The use of echocardiography as a health assessment tool in green sea turtles (Chelonia mydas).

There are limited techniques available to assess the health of sea turtles as physical examination has little correlation to clinical findings, and blood reference intervals are broad and provide limited prognostic significance. Advances in the portability of ultrasound machines allow echocardiography to be increasingly used in the health assessments of wild animals. This study performed blood analysis and echocardiograms on 11 green sea turtles upon admission to a rehabilitation clinic and six animals before release. Significant differences were seen between groups, with admission animals having significantly smaller diameters of the cavum arteriosum at systole and diastole, smaller E-waves and an increased fractional shortening. Pre-release animals displayed significant increases in the maximum blood velocities of both the pulmonary artery and the left aorta. Significant negative correlations were seen between fractional shortening and uric acid and between the velocity time integral of the pulmonary artery and urea. The pulmonary artery velocity time integral was also significantly correlated to the E wave. Furthermore, there was asynchrony between the cavum arteriosum and the cavum pulmonale and the detection of a parasitic granuloma in the ventricular outflow tract of one animal. Overall, the results suggest that cardiac function in stranded green sea turtles is significantly impaired and that echocardiography has applications in the health assessments of green sea turtles.

Solute Partitioning in Micelles: Combining Molecular Dynamics Simulations, COSMOmic, and Experiments.

The partition equilibria of solutes between micelles and an aqueous phase is a key factor in many applications. Depending on the task, many micelle-solute combinations are possible. Therefore, theoretical methods to predict the partition behavior in micellar systems are needed. Here, two predictive methods are evaluated and compared. First, it is shown how molecular dynamics simulations (MD) with the umbrella sampling method can be used to calculate free energy profiles in micellar systems. The second applied method is an extension of the COSMO-RS theory to anisotropic systems termed COSMOmic. Both methods are compared by means of free energy profiles and experimental micelle/water partition coefficients. A particular focus is on the partitioning of ionized solutes. As experimental data for partitioning in micelles especially for charged solutes is rare, partition coefficients were also determined experimentally. To get a general understanding of micelles examples of all micelle classes (classified by headgroup charge) are studied: nonionic Triton X-114 (TX114), zwitterionic miltefosine (HePC), anionic sodium dodecyl sulfate (SDS), and cationic cetyltrimethylammonium bromid (CTAB). The free energy profiles of neutral solutes obtained from MD simulations and COSMOmic are in an overall good agreement, and partition coefficients from both methods are in good agreement with experimental data. Depending on the system, the results for charged solutes show some deviations between the methods and experimental data.

Predicting solute partitioning in lipid bilayers: Free energies and partition coefficients from molecular dynamics simulations and COSMOmic.

Quantitative predictions of biomembrane/water partition coefficients are important, as they are a key property in pharmaceutical applications and toxicological studies. Molecular dynamics (MD) simulations are used to calculate free energy profiles for different solutes in lipid bilayers. How to calculate partition coefficients from these profiles is discussed in detail and different definitions of partition coefficients are compared. Importantly, it is shown that the calculated coefficients are in quantitative agreement with experimental results. Furthermore, we compare free energy profiles from MD simulations to profiles obtained by the recent method COSMOmic, which is an extension of the conductor-like screening model for realistic solvation to micelles and biomembranes. The free energy profiles from these molecular methods are in good agreement. Additionally, solute orientations calculated with MD and COSMOmic are compared and again a good agreement is found. Four different solutes are investigated in detail: 4-ethylphenol, propanol, 5-phenylvaleric acid, and dibenz[a,h]anthracene, whereby the latter belongs to the class of polycyclic aromatic hydrocarbons. The convergence of the free energy profiles from biased MD simulations is discussed and the results are shown to be comparable to equilibrium MD simulations. For 5-phenylvaleric acid the influence of the carboxyl group dihedral angle on free energy profiles is analyzed with MD simulations.

[Bilateral medial rectus recession with posterior fixation suture for large infantile esotropia]. / Beidseitige Medialis-Rücklagerung mit Fadenoperation bei großer frühkindlicher Esotropie.

