[CROHN'S DISEASE. TO THE 90th ANNIVERSARY OF THE DESCRIPTION].

The article describes the main achievements in the study of Crohn's disease, first described as a disease of the terminal ileum, affecting mainly young people, characterized by subacute or chronic necrotizing and scarring inflammation. In subsequent years, the inflammatory disease was also detected in other parts of the gastrointestinal tract. This disease affects the entire intestine and can involve every part of the gastrointestinal tract, from the mouth to the anus. The history of the study of Crohn's disease for 90 years has made it possible to delve deeply into the pathogenesis of inflammation, but has not yet come closer to revealing its etiology. Therefore, it is impossible to talk about the possibility of recovery from CD.

[SURGICAL TREATMENT OF ULCERATIVE COLITIS. HISTORY].

The article describes the main achievements in the study of ulcerative colitis (UC) - a disease known since ancient times. «Bloody¼ non-epidemic diarrhea was described by Hippocrates. The first detailed description was made by K. Rokitansky in 1842. In 1875, S. Wilks and W. Mason first studied the pathomorphology of the colon in UC. The term «non-specific ulcerative colitis¼ was proposed by the Russian surgeon A. S. Kazachenko in 1913 at the 13th Congress of Russian surgeons. The historical excursion presents the main stages and achievements of surgical treatment of UC.

[ECONOMIC BURDEN AND CURRENT STATUS OF THE DRUG SUPPLY MANAGEMENT FOR IMMUNE INFLAMMATORY DISEASES (BY EXAMPLE OF ULCERATIVE COLITIS AND CROHN'S DISEASE)].

AIM: to estimate the quality and availability of medical care for patients with ulcerative colitis (UC) and Crohn's disease (CD), to assess the impact of the economic burden of these diseases on the healthcare budget of Russia and to systematize the main problems in the organization of medical care and drug supply for patients with inflammatory bowel diseases (IBD). Regional IBD databases (2016-2018), official statistical databases, costs of treatment and results of expert interviews with specialists in IBD were used in the study. The analyzed databases showed 104,668 patients with UC in Russia in 2018 (prevalence rate 71 per 100,000 people) and 66,647 patients with CD (prevalence rate of 45 per 100,000 people). The economic burden including agents for biologic therapy (ABT) for the UC was 39.54 billion rubles a year (495 rubles per capita), and CD - 32.98 billion rubles a year (378 rubles per capita). It requires an additional 9.87 billion rubles annually for UC and 9.20 billion rubles annually for CD patients to provide the complete supply with ABT. The annual burden of IBD is 72.52 billion rubles, which is comparable to the costs of other socially significant diseases, including malignant tumors. It shows the high social and economic value of IBD for the country. The main problems of medical care and drug supply for IBD patients are the mismatch of official statistical data and real IBD prevalence in Russia due to absence of comprehensive register and the insufficient supply with ABT due to limited funding. A federal center for IBD should be founded for better quality of registration, for the precise monitoring and for the active management of personal drug supply.

[Evaluation of efficacy and comparative frequency of adverse events in patients with ulcerative colitis receiving the original infliximab and its biosimilar. One year of observation].

