Soroepidemiologia da hepatite C em pacientes HIV/AIDS do serviço ambulatorial especializado do Programa DST/AIDS de Imperatriz-Maranhão

A coinfecção do vírus da hepatite C (HCV) em pessoas portadoras do vírus da imunodeficiência humana (HIV) é freqüentemente observada em virtude destes vírus apresentarem similaridade em suas rotas de transmissão, principalmente no que se refere à via parenteral. No Brasil, a prevalência depende da área geográfica considerada, variando de 8,9% a 54%. Nos coinfectados, a progressão da doença pelo HCV é usualmente mais agressiva e apresenta alto nível de viremia, como também, há um risco maior de associação do HCV com a cirrose hepática e/ou hepatocarcinoma. O objetivo do presente estudo foi estimar a prevalência de HCV e fatores de risco associados à coinfecção em pessoas soropositivas para HIV na cidade de Imperatriz Maranhão. Participaram 249 pacientes soropositivos para HIV atendidos no SAE do Programa Municipal de DST/AIDS de Imperatriz do Maranhão. Foi coletado de cada voluntário 10 mL de sangue periférico para realização do teste sorológico, onde foi realizada pesquisa de anticorpos IgG HCV específicos e testes de Biologia Molecular (RT-PCR) para pesquisa do RNA viral e genotipagem. Entre os pacientes observou-se similaridade entre a frequência dos gêneros, 49% masculino e 51% feminino, com média de idade de 40 anos. Foi observado que 98% possuem baixo nível de instrução e 63% possuem renda mensal de até um salário mínimo. A soroprevalência do anti-HCV foi de 2.4% (6/249). Na comparação dos fatores de risco pesquisados entre os pacientes reagentes e não reagentes na pesquisa sorológica de anticorpos HCV específicas demonstraram que a presença de tatuagens e piercing foi o único fator que se mostrou significantes, sendo mais frequente nos reagentes. Esse foi o primeiro estudo que investiga a coinfecção HIV e HCV na cidade de Imperatriz, Maranhão e a identificação de pacientes coinfectados foi de fundamental importância para o serviço que a partir de então irá realizar o acompanhamento destes pacientes.

Efeito da suplementação de vitamina D no desenvolvimento de lesões pré-neoplásicas quimicamente induzidas em ratos Wistar macho

Pós-graduação em Biologia Geral e Aplicada - IBB

Consultas de enfermagem com pacientes em tratamento para hepatite C

Infection with hepatitis C virus (HCV) is a worldwide problem of public health and who estimates 2.5% to 4.9% of infection by this virus among the population. This means that there are 3.9 to 7.6 million people at risk of developing cirrhosis or liver cancer. In Brazil, 20% to 58% of patients with chronic liver disease have antibodies to HCV (anti-HCV). To characterize the profile of patients undergoing treatment for hepatitis C in the Ambulatory General HC-FMB/UNESP, identify aspects of the disease and the phases of nursing process addressed during consultation. Transverse and descriptive study involving 38 patients undergoing treatment for Hepatitis C in Ambulatory General Area (Viral Hepatitis) in the period from July to September 2010. The population consisted of 38 patients, most of the males with completed higher education level, Catholic, married and aged predominantly between 41 and 60 years. Among the drugs used, we find the use of antihypertensive, antidepressant / anxiolytic and antidiabetic / hypoglycemic. With respect to specific medications used to treat hepatitis C, we found the use mainly of alfapeguinterferona 2b + ribavirin. The drugs used were complementary erythropoietin and filgastrim. There was a predominance of fibrosis 2 (F2) and genotype 1 (G1). Regarding the means of contamination, it was stressed blood transfusion and injection drug use. The most frequent drug reactions were decreased appetite, weight loss and discouragement. : The Nursing Process is considered a valuable tool in caring for patients with hepatitis C, because it works as identifying aspects of lifestyle, needs and potential of these patients and allows the deployment of humanized care strategies aimed at reduction of health hazards and improving the quality of life of these patients

Avaliação dos efeitos antitumorais de extratos brutos produzidos por fungos endofíticos isolados de Eugenia jambolana em células de hepatocarcinoma murino (Hepa-1c1c7)