BACKGROUND: Surgery for infantile large angle esotropia is not uniform. Bilateral medial rectus recession (BMR), combined recess-resect procedure, also combined with simultaneous contralateral medial rectus recession or secondary other procedures are common. Alternatively, bilateral medial rectus recession with posterior fixation suture (BMRF) has been used. We analysed the effect of BMRF for this specific indication. PATIENTS AND METHODS: We undertook a retrospective evaluation of squint angles in simultaneous (S) and alternating (A) prism cover test before and 3 months after BMRF with and without additional oblique muscle surgery as primary surgery for esotropia ≥ 20° performed at our department between 1997 and 2009, as well as the rate of second procedures. RESULTS: Sixty-one children (0.5 % of all patients who received eye muscle surgery during the same time interval) were included. Medians (10 % and 90 % quantiles) were: age at surgery 48.4 months (23.6; 76.0), refraction (spherical equivalent)2.25 dpt (0.25; 5.50), posterior fixation 5.5 mm + 13.0 mm (12.5; 13.0) from limbus, recession 5.0 mm (4.0; 5.0), inferior oblique recession in 29 children (27 bilateral), preoperative squint angles at 5 m S/A 29° (20; 40), at 0.3 m S/A 35° (24; 45), postoperative at 5 m S 0° (-6; 10), A 2° (-6; 11), at 0.3 m S 1° (-5; 12), A 3.5° (-5; 13), S ≤ 5° in 70.2 % at 5 m and 60.3 % at 0.3 m, consecutive exotropia 6-10° and > 10° in 7.0 and 3.5 % at 5 m and 8.6 and 1.7 % at 0.3 m, residual esotropia 6-10° and > 10° in 10.5 and 8.8 % at 5 m and 13.8 and 15.5 % at 0.3 m. Seven children (11.5 %) were re-operated for esotropia, four for exotropia (6.6 %). CONCLUSION: Bilateral medial rectus recession with retroequatorial myopexy (Cüppers procedure) is an effective one-step procedure for large infantile esotropia. In roughly two-thirds of the cases, the squint angle was corrected within ±â€Š5° with one surgery, which is similar to reported success rates of BMR.

Characterization of the neuraminidase of the H1N1/09 pandemic influenza virus.

In this study, we compared properties of the neuraminidase (NA) of the H1N1/2009 pandemic virus (H1N1pdm) and N1 NAs of other influenza viruses. The H1N1pdm NA was more active than NAs of seasonal H1N1 viruses, hydrolyzed Neu5Acα2-3Gal linkage as efficiently as did avian viruses and cleaved Neu5Acα2-6Gal linkage as efficiently as classical swine viruses. To assess the functional balance between heterologous NAs and pandemic virus HA, we generated four recombinant viruses that shared seven genes of A/Hamburg/5/09 and contained the NA gene from representative avian, swine and human viruses. The viruses harboring NA from avian, Eurasian avian-like swine and seasonal human viruses eluted more slowly from red blood cells, were more sensitive to neutralization by human airway mucins, and replicated less efficiently in differentiated human tracheo-bronchial epithelial cultures as compared with the viruses containing the NA of H1N1pdm and the NA of the North American classical swine virus lineage. Our data suggest that functional properties of the NA of H1N1pdm could be closer to those of classical swine viruses than to those of avian, avian-like swine and seasonal human viruses.

Critical review of the use of erythropoietin in the treatment of anaemia during therapy for chronic hepatitis C.

Combined pegylated interferon (PegIFN) and ribavirin represents the standard therapy for patients with chronic hepatitis C (CHC), which allows for sustained viral response (SVR) in up to 90% of patients depending on certain viral and host factors. Clinical studies have demonstrated the importance of adherence to therapy, that is, the ability of patients to tolerate and sustain a fully dosed therapy regimen. Adherence is markedly impaired by treatment-related adverse effects. In particular, haemolytic anaemia often requires dose reduction or termination of ribavirin treatment, which compromises treatment efficacy. Recent evidence points to a beneficial role of recombinant erythropoietin (EPO) in alleviating ribavirin-induced anaemia thereby improving quality of life, enabling higher ribavirin dosage and consequently improving SVR. However, no general consensus exists regarding the use of EPO for specific indications: its optimal dosing, treatment benefits and potential risks or cost efficiency. The Swiss Association for the Study of the Liver (SASL) has therefore organized an expert meeting to critically review and discuss the current evidence and to phrase recommendations for clinical practice. A consensus was reached recommending the use of EPO for patients infected with viral genotype 1 developing significant anaemia below 100 g/L haemoglobin and a haematocrit of <30% during standard therapy to improve quality of life and sustain optimal ribavirin dose. However, the evidence supporting its use in patients with pre-existing anaemia, non-1 viral genotypes, a former relapse or nonresponse, liver transplant recipients and cardiovascular or pulmonary disease is considered insufficient.

