Do insulin-like growth factor associated proteins qualify as a tumor marker? Results of a prospective study in 163 cancer patients.

OBJECTIVE: Insulin-like growth factor (IGF)-1, -2 and Insulin like growth factor binding proteins (IGFBP) are involved in the proliferation and differentiation of cells. It has never been evaluated, if the IGF-system can serve as a tumor marker in neoplasms. METHODS: In our prospective study 163 patients with colorectal cancer (22), prostate cancer (21), head and neck tumors (17), lymphomas (20), lung cancer (34) and other entities (49) were analysed for their IGF and IGFBP serum levels at the beginning and the end of radiotherapy and compared to 13 healthy people. Subgroups of patients with local tumor disease versus metastatic disease, primary and recurrent therapy and curative versus palliative therapy were compared. RESULTS: The serum levels of IGF-2 were significantly elevated in patients with prostate and colorectal cancer. However, sensitivity and specificity were only 70%. IGFBP-2 serum levels were elevated in patients with head and neck tumors. Again sensitivity and specificity were only 73%. A difference between local disease and metastatic disease could not be found. A difference between IGF serum levels before and after radiotherapy could not be detected. CONCLUSION: The IGF-system cannot serve as a new tumor marker. The detected differences are very small, sensitivity and specificity are too low. IGF measurement is not useful for the evaluation of the success of radiotherapy in malignancies.

Genetic relatedness of Cuban HAV wild-type isolates.

Knowledge of the nucleotide sequence in the region of the putative VP1/2A junction of the Hepatitis A virus (HAV) genome has enabled differentiation of HAV strains and their classification into seven genotypes, in some of which sub-genotypes A and B can be defined. A 168 base segment encompassing the putative VP1/2A junction of 27 clinical wild-type isolates of HAV from Cuba was amplified by reverse transcriptase-polymerase chain reaction and then sequenced. The Cuban isolates are clustered within sub-genotype IA. A single amino acid substitution, which does not correspond with any of the reported changes for other strains, was observed. A new sub-genotype variant is therefore postulated. This study provides new data on the genetic relatedness of HAVs from Cuba and on the distribution of sub-genotype IA in the Caribbean area.

Influence of the 5' noncoding region of hepatitis A virus strain GBM on its growth in different cell lines.

Previous sequence analysis of consecutive passages of the hepatitis A virus (HAV) strain GBM/WT in human embryonic kidney cells (HEK cells), human embryonic lung fibroblasts (HFS cells) and in FRhK-4 cells (foetal rhesus monkey kidney cells) pointed to a host cell dependent cell culture adaptation of GBM/WT in HFS cells involving mutations in the 5' noncoding region (5'NCR). Multiple nucleotide changes occurred in the 5'NCR of the GBM genome after the cell line used for virus passage was changed from HEK cells to HFS cells. In contrast, no mutations in the 5'NCR occurred during the first 20 passages of GBM/WT in FRhK-4 cells. In order to analyse the influence of the 5'NCR on host cell specific adaptation of HAV strain GBM in different cell cultures, GBM/HM175 chimeras were constructed which contained 5'NCRs from different GBM variants by replacing the 5'NCR of the infectious clone pHAV/7. Parallel transfection assays in FRhK-4 and HFS cells, performed with transcripts from the chimeric GBM/HM175 constructs, showed that the 5'NCR of the GBM variant GBM/HFS is essential for virus growth in HFS cells. The GBM/HM175 chimeric RNA, which contained the 5'NCR of GBM/HFS, exclusively, was able to produce infectious virus after transfection of HFS cells. The growth of the different GBM/HM175 chimeras in FRhK-4 cells, in contrast, did not seem to be strongly influenced by a specific sequence of the 5'NCR.

Early appearance of neutralizing antibodies after vaccination with an inactivated hepatitis A vaccine.

