Non-response to antiviral therapy is associated with obesity and increased hepatic expression of suppressor of cytokine signalling 3 (SOCS-3) in patients with chronic hepatitis C, viral genotype 1.

BACKGROUND: Interferon alpha (IFN-alpha) activated cellular signalling is negatively regulated by inhibitory factors, including the suppressor of cytokine signalling (SOCS) family. The effects of host factors such as obesity on hepatic expression of these inhibitory factors in subjects with chronic hepatitis C virus (HCV) are unknown. OBJECTIVES: To assess the independent effects of obesity, insulin resistance, and steatosis on response to IFN-alpha therapy and to determine hepatic expression of factors inhibiting IFN-alpha signalling in obese and non-obese subjects with chronic HCV. METHODS: A total of 145 subjects were analysed to determine host factors associated with non-response to antiviral therapy. Treatment comprised IFN-alpha or peginterferon alpha, either alone or in combination with ribavirin. In a separate cohort of 73 patients, real time-polymerase chain reaction was performed to analyse hepatic mRNA expression. Immunohistochemistry for SOCS-3 was performed on liver biopsy samples from 38 patients with viral genotype 1 who had received antiviral treatment. RESULTS: Non-response (NR) to treatment occurred in 55% of patients with HCV genotypes 1 or 4 and 22% with genotypes 2 or 3. Factors independently associated with NR were viral genotype 1/4 (p < 0.001), cirrhosis on pretreatment biopsy (p = 0.025), and body mass index > or = 30 kg/m2 (p = 0.010). Obese subjects with viral genotype 1 had increased hepatic mRNA expression of phosphoenolpyruvate carboxy kinase (p = 0.01) and SOCS-3 (p = 0.047), in comparison with lean subjects. Following multivariate analysis, SOCS-3 mRNA expression remained independently associated with obesity (p = 0.023). SOCS-3 immunoreactivity was significantly increased in obesity (p = 0.013) and in non-responders compared with responders (p = 0.014). CONCLUSIONS: In patients with chronic HCV viral genotype 1, increased expression of factors that inhibit interferon signalling may be one mechanism by which obesity reduces the biological response to IFN-alpha.

A combination of genetic polymorphisms increases the risk of progressive disease in chronic hepatitis C.

BACKGROUND: There is increasing interest in the influence of host genetic factors on hepatic fibrosis, and whether genetic markers can reliably identify subjects at risk of developing severe disease. We hypothesised that hepatitis C virus (HCV) infected subjects with progressive fibrosis, classified using strict criteria based on histology at biopsy in addition to disease duration would be more likely to inherit several genetic polymorphisms associated with disease progression compared with subjects with a low rate of disease progression. METHODS: We examined polymorphisms in eight genes that have been reported to have an association with hepatic fibrosis. RESULTS: Associations between polymorphisms in six genes and more rapidly progressing fibrosis were observed, with individual adjusted odds ratios ranging from 2.1 to 4.5. The relationship between rapidly progressing fibrosis and possession of > or =3, > or =4, or > or =5 progression associated alleles was determined and the adjusted odds ratios increased with increasing number of progression associated alleles (9.1, 15.5, and 24.1, respectively). Using logistic regression analysis, a predictive equation was developed and tested using a second cohort of patients with rapidly progressing fibrosis. The predictive equation correctly classified 80% of patients in this second cohort. CONCLUSIONS: This approach may allow determination of a genetic profile predictive of rapid disease progression in HCV and identify patients warranting more aggressive therapeutic management.

Expression and distribution of the dentatorubral-pallidoluysian atrophy gene product (atrophin-1/drplap) in neuronal and non-neuronal tissues.

Utilizing an affinity-purified antiserum directed against the carboxyl terminal region of atrophin-1/drplap (residues 1170-1185), we have examined the expression and distribution of the protein in a variety of neuronal and non-neuronal tissues. Immunohistochemical analyses of gelatin-embedded sections of monkey brain demonstrated a wide-spread distribution of the protein throughout the cerebrum and cerebellum. Labeling was primarily cytoplasmic within neuronal cell bodies and dendrites. Prominently staining regions included layers II, III, V, and VI of cerebral cortex, CA1-4 of the hippocampus, caudate nucleus, putamen, globus pallidus, amygdala, thalamus, red nucleus, pons, Purkinje cells, and deep cerebellar nuclei. Immunoblot analysis of extracts of frontal cortex from a wide variety of mammalian species (human, monkey, rabbit, rat, mouse, and bovine) detected a 190 kDa band in each extract. No cross-reactive material of similar molecular weight was detected in an extract of avian (chicken) central nervous system (CNS) tissue. Furthermore, in the rat, expression of the protein was predominantly neuronal in origin as immunoblot analyses of non-neuronal tissue extracts detected little or no 190 kDa protein. Collectively these investigations suggest a ubiquitous expression of atrophin-1/drplap in mammalian CNS tissue and provide initial immunochemical data for the study of the neuroanatomic and perhaps, phylogenetic relationships between mammalian and non-mammalian forms of the protein.

Psychosocial health issues in pediatric practices: parents' knowledge and concerns.

Parents' general knowledge of child development and the demographic factors associated with that knowledge were studied. A questionnaire was completed by 230 parents of patients from three quite different pediatric practices in the south-central United States. Chi square analysis was used as the major statistical technique. Results indicated that age, educational level, and income were associated with level of child development knowledge. Parents reported the sources and educational techniques that were most helpful to them in the past and present. The majority (81%) of the questions that parents wished to direct to pediatricians, given sufficient time, were concerned with psycho- social issues. It appears that the pediatric practice is a logical means of providing information to parents about their children's health concerns, both behavioral and physical. These results emphasize the importance of training pediatricians in behavioral issues and in improving their communication skills. The results are presented to help pediatricians select the anticipatory guidance and educational techniques that might be provided to parents through the pediatric practice.

Prenatal diagnosis of recurrence of Saldino-Noonan dwarfism.

The occurrence in a family of three spontaneous abortions and two siblings with Saldino-Noonan dwarfism supports an autosomal recessive etiology and raises the possibility of lethality early in utero. No long bones were visualized in radiographs at 19 weeks' gestation in the second affected pregnancy. highlighting the difficulties of distinguishing technical limitations from fetal anatomic abnormalities. Ultrasound studies demonstrated oligohydramnios. Radiologic prenatal diagnosis can rule out this condition prior to 20 to 24 weeks' gestation and affected fetuses can be suspected if not proved by radiographs and ultrasound examination.