As the number of people receiving a Hepatitis C diagnosis grows, media attention focusing on this virus has intensified. Education about the prevalence and potential severity of Hepatitis C is badly needed to raise awareness of this highly communicable and often asymptomatic (until it's too late) disease. A television program broadcast in June of 2010 is to be commended for spearheading such an awareness campaign; but it also has some people expecting a cure for Hepatitis C to arrive unrealistically soon.

As described in a recent TV presentation, scientists around the world are fervently working to find effective, safe drugs for treating and preventing Hepatitis C. However, those who are not familiar with the process of drug development could easily misinterpret the progress described on television with the notion that a vaccine for Hepatitis C will hit the market any day now.

Believed to currently infect between four and five million Americans, those infected with Hepatitis C far outnumber those with HIV, the virus that causes AIDS. A leading cause of chronic liver disease that has no vaccine or reliable cure, Hepatitis C presents many challenges to the medical community. Among those challenges are:

· The current treatment in effect is only successful in about half of all cases.

· The virus demonstrates an ability to develop drug resistance.

· Chronic Hepatitis C can progress to severe or even fatal liver disease.

According to their website, KQED Public Television 9 is one of the nation's most-watched public television stations during primetime with more than 1.5 million households viewing per month. A KQED weekly program, This Week in Northern California with host Belva Davis follows a magazine format and is committed to news and public affairs. The June 25, 2010 episode of This Week in Northern California featured an informative piece entitled "Hepatitis C: The Silent Epidemic." Summing up this segment, KQED reports:

"A San Francisco Task Force on Hepatitis C is helping to find a cure for the disease, which is four times more prevalent in the Bay Area as AIDS. ...Dr. Jeffrey Glenn and his team of researchers at the Stanford University School Of Medicine are looking for compounds that will prevent the Hepatitis C virus from replicating. And at the Gladstone Institutes at UCSF, Dr. Melanie Ott and her staff are doing groundbreaking research on the relationship between the virus and fat droplets in the liver that could soon lead to a cure."

Watching the video segment delivers hope to those waiting for a reliable solution for Hepatitis C. The researcher interviewed appears excited to be a part of a Hepatitis C-soon-to-be-cure. While it is hard not to get caught up in the excitement, the research from Stanford and UCSF's Gladstone Institutes are still in the beginning stages of making progress against this virus.

A scientific discovery that further unravels the mystery behind Hepatitis C is definitely reason for celebration, but it is far from delivering a cure. After realizing the clinical impact of the discovery, scientists begin the process of identifying potential substances that could inhibit or fight the virus. Once a promising medication is apparent, the testing of that drug is a long process. Typically taking about 12 years to come to fruition, a new drug must persevere through pre-clinical testing, clinical trials and U.S. Food and Drug Association (FDA) approval before it finally reaches the marketplace. For more detailed information about this process, read "An Overview of the HCV Drug Development Process."

The research described in the KQED segment is encouraging. Scientists at the Gladstone Institute of Virology and Immunology found that an important viral protein, called the "core" protein, localizes to the mitochondria. Through examining liver fat droplets in the mitochondria, new mechanisms for treating Hepatitis C could follow. While drugs capitalizing on this information could be in the future, there are others that are closer to actualization. This television program focused solely on San Francisco Bay area developments. However, there are other medications, such as telaprevir, that have already endured years of development. Shown to drastically boost the Hepatitis C cure rate, telaprevir could be available to the public as early as 2011.

Good job to KQED for bringing the lack of Hepatitis C awareness and education to the forefront. The research focusing on fat droplets in the liver is invaluable to the eventual conquering of the Hepatitis C virus, but it has not yet produced a cure. As we see more education campaigns exposing the gravity of Hepatitis C infection, a greater level of comprehension will also be needed to understand the drug development process. In the meantime, rest assured that progress is being made - and even if it doesn't end the Hepatitis C epidemic this year - the scientific community is certainly headed in that direction.

References:

http://news.ucsf.edu/fyi/daily/2010/06/28/, UCSF Television Coverage, Retrieved August 26, 2010, The Regents of the University of California, 2010.

http://www.gladstone.ucsf.edu/wp/2010/02/hepcviralprotein/, Hepatitis C Viral Protein Associates with the Mitochondria, Retrieved August 25, 2010, J. David Gladstone Institutes, 2010.

http://www.hepatitis-central.com/mt/archives/general_hepatitis_c_newsupdates/, An Overview of the HCV Drug Development Process, Nicole Cutler, L.Ac., Retrieved August 28, 2010, Natural Wellness, 2010.

http://www.kqed.org/tv/programs/thisweek/watch/archive/226569/b, Hepatitis C: The Silent Epidemic, Retrieved August 26, 2010, KQED, 2010.

http://www.mdpi.com/1999-4915/2/5/1195/, Lipid Metabolism and HCV Infection, Paul Targett-Adams, et al, Retrieved August 25, 2010, Viruses, May 2010.

Proof-of-Concept Trial in Patients with Chronic Hepatitis C Planned for Q4 2010

ATLANTA, Sep 01, 2010 (BUSINESS WIRE) -- Inhibitex, Inc. announced today that it has successfully completed a Phase1a, first-in-man, single ascending dose trial of INX-189, its nucleotide polymerase inhibitor in development for the treatment of chronic hepatitis C (HCV) infections. In this trial, 42 healthy volunteers received either a single oral dose of INX-189, ranging from 3 mg to 100 mg, or placebo.

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http://www.marketwatch.com/story/inhibitex-successfully-completes-phase-1a-trial-of-inx-189-2010-09-01?reflink=MW_news_stmp

Acupuncture treatments are often considered to help those with Hepatitis C, the most common chronic blood borne pathogen in the United States. Affecting over four million Americans, chronic Hepatitis C can progress to advanced liver disease - a severe, potentially fatal condition. Although recent pharmaceutical developments look promising, the current treatment for Hepatitis C is effective in only about half of those infected. Without a guaranteed cure, many people look for help outside of the pharmaceutical industry.