Pós-graduação em Biociências e Biotecnologia Aplicadas à Farmácia - FCFAR

Inhibition of diethylnitrosamine-initiated alcohol-promoted hepatic inflammation and precancerous lesions by flavonoid luteolin is associated with increased sirtuin 1 activity in mice

Chronic and excessive alcohol consumption is an established risk for hepatic inflammation and carcinogenesis. Luteolin is one of the most common flavonoids present in plants and has potential beneficial effects against cancer. In this study, we examined the effect and potential mechanisms of luteolin supplementation in a carcinogen initiated alcohol-promoted pre-neoplastic liver lesion mouse model. C57BL/6 mice were injected with diethylnitrosamine (DEN) [i.p. 25 mg/kg of body weight (BW)] at 14 days of age. At 8 weeks of age mice were group pair-fed with Lieber-DeCarli liquid control diet or alcoholic diet [ethanol (EtOH) diet, 27% total energy from ethanol] and supplemented with a dose of 30 mg luteolin/kg BW per day for 21 days. DEN-injected mice fed EtOH diet displayed a significant induction of pre-neoplastic lesions, a marker associated with presence of steatosis and inflammation. Dietary luteolin significantly reduced the severity and incidence of hepatic inflammatory foci and steatosis in DEN-injected mice fed EtOH diet, as well the presence of preneoplastic lesions. There was no difference on hepatic protein levels of sirtuin 1 (SIRT1) among all groups; however, luteolin supplementation significantly reversed alcohol-reduced SIRT1 activity assessed by the ratio of acetylated and total forkhead box protein O1 (FoXO1) and SIRT1 target proliferator-activated receptor gamma, coactivator 1 alpha (PGC1α). Dietary intake of luteolin prevents alcohol promoted pre-neoplastic lesions, potentially mediated by SIRT1 signaling pathway.

Prevalence of hepatitis B virus infection and carriage after nineteen years of vaccination program in the Western Brazilian Amazon

Introduction: Reductions in the prevalence of hepatitis B virus (HBV) infection and carriage, decreases in liver cancer incidence, and changes in patterns of liver dysfunctions are described after hepatitis B vaccination. Methods: We conducted a population-based seroprevalence study aimed at estimating the HBV prevalence and risk of infection in the rural area of Labrea following nineteen years of HBV vaccination. Results: Half of the subjects showed total anti-HBc of 52.1% (95% CI 49.6-54.7). The HBsAg prevalence was 6.2% (95% CI 5.1-7.6). Multivariate analysis showed an inverse association between HBV infection and vaccination (OR 0.62; 95% CI 0.44-0.87). HBsAg remained independently associated with past hepatitis (OR 2.44; 95% CI 1.52-3.89) and inversely to vaccination (OR 0.43; 95% CI 0.27-0.69). The prevalence of HBeAg among HBsAg-positive individuals was 20.4% (95% CI 12.8-30.1), with the positive subjects having a median age of 11 years (1-46) p=0.0003. Conclusions: We demonstrate that HBV infection is still an important public health issue and that HBV vaccination could have had better impact on HBV epidemiology. If we extrapolate these findings to other rural areas in the Brazilian Amazon, we can predict that the sources of chronic infected patients remain a challenge. Future studies are needed regarding clinical aspects, molecular epidemiology, surveillance of acute cases, and risk groups.

Biomonitoring genotoxicity and cytotoxicity of Microcystis aeruginosa (Chroococcales, Cyanobacteria) using the Allium cepa test

