Viral interference: A potential therapeutic method for chronic viral hepatitis?

Viral interference exists between different viral hepatitis. Acute Hepatitis C virus (HCV) super-infection on Hepatitis B virus (HBV) chronic carriers showed an inhibition of the HBV genome. And acute HBV super-infection on HCV chronic carriers indicated a similar interaction. In these cases, if the acute liver viral super-infection presents a self-limited course, the patients may be free from both viral infections or at least with undetectable underlying chronic viremia. The mechanism of viral interference is still undefined. Anyway this still leads to the hypothesis of using one hepatitis virus (live attenuated vaccine) to treat another hepatitis virus.     

Treating Hodgkin's disease: for whom the more means better?

During the last half century, our knowledge and expertise increased, and Hodgkin's disease became one of the most curable malignant diseases. However, our results are still not satisfactory in the case of advanced stage. Apart from standard chemotherapy regimens, several other, so-called intensive first line therapy schedules have been tried, whose common characteristic is that more antineoplastic drugs within a reasonably shorter period and sometimes with increased dose had been administered. Out of these regimens, escalated dose BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisolone), the therapy yielding the best results and inciting hot debates in the literature is discussed here in detail. Though many questions related to BEACOPP scheme are still unanswered and at present it is not recommended for use in first line therapy except for trials, it seems that patients under 60 years of age, with advanced stage disease having poor prognosis, may benefit from this treatment.     

Therapy for CAG-repeat diseases?

Suppression of aggregate formation and apoptosis by transglutaminase inhibitors in cells expressing truncated DRPLA protein with an expanded polyglutamine stretchIgarashi, S. et al. (1998)Nat. Genet. 18, 111–117     

Recombination in HIV and the evolution of drug resistance: for better or for worse?

The rapid evolution of drug resistance remains a major obstacle for HIV therapy. The capacity of the virus for recombination is widely believed to facilitate the evolution of drug resistance. Here, we challenge this intuitive view. We develop a population genetic model of HIV replication that incorporates the processes of mutation, cellular superinfection, and recombination. We show that cellular superinfection increases the abundance of low fitness viruses at the expense of the fittest strains due to the mixing of viral proteins during virion assembly. Moreover, we argue that whether recombination facilitates the evolution of drug resistance depends critically on how resistance mutations interact to determine viral fitness. Contrary to the commonly held belief, we find that, under the most plausible biological assumptions, recombination is expected to slow down the rate of evolution of multi-drug-resistant virus during therapy.     

Neoadjuvant checkpoint inhibition in non-small cell lung cancer: Is earlier unquestionably better than later?

On March 4th 2022, nivolumab received regular US Food and Drug Administration approval, based on the CheckMate 816 trial results, for use “with platinum-doublet chemotherapy for adult patients with resectable NSCLC in the neoadjuvant setting”. This is the first neoadjuvant approval of a checkpoint inhibitor, a unique event in the history of lung cancer treatment. However, open questions remains. First, the co-primary endpoints of the CheckMate 816 trial (event-free survival and pathological complete response) are not yet validated surrogate endpoints in this setting. Second, the control arm was not reflecting the most common approach, being upfront surgery followed by adjuvant chemotherapy. Third, protocol changes were not plainly justified, questioning the analytic plan of the trial. Fourth and last, a subpar access to checkpoint inhibitor for patients upon progression may weaken overall survival results. Neoadjuvant strategies allow to study initial response under treatment, and constitute an encouraging therapeutic avenue. However, the best sequence of treatment is the key question in the neoadjuvant or adjuvant settings: is treating everyone upfront better than treating only patients that will eventually recur?Investigating optimal sequence strategy is even more critical within the checkpoint-inhibitor era, where patients with advanced or metastatic disease may present long-term advantage. Trials with optimal post-progression treatment are needed to help optimize our treatment algorithm, and spare toxicity for patients who don't derive benefit.     

Non-classical MHC-Ι genes in chronic hepatitis B and hepatocellular carcinoma

The non-classical human leukocyte antigens (HLA)-E, HLA-G, and HLA-F have been shown to modulate immune responses. We examined whether non-classical HLA polymorphisms are associated with hepatitis B virus (HBV) infection and hepatocellular carcinoma (HCC). Fifteen Single-nucleotide polymorphisms (SNPs) in these non-classical class I alleles were investigated by ligase detection reaction. A fragment of 650 bp located in the 3' untranslated region of HLA-G was investigated. Four SNPs (rs17875380, rs41557518, rs114465251, and rs115492845) were associated with altered susceptibility to HBV or HCC, and HLA-F*01:04, HLA-G*01:05N, and HLA-E*01:01 were associated with hepatitis B or hepatitis B complicated with HCC. Six of 16 designated HLA-E, -G, and -F haplotypes were associated with risk of hepatitis B or HCC. Our study provides healthy reference and detailed analyses of non-classical HLA class Ι polymorphisms that provide insight into immune mechanisms involved in susceptibility to hepatitis B and HCC.     

Artichoke leave extract for chronic hepatitis C – A pilot study

BackgroundArtichoke leave extracts (ALE) have hepatoprotektive properties and are used by patients with chronic liver disease. Effects in patients with chronic hepatitis C are unclear.Methods17 patients with chronic hepatitis C and persistently elevated aminotransferase levels were treated for 12 weeks with 3200 mg standardized ALE per day. Primary outcome parameter was the rate of alanine aminotransferase (ALT) normalisation after 12 weeks. Secondary parameters were the course of ALT, aspartate aminotransferase and γ glutamyltransferase levels, quantitative HCV RNA, subjective symptoms frequently associated with chronic hepatitis C (fatigue, discomfort upper abdomen, joint problems) and safety.ResultsNone of the patients had normalized ALT levels after 12 weeks of treatment. There was no significant change of aminotransferase levels or viral load compared to baseline levels. Fatigue and joint problems significantly improved after 4 weeks of treatment. However, after 12 weeks, there was no significant difference to baseline. Tolerability of ALE was rated as good to excellent. Severe side effects did not occur.ConclusionALE seem not to be effective to improve aminotransferase levels in patients with chronic hepatitis C     

Denitrification in pathogenic bacteria: for better or worst?

A large variety of physiological and taxonomic groups have the ability to use nitrogen oxides as alternative electron acceptors. Brucella spp. is an alpha-proteobacteriaceae that induces a persistent disease in some mammals. Recent work has revealed that a denitrifying gene cluster is important in the interaction of Brucella neotomoae with its host.     

Shh Signaling and Pancreatic Cancer: Implications for Therapy?

Hedgehog signaling has been implicated in the development of several human cancers, including small cell lung carcinomas, medulloblastomas, basal cell carcinomas, and digestive tract tumors. Elevated levels of pathway components are observed in pancreatic ductal adenocarcinoma (PDAC) precursor lesions, and these levels increase further as lesions progress to more advanced stages. Yet the mechanisms by which hedgehog signaling contributes to pancreatic tumorigenesis were poorly understood. We recently published results showing that activated hedgehog signaling enhances the proliferation and survival of pancreatic duct epithelial cells, the presumptive target cells for PDAC development. We also demonstrated that sonic hedgehog (Shh) expression, in cooperation with loss of the Trp53 and Ink4a/Arf tumor suppressor loci, was sufficient to initiate the formation of early pancreatic lesions. Furthermore, Shh signaling enhanced K-Ras-mediated pancreatic tumorigenesis and reduced the dependence of tumor cells on the sustained activation of Ras-stimulated signaling pathways. Here we discuss the significance of these findings and the implications for therapy.