Benefitting people with liver diseases for at least 2,000 years, Traditional Chinese Medicine (TCM) has many approaches for combating Hepatitis C; the most well known of which is acupuncture. Despite the success many have had with acupuncture, fears and misconceptions still keep others from experiencing its benefits. Several of the myths that perpetuate acupuncture's misunderstanding, include:

• Myth - Hepatitis C is easily spread through acupuncture.
• Truth - While sharing contaminated needles can transmit this blood borne virus, today's acupuncturists only use sterile, single-use, disposable needles. When used appropriately by a licensed acupuncturist, there is no risk of Hepatitis C transmission.

• Myth - Acupuncture is painful.
• Truth - Most acupuncture recipients experience gentle sensations from acupuncture needles that range from warmth to tingling to heaviness. For those who are particularly sensitive to acupuncture, TCM practitioners can use pediatric needles to prevent any painful sensations.

• Myth - Acupuncture can cure Hepatitis C.
• Truth - Acupuncture treatments can help many aspects of chronic Hepatitis C infection (ease symptoms, strengthen immunity and improve liver function), but claims that it can cure this virus are not valid.

One of the tenets of TCM is that each person is treated as an individual, based on his or her specific presentation. Thus, acupuncture treatments for Hepatitis C are custom-tailored to the recipient. When it comes to scientifically proving its effectiveness, this customized approach is acupuncture's predominant weakness. This is because respectable clinical trials rely on treatment uniformity to arrive at a reproducible conclusion. Regardless of this challenge, anecdotal evidence and several studies favor acupuncture's use for Hepatitis C.

Devised for several of the most common ways Hepatitis C is presented, acupuncture protocols have successfully helped people infected with the virus decrease symptoms, normalize or lower liver enzymes and slow the progression of liver disease:

• A 1995 pilot study conducted among people co-infected with HIV and viral Hepatitis (B and C) at San Francisco's Quan Yin Healing Arts Center indicated acupuncture alone may have an effect in lowering and/or normalizing liver enzyme levels.
• Published in a June 2010 issue of Acupuncture in Medicine, Turkish researchers found that depressive symptoms and myalgia (muscle pain) that are commonly seen in patients with chronic Hepatitis B and C can be relieved significantly with acupuncture.
• Published in an August 2010 edition of Neuroscience Letters, a Brazilian study found that acupuncture increased T-cell proliferation, an effect known to strengthen the immune system.
• Published in a June 2010 issue of Medical Acupuncture, researchers from Oregon investigated acupuncture's effectiveness at reducing adverse side effects from interferon therapy for Hepatitis C. They found that acupuncture offered significant benefits to patients treated with interferon for Hepatitis C in decreasing muscle aches, fatigue, irritability and nausea.

Acupuncture is typically painless and does not carry a risk of disease transmission; however, it is not a reliable means to eliminate Hepatitis C. Instead, acupuncture should be utilized as a powerful adjunct to traditional medical therapies. Until the pharmaceutical industry creates a more effective treatment regimen for Hepatitis C, acupuncture appears to be a drug-free method capable of reducing symptoms, fortifying the immune system and improving liver function.

References:

http://aim.bmj.com/content/early/2010/06/04/aim.2009.002170.abstract, Acupuncture for depression and myalgia in patients with hepatitis: an observational study, Zeliha Kocak Tufan, et al, Acupuncture in Medicine, June 2010.

http://www.acufinder.com/Acupuncture+Information/Detail/Chinese+Traditional+Medicine+for+Hepatitis+C, Chinese Traditional Medicine for Hepatitis C, Dr. Misha Cohen, OMD, L.Ac., Retrieved August 21, 2010, docmisha.com, 2010.

http://www.docmisha.com/applying/hepatitisc/hepatitisc.htm, Hepatitis C Help, Misha Cohen, OMD, L.Ac., Retrieved August 21, 2010, Misha Ruth Cohen, 2010.

http://www.liebertonline.com/doi/abs/10.1089/acu.2010.0740, Acupuncture for Adverse Effects of Interferon Therapy for Hepatitis C Infection, Diane Miller MD, et al, Retrieved August 22, 2010, Medical Acupuncture, June 2010.

http://www.ncbi.nlm.nih.gov/pubmed/20709154, Acupuncture is Effective to Attenuate Stress and Stimulate Lymphocyte Proliferation in the Elderly, Pavao TS, et al, Retrieved August 22, 2010, Neuroscience Letters, August 2010.

http://www.pacificcollege.edu/acupuncture-massage-publications/acupuncture-for-cirrhosis.html, Acupuncture for Cirrhosis, Retrieved August 22, 2010, Pacific College of Oriental Medicine, 2010.

For centuries, the extract from the milk thistle plant has been used to improve liver function. This practice is widely recognized - especially by the millions of people living with chronic Hepatitis C - a viral infection that can cause progressive damage to the liver. Hundreds of studies have provided evidence that silymarin, milk thistle's extract, is a potent liver cell protector. However, there have also been an abundance of conflicting reports regarding milk thistle's ability to directly affect the Hepatitis C virus. Providing even more reason for those with Hepatitis C to take milk thistle, a new study tips the scales of doubt by showing that silymarin exerts multiple effects against the lifecycle of the Hepatitis C virus.

Two previous studies that have indicated silymarin's usefulness against Hepatitis C include:

· The February 2008 issue of Hepatology looked at milk thistle use among 1,145 participants in the HALT-C study, sponsored by the National Institute of Diabetes and Digestive and Kidney Disease. Although milk thistle users in this study showed similar liver enzyme levels and Hepatitis C viral loads to non-users, those taking milk thistle showed fewer liver-related symptoms and an improved quality of life.

· The March 2010 issue of Gastroenterology published a French study where researchers evaluated a commercially available intravenous preparation of silibinin - the most active component of silymarin - in those with the Hepatitis C virus. The researchers agreed that silibinin inhibited Hepatitis C polymerase function - a result comparable to what the STAT-C (specifically targeted antiviral therapy for Hepatitis C) drugs can do - without their accompanying hazards.