Water pollution caused by toxic cyanobacteria is a problem worldwide, increasing with eutrophication. Due to its biological significance, genotoxicity should be a focus for biomonitoring pollution owing to the increasing complexity of the toxicological environment in which organisms are exposed. Cyanobacteria produce a large number of bioactive compounds, most of which lack toxicological data. Microcystins comprise a class of potent cyclic heptapeptide toxins produced mainly by Microcystis aeruginosa. Other natural products can also be synthesized by cyanobacteria, such as the protease inhibitor, aeruginosin. The hepatotoxicity of microcystins has been well documented, but information on the genotoxic effects of aeruginosins is relatively scarce. In this study, the genotoxicity and ecotoxicity of methanolic extracts from two strains of M. aeruginosa NPLJ-4, containing high levels of microcystin, and M. aeruginosa NPCD-1, with high levels of aeruginosin, were evaluated. Four endpoints, using plant assays in Allium cepa were applied: rootlet growth inhibition, chromosomal aberrations, mitotic divisions, and micronucleus assays. The microcystin content of M. aeruginosa NPLJ-4 was confirmed through ELISA, while M. aeruginosa NPCD-1 did not produce microcystins. The extracts of M. aeruginosa NPLJ-4 were diluted at 0.01, 0.1, 1 and 10 ppb of microcystins: the same procedure was used to dilute M. aeruginosa NPCD-1 used as a parameter for comparison, and water was used as the control. The results demonstrated that both strains inhibited root growth and induced rootlet abnormalities. The strain rich in aeruginosin was more genotoxic, altering the cell cycle, while microcystins were more mitogenic. These findings indicate the need for future research on non-microcystin producing cyanobacterial strains. Understanding the genotoxicity of M. aeruginosa extracts can help determine a possible link between contamination by aquatic cyanobacteria and high risk of primary liver cancer found in some areas as well as establish water level limits for compounds not yet studied. (C) 2012 Elsevier B.V. All rights reserved.

Mechanismen der Aktivierung und Detoxifizierung von Aflatoxin B 1 in verschiedenen Leberzelltypen von Ratten, Mäusen und Waldmurmeltieren

Zusammenfassung: Die Applikation des Mykotoxins Aflatoxin B1 (AFB1) führt in der Ratte zu Lebertumoren hepatozellulären Ursprungs, während bisher keine transformierende Wirkung dieses Mykotoxins auf Kupffer- und Endothelzellen (Nichtparenchymzellen, NPC) nachgewiesen werden konnte. Diese Resistenzmechanismen der NPC gegenüber AFB1 wurden im ersten Teil dieser Arbeit untersucht. AFB1 ist per se inaktiv, wird jedoch durch Verstoffwechselung in den chemisch reaktiven, an DNA bindenden Metaboliten AFB1-8,9-Epoxid überführt. Daneben stellt die enzymatische Hydroxylierung von AFB1 am Kohlenstoff-9a zum Aflatoxin M1 eine Detoxifizierung dar. Durch HPLC-Analyse der AFB1-Metabolite konnte gezeigt werden, daß in Nichtparenchymzellen (NPC) das Verhältnis von 9a-Hydroxylierung zu 8,9-Epoxidierung höher als in Parenchymzellen (PC) ist. Die AFB1-9a-hydroxylase fördert insbesondere in den NPC der Leber die Bildung des weniger gentoxischen Metaboliten AFM1 und konkurriert daher um die Aktivierung von AFB1 zum mutagenen und kanzerogenen 8,9-Epoxid. Dieser metabolische Unterschied scheint also einen Beitrag zur Resistenz der NPC der Leber gegenüber der hepatokanzerogenen Wirkung von AFB1 zu leisten. Da ein Synergismus zwischen der AFB1-Exposition und einer Infektion mit dem Hepatitis B-Virus (HBV) beim Menschen bezüglich des Auftretens von hepatozellulären Karzinomen zu bestehen scheint, wurde im zweiten Teil dieser Arbeit untersucht, ob die metabolische Aktivierung von AFB1 durch eine HBV-Infektion verstärkt wird. In einem Vergleich der Biotransformation von AFB1 mit mikrosomalen Leberfraktionen von transgenen HBV-Mäusen und Kontrollmäusen wurde keine signifikanten Unterschiede festgestellt. Dagegen wurde bei Virus-infizierten Waldmurmeltieren eine deutlich reduzierte Bildung des AFB1-8,9-Epoxids beobachtet. Es konnte z.T. ein Zusammenhang zwischen den verschiedenen Stadien der Leberschädigung und den Metabolismusraten festgestellt werden, wobei die metabolische Aktivierung mit zunehmender Leberschädigung abzunehmen scheint. Auch hinsichtlich der Aktivitäten verschiedener Cytochrom P450 abhängiger Monooxygenasen wurde eine weitgehende Übereinstimmung mit den durch HPLC ermittelten Metabolitenprofilen des AFB1 beobachtet. Diese Studien mit subzellulären Leberfraktion der transgenen HBV-Mäusen und der Waldmurmeltieren zeigen, daß die Interaktion zwischen Hepatitis und AFB1 nicht mit der verstärkten metabolischer Aktivierung von AFB1 zu erklären ist. TGF-ß1, aus der Gruppe der Cytokine, wird als Mediator bei Entzündungsprozessen in der Leber so z.B. im Verlauf einer Virushepatitis freigesetzt. Aufgrund der besonderen Bedeutung des murinen CYP2A5 (ortholog zum humanen CYP2A6) bei der Aktivierung von AFB1 wurde der Einfluß von TGF-ß1 auf CYP2A5 in Primärkulturen von Maushepatozyten untersucht. Durch Messung der Aktivität der Cumarin-7-hydroxylase sowie durch Bestimmung der Proteinmenge von CYP2A5 mittels Western Blotting konnte zunächst die Induzierbarkeit des CYP2A5-Isoenzyms durch Phenobarbital in kultivierten Hepatozyten der Maus gezeigt werden. Nur bei einer niedrigen TGF-ß1-Konzentration wurde eine leicht erhöhte Expression von CYP2A5 festgestellt, ansonsten führte die Behandlung der kultivierten Maushepatozyten mit TGF-ß1 zu einer dosisabhängigen Verminderung der Expression von CYP2A5.

