1984 – 1994) [p = 0.003; RR = 0.12 (95% CI: 0.03 – 0.5)]. The aRR in 2000-2001 for children 0 – 4 years (0.00) and 5 – 10 years (0.09) were significantly lower than in the pre-vaccination years (0.16 and 0.46, p = 0.01 and 0.02 respectively). Thus, HBV vaccine, even at low coverage for the full EPI schedule, reduced the hospital incidence of HBVMN by six years [22]. From this series of studies we concluded that prior to the introduction of the HBV vaccine into the Expanded Programme on Immunisation in Children, HBV-associated nephropathy, particularly MN was the commonest form of NS in black children. Several studies have suggested on the basis of epidemiological, clinical and immunological evidence a causal association between chronic HBV carriage and the development of nephropathy. In our present series of studies we have findings that lend further support to the causal association between HBV carriage and development of nephropathy, particularly MN, in black children. We have shown that genetic and other environmental factors may also play a role in determining the degree of proteinuria. Those children with abnormal range proteinuria less than the nephrotic range show no association with HBV carriage or genetic factors with regard to HLA linkage. The efficacy of interferon treatment in elimination of the HBV and abrogation of proteinuria following clearance of the virus (particularly the HBeAg) as well as the impact of routine HBV immunisation in preventing HBV carriage and subsequent development of nephropathy lends further support to our findings. The impact of viral load has yet to be investigated. / Thesis (Ph.D.)-University of Natal, Durban, 2002.

This thesis examines cancer and mortality rates among people diagnosed with hepatitis B (HBV) and C (HCV) infection in New South Wales (NSW) from 1990 through 2002, by linking hepatitis notifications with the NSW Central Cancer Registry (CCR) and National Death Index. Of the 39101 HBV, 75834 HCV and 2604 HBV/HCV co-infection notifications included 1052, 1761 and 85 were linked to cancer notifications and 1233, 4008 and 186 were linked to death notifications respectively. Of 2072 hepatocellular carcinoma (HCC) notifications to the CCR 323, 267 and 85 were linked to HBV, HCV and HBV/HCV co-infection notifications. Incidence of HCC was 6.5, 4.0 and 5.9 per 1000 person years for HBV, HCV and HBV/HCV co-infected groups. Risk of HCC in those diagnosed with hepatitis was 20 to 30 times greater than the standard population. There was a marginally statistically significant increased risk of immunoproliferative malignancies associated with HCV infection (SIR=5.6 95% CI 1.8 ???17.5). Risk of death for those with hepatitis was significantly greater, 1.5 to 5 fold, than the general population with the greatest risk among those with HBV/HCV co-infection. The primary cause of HBV deaths was liver related, particularly HCC, whereas in the HCV groups drug related deaths were most frequent. Among people with HCV, risk of dying from drug related causes was significantly greater than from liver related causes (p=0.012), with the greatest increased risk in females age 15- 24 years (SMR 56.9, 95%CI 39.2???79.9). Median age at diagnosis of HCC varied markedly by country of birth and hepatitis group: HBV 66, 63 and 57years ; HCV 51, 68 and 71 years; unlinked 69, 70 and 64 years for Australian, European, and Asian-born groups, respectively (P<0.0001 for all groups). While the risk of cancer, particularly HCC, is elevated among people with HBV and HCV infection, the absolute risk remains low. Young people with HCV face a higher mortality risk from continued drug use than from liver damage related to their HCV infection. The influence of IDU in the epidemiology of HCC in New South Wales was possibly reflected in the varying distributions of age and country of birth.