The new study that further identifies milk thistle as an anti-Hepatitis C substance examined the antiviral properties and mechanisms of silymarin on cultured (grown in a lab) human liver cells infected with the virus. The study, funded in part by the National Center for Complementary and Alternative Medicine (NCCAM), was published in the June 2010 edition of the journal, Hepatology.

After growing human liver cells and infecting them with the Hepatitis C virus, the cells were exposed to either standard Hepatitis C drug treatment or a diluted dose of silymarin. The researchers then found the following:

· Silymarin prevented the entry and fusion of the Hepatitis C virus into the target liver cells.

· Silymarin inhibited the ability of the virus to produce RNA, thus interfering with a portion of the virus' lifecycle.

· When measured against untreated cells, silymarin significantly decreased viral load (although to a lesser degree than treatment with interferon did).

· Silymarin prevented the cell-to-cell spread of the Hepatitis C virus.

Upon carefully taking all of the variables into account, the researchers concluded that silymarin's antiviral action appears to include blocking the entry and transmission of the Hepatitis C virus, possibly by targeting the host cell.

Experts agree that more well-structured trials are needed to understand, quantify and verify silymarin's effectiveness against the Hepatitis C virus. More ammunition is required to break down the wall of doubt surrounding this herb's contribution to the Hepatitis C community. In the meantime, there is sufficient evidence confirming silymarin's ability to protect liver cells and improve liver function - two properties that everyone with Hepatitis C could benefit from.

References:

http://nccam.nih.gov/research/results/spotlight/061610.htm, Effects of Milk Thistle Extract on the Hepatitis C Virus Lifecycle, Retrieved August 13, 2010, National Institutes of Health National Center for Complementary and Alternative Medicine, 2010.

http://www.hcvadvocate.org/news/newsLetter/2010/advocate0210.html#2, Healthwise: Milk Thistle, Lucinda K. Porter, RN, Retrieved August 13, 2010, Hepatitis C Support Project, 2010.

http://www.ncbi.nlm.nih.gov/pubmed/19962982, Silibinin and related compounds are direct inhibitors of hepatitis C virus RNA-dependent RNA polymerase, Ahmed-Belkacem A, et al, Retrieved August 14, 2010, Gastroenterology, March 2010.

http://www.ncbi.nlm.nih.gov/pubmed/20512985, Multiple effects of silymarin on the hepatitis C virus lifecycle, Wagoner J, et al, Retrieved August 13, 2010, Hepatology, June 2010.

http://www.webmd.com/digestive-disorders/tc/milk-thistle-topic-overview?ecd=wnl_hep_071510, Milk Thistle - Topic Overview, Retrieved August 14, 2010, WebMD, LLC, 2010.

8/12/2010

PRINCETON, N.J., Aug. 12 /PRNewswire-FirstCall/ -- Pharmasset, Inc. (Nasdaq:VRUS - News) has received fast track designation from the U.S. Food and Drug Administration (FDA) for PSI-7977 for the treatment of chronic hepatitis C virus (HCV) infection. PSI-7977 is an oral uridine nucleotide analog polymerase inhibitor of HCV. Pharmasset recently completed dosing in a 28 day Phase 2a trial to evaluate PSI-7977 in combination with Pegasys (pegylated interferon) plus Copegus (ribavirin) in treatment-naive patients chronically infected with HCV genotype 1. Pharmasset expects to initiate a 12-week Phase 2b study of PSI-7977 in the fourth quarter of 2010.

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http://www.biospace.com/news_story.aspx?NewsEntityId=190768&Source=TopBreaking

Many women with a chronic viral infection are wary of procreating, because of the chance they may pass their illness on during pregnancy or birth. For those infected with Hepatitis C, this fear is especially pronounced.

There are a handful of reasonable causes supporting a fear of carrying a baby and giving birth with Hepatitis C. They include:

· Hepatitis C is rampant in our society - affecting approximately four million Americans.

· Hepatitis C often leads to chronic liver disease.

· There is currently no guaranteed cure for Hepatitis C.

· Nearly half of those with Hepatitis C are unsure as to how they originally became infected.

Known as vertical transmission, the risk of infants acquiring Hepatitis C from their mother during pregnancy or childbirth is surprisingly low. There have been quite a few studies examining what the likelihood is of vertical transmission and what increases or decreases the risk of infecting a newborn with Hepatitis C.

Although the statistics determining the rate of vertical transmission is not uniform among these studies, experts believe the most accurate estimate of vertical transmission from mothers with Hepatitis C is five percent. Based upon a comprehensive review of trials investigating Hepatitis C vertical transmission, the following appear to represent the two largest risks for bearing a child with Hepatitis C:

1. The mother is co-infected with Hepatitis C and HIV.

2. The mother has a high Hepatitis C viral load during birth.
In addition, physicians typically relay the following information to pregnant women with Hepatitis C:

· The presence of Hepatitis C infection does not appear to result in a higher risk pregnancy or a higher incidence of poor obstetric outcome.

· Testing for the presence of Hepatitis C in infants born to infected mothers should not begin until at least one year following delivery. The natural history of Hepatitis C infected infants is poorly understood at this time.

· Prophylactic caesarian section is not recommended in Hepatitis C infected mothers. The role of cesarean delivery in mothers co-infected with Hepatitis C and HIV remains controversial.

· Breastfeeding presents a negligible risk of Hepatitis C transmission. Given the well-documented benefits of breastfeeding, it is highly recommended.

It has been a while since there were any additional factors recognized to affect the likelihood of vertical transmission. However, researchers from Italy have recently identified a genetic component that reliably foretells this possibility.

As published in the July 2009 edition of the journal Virology, a mismatch between genes carried by a mother and her infant appear to confer protection against Hepatitis C transmission. Elena Bevilacqua and colleagues from Italy investigated the role of several genes known to play a role in Hepatitis C infection. These researchers found that a specific gene, HLA-DRB1, could predict whether or not the infant acquires Hepatitis C infection from its mother. Based on this research:

1. When a mother and child have the same genetic variant of HLA-DRB1, there is no guarantee that vertical transmission will occur; it just increases the likelihood.

2. When a mother and child have different variations of HLA-DRB1, there appears to be guaranteed protection from vertical transmission.

