When acute hepatitis develops into chronic hepatitis

February 17, 2009

Researchers at the Helmholtz Center in Braunschweig demonstrate how the immune system reacts to a hepatitis B infection

To achieve this, Carlos A. Guzmán, Head of the "Vaccinology and Applied Microbiology" working group and Robert Geffers, Head of the "Gene Expression Analysis" platform, examined the incidence and species of special defence cells, T helper cells, along with their role in the development of the disease in conjunction with their Indian colleagues. With the aid of genetic analysis, they showed how the genes in these immune cells are regulated differently according to the development of the disease. These new results can help doctors to discover whether an infection is curable or whether by settling in the liver, it will develop into a chronic case. These results are now published in the scientific journal, Hepatology.

Approximately 300 to 420 million people (5 to 7% of the world's population) have a chronic hepatitis B infection. India is one of the countries, in which hepatitis B is very common. A differentiation is made with the development of the disease between acute and chronic hepatitis B. The most common symptom of an acute infection is jaundice. In 5% of the infections, the disease becomes chronic, that is to say, the viruses remain in the liver. If left untreated, chronic hepatitis B can lead to a change in consciousness, cirrhosis and cancer of the liver. Until today scientists have not fully understood the role that the immune system plays in characterising an acute or chronic hepatitis B infection.

A decisive factor in achieving an appropriate immune reaction is the quick mobilisation of immune cells. These specifically attack the infected liver cells without destroying any unnecessary liver tissue in the process. Subspecies of the T helper cells play a decisive role in achieving this necessary balance between immunological defence and tolerance: effector T cells and regulatory T cells (Treg). Whilst the effector T cells fight a virus infection and kill off the infected host cells, the Treg cells shut down an immune reaction and cut off the effector T cells. They counteract any destruction of the tissue.

The international team of research scientists examined how these T helper cells influence the development of the hepatitis B disease. To this end, they took blood samples from Indian patients with hepatitis B and compared the extent to which the altered incidence of the T cell subsets in the blood influences the development of the illness and which genes are responsible for this.

Guzman's and Geffers's teams were able to show that, with acute hepatitis B, the effector T cells are extremely active and destroy infected host cells. Treg cells prevent effector T cells damaging healthy liver tissue during this stage of the infection. On the other hand, T effector cells are largely inactive with chronic hepatitis B infections: the Treg cells prevent an immune reaction and, in doing so, increase the number of hepatitis B viruses that are able to live in the organ. The immune system's constant struggle against the virus leads to a slow destruction of the liver tissue. The researchers checked their observations with gene activity: They demonstrated that more that one hundred genes in effector T cells are regulated differently in an immune reaction to acute hepatitis B than to a chronic case.

"The molecular mechanisms and the specific gene activities of a hepatitis B infection were unknown up until now. We now have a much better understanding of how acute and chronic hepatitis B infections develop and which processes are involved", says Carlos A. Guzmán. "With gene analysis we are able to further investigate the molecular links, which, in many ways, are a reason for the clinical observations". The doctor thus has an opportunity to improve his diagnosis with so-called "marker genes" and to improve his treatment of the patients with targeted, immunotherapeutic measures", says Robert Geffers, who conducted the gene analysis of the blood tests.