Cambiamenti dello scenario epidemiologico e clinico dell'epatocarcinoma in Italia nell'ultimo ventennio

Background & Aims: This study investigates whether the aetiologic changes in liver disease and the improved management of hepatocellular carcinoma (HCC) have modified the clinical scenario of this tumour over the last 20 years in Italy. Methods: Retrospective study based on the analysis of the ITA.LI.CA (Italian Liver Cancer) database including 3027 HCC patients managed in 11 centres. Patients were divided into 3 groups according to the period of HCC diagnosis: 1987–1996 (year of the ‘‘Milano criteria’’ publication), 1997–2001 (year of release of the EASL guidelines for HCC), and 2002–2008. Results: The significant changes were: (1) progressive patient ageing; (2) increasing prevalence of HCV infection until 2001, with a subsequent decrease, when the alcoholic aetiology increased; (3) liver function improvement, until 2001; (4) increasing ‘‘incidental’’ at the expense of ‘‘symptomatic’’ diagnoses, until 2001; (5) unchanged prevalence of tumours diagnosed during surveillance (around 50%), with an increasing use of the 6- month schedule; (6) favourable HCC ‘‘stage migration’’, until 2001; (7) increasing use of percutaneous ablation; (8) improving survival, until 2001. Conclusions: Over the last 20 years, several aetiologic and clinical features regarding HCC have changed. The survival improvement observed until 2001 was due to an increasing number of tumours diagnosed in early stages and in a background of compensated cirrhosis, and a growing and better use of locoregional treatments. However, the prevalence of early cancers and survival did not increase further in the last years, a result inciting national policies aimed at implementing surveillance programmes for at risk patients.