Unfortunately, a mother cannot control the similarity or dissimilarity of her infant's genetic construction. However, whenever a trial reveals a definitive link for Hepatitis C transmission, we gain some ground in understanding this virus. Undoubtedly, the more information gathered on how Hepatitis C is transmitted, infects people, replicates and dies, the closer we are - as a whole - to putting an end to this source of chronic liver disease.

References:

http://en.wikipedia.org/wiki/HLA-DR, HLA-DR, Retrieved September 17, 2009, Wikimedia Foundation Inc., 2009.

http://www.hcvadvocate.org/hcsp/articles/HERRINE.html, Mother-to-Child Transmission of HCV, Steven K. Herrine, MD, Retrieved September 15, 2009, Hepatitis C Support Project, 2009.

http://www.hivandhepatitis.com/hep_c/news/2009/090109_a.html, Genetic Factors Influence Risk of Mother-to-child Hepatitis C Virus Transmission, Retrieved September 15, 2009, hivandhepatitis.com, 2009.

http://www.ncbi.nlm.nih.gov/pubmed/15239255, Diagnostic and prognostic value of virologic tests in vertical transmission of hepatitis C virus infection: results of a large prospective study in pregnant women, Saez, A, et al, Retrieved September 16, 2009, Hepato-Gastroenterology, July-August 2004.

http://www.ncbi.nlm.nih.gov/pubmed/19481774, Genetic factors in mother-to-child transmission of HCV infection, Bevilacqua E, et al, Retrieved September 16, 2009, Virology, July 2009.

Ryan McBride 8/10/10

[Updated. 8:55 am Eastern time. See editor's note.] Vertex Pharmaceuticals's (NASDAQ:VRTX) lead drug candidate for hepatitis C infection has passed another test. The Cambridge, MA-based company, which has West Coast operations in San Diego, says today that it now has proof that its drug in combination with standard therapies can wipe out the chronic liver damaging disease about as well in 24 weeks as in 48 weeks.

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http://www.xconomy.com/boston/2010/08/10/vertexs-telaprevir-clears-hurdle-could-halve-treatment-times-for-hepatitis-c/

A hormone normally found in the stomach is proving to be of great interest to the Hepatitis C community. Known as an appetite-stimulating hormone, ghrelin is regarded with disdain by dieters and overweight individuals. Interestingly, ghrelin has demonstrated the ability to minimize one of the greatest hazards of the Hepatitis C virus - liver fibrosis.

About Ghrelin
Made in the stomach, ghrelin levels rise when people are hungry and they wane after a meal. People who get injections of this hormone gorge themselves, and those suffering from a rare disease that keeps ghrelin levels unusually high tend to be obese overeaters. Not surprisingly, researchers seeking to help people shed excessive weight have been actively trying to block ghrelin since its recognition in the late '90s. Of course, blocking an essential hormone carries unknown risks to our health. For people with chronic liver disease, researchers from Spain have uncovered a valid reason to treasure ghrelin - and be weary of blocking this curious hormone.

Fibrosis
One of the few organs that can regenerate, the liver has the remarkable ability to recover from minor injuries by healing itself. Unfortunately, this regenerative capacity can't keep up with diseases that cause significant liver damage. For those individuals living with chronic Hepatitis C (or any other kind of chronic liver disease), progressive scarring of liver tissue is a major concern.

Otherwise known as fibrosis, continual liver scarring can lead to cirrhosis - which ultimately renders the liver unable to function. Over 27,000 Americans die from cirrhosis annually, making it the country's third leading cause of death for people between the ages of 25 and 59, and the seventh leading cause of death overall. Needless to say, strategies to prevent fibrosis from worsening to cirrhosis are in high demand. Despite this need, there are currently no approved anti-fibrotic therapies on the market.

Ghrelin Fights Fibrosis
Published in the March 2010 edition of Hepatology, researchers from Spain's Hospital Clinic of Barcelona discovered that ghrelin has the potential of being a novel, anti-fibrotic therapy. According to Dr. Ramón Bataller, part of the team involved in the Barcelona study, "Our aim was to determine if recombinant ghrelin could regulate the formation of fibrous tissue associated with chronic liver damage."

The research team found the following:

· In animal models, ghrelin reduced the amount of fibrogenic cells by 25 percent.

· Participants with chronic Hepatitis C and alcoholic hepatitis had significantly lower ghrelin levels than did healthy individuals.

The researchers concluded that ghrelin inhibits the development of liver fibrosis in both animals and humans.

Insulin Resistance
The link connecting this appetite-stimulating hormone to its protection against liver fibrosis remains unclear. However, research from 2003 may be on the right track. According to an Italian study published in the Journal of Clinical Endocrinology & Metabolism, insulin resistance may be the bridge between ghrelin levels and liver damage. In individuals with NAFLD (non-alcoholic fatty liver disease), insulin resistance is believed to be relatively independent of obesity. After evaluating subjects with NAFLD, the Italian researchers found that insulin resistance plays a primary role in controlling ghrelin levels.

Insulin resistance is a decreased ability to respond to the effects of insulin, a hormone that helps transport glucose into the body's cells for making energy. Since cells need glucose to survive, the body compensates for insulin resistance by producing additional amounts of this hormone. Although not a disease or specific diagnosis, insulin resistance has a ripple effect on the body and is associated with heart disease, polycystic ovarian syndrome, Type 2 diabetes, obesity and NAFLD.

Thanks to Bataller's team, the connection between ghrelin and fibrosis could help prevent liver scarring in people who are most prone. Future studies are likely going to take insulin resistance into consideration while determining the safety and efficacy of ghrelin in people with chronic liver disease. If this hormone continues to prove its value to the liver, efforts to block ghrelin for weight loss purposes will likely lose steam. On the other hand, those with Hepatitis C could benefit by finally having a therapeutic option to prevent the progression of liver scarring.