Sera from 30 subjects vaccinated with the Pasteur Merieux Serums & Vaccins (PM) inactivated hepatitis A vaccine, and from 30 subjects vaccinated with the Smithkline Beecham (SB) inactivated hepatitis A vaccine, were tested in two laboratories in order to provide comparative data on neutralizing activities of vaccine-induced antibodies. Sera were also evaluated by a modified radioimmunoassay (mRIA) and results were compared to neutralization assays results. Neutralizing antibody titres provided by the two laboratories correlated well (coefficient or correlation 0.42, P < 0.001). Neutralizing antibodies were detected after vaccination with both vaccines, and the kinetics of neutralizing antibody were the same with both vaccines. The titres gradually increased between the second week after the first dose and the post-booster dose (week 28). A strong booster effect of the booster vaccine dose on neutralizing titres was observed. Significantly higher neutralizing antibody titres with the PM vaccine were observed as early immune response on week 2 titres on both series of results. Vaccine-induced neutralizing antibody titres and vaccine-induced antibody mRIA titres correlated well (coefficient of correlation 0.82 and 0.72, respectively, P < 0.0001 in both cases). These results demonstrate early appearance of neutralizing antibody at high titre with the PM vaccine.

Identification of GBV-C hepatitis G RNA in chronic hepatitis C patients.

Sera from patients with chronic hepatitis C were examined for the presence of GBV-C/HGV RNA by RT-PCR. The amplified products, derived from the 5' non-coding, NS3, and NS5a regions, were detected in 19 (19%) of the 100 HCV RNA-positive samples. Analysis of GBV-C/HGV prevalence rates revealed that dual infections are related to shared parenteral risk factors. Intravenous drug abuse and multiple transfusions were the factors clearly associated with a simultaneous HCV and GBV-C/HGV infection. Apart from this, patients with dual infections had a statistically significant lower mean age compared to those patients infected solely by HCV. Determination of HCV genotypes involved in GBV-C/HGV coinfection by RFLP analysis showed no correlation between the presence of GBV-C/HGV and a distinct HCV genotype. The study demonstrates that, based on the assessment of risk criteria, GBV-C/HGV is transmitted efficiently parenterally and is frequently linked to hepatitis C coinfection, regardless of HCV genotype.

Improvement of virus safety of a S/D-treated factor VIII concentrate by additional dry heat treatment at 100 degrees C.

In order to increase the virus safety of a solvent/detergent-treated Factor VIII concentrate in regard to non-lipid coated viruses and to respond to the continuous discussion about reports on hepatitis A transmission by Factor VIII preparations, we have investigated the effect of a terminal dry heat treatment (30 min 100 degrees C) on HAV and various other viruses. By this treatment Hepatitis A virus was inactivated below detectable level after a few minutes (> 5.3 log10). Other RNA viruses such as the Human Immunodeficiency Virus (> 6.6 log10), bovine viral diarrhoea virus (> 6.6 log10) and vesicular stomatitis virus (> 5.8 log10) were also inactivated below detectable level. Pseudo rabies virus and reovirus Type 3 are inactivated by 5.7 and > 6.0 log10, respectively. SV40 and bovine parvo virus showed significant resistance to dry heat treatment. We conclude that the involvement of two strong virus inactivation steps, acting by different mechanisms, improves the virus safety of Factor VIII concentrates without destroying the Factor VIII activity. Moreover, the terminal 100 degrees C heat treatment for 30 min represents an effective measure to inactivate non-lipid enveloped viruses, in particular hepatitis A, which is resistant to solvent/detergent treatment.

Immune response to hepatitis A virus capsid proteins after infection.

This study was undertaken to determine the immune response of humans to viral capsid polypeptides of hepatitis A virus (HAV) after natural infection, which is very important for vaccine development. Antiviral capsids in 73 serum samples from patients with acute and chronic HAV infections were analyzed by immunoblotting against individual HAV capsid polypeptides (VP1, VP2, VP3, and VP4) by using a cell culture-based HAV antigen. For reference, total anti-HAV immunoglobulin G (IgG) and anti-HAV IgM were also determined by radioimmunoassay. As a result, a dominant immune response against VP1 (98% IgG, 94% IgM) was found in the acute phase. However, many other sera also reacted with VP0 (88% IgG; 35% IgM) and VP3 (81% IgG and 29% IgM). In contrast to the acute phase, anti-VP1, anti-VP0, and anti-VP3, IgG antibodies against all three viral proteins (29, 29, and 73% respectively), especially those against VP3, were found years after onset of HAV disease and over long periods in the sera of hepatitis patients. These results suggest that antibodies for capsid polypeptides are present over an extended period in the sera of HAV-infected patients. They are likely of importance in maintaining long-term immunity.