Made available in DSpace on 2015-04-11T13:57:17Z (GMT). No. of bitstreams: 1 Lucinete Okamura Kimura.pdf: 3604811 bytes, checksum: 944fcd9a6fb1e06fc9a8b1ff83801f92 (MD5) Previous issue date: 2011-02-03 / Hepatitis B virus (HBV) infection is one of the most serious public health problems in the world. At least two billion people are infected, with over 350 million showing serological markers of active infection, despite prevention by vaccination. In Brazil, the HBV endemicity is heterogeneous, with the most prevalent disease in the north region. Among the indigenous population, epidemiological serum studies have reported high rates of hepatitis B prevalence in the Brazilian component of the Amazon rainforest. Studies have shown that in some cases the serological markers are not enough to detect viral activity, and in these situations, molecular tests are more sensitive and specific. The proposal of this study was to determine the prevalence of DNA (deoxyribonucleic acid) of hepatitis B virus in indigenous ethnic groups (Kanamary, Matis, Mayoruna, Marubo, Kulina and Korubo) in habitants of the rivers Curuçá and Itaquaí at the Javari Valley, Amazon, Brazil. This was a descriptive, cross-sectional study, such as used in case detection. One hundred and eighty (180) samples were analyzed from the indigenous communities of São Sebastião, Volta Grande, Pedro Lopes, Massapê, Remancinho and Bananeira. The samples were subjected to polymerase chain reaction (PCR) and semi-nested PCR to Hepatitis B virus, S gene. The prevalence for HBV-DNA of S gene was 51.1% (92/180). Among the PCR positive samples for HBV-DNA, 18/49 (36.7%) were from Marubo, 68/125 (54.4%) from Kanamary and 6/6 (100%) from other ethnicities. With regards to socio-demographic data, no significant difference was found (p=0.889) in relation to gender (statistical analysis at 5%). However, when analyzing age it was observed that the natives had lower median age (p<0.001) of 23 years old, suggesting that sexual activity was the main form of HBV transmission. There was no statistical difference found in relation to sources of infection and the presence of HBV DNA, as well as clinical aspects, with the exception of fever (p<0.001). The high prevalence of HBV-DNA of 75% (15/20) in pregnant women (p=0,009) demonstrates association with vertical transmission. The results confirm the high prevalence of HBV DNA in the Javari Valley, making it important to devise strategies for control and a more effective prevention in combating the spread of HBV / A infecção pelo vírus da hepatite B (VHB) é um dos mais sérios problemas de Saúde Pública do mundo. Estima-se que dois bilhões de pessoas estejam infectadas, com mais de 350 milhões apresentando marcadores sorológicos de infecção ativa, apesar da prevenção pela vacinação. No Brasil, a endemicidade do VHB é heterogênea, sendo a doença mais prevalente na região norte do país. Entre a população indígena, estudos soro epidemiológicos relatam altas taxas de prevalência de hepatite B na Amazônia brasileira. Pesquisas têm demonstrado que, em alguns casos, os marcadores sorológicos não são suficientes para detectar uma atividade viral e, nessas situações, os testes moleculares se mostram mais sensíveis e específicos. O presente estudo se propôs determinar a prevalência do DNA (ácido desoxirribonucléico) do vírus da hepatite B em povos de etnias indígenas habitantes dos rios Curuçá e Itaquaí no Vale do Javari, Amazonas, Brasil, pertencentes às etnias Kanamary, Matis, Mayoruna, Marubo, Kulina e Korubo. Tratou-se de um estudo descritivo, transversal, do tipo detecção de caso. Foram analisadas 180 amostras pertencentes às comunidades indígenas de São Sebastião, Volta Grande, Pedro Lopes, Massapê, Remancinho e Bananeira. As amostras foram submetidas à reação em cadeia da polimerase (PCR) e semi-nested para vírus da hepatite B, gene S. A prevalência encontrada para o DNA-VHB gene S foi de 51,1% (92/180). Entre as amostras positivas para DNA-VHB PCR, 18/49 (36,7%) pertenciam à etnia Marubo, 68/125 (54,4%) à Kanamary e 6/6 (100%) a outras etnias. Quanto aos dados sóciodemográficos dos casos positivos para DNA-VHB PCR, pôde-se verificar que não houve diferença significante ao nível de 5% em relação ao gênero (p= 0,889). No entanto, quando se analisou a idade foi observado que os indígenas com PCR positiva para DNA-VHB apresentavam menores mediana de idade (p<0,001) de 23 anos, sugerindo ser a atividade sexual uma das principais formas de transmissão do VHB. Não foi constatada nenhuma diferença estatística em relação às fontes de contágio e à presença do DNA-VHB, como também aos aspectos clínicos, com exceção da febre (p<0,001). A alta prevalência do DNA-VHB de 75% (15/20) em gestantes (p=0,009) demonstra associação com a transmissão vertical. Os resultados comprovam a alta prevalência do DNA-VHB no Vale do Javari, tornando-se importante traçar estratégias de controle e prevenção mais eficazes no combate à disseminação do VHB