References:

http://cordis.europa.eu/fetch?CALLER=EN_NEWS&ACTION=D&SESSION=&RCN=31823, Body's own hormone may be liver disease's worst foe, Retrieved March 15, 2010, CORDIS Services, 2010.

http://jcem.endojournals.org/cgi/content/abstract/88/12/5674, Low Ghrelin Concentrations in Nonalcoholic Fatty Liver Disease Are Related to Insulin Resistance, G.Marchesini, et al, Retrieved March 19, 2010, Journal of Clinical Endocrinology & Metabolism, August 2003.

http://www.cbsnews.com/stories/2003/03/11/60II/main543614.shtml, The Hunger Hormone, Carol Kopp, Retrieved March 15, 2010, CBS Interactive Inc., 2010.

http://www.eurekalert.org/pub_releases/2010-03/w-gml022510.php, Ghrelin mitigates liver fibrosis in animal models; regulates human fibrosis, Retrieved March 15, 2010, EurekAlert, 2010.

http://www.healthsquare.com/fgpd/fg4ch20.htm, Dealing with Liver Disease, Retrieved March 19, 2010, The HealthCentral Network, Inc., 2010.

http://www.labtestsonline.org/understanding/conditions/insulin_resistance.html, Insulin Resistance, Retrieved March 19, 2010, American Association for Clinical Chemistry, 2010.

http://www.ncbi.nlm.nih.gov/pubmed/20077562, Ghrelin attenuates hepatocellular injury and liver fibrogenesis in rodents and influences fibrosis progression in humans, Moreno M, et al, Retrieved March 15, 2010, Hepatology, March 2010.

http://www.newscientist.com/article/dn13845-stomach-hormone-turns-hungry-people-into-junkies.html, Stomach hormone turns hungry people into junkies, Ewen Callaway, Retrieved March 18, 2010, Reed Business Information Ltd, 2010.

August 5, 2010

Research led by the University of Leeds has found drugs such as anti-diabetic drug Metformin and AICAR, used to combat obesity, can prevent the hepatitis C virus from replicating in the body. Hepatitis C virus affects an estimated three per cent of the world's population and there are four million carriers of the virus in Europe alone. The virus affects the liver and recovery rates are low: only around 40 % of hepatitis C sufferers will fully recover, with others developing cirrhosis and in many cases, liver cancer.

"We're very excited about these findings," said Professor Mark Harris from the University's Faculty of Biological Sciences. "These drugs are already on the market, and whilst substantial clinical trials still need to take place before they can be used to treat hepatitis C infection, we think it could be an enormous step forward in the battle against the virus."

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http://www.labmate-online.com/news/news-and-views/5/news/new_use_for_old_drugs_in_treating_hepatitis_c/11108/

NEW YORK

Drug developer Merck & Co. said Wednesday its potential hepatitis C drug boceprevir met key goals in late-stage studies.

The company said the drug prompted immune system responses to fighting the disease in studies involving newly treated patients and patients taking additional treatments.

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http://www.businessweek.com/ap/financialnews/D9HCM6100.htm

The medical use of oxygen at a level higher than atmospheric pressure, hyperbaric oxygen therapy is creating a buzz in the Hepatitis C community. This interest is not surprising, considering the purported benefits this noninvasive treatment has on human health. As the positive impact oxygen has on the body's systems becomes better realized, the list of conditions helped by this fascinating treatment continues to grow.

What Is Hyperbaric Oxygen Therapy?
While hyperbaric oxygen therapy delivers 100 percent oxygen to the recipient, the air we normally breathe contains far less oxygen. In our atmosphere, air generally contains:

· 21 percent oxygen
· 78 percent nitrogen
· 1 percent is a combination of the noble gases and carbon dioxide

In air, the exact concentration of these gases is determined by atmospheric pressure, a measurement that is affected by weather and altitude. To deliver 100 percent oxygen, a hyperbaric chamber is needed to allow the pressure around the body to be increased. This technology is well-established, as all commercial aircraft are hyperbaric chambers equipped with oxygen breathing systems.

While the air we breathe generally provides a sufficient quantity of oxygen for tissue damage repair, delivering 100 percent oxygen in a hyperbaric chamber increases the amount of oxygen dissolved in the bloodstream. Tissue damage is frequently accompanied by capillary damage - a combination that hinders oxygen distribution. Even if the amount of oxygen in the blood is normal, tissue and capillary damage can lead to a severe oxygen deficit. By simultaneously raising the air pressure around the body and increasing oxygen concentration, normal cellular repair mechanisms are believed to improve.

Hyperbaric Oxygen Approved Uses
Nearly all medical clinics, doctor's offices and hospitals use U.S. Food and Drug Administration (FDA) approved drugs and medical devices for "off-label" use on a consistent basis. Although "off-label" use for hyperbaric oxygen therapy is common, the FDA requests that unapproved uses be supported by scientific data and administered under the supervision of a licensed physician. Currently, there are fourteen conditions that are FDA approved for treatment with hyperbaric therapy:

1. Actinomycosis
2. Air or Gas Embolism
3. Carbon Monoxide Poisoning and Smoke Inhalation
4. Clostridial Myonecrosis (Gas Gangrene)
5. Cyanide Poisoning
6. Crush Injury, Compartment Syndrome and Other Acute Traumatic Ischemias
7. Decompression Sickness (the Bends)
8. Diabetic Wounds
9. Necrotizing Soft Tissue Infections
10. Osteomyelitis (Refractory)
11. Radiation Tissue Damage (Osteoradionecrosis)
12. Severe Anemia
13. Skin Grafts and Flaps (Compromised)
14. Thermal Burns

It is obvious from the conditions above that Hepatitis C - or any other infectious liver disease - is not included on this FDA approval list.

Is There Scientific Data for Hyperbaric Oxygen and Hepatitis C?
Because of the FDA's exception for "off-label" use, there could still be reason to consider hyperbaric oxygen therapy for those with Hepatitis C if supportive scientific data exists. Unfortunately, that data is lacking.

However, a Russian team did find a potential hepatitis benefit for hyperbaric oxygen back in 2009. Upon studying animals with chronic toxic hepatitis, the researchers found that hyperbaric oxygenation during the first three days after a liver resection improved postoperative outcome. While this study is interesting, it is not comparable to hyperbaric oxygen therapy for humans with Hepatitis C.