Treatment outcome in relation to alcohol consumption during hepatitis C therapy: an analysis of the Swiss Hepatitis C Cohort Study.

BACKGROUND: Adherence to hepatitis C treatment is influenced by alcohol as is the action of interferon; yet the clinical significance of the latter remains unclear. The aim of our study was to investigate the influence of ongoing alcohol intake on sustained viral response (SVR) rates in adherent patients receiving hepatitis C treatment. METHODS: A retrospective analysis of patients treated with antiviral therapy for hepatitis C infection who were enrolled in the Swiss Hepatitis C Cohort Study was completed. Patients were eligible for the study if they had their HCV RNA tested 6 months following treatment completion and at least one cohort follow-up visit during HCV therapy, documenting the consumed amount of alcohol. They were assigned to three groups according to the amount of alcohol consumption: group A without alcohol consumption, group B < or =24 g/d alcohol and group C >24 g/d alcohol. RESULTS: 554 patients were included. Patients with at least 80% of the scheduled cumulative dose and duration did not significantly differ between the three groups. SVR rates according to alcohol consumption were 60% for non-drinkers (group A), 57% in group B and 50% in group C. No significant negative influence from alcohol consumption during therapy was observed in the multiple regression analysis for treatment success. CONCLUSION: In this evaluation, we demonstrated comparable SVR rates in non-drinkers and in patients with daily amounts of alcohol intake up to 24 g during hepatitis C therapy.

Effect of antiviral therapy on circulating cytokeratin-18 fragments in patients with chronic hepatitis C.

Hepatocellular apoptosis plays a major role in the pathogenesis of chronic hepatitis C. It can be measured noninvasively by determining the circulating levels of cytokeratin-18 fragments. We hypothesized that the effect of antiviral therapy on this parameter will be different in patients with a sustained virological response, relapse (REL) and nonresponse (NR). We quantified cytokeratin-18 fragments in plasma of patients participating in the Swiss Hepatitis C cohort, who received antiviral therapy without stopping because of sides effects. A total of 315 patients were included, 183 with a sustained response, 64 with NR and 68 who relapsed. Mean levels ±SD of circulating cytokeratin-18 fragments before therapy were 174 ± 172 U/L for responsders, 188 ± 145 for nonresponders and 269 ± 158 U/L for patients who relapsed. The values were significantly higher in the REL group (ANOVA P < 0.006). A sustained response was associated with a significant improvement of the plasma levels (94 ± 92 U/L, paired test P < 0.000001), whereas there was no improvement in the nonresponder group (183 ± 158 U/L) and in the relapser group (158 ± 148 U/L). There was a weak correlation between alanine aminotransferase (ALT) and cytokeratin-18 fragment levels (r² = 0.35, P < 0.000001) before therapy but not after therapy and none with hepatitis C virus (HCV) viremia. Successful antiviral therapy results in a significant decrease in circulating levels of cytokeratin-18 fragments arguing for a reduction in hepatocellular apoptosis after clearance of the HCV. Baseline cytokeratin-18 fragment levels are higher in relapsers. Correlations with ALT are weak, suggesting that these two tests measure different but related processes.

Concepts for the treatment of adolescent patients with missing permanent teeth.

INTRODUCTION: Missing permanent teeth is observed with syndromes or is frequently hereditarily propagated in families. The treatment of these patients is a multi-task of specialists of oral surgery, orthodontics and prosthodontics. DISCUSSION: Despite functional and aesthetic considerations, the main problem of all treatment is that it had to be performed in a growing child. This article discusses the conventional and implant-driven concepts to treat patients from childhood to adolescence with selective or multiple missing permanent teeth.

13C-methacetin breath test as a quantitative liver function test in patients with chronic hepatitis C infection: continuous automatic molecular correlation spectroscopy compared to isotopic ratio mass spectrometry.

BACKGROUND: The (13)C-methacetin breath test (MBT) has been proposed for the non-invasive evaluation of hepatic microsomal activity. AIM: To test a new continuous breath analysis system (BreathID) in comparison with gold-standard isotopic ratio mass spectrometry (IRMS) in patients with chronic hepatitis C infection and to assess the diagnostic performance of these validation data compared with liver biopsy for the quantification of liver fibrosis. METHODS: Fifty patients at different METAVIR stages received 75 mg of (13)C-methacetin. Breath isotopic ratio was analysed over 90 min by BreathID (one sample/3 min; BreathID) and IRMS (one sample/10 min). Results were expressed as delta over baseline [DOB (%)] at each time interval and maximal DOB [DOB(max)(%)]. RESULTS: A high linear association between both methods was observed (R(2) = 0.95, P < 0.001). For all DOB and DOB(max), the limits of agreement by Bland-Altman analysis were within the predefined maximal width of s.d. <2.5%. MBT parameters in patients with high-grade fibrosis were different from patients with low-grade fibrosis (P < 0.001). CONCLUSION: The MBT obtained by an easy to operate, automated BreathID provides results comparable with standard IRMS and differentiates fibrosis grades in patients with chronic hepatitis C infection.