Real - life data on the effectiveness and safety of biosimilar and biologic drugs licensed for treatment of inflammatory bowel diseases (IBD) is lacking. AIM: To investigate efficacy of original Infliximab (IFX) and its biosimilar in treating patients with ulcerative colitis (UC) and determine the frequency of adverse events during 1 year follow - up period. MATERIALS AND METHODS: Our cohort consisted of 98 ulcerative colitis patients, treated with original IFX and its biosimilar since December 2017 till December 2018 years. Original Infliximab was prescribed in 56 UC patients (57.1%) during 5 years and longer; 16 patients (16.3%) were switched to IFX biosimilar; 13 UC bio - naïve patients (13.3%) received original IFX, 29 (29.6%) patients - biosimilar IFX. In 14 patients (14.3%) original infliximab was rotated with biosimilar. We picked out 42 patients to assess efficacy of original IFX and biosimilar. RESULTS AND DISCUSSION: Twelve patients, received original IFX and 28 patients, treated with its biosimilar, showed significant clinical improvement by decreasing Mayo index from 9.7±0.4 and 10.2±0.2 points to 1.9±0.09 and 2.1±0.1 points, accordingly. Also we noticed positive change in laboratory markers - CRP decrease from 89.6±8.7 mg/l and 77.5±8.0 mg/l to 6.5±0.8 mg/l and 6.9±0.8 mg/l (p>0.05), albumin increase from 30.1±4.7 g/l and 29.6±3.6 g/l to 34.1±6.3 g/l and 32.8±5.9 g/l (p>0.05), increase of serum iron levels from 6.4±0.5 mcg/l and 7.1±0.65 mcg/l to 14.6±4.4 mcg/l and 15.9±5.1 mcg/l (p>0.05), hemoglobin increase from 104.7±9.8 g/l and 102.2±8.8 g/l till 124±11.3 g/l and 121±10.9 g/l (p>0.05), and fecal calprotectin decrease from 1680±134 mcg/g and 1720±126 mcg/g till 245.5±33.4 mcg/g and 230.5±29.8 mcg/g (p>0.05). During 1 year follow - up 12 UC patients, treated with original IFX and its biosimilar, developed adverse events. The majority of adverse events (n=8) were registered in patients, rotating administration of original IFX and its biosimilar. CONCLUSION: IFX biosimilar is effective as well as original IFX. Frequency of adverse events, occurred in patients, treated with original IFX, was comparable with adverse events frequency in patients, received biosimilar IFX. Frequency of adverse events was significantly higher in UC patients, rotating original IFX and its biosimilar.

[Comparative analysis of hepatitis C virus core protein in the plasma and serum samples from HCV-infected blood donors and patients with hepatitis C].

The aim of the study was to develop a sensitive and specific method for revealing the direct marker of hepatitis C virus (HCV)--core protein in the serum and to test it in the laboratory setting. Experiments were made on plasma and serum samples from asymptomatic HCV-seropositive blood donors (n=65), patients with acute (AHC) and chronic (CHC) hepatitis C (n=295), and HCV-seronegative blood donors (n=20). The processing protocol for serum included their concentration by means of polyethylene glycol and subsequent treatments of pellets to detect core protein in free virions, nonenveloped nucleocapsids, and immune complexes. This allowed an assay to be developed for the detection of core protein, by using a sandwich ELISA. Inclusion of a combination of three original monoclonal antibodies into the sandwich could reveal in the samples core proteins of at least 3 genotypes of HCV (1, 2, and 3) with a sensitivity of 20 pg/ml in the majority of HCV-infected subjects. The results of determination of core protein and HCV RNA correlated with a high degree of sensitivity. To detect HCV in the blood of patients with AHC, it was shown to be sufficient to find freely circulating virions whereas an analysis of immune complexes should be included in cases of CHC to achieve more sensitivity. The findings are a basis for developing a test system for the diagnosis of hepatitis C, including its early stages before seroconversion and for determining a viral load during interferon therapy. Introduction of the method into practice increases the reliability of the diagnosis of hepatitis C and virus-free safety of blood transfusions.

[Hepatitis C virus proteins in the liver cells in acute hepatitis C: their association with liver damage and with the outcome of the disease].

The accumulation of individual hepatitis C virus (HCV) proteins in the liver cells of patients with acute hepatitis C (AHC) and their association with the course and outcome of the disease were studied. AHC protein expression in the cryostat liver sections from 20 patients with AHC was estimated by immunohistochemical assay using original monoclonal antibodies to 5 HCV proteins (core, NS3, NS4A, NS4B, and NS5A). The results of HCV detection in the patients were compared with their biochemical, clinical, and morphological findings. HCV proteins were totally revealed in the livers of all the patients, individual proteins were identified with a frequency of 89-95%, which is significantly more than those in patients with chronic hepatitis C. The hepatic expression of core protein was shown to inversely correlate with the duration of an acute period. There was a direct relationship between the accumulation of core, NS3, and NS5A proteins and the liver tissue damage caused by stepwise necrosis rather than intralobular necrosis. The presumed convalescence was ascertained to be associated with the larger count of hepatocytes containing the proteins NS4A and NS3 early after AHC manifestation.