Inspiring hope for new therapeutic options in hepatology, a study to treat alcoholic liver disease with hyperbaric oxygen therapy has been launched by Castle Craig Hospital and the Department of Hepatology at The University of Edinburgh. This Phase I study is currently in progress, and aims to determine if there is an improvement in liver function following hyperbaric oxygen therapy.

Although there is a substantial list of conditions that the FDA has approved as treatable with hyperbaric oxygen, Hepatitis C is not among them. Supporters may claim that improving liver health or defeating a hepatitis virus are ideal, "off-label" uses for hyperbaric oxygen therapy, but the evidence just isn't there yet.

References:

http://springfield.news-leader.com/lifestyle/health/20050322-Hyperbarictreat.html, Hyperbaric treatment increases blood's oxygen-carrying capacity, Wes Johnson, Retrieved August 1, 2010, News-Leader.com, 2010.

http://www.chamberofhope.org/?page_id=47, Medical Evidence, Retrieved July 31, 2010, Chamber of Hope of the Selama Grotto Cerebral Palsy Endowment, 2010.

http://www.hyperbaricoxygentherapy.org.uk/article-letter-from-the-chairman-8, Letter From the Chairman, Peter McCann, Retrieved August 1, 2010, Hyperbaric Oxygen Treatment Trust, 2010.

http://www.medicalnewstoday.com/articles/139712.php, University Of Edinburgh And Castle Craig Hospital Launch Pilot Study For Hyperbaric Oxygen Therapy In The Treatment Of Alcoholic Liver Disease, Retrieved July 31, 2010, MediLexicon International Ltd., 2010.

http://www.ncbi.nlm.nih.gov/pubmed/20000127, [Correction of glutamine metabolism impairments in the operated liver with chronic hepatitis by hyperbaric oxygen], Savilov PN, Retrieved July 31, 2010, Biomedit͡sinskai͡a khimii͡a, July-August 2009.

Often added to milkshakes or blended drinks, whey protein can usually be found on store shelves in sections dedicated to building muscle mass. As such, whey protein has long been an ingredient consumed by bodybuilders and serious athletes. Despite whey protein's popularity with the muscle-pumping crowd, it has several characteristics that also make it an ideal staple for those living with chronic, viral hepatitis.

About Chronic, Viral Hepatitis
Chronic, viral hepatitis describes liver disease that is usually caused by the Hepatitis B virus or Hepatitis C virus. Hepatitis A usually does not progress to a chronic problem, and the other hepatitis viruses are much less common. Hepatitis B and C have the potential to be cured with modern medicine. However, a significant portion of those infected are unable to clear the virus from their liver with the currently available medications. These individuals are advised to make an array of lifestyle changes to protect their liver from damage and prevent this disease from progressing to a more advanced stage.

About Whey
The protein in milk is whey protein. Whey is the liquid that separates from curd during the production of cheese. When the liquid dries into powdered whey, the nutrients become concentrated, and it can be packaged and used in that form.

While predominantly composed of protein, whey is a complex substance that also contains lactose, fat and minerals. Each with its own unique properties, whey's protein content is a conglomeration of smaller components (called sub-fractions). A handful of whey's sub-fractions include:

· Beta-lactoglobulin - Provides an excellent source of essential and branched chain amino acids (BCAAs). While BCAAs help prevent muscle breakdown and spare glycogen during exercise, they also are helpful for those with advanced liver disease. Although the reason is unclear, experts understand that people with cirrhosis of the liver may live longer, improve their liver function, have fewer hospital admissions and have an increased quality of life by taking supplemental BCAAs.

· Alpha-lactalbumin - The primary protein found in human breast milk, alpha-lactalbumin is high in tryptophan, an essential amino acid. Potential benefits of this protein include sleep regulation and mood improvement under stress.

· Immunoglobulins (IgGs) - Provides immunity-enhancing benefits, a coveted function for those with chronic hepatitis.

· Glycomacropeptides - Helps control and inhibit the formation of dental plaque and dental cavities - a common problem in those with chronic hepatitis.

· Lysozyme - Contains immunity-enhancing properties, a coveted function for those with chronic hepatitis.

· Lactoferrin - May help to reduce inflammation, an invaluable characteristic for those whose liver easily becomes inflamed.

Whey and Glutathione
While some of whey protein's sub-fractions can help someone with hepatitis remain healthy, whey's promotion of glutathione delivers a specific benefit to those with liver disease. Whey protein contains high levels of the amino acid cysteine, which is needed for the body to produce glutathione.

Glutathione is an antioxidant found in all tissues protecting against potential damage from wastes and toxins. Clinical studies have demonstrated that the level of glutathione is significantly depressed in many people with Hepatitis C. Experts also recognize that glutathione deficiency is an important factor contributing to liver damage. Thus, supplements that boost the body's production of glutathione indirectly benefit people with chronic hepatitis.

Japanese Study
A Japanese animal study published in the May 2006 edition of Bioscience, Biotechnology and Biochemistry, investigated the effect of whey protein on the liver. Although their subjects were not human, the researchers found that rats on a whey-containing diet demonstrated the following:

· Lower liver enzyme levels indicating liver damage (ALT and AST)
· Lower indicators of liver fibrosis (hyaluronic acid)
· Lower levels of traditional hepatitis markers (lactate dehydrogenase and bilirubin)

Based on the results, the authors concluded that supplementing with whey protein can help prevent the development of hepatitis and portal fibrosis.

Too Much Whey
As a dietary supplement, whey protein is generally considered to be safe. However, the sentiment that you can have too much of a good thing applies to whey protein. Extremely high doses of whey protein supplements could overload the liver and cause damage. To avoid this possibility, experts suggest restricting intake of whey protein to less than 30 grams at one time.

While whey protein is certainly no cure, it does show great potential as a dietary supplement for those with liver disease. Because it supports the immune system, helps the body handle stress, eases inflammation and promotes glutathione production, whey protein should be considered by anyone who is managing chronic, viral hepatitis.