Immunogenicity and efficacy of a killed hepatitis A vaccine in day care center children.

The objective of this study was to characterize the immune response of children after the use of two different vaccine doses and to evaluate whether vaccination benefits children attending day care centers in areas with high anti-HAV seroprevalence. The study was conducted in a day care center with a stable population in São Paulo, Brazil. Two groups of 20 children, all seronegative for hepatitis A antibodies, were assigned randomly to receive three times 0.5 and 1.0 ml of the vaccine, the second and third dose 1 and 6 months after the first dose, respectively. There were 27 children in the control group. All children in both vaccinated groups had protective levels of antibodies in the serum after two inoculations, and serious adverse reactions were not observed. In the eighth month of follow-up, a hepatitis A outbreak occurred in the day care center. Five children in the control group had high titers of IgM class anti-HAV, four with clinical manifestations of acute hepatitis. None of the vaccinated children developed symptoms or signs of hepatitis (P = 0.0125), and the estimate of vaccine efficacy was 100%. Two nonstudy children from the center also had clinical and serological evidence of acute hepatitis A. It is concluded that vaccination represents an important method for prevention of hepatitis A transmission in day care centers. The results of this pilot study justify further testing in larger groups.

Molecular epidemiology of an outbreak of hepatitis A in Italy.

The relationship of hepatitis A virus (HAV) isolates associated with an outbreak in Genoa, Italy, in 1993 was examined using direct sequencing of amplicons derived by antigen capture PCR (AC/PCR) from faecal samples of the infected persons. Forty samples recovered from 38 primary and two secondary cases were examined. The latter were household contacts of the primary cases. In addition, faecal material of 2 unrelated persons infected simultaneously with hepatitis A in Genoa were tested. The PCR products derived from the P1/P2 junction of the HAV genome were analysed. A 100% nucleotide identity was detected between the viral isolates originating from the primary as well as the secondary cases. The viral isolates recovered from the faecal samples of the two unrelated cases differed from the virus causing the outbreak as well as from each other. These results indicate that a single HAV strain caused the outbreak. The virus might have been transmitted by ingestion of contaminated food or water since all hepatitis A infected employees of the factory had eaten in the same canteen. Definitions of HAV genotypes are based on numerous genetic comparisons of different strains. The sequence comparison of the investigated isolates with published HAV sequences of the P1/P2 genome region revealed that the virus associated with the outbreak belongs to HAV subgenotype IA, whereas the strains recovered from the viral isolates of the unrelated cases belong to subgenotype IB.

Hepatitis A virus and polymerase chain reaction amplification: methodology and results.

Hepatitis A infection among patients receiving solvent/detergent inactivated factor VIII preparations in various locations in Europe have been documented recently. In investigations in Italy, Germany and Ireland, polymerase chain reaction (PCR) amplification was used to detect hepatitis A virus in frozen plasma pools, purified factor VIII, patient sera and samples from animal transmission studies; nucleic acid sequencing was used to clarify and identify the virus responsible based upon genotype analysis. Unique virus strains were found among the cases in Italy and Germany, and identical virus sequences were also found in some factor VIII lots. However, with the exception of the Italian investigation, lack of appropriate samples have precluded the identification of virus in these outbreaks. In addition, animal infectivity studies have not been successful in demonstrating infectivity under laboratory conditions. We discuss the limitations of PCR amplification with respect to detecting virus within these situations, and the necessity for the corresponding epidemiologic investigations.

Antigenicity of hepatitis A virus after ultra-violet inactivation.