[Changes of humoral and cellular immunity in chronic hepatitis C patients of different staging]. / Izmenenie pokazatelei gumoral'nogo i kletochnogo immuniteta u patsientov s khronicheskim gepatitom C pazlichnoi tiazhesti.

The purpose of the present study was to investigate the influence produced by viral proteins in the hepatic cells and RNA of hepatitis C virus (HCV) on the indices of T- and B-cell response in 52 patients with chronic hepatitis C (CHC). A relative count of peripheral-blood lymphocytes (PBL), expressing antigens CD3+, CD4+, CD8+, CD16+, CD20+ and CD95+ was estimated. The repertoire of antibodies to HCV proteins was specified. The thus obtained data were compared with an activity and a disease stage by using the histological diagnosis and alanine-amino-transferase (ALT) level as well as with the presence of HCV RNA in the serum and viral protein of the liver. Such comparison of data and the use of the correlation analysis made it possible to establish that the antibodies to NS5 protein were detected reliably more often in patients with a more pronounced hepatic fibrosis, with a higher ALT activity and with expression of HCV proteins in the liver. At the same time, the presence of proteins in the liver and of RNA in the serum were accompanied by a more active humoral response to the non-structure proteins of NS4 and NS5 as well as by more profound discrepancies of the immunity T-cell chain (a lowered ratio of CD4+/CD8+ and a smaller content of CD95+). There were no differences between PBL of the studied populations in patients with various activities and an HCV stage. A relatively bigger quantity of CD95(+)--positive PBL was found to be reliably higher in patients with viremia but lower in those cases, in which HCV proteins were detected in the liver. This confirms the inhibiting ability of HCV proteins to the Fas-mediated apoptose of PBL in CHC patient.

[Analysis of hepatitis C virus proteins in hepatic cells of patients with chronic hepatitis C]. / Analiz belkov gepatita C v kletkakh pecheni bol'nykh khronicheskim gepatitom C.

A correlation between the detection of proteins and an activity of the pathological process was analyzed in a study of the content of the C virus hepatitis (CVH) proteins in hepatic cells of patients with chronic C hepatitis (CCH). The expression of CVH proteins in frozen sections of biopsy samples of 69 CCH patients was evaluated by using the immune-histological method involving original monoclonal antibodies (MCA) to 5 CVH proteins. The results of the detection of proteins in patients were compared with an activity and stage of CCH (by using histological tests and a level of alanine aminotransferase--AAT). A set of the CVH proteins were found in the liver of 74% of patients, i.e. core proteins, NS3, NS4A, NS4B and NS5A--in 28, 43, 43, 55 and 58%, respectively. All studied proteins were detected in the cytoplasm of hepatocytes. Proteins were found in the liver more often as compared with the detection rate of CVH RNA in the blood serum (61%). This demonstrates a high sensitivity of the discussed test at detecting the CVH infection. The accumulation of the core protein was shown to correlate with the presence of the replicative form of CVH RNA in the liver and with a higher level of AAT. The quantity of NS5 A-expressing cells correlated directly with a CCH stage. The quantity of NSB- and NS3-positive hepatocytes correlated negatively with an activity of the inflammatory-and-necrotic processes in the liver. Hyper-fermentation was found more often among the antigen-positive patients. The CCH histological activity was proven to be reliably higher at a simultaneous detection of CCH proteins in the liver and of CVH RNA--in the serum.

Characterization of monoclonal antibodies and epitope mapping of the NS4 protein of hepatitis C virus.