References:

http://articles.mercola.com/sites/articles/archive/2009/12/08/Top-12-Foods-for-Healthy-Immune-Response.aspx, Top 12 Foods for Healthy Immune Response, Dr. Mercola, Retrieved December 11, 2009, Dr. Joseph Mercola, 2009.

http://bastyrcenter.org/content/view/787/, Branched-Chain Amino Acids Treat Cirrhosis, Retrieved December 13, 2009, Bastyr Center for Natural Health, 2009.

http://health.learninginfo.org/liver-health.htm, Liver Health: How to Care for Your Liver, Retrieved December 13, 2009, learninginfo.org, 2009.

http://www.fitfaq.com/whey-protein.html, The Whey It Is, William D. Brink, Retrieved December 12, 2009, fitFAQ.com, 2009.

http://www.hepatitis-central.com/mt/archives/2007/07/hcv_and_the_bod.html, HCV and the Body's Most Important Antioxidant, Nicole Cutler, L.Ac., Natural Wellness, 2009.

http://www.jstage.jst.go.jp/article/bbb/70/5/70_1281/_article, Hepatoprotective Effects of Whey Protein on D-Galactosamine-Induced Hepatitis and Liver Fibrosis in Rats, Hisae Kume, et al, Bioscience, Biotechnology and Biochemistry, May 2006.

http://www.wheyoflife.org/articles/Aug_ARA_Article.pdf, Nourish Your Body The Healthy "Whey", Retrieved December 13, 2009, Whey Protein Institute, 2009.

http://www.wheyoflife.org/faq.cfm#1, Whey Protein FAQ's, Retrieved December 13, 2009, Whey Protein Institute, 2009.

To everyone except physicians who treat hepatitis and fastidious researchers, the range of tests that someone with the Hepatitis C virus (HCV) endures can be dizzying. Unless you are lucky enough to have a hepatologist sit down and explain the differences and implications of each blood draw, it is easy to be misled by the barrage of lab test results. Especially important for individuals who are currently enrolled in or who have finished HCV antiviral therapy, understanding viral load tests can bring clarification to an otherwise confusing lab result.

Hepatitis C RNA tests are tools clinicians use to confirm a diagnosis and guide treatment. The challenge in discerning between the kinds of HCV tests likely lies in the similar sounding words to describe the tests: qualitative and quantitative. Even the most seasoned healthcare practitioners frequently flub these categories. Below you will find a brief description of the two HCV RNA (the genetic material for Hepatitis C) tests and a helpful mnemonic technique to differentiate between the two:

· Qualitative Test - This kind of test detects the presence or absence of HCV RNA. It is reported as either detected (positive) or not detected (negative). The qualitative test is useful to confirm an active HCV infection. The L in qualitative can be equated to a label - as in it is used to label someone as having or not having the virus.

· Quantitative Test - The quantitative test measures the actual number of copies of HCV RNA in the blood. Commonly referred to as the viral load, a quantitative test is typically used to monitor how a person is responding to HCV treatment. The N in quantitative can be equated to a number - as in it is used to report the number of HCV viral particles present.

More About Qualitative Testing
To report whether or not HCV is present in the blood, the qualitative HCV RNA tests use either a process called polymerase chain reaction (PCR) or a process called transcription-mediated amplification (TMA). If such a test is positive, or detected, then chronic Hepatitis C infection is confirmed. Although it does not compute a number, the qualitative test is more accurate than the quantitative test because it can detect very low levels of the virus.

More About Quantitative Testing
Quantitative tests that measure the actual level of Hepatitis C virus in the blood may use the processes of PCR, TMA or signal amplification (branched DNA). These viral load tests compute the number of HCV RNA particles present, and are expressed in either international units per liter (IU/L) or copies per milliliter (mL). The quantitative HCV RNA test is used to monitor individuals who undergo antiviral treatment - prior to beginning therapy, during therapy and upon its completion.

Additional Viral Load Test Facts
The following seven facts about Hepatitis C viral load tests help deepen our understanding of the testing process.

1. If someone has a positive qualitative test but a quantitative test showing no detectable virus, then that person has a very low level of the virus in his or her blood.

2. If someone has a negative qualitative test following antiviral treatment, they are clear of the Hepatitis C virus.

3. In order to obtain a sustained viral response (considered a successful conclusion to HCV treatment), a qualitative test should be negative following the completion of treatment and then again six months later. Most physicians will use a qualitative test (as opposed to a quantitative test) to confirm a sustained viral response.

4. Viral load as measured by a quantitative test does not correlate with the severity of Hepatitis C.

5. The viral load measurement does not correlate with the severity of liver disease. Only a liver biopsy (or equivalent method) can determine the health of the liver.

6. Because HCV viral load will normally fluctuate, repeated viral load tests are only indicated for those on or considering antiviral treatment.

7. If a quantitative HCV RNA result is reported as <615 IU/L, then the test is unable to measure any of the virus. Thus, such a result should be followed by a qualitative test.

Upon reviewing the differences between quantitative and qualitative Hepatitis C tests, there will be a little less mystery in deciphering lab results. Although HCV RNA quantitative tests are mostly used to gauge how someone progresses with antiviral therapy, the qualitative test is the only way to know for sure if the Hepatitis C virus is still taking up residence in your body.

References:

http://digestive.niddk.nih.gov/ddiseases/pubs/chronichepc/#c, Chronic Hepatitis C: Current Disease Management, Retrieved July 14, 2010, National Digestive Diseases Information Clearinghouse, 2010.

http://hepatitis.about.com/od/diagnosis/f/HCVRNATest.htm, What are HCV RNA Tests?, Charles Daniel, Retrieved July 15, 2010, about.com, 2010.

http://www.hcvadvocate.org/hcsp/articles/Bernstein-1.html, The Importance of Laboratory Test Results in Hepatitis C Infection, David Bernstein, MD, FACP, FACG, Retrieved July 15, 2010, Hepatitis C Support Project, 2010.

http://www.hepatitis.va.gov/vahep?page=diag-tests-03-02, Hepatitis C RNA Qualitative Testing, Retrieved July 15, 2010, US Department of Veteran Affairs, 2010.

http://www.questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?fn=TG_HCV_MolecularTesting.htm, Molecular Testing in the Management of Hepatitis C Virus Infection, Retrieved July 15, 2010, Quest Diagnostics, 2010.