Therapeutic vaccination for chronic hepatitis B in the Trimera mouse model

Therapeutic vaccination for chronic hepatitis B in the Trimera mouse modelrnRaja Vuyyuru and Wulf O. BöcherrnHepatitis B is a liver disease caused by Hepatitis B virus (HBV). It ranges in severity from a mild illness, lasting a few weeks (acute), to a serious long-term (chronic) illness that can lead either to liver disease or liver cancer. Acute infection is self limiting in most adults, resulting in clearance of virus from blood and liver and the development of lasting immunity. However 5% of acutely infected patients do not resolve primary HBV infection, leading to chronic infection with persistent viral replication in the liver. The strength of the initial antiviral immune response elicited to Hepatitis B determines the subsequent clinical outcome. A strong and broad T cell response leads to spontaneous resolution. Conversely, a weak T cell response favours viral persistence and establishment of chronic disease. While treatments using interferon-alpha or nucleos(t)ide analogues can reduce disease progression, they rarely lead to complete recovery. The lack of a suitable small animal model hampered efforts to understand the mechanisms responsible for immune failure in these chronic patients.rnIn current study we used Trimera mice to study the efficacy of potential vaccine candidates using HBV loaded dendritic cells in HBV chronic infection in vivo. The Trimera mouse model is based on Balb/c mice implanted with SCID mouse bone marrow and human peripheral blood mononuclear cells (PBMC) from HBV patients, and thus contains the immune system of the donor including their HBV associated T cell defect.rnIn our present study, strong HBV specific CD4+ and CD8+ T cell responses were enhanced by therapeutic vaccination in chronic HBV patients. These T cell responses occurred independently of either the course of the disease or the strength of their underlying HBV specific T cell failure. These findings indicate that the Trimera mouse model represents a novel experimental tool for evaluating potential anti-HBV immunotherapeutic agents. This in vivo data indicated that both the HBV specific CD4+ cell and CD8+ responses were elicited in the periphery. These HBV specific T cells proliferated and secreted cytokines upon restimulation in Trimera mice. The observation that these HBV specific T cells are not detectable directly ex vivo indicates that they must be immune tolerant or present at a very low frequency in situ. HBV specific T cell responses were suppressed in Trimera mice under viremic conditions, suggesting that viral factors might be directly involved in tolerizing or silencing antiviral T cell responses. Thus, combination of an effective vaccine with antiviral treatment to reduce viremia might be a more effective therapeutic strategy for the future. Such approaches should be tested in Trimera mice generated in HBV or HBs expressing transgenic mice before conducting clinical trials.rn

Heterogeneity of patients with intermediate (BCLC B) Hepatocellular Carcinoma: proposal for a subclassification to facilitate treatment decisions

The intermediate stage of hepatocellular carcinoma (HCC) comprises a highly heterogeneous patient population and therefore poses unique challenges for therapeutic management, different from the early and advanced stages. Patients classified as having intermediate HCC by the Barcelona Clinic Liver Cancer (BCLC) staging system present with varying tumor burden and liver function. Transarterial chemoembolization (TACE) is currently recommended as the standard of care in this setting, but there is considerable variation in the clinical benefit patients derive from this treatment.In April 2012, a panel of experts convened to discuss unresolved issues surrounding the application of current guidelines when managing patients with intermediate HCC. The meeting explored the applicability of a subclassification system for intermediate HCC patients to tailor therapeutic interventions based on the evidence available to date and expert opinion. The present report summarizes the proposal of the expert panel: four substages of intermediate HCC patients, B1 to B4.

Characteristics of patients with chronic hepatitis C who develop hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most frequent form of primary liver cancer and chronic infection with hepatitis C virus is one of the main risk factors for HCC. This study analyses the characteristics of the patients with chronic hepatitis C participating in the Swiss Hepatitis C Cohort Study who developed HCC.

Fenofibrate metabolism in the cynomolgus monkey using ultraperformance liquid chromatography-quadrupole time-of-flight mass spectrometry-based metabolomics

Fenofibrate, widely used for the treatment of dyslipidemia, activates the nuclear receptor, peroxisome proliferator-activated receptor alpha. However, liver toxicity, including liver cancer, occurs in rodents treated with fibrate drugs. Marked species differences occur in response to fibrate drugs, especially between rodents and humans, the latter of which are resistant to fibrate-induced cancer. Fenofibrate metabolism, which also shows species differences, has not been fully determined in humans and surrogate primates. In the present study, the metabolism of fenofibrate was investigated in cynomolgus monkeys by ultraperformance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-QTOFMS)-based metabolomics. Urine samples were collected before and after oral doses of fenofibrate. The samples were analyzed in both positive-ion and negative-ion modes by UPLC-QTOFMS, and after data deconvolution, the resulting data matrices were subjected to multivariate data analysis. Pattern recognition was performed on the retention time, mass/charge ratio, and other metabolite-related variables. Synthesized or purchased authentic compounds were used for metabolite identification and structure elucidation by liquid chromatographytandem mass spectrometry. Several metabolites were identified, including fenofibric acid, reduced fenofibric acid, fenofibric acid ester glucuronide, reduced fenofibric acid ester glucuronide, and compound X. Another two metabolites (compound B and compound AR), not previously reported in other species, were characterized in cynomolgus monkeys. More importantly, previously unknown metabolites, fenofibric acid taurine conjugate and reduced fenofibric acid taurine conjugate were identified, revealing a previously unrecognized conjugation pathway for fenofibrate.