Dopaminergic and opioidergic regulation of gonadotropin and prolactin release in stallions.

In the non-breeding season, LH release is reduced via dopaminergic systems in the ram. On the other hand, our previous studies demonstrated an opioidergic inhibition of LH release in stallions outside the breeding season. Thus, in the present study we investigated the dopaminergic regulation of LH and prolactin secretion in stallions, considering interactions between dopamine and opioids. To achieve this, stallions (n=8) were treated with the dopamine antagonist sulpiride (0.6 mg/kg), the opioid antagonist naloxone (0.5 mg/kg), sulpiride plus naloxone or saline in December, March and June. Two hours after the respective treatments, they received a GnRH agonist. Sulpiride induced a significant prolactin release which was most pronounced in December, indicating seasonal variations in the inhibition of prolactin secretion by dopaminergic systems. Prolactin concentrations were not changed by naloxone. Neither during nor outside the breeding season, a dopaminergic regulation of LH release could be demonstrated. In contrast, naloxone caused a significant (p < 0.05) LH release, confirming an opioidergic inhibition of LH release. In conclusion, opioidergic regulation of LH and dopaminergic inhibition of prolactin secretion undergo seasonal changes. Neither during nor outside the breeding season, dopaminergic effects on LH release exist in the stallion.

Sustained dysfunction of antiviral CD8+ T lymphocytes after infection with hepatitis C virus.

Hepatitis C virus (HCV) sets up persistent infection in the majority of those exposed. It is likely that, as with other persistent viral infections, the efficacy of T-lymphocyte responses influences long-term outcome. However, little is known about the functional capacity of HCV-specific T-lymphocyte responses induced after acute infection. We investigated this by using major histocompatibility complex class I-peptide tetrameric complexes (tetramers), which allow direct detection of specific CD8+ T lymphocytes ex vivo, independently of function. Here we show that, early after infection, virus-specific CD8+ T lymphocytes detected with a panel of four such tetramers are abnormal in terms of their synthesis of antiviral cytokines and lytic activity. Furthermore, this phenotype is commonly maintained long term, since large sustained populations of HCV-specific CD8+ T lymphocytes were identified, which consistently had very poor antiviral cytokine responses as measured in vitro. Overall, HCV-specific CD8+ T lymphocytes show reduced synthesis of tumor necrosis factor alpha (TNF-alpha) and gamma interferon (IFN-gamma) after stimulation with either mitogens or peptides, compared to responses to Epstein-Barr virus and/or cytomegalovirus. This behavior of antiviral CD8+ T lymphocytes induced after HCV infection may contribute to viral persistence through failure to effectively suppress viral replication.

Vigorous peripheral blood cytotoxic T cell response during the acute phase of hepatitis C virus infection.

After infection by hepatitis C virus (HCV), a minority of patients develop acute symptomatic disease and some of them are able to clear the virus. In this study, we analyzed peripheral blood mononuclear cells from nine patients with acute symptomatic disease with respect to their cytotoxic T lymphocyte (CTL) response using a panel of HCV-derived peptides in a semiquantitative secondary in vitro culture system. We could detect early CTL responses in 67% of these patients. The CTL responses were directed against multiple viral epitopes, in particular within the structural (core 2-9, core 35-44, core 131-140, and core 178-187) and nonstructural regions of the virus (NS3 1073-1081, NS3 1406-1415, NS4 1807-1816, NS5 2252-2260, and NS5B 2794-2802). We compared the CTL responses displayed by recently and chronically infected HLA-A2-positive patients. Virus-specific CTLs were detectable in chronic carriers but the percentage of positive peptide-specific CTL responses was significantly higher in recently infected patients (P = 0.002). Follow-up of recently infected patients during subsequent disease development showed a significant decrease in the values and proportions of positive peptide-specific CTL responses (P = 0.002 and 0.013, respectively). Patients with limited viral replication exhibited significantly more vigorous early responses (P = 0.024). These data suggest a protective role for the early antiviral CTL response in HCV infection.