Ultra-violet (UV) treatment has been shown to inactivate hepatitis A virus (HAV) in wastewater and polluted drinking water. Whether this method could be used to inactivate virus preparations made for vaccine purposes is not known since the effect of UV on the antigenicity of HAV has not been studied. HAV vaccine preparations have been treated effectively with formaldehyde. However, this method is time-consuming, since treatment times of up to 15 days have been published as necessary for a complete and safe inactivation. We used a cell-culture-derived HAV preparation with a TCID50 of 10(9) for a UV irradiation experiment. The antigenicity (assessed by a panel of anti-HAV antibodies), viral genome titre (quantitated by polymerase chain reaction) and HAV infectivity were compared after treatment with UV doses of 0, 184, 368, 552, 736 and 920 J m-2. Our results showed the antigenicity of HAV was almost unaltered even when infectious viral particles were no longer detectable. This technique shows potential as a simple and low-cost method for an inactivated HAV vaccine.

New epidemiological patterns of hepatitis A and B infections in Germany.

A sero-prevalence study of antibodies against the hepatitis A and B virus is described along with the prevalence of the surface antigen of the hepatitis B virus (HBs1 Ag). Two groups are compared: the first comprising young adults born between 1961 and 1968; the second, an older population aged 50 and above. Results show that only 3.9% of the younger population were found to have antibodies against the hepatitis A virus, in sharp contrast to the older generation in whom the prevalence of antibodies was as high as 40.3%. There is a prevalence of 0.4% of HBs Ag in the younger group, while the rate in the older population is 1.5%. Only 7.1% of the younger group were found to have antibody markers for anti-HBc2 and 3.5% for anti-HBs. In the older group the respective figures are 32.5% and 15.8%.

[A trial of a hepatitis A cultured inactivated vaccine on rhesus macaques]. / Ispytanie kul'tural'noi inaktivirovannoi vaktsiny gepatita A na makakakh rezusakh.

In this work experimental model of hepatitis A virus (HAV) infection in macaques rhesus was used. In 6 seronegative monkeys immunized with the inactivated vaccine (3 injections of 0.3 micrograms of viral protein each at an interval of 1 month) pronounced antibody response was observed. The dynamics and titers of anti-HAV antibodies were similar to those in 5 rhesus macaques which received the active virus. But, in contrast to the latter, no IgM antibodies were detected in the immunized animals. Three months after the end of immunization the monkeys were resistant to challenge with a HAV strain pathogenic for humans (10(3) - 10(4) ID50). The monkeys had no morphological changes in the liver and no rise in the serum alanine-amino transferase activity, but exhibited transient excretion of the virus in feces, as well as stimulation of anti-HAV antibodies (in the absence of IgM antibodies). The vaccine under test proved to be safe, immunogenic and produced a protective effect.

Mutational events in consecutive passages of hepatitis A virus strain GBM during cell culture adaptation.

In order to study the adaptation of hepatitis A virus (HAV) in cell culture, we examined the mutational events of the genome in early passages of HAV strain GBM propagated either in FRhK-4 cells (fetal rhesus monkey kidney-derived) or in human embryonic kidney (HEK) and human embryonic fibroblast cells (HFS) in relation to their growth characteristics. Sequence analysis of the nucleotide region encoding 2B, 2C, and the beginning of 3A as well as the nucleotide region encompassing the 5' noncoding region (5'NCR) of the genome was performed on consecutive virus passages after amplification of the viral RNA from the cell culture supernatant by antigen-capture PCR. By the 2nd passage of the GBM variants cultured in FRhK-4 or in HEK cells we found a mutation at nucleotide position 3889 (2B coding region) which results in an amino acid substitution from alanine to valine. Further mutations present in the 2B/2C region of the cell culture-adapted GBM variants differ from each other and occur after the 10th or even the 40th virus passage. Another early change, an in frame deletion of nine nucleotides in the 3A region, appeared in the 5th virus passage only in GBM cultured on FRhK-4 cells. This genome region showed different mutations in the virus passages on HEK and HFS cells. The 5'NCR of the cell culture-adapted GBM variants, in contrast, did not show any mutations before the 8th virus passage. The faster and more efficient growth of the HAV strain GBM during successive propagation on cell cultures seems to correlate with the appearance of mutations in the investigated genome regions.