Molecular evolution of primate immunodeficiency viruses and hepatitis delta virus

Primate immunodeficiency viruses, or lentiviruses (HIV-1, HIV-2, and SIV), and hepatitis delta virus (HDV) are RNA viruses characterized by rapid evolution. Infection by primate immunodeficiency viruses usually results in the development of acquired immunodeficiency syndrome (AIDS) in humans and AIDS-like illnesses in Asian macaques. Similarly, hepatitis delta virus infection causes hepatitis and liver cancer in humans. These viruses are heterogeneous within an infected patient and among individuals. Substitution rates in the virus genomes are high and vary in different lineages and among sites. Methods of phylogenetic analysis were applied to study the evolution of primate lentiviruses and the hepatitis delta virus. The following results have been obtained: (1) The substitution rate varies among sites of primate lentivirus genes according to the two parameter gamma distribution, with the shape parameter $\alpha$ being close to 1. (2) Primate immunodeficiency viruses fall into species-specific lineages. Therefore, viral transmissions across primate species are not as frequent as suggested by previous authors. (3) Primate lentiviruses have acquired or lost their pathogenicity several times in the course of evolution. (4) Evidence was provided for multiple infections of a North American patient by distinct HIV-1 strains of the B subtype. (5) Computer simulations indicate that the probability of committing an error in testing HIV transmission depends on the number of virus sequences and their length, the divergence times among sequences, and the model of nucleotide substitution. (6) For future investigations of HIV-1 transmissions, using longer virus sequences and avoiding the use of distant outgroups is recommended. (7) Hepatitis delta virus strains are usually related according to the geographic region of isolation. (8) Evolution of HDV is characterized by the rate of synonymous substitution being lower than the nonsynonymous substitution rate and the rate of evolution of the noncoding region. (9) There is a strong preference for G and C nucleotides at the third codon positions of the HDV coding region. ^

Regorafenib as second-line therapy for intermediate or advanced hepatocellular carcinoma: Multicentre, open-label, phase II safety study

PURPOSE: We assessed the safety of the multikinase inhibitor regorafenib in patients with hepatocellular carcinoma (HCC) that had progressed following first-line sorafenib. PATIENTS AND METHODS: Thirty-six patients with Barcelona Clinic Liver Cancer stage B or C HCC and preserved to mildly impaired liver function (Child-Pugh class A) received regorafenib 160 mg once daily in cycles of 3 weeks on/1 week off treatment until disease progression, unacceptable toxicity, death or patient/physician decision to discontinue. The primary end-point was safety; secondary end-points included efficacy (including time to progression and overall survival). RESULTS: The median treatment duration was 19.5 weeks (range 2-103). At data cutoff, three patients remained on treatment. Reasons for discontinuation were adverse events (n=20), disease progression (n=10), consent withdrawal (n=2) and death (n=1). Seventeen patients required dose reductions (mostly for adverse events [n=15]); 35 patients had treatment interruption (mostly for adverse events [n=32] or patient error [n=11]). The most frequent treatment-related adverse events were hand-foot skin reaction (any grade n=19; grade ≥3 n=5), diarrhoea (n=19; n=2), fatigue (n=19; n=6), hypothyroidism (n=15; n=0), anorexia (n=13; n=0), hypertension (n=13; n=1), nausea (n=12; n=0) and voice changes (n=10; n=0). Disease control was achieved in 26 patients (partial response n=1; stable disease n=25). Median time to progression was 4.3 months. Median overall survival was 13.8 months. CONCLUSION: Regorafenib had acceptable tolerability and evidence of antitumour activity in patients with intermediate or advanced HCC that progressed following first-line sorafenib.