Association of hepatitis C virus-specific CD8+ T cells with viral clearance in acute hepatitis C.

CD8+ T lymphocytes play a major role in antiviral immune defense. Their significance for acute hepatitis C is unclear. Our aim was to correlate the CD8+ T cell response with the outcome of infection. Eighteen patients with acute hepatitis C and 19 normal donors were studied. Hepatitis C virus (HCV)-specific CD8+ T cells were identified in the enzyme-linked immunospot assay by their interferon-gamma (IFN-gamma) production after specific stimulation. The highest numbers of IFN-gamma-producing HCV-specific CD8+ T cells were found in patients with acute hepatitis C and a self-limited course of disease during the first 6 months after onset of disease, but these numbers dropped thereafter to undetectable levels. The differences in responsiveness between patients with self-limited disease versus patients with a chronic course were statistically significant (P<.001). Our data show that the number of IFN-gamma-producing HCV-specific CD8+ T cells during the first 6 months after onset of disease is associated with eradication of the HCV infection.

Regulation of seasonal reproductive activity in the stallion, ram and hamster.

This review considers seasonal reproduction in male animals with emphasis on the stallion, ram and hamster. The pineal hormone melatonin is the common link between photoperiod and reproduction. An increase in the daily diurnal period of melatonin secretion is associated with a decrease in GnRH release in long-day breeders, but an increase in GnRH release in short-day breeders. Melatonin influences GnRH release within or close to the mediobasal hypothalamus in rams; whereas melatonin receptors have not been found in the hypothalamus of horses. Prolactin release is positively correlated with daylength. Prolactin concentrations are consequently low during the breeding season of sheep and high during the breeding season of horses and hamsters. Prolactin stimulates testicular function in rams. Seasonal changes in GnRH release in the horse are regulated by changes in a GnRH-inhibitory opioidergic tone. Opioids are at least, in part, responsible for the decrease in testicular function during winter. An opioidergic inhibition of LH release is present during the breeding season in rams; but dopaminergic pathways inhibit LH release during long daylight hours. A dopaminergic inhibition of LH release does not exist in stallions.

Seasonal variation and opioidergic regulation of growth hormone release in cyclic, ovariectomized, and pregnant pony mares.

Modulation of reproductive functions is one of the multiple effects of growth hormone (GH). To investigate effects of reproductive functions on GH release in the horse, plasma GH concentrations in ovary-intact (n = 7) and ovariectomized (n = 8) mares during the anovulatory and breeding seasons and in pregnant mares (n = 6) at various stages of gestation were determined. To analyze an opioidergic regulation of GH release, repeated blood samples were taken over 3 h, and mares were injected with the opioid antagonist naloxone (0.5 mg/kg i.v.) or saline. GH was determined by RIA with an antiserum raised against porcine GH and equine GH as standard. In ovariectomized and ovary-intact, cyclic mares, GH concentrations were low and not different between the two groups in November and December. GH concentrations increased significantly (P < 0.05) in cyclic mares during May and June but were not affected by stage of the cycle and were low in ovariectomized mares. In pregnant mares, plasma GH concentrations remained high throughout pregnancy and did not decrease during winter but increased significantly (P < 0.05) postpartum. Naloxone induced a significant GH release in ovary-intact mares; this response was most pronounced (P < 0.05) during the breeding season. Naloxone did not affect GH in ovariectomized mares. During pregnancy, naloxone induced a significant release of GH around Day 280 (P < 0.05) but not at other times of pregnancy. In conclusion, GH release is influenced by season. The seasonal changes depend on ovarian factors, are absent in ovariectomized mares, and can be modulated by pregnancy. GH release is regulated at least in part by opioidergic pathways.

Role of the specific T-cell response for clearance and control of hepatitis C virus.