Recombinant DNA containing sequences of HCV NS4 protein was expressed in Escherichia coli cells. Six hybridoma clones producing monoclonal antibodies (MAB) to recombinant NS4 protein (rNS4), aa 1677-1756, were developed. Mapping with a panel of 33 peptides and reciprocal competitive EIA have shown that MAB obtained revealed five antigen determinants, not described earlier: MAB 3F11 and 3F12-one genotype-independent epitope of NS4A (aa 1700-1707) common for genotypes 1, 2 and 3; MAB 1D11-genotype-independent epitope (aa 1713-1728) and MAB 1D3-genotype (subtype 1b)-specific epitope of NS4B (aa 1711-1731); MAB 6B11 and C1-two conformation-dependent determinants in 5-1-1 region. These data indicate that the 5-1-1 region of NS4 protein has a complex antigenic structure and contains at least eight epitopes, including five, revealed in the present work. MAB obtained recognized native viral protein in the cytoplasm of liver cells of patients with chronic hepatitis C. The positive rates of the immunostaining for NS4 antigen using MAB 6B11, 1D11 and 3F12 were 64, 59 and 50%, respectively. It was found that 6B11 MAB to a conformation-dependent epitope much more actively interacts with native NS4 than with the recombinant protein to which MAB was developed. The epitope recognized by 6B11 MAB is highly immunogenic since it induces the B-cell response in all patients investigated with identified anti-NS4 antibodies in blood serum. The MAB panel obtained in this study may become a useful tool for the diagnostic purposes, for the investigation of NS4B function and for the host-viral interactions at the cell level.

[Acute hepatitis C in the presence of chronic HBV infection]. / Ostryi gepatit C na fone khronitseskoi GBV-infektsii.

Acute HCV superinfection was studied in 23 patients with chronic hepatitis B virus infection. HBsAg, anti-HCV (C-100, core, NS3, NS5) were detected in patients' sera at first investigation. Predominant replication of HBV DNA was detected in the sera of 68% patients and HCV RNA in only 24% patients. The clinical course of acute hepatitis C in patients with chronic HBV infection in general corresponded to HCV monoinfection except for more pronounced biochemical shifts and shorter intoxication. The role of HBV and HCV in infectious process is discussed.

[Acute hepatitis B in anti-HCV-positive patients]. / Ostryi gepatit B u anti-HCV-pozitivnykh patsientov.

Seventy-six anti-HCV-positive patients with acute hepatitis B were observed. HBsAg, anti-HBc IgM, and anti-HCV were detected in the sera of all patients. During the acute phase of illness, HBV DNA was present in the sera of 90.8% patients, but not HCV RNA. The clinical picture of acute hepatitis B in anti-HCV-positive patients corresponded to HBV monoinfection with prolonged intoxication and a more benign biochemical course. Out of 10 patients observed during 2 years chronic mixed HBV/HCV hepatitis was diagnosed in 1 patient, in 8 patients only HCV infection was diagnosed, and in 6 cases HCV RNA was detected. Virus interference may be responsible for successive alternative dominant replication of HBV and HCV.

Detection of hepatitis G virus (HGV) RNA: clinical characteristics of acute HGV infection.

The role of hepatitis G virus (HGV) infection in acute non-A-E hepatitis was investigated in adults with viral hepatitis. HGV RNA was present in 1 of 28 patients with non-A-E hepatitis but 9 of 22 with hepatitis C (P < .003). HGV RNA-positive patients (HGV-infected and HGV-hepatitis C virus [HCV]-coinfected) developed light-to-moderate jaundice. Clinical and biochemical features of HGV-positive and HCV-positive patients and patients with non-A, non-G hepatitis were similar. Three patients with HGV-HCV coinfection, tested within 18 months after disease onset, have remained HGV RNA-positive but have become HCV RNA-negative. Only 1 non-A-E hepatitis patient was confirmed as being infected with HGV alone, suggesting that HGV is not the main etiologic agent of non-A-E hepatitis. Although HGV RNA was significantly associated with hepatitis C, patients with mixed HCV-HGV infections did not demonstrate a more severe course of disease than did patients with HCV infection.