Helmholtz Association of German Research Centres

---

---

	Dr. Melissa Palmer's Guide To Hepatitis and Liver Disease by Melissa Palmer (Author) In the United States alone, more than four million people are infected with the hepatitis C virus, and chronic liver disease is the twelfth leading cause of death. In this revised and updated edition of her groundbreaking 2000 book, renowned hepatologist Dr. Melissa Palmer discusses all facets of liver disease, from symptoms and tests to treatment options and lifestyle changes. In addition, this comprehensive handbook reveals cutting-edge research on the dangers of hepatitis C, one of the world's fasting-growing microbial threats.
	The Liver Disorders and Hepatitis Sourcebook (Sourcebooks) by Howard Worman (Author) The latest information on living with and treating liver disorders The Liver Disorders and Hepatitis Sourcebook, Revised Edition, gives you frank assessments of the latest therapies and drugs. It also provides advice on how you can navigate the day-to-day challenges of living with a liver disorder, and diet and nutrition guidelines, including the truth about the effectiveness of herbal remedies and liver-cleansing diets.
	Free from Hepatitis C: Your Complete Guide to Healing Hepatitis C by Lucinda K. Porter (Author) For decades, a diagnosis of hepatitis C was the equivalent of serving a life sentence--with a dangerous liver disease. It left patients frightened, confused, and vulnerable, and they took little comfort in knowing that, at best, their condition could be managed but not cured. All of that changed with the discovery that the hepatitis C virus (HCV) could be defeated with new treatments. To shed light on these groundbreaking treatments, Lucinda Porter, a registered nurse, a passionate HCV advocate, and a Hep C patient herself, has written this all-important guide. This comprehensive volume is a must for anyone considering, undergoing, or just wanting to understand HCV treatment.
	Conquering Hepatitis C And Surviving Treatment: An Essential Guide Through Every Step of The HCV Treatment Process - Companion Website: www.hcvshare.org by Tim Duncan (Author), Catherine Olivolo (Author) Conquering Hepatitis C and Surviving Treatment This book's whole focus is on killing the virus and making it through the necessary treatment journey. Both authors have followed this path. They reveal the latest in research findings on methods to improve treatment success and how to integrate those crucial results in the HCV treatment process. Nine others share their emotional response to learning of their infection, their decision to begin treatment, experiences while undergoing treatment, and what they are doing now. This book provides the necessary information and tools to follow in their footsteps with confidence. - Gives predictive pre-treatment indicators to success. - Shows steps to take to improve chances of success. - Provides proven methods for side effect management. - Reveals...
	Living with Hepatitis C, Fifth Edition: A Survivor's Guide by Gregory T. Everson (Author) The Most Trusted Resource and Reference for Millions of Americans Living with Hepatitis C was the first book to explain in everyday language the causes of this disease, its major and minor symptoms, and all of the latest treatments available. Researchers have continued to make dramatic strides in helping the millions of Americans who suffer from Hepatitis C since the book's first publication, and each new edition has kept up with the most recent findings. The latest revised Living With Hepatitis C, Fifth Edition includes cutting-edge information on: * New treatments including pegylated and consensus interferons * Living-donor transplants * Co-infections with Hepatitis B and HIV/AIDS * Promising new clinical trials of protease and polymerase inhibitors *...
	Living With Hepatitis C For Dummies by Nina L. Paul (Author), Gina Pollichino (Foreword) A comprehensive, empathetic guide for anyone suffering from this serious liver disease Approximately 4 million Americans and 170 million people worldwide suffer from hepatitis C, a viral liver disease that is treatable but not curable. It accounts for more than 40 percent of U.S. liver disease deaths-about 8,000 to 10,000 people annually-and is the most common reason for liver transplantation. This compassionate guide explains how hepatitis C affects the liver and the body and provides solid advice on today's treatment options-from drugs (and their side effects) to transplants and alternative therapies-as well as tips on dealing with the emotional and financial burdens the disease brings with it. Nina L Paul, PhD (New York, NY) earned her doctorate in infectious disease epidemiology...
	The Hepatitis C Handbook by Matthew Dolan (Author), Iain Murray-Lyon (Editor), John Tindall (Editor) This definitive guide explains clearly what Hepatitis C is, outlines the course of the disease and the associated symptoms, and describes how it is transmitted. The author discusses available treatments as well as lifestyle changes that may help. Extensive sections on herbs, vitamins, and nutritional supplements are also included.
	The Hepatitis C Cookbook: Easy and Delicious Recipes by Heather Jeanne (Author), Eugene Sommer (Introduction), Kev Krueger (Introduction) Hepatitis C is a potentially fatal virus that attacks the liver. According to the Centers for Disease Control, Hepatitis C has already infected an estimated four to five million Americans, and worldwide it may have infected as many as 200 million. Most experts agree that if the rate of Hepatitis C infection isn't curbed soon, it will eventually kill more people each year than AIDS. However, Hepatitis C is not always fatal, and it can be fought successfully. For many who suffer from the virus, eating properly can delay the end stages leading to cirrhosis of the liver. It also can diminish the uncomfortable symptoms of the disease. The Hepatitis C Cookbook has been prepared with the special dietary needs of people suffering from Hepatitis C in mind. Hepatitis C does not have to make eating...
	Hepatitis (Diseases and Disorders) by Melissa Abramovitz (Editor) The Diseases & Disorders series offers young readers and researchers a means of understanding ailments and their ramifications. Clear, careful explanations offer insight into what these conditions are, what causes them, how people live with them, and the latest information about treatment and prevention. All volumes include primary and secondary source quotations, annotated bibliographies and lists of organizations to contact for additional information.
	Herbs for Hepatitis C and the Liver (A Storey Medicinal Herb Guide) by Stephen Harrod Buhner (Author) An insightful overview of the impending Hepatitis C epidemic, its causes, the most recent research, and an in-depth, detailed look at the botanical medicines that show promising results for restoring liver function. Includes formulas for using herbs to strengthen the liver and combat disease.