T cells are believed to be the main players in antiviral defence. To investigate the role of the specific CD4+ T cell response for clearance and control of the hepatitis C virus we studied patients with acute hepatitis C (AHC) during the phase of spontaneous viral clearance and during follow up after elimination of the virus and resolution of disease. Symptomatic AHC has a self-limited course in 50% of patients, whereas the other half show virus persistence and develop chronic course of disease. Patients who were able to mount a vigorous, polyclonal, multispecific, TH1 lymphokine dominated CD4+ T-cell response showed viral clearance and a self-limited course of disease. In contrast, absence of this T-cell response in patients with AHC invariably led to viral persistence and chronic hepatitis. The characteristics of the T-cell response were as follows: it was mainly directed against nonstructural proteins of the virus, it was multispecific and demonstrated immunodominant epitopes, and the majority of T-cell clones established from our patients responded to a single peptide (NS3 amino acid 1248-1261) within the helicase region of HCV. Presentation of the peptide was HLA DR specific, the peptide showed promiscuous binding, and it had high binding affinity to 10 of the most common 13 HLA DR alleles, thus patients with diverse HLA DR backgrounds could mount an immune response. Furthermore, the epitope was conserved in 100% of 33 HCV strains published in databases. This strong initial CD4+ T-cell response is not sufficient for a definitive recovery from AHC, it has to be maintained to control the hepatitis C virus. Loss of the response after initial resolution of disease is followed by relapse. Even 20 years after an episode of self-limited AHC with elimination of HCV, we have observed a significant virus-specific CD4+ T-cell response. Our data indicate the decisive role of the virus-specific CD4+ T-cell response for clearance and control of HCV, and contribute to our understanding of immune mechanisms by which the host defends the HCV virus. This is a prerequisite for the development of new strategies to efficiently defend the virus by manipulating or modulating the immune response.

Effect of hyperbaric oxygen on survival of the composite ear graft in rats.

In this study the authors set out to determine whether postoperative hyperbaric oxygen (HBO) therapy increases the survival rate of the composite graft in the rat ear model. A composite graft (1 x 0.5 cm2) that included skin, subcutaneous tissue, and cartilage was created from the left ear, and was transferred onto the posterior auricular site of the right ear. The animals were divided into two groups: a control group (N = 10) and an experimental group receiving HBO (N = 10). The experimental group was given HBO immediately following reattachment for 4 hours, and then for 6 hours each day for 5 days (2 atm). The results showed the average ear flap survival area in the experimental group was 82%, and it was 26.5% in the control group (p < 0.01). Histology demonstrated the existence of neovascularization in the experimental group. We have concluded that postoperative HBO therapy increases the survival of the rat ear composite graft, and that the effect of this therapy is influenced by the magnitude (size and thickness) of the graft.

Anergic TH1 clones specific for hepatitis B virus (HBV) core peptides are inhibitory to other HBV core-specific CD4+ T cells in vitro.

A strong and transient hepatitis B virus core (HBc)-specific CD4+ T-cell response has been shown to be associated with viral elimination in acute self-limited hepatitis B but to be absent in chronic hepatitis B. So far, little is known about immunological mechanisms involved in the regulation of the HBc-specific CD4+ T-cell response. We studied 28 patients with acute hepatitis B, and frequently a sudden decrease in the HBc-specific CD4+ T-cell response was found between 4 and 8 weeks after disease onset. Thirty-two CD4+ T-cell clones specific for amino acids 50 to 69, 81 to 105, 117 to 131, or 141 to 165 of HBc were isolated from a patient shortly before the peripheral blood mononuclear cell response to most HBc-derived peptides abruptly disappeared. TH1 clones, but not TH0 clones, could be anergized in vitro by stimulation with specific peptides even in the presence of costimulatory cells. Moreover, when anergic cells were mixed with responsive cells, the proliferation of HBc-specific TH1 or TH0 clones was inhibited antigen specifically by anergic cells. The unusual susceptibility of HBc-specific TH1 clones to anergy induction in vitro as well as their potential to inhibit other HBc-specific TH1 and TH0 clones suggests that anergy induction may be involved in the downregulation of the virus-specific immune response during acute hepatitis B in vivo.

The role of hepatitis C virus specific CD4+ T lymphocytes in acute and chronic hepatitis C.

Since the discovery of hepatitis C virus it has become clear that chronic hepatitis C is a major health problem throughout the world. Because antiviral agents are of limited value in the treatment of chronic hepatitis C, research has focused on the antiviral immune response for the development of both a protective vaccine and effective immunotherapies for established chronic infection. Antiviral antibodies are present in almost all patients with chronic hepatitis C but do not seem to be virus neutralizing, probably due to the high mutational rate of viral envelope proteins. Studies on the antiviral T cell response have revealed the presence of virus-specific CD4+ helper and CD8+ cytotoxic T cells in a substantial proportion of patients with chronic hepatitis C. Recent studies describe an association between strong CD4+ T helper cell activity to certain hepatitis C virus antigens and a self-limited course of acute hepatitis C and possibly also a sustained response to treatment with interferon-alpha. Therapeutic manipulation of the virus-specific T cell response may thus develop into a new approach for prevention and treatment of hepatitis C virus infection.