By evaluating one of the cellular components of senescence (the period of decline in health and function associated with aging), British researchers have identified a reason that liver transplant recipients are particularly susceptible to degenerating health. Since the Hepatitis C virus (HCV) is the most likely reason for a liver transplant in the United States, those with advanced HCV are more vulnerable to this characteristic of aging. Although the medical community is just beginning to unravel some of the biological factors involved in senescence, those with HCV who need a liver transplant can capitalize on the knowledge garnered thus far.

Telomeres
Three American scientists were awarded the 2009 Nobel Prize for Physiology and Medicine for their discovery about aging. Involving how chromosomes are copied during cellular division, these scientists identified telomere length as a predictor of health and longevity.

Crucial for cellular division, telomeres are protective DNA-protein complexes positioned at the tips of chromosomes:

· When cells divide, the exact sequence of DNA must be transcribed from the chromosomes of the parent cell to create chromosomes for the new cell.

· A piece of the telomere is clipped off and donated to the DNA sequence at the end of the chromosome so that the copying is complete and accurate.

· Most cells normally divide about 50-70 times, their telomeres getting progressively shorter until the cells lose their ability to divide, sustain genetic damage (which can cause cancer) or die.

Telomeres and Liver Transplant Recipients
On the heels of recognizing shortened telomere length as a hindrance to health and longevity, William Gelson from the University of Cambridge and colleagues investigated whether liver transplant recipients demonstrated this unwanted feature of senescence in immune cells.

As published in the May 2010 issue of Liver Transplantation, the British researchers found this marker of senescence to be accelerated in those with Hepatitis C who undergo liver transplants. Gelson and colleagues found that the telomeres of an important immune cell (lymphocytes) were significantly shorter in liver transplant recipients compared with control subjects. These findings suggest that besides immunosuppressive drugs used to prevent organ rejection, weakened immunity leading to complications (infections and cancers) in transplant patients may be attributable to senescence of the immune system - as identified by lymphocytes with shortened telomeres.

These findings suggest that liver transplant recipients may experience faster immune cell aging, which could help explain their increased rates of infections, cancer and other serious conditions.

Keeping Telomeres Long
While modern science is still a long time away from discovering the fountain of youth that prevents senescence, many experts believe that antioxidants represent the best defense against aging and illness.

As published in the July 2002 edition of the journal, Trends in Biochemical Sciences, researchers from the University of Newcastle found that oxidative damage is repaired less well in the DNA of the telomere than elsewhere in the chromosome. Additionally, it was determined that oxidative stress accelerates telomere loss, whereas antioxidants decelerate it.

For decades, increasing the dietary consumption of antioxidants has been considered to be a superior strategy for retaining one's youth and healthfulness. However, our new understanding of telomere length in liver transplant recipients gives those with late stage HCV infection more incentive than ever to indulge in antioxidants. Because shortened telomeres are more abundant following a liver transplant - and they foretell of a shorter life span - strategies to preserve telomere length (such as antioxidant consumption) will emerge as paramount to delay senescence in HCV liver transplant recipients.

References:

http://nobelprize.org/nobel_prizes/medicine/laureates/2009/press.html, The Nobel Prize in Physiology or Medicine 2009, Retrieved July 11, 2010, Nobel Web AB, 2010.

http://www.all-things-aging.com/2010/06/telomeres-aging-and-cancer.html, Telomeres, Aging and Cancer, Constance McCloy, PT, EdD, Retrieved July 11, 2010, All Things Aging, 2010.

http://longevity.about.com/od/whyweage/a/senescence.htm, Senescence, Healthy Aging and Longevity, Mark Stibich, PhD, Retrieved July 11, 2010, About.com, 2010.

http://www.hivandhepatitis.com/hep_c/news/2010/0709_2010_c.html, Immune Cells Show Signs of Senescence after Liver Transplantation, Liz Highleyman, Retrieved July 10, 2010 hivandhepatitis.com, 2010.

http://www.ncbi.nlm.nih.gov/pubmed/12114022, Oxidative stress shortens telomeres, von Zglinicki T, Retrieved July 11, 2010, Trends in Biochemical Sciences, July 2002.

http://www.ncbi.nlm.nih.gov/pubmed/20440767, Features of immune senescence in liver transplant recipients with established grafts, Gelson W., et al, Retrieved July 11, 2010, Liver Transplantation, May 2010.

http://www.springerlink.com/content/jw847g541l435103/, Cellular senescence, ageing and disease, D.G.A. Burton, Retrieved July 11, 2010, Age, March 2009.

Chronic Hepatitis C is a worldwide problem, infecting the livers of an estimated four million people in the U.S. alone. Until a guaranteed cure is devised for Hepatitis C, those with the virus must make every effort to support their liver's health by relieving it of unnecessary tasks. While there are a variety of strategies employed to support liver health, one that is often overlooked is working with the liver's schedule.

In charge of a long list of life-sustaining functions, the liver is an extremely busy organ. A few of its crucial duties, include:

· Producing bile, which helps carry away waste and breaks down fats in the small intestine during digestion.

· Producing certain proteins for blood plasma.

· Making cholesterol and special proteins to help carry fats through the body.

· Converting excess glucose into glycogen for storage.

· Converting poisonous ammonia to urea (urea is an end product of protein metabolism and is excreted in the urine).

· Clearing the blood of drugs and other poisonous substances.

· Resisting infections by producing immune factors and removing bacteria from the bloodstream.

Not surprisingly, the liver can't accomplish all of its amazing feats simultaneously. All of the body's organs, including the liver, have periodic cycles where different functions are emphasized at different times. The liver is no different, with a cycle completing every 24 hours.

The Liver Cycle
Although scientists are just beginning to recognize the phases of the liver's cycle, the following appear to describe the hepatic clock:

· The liver synthesizes complex chemicals and processes toxins the most when the production of bile is lowest.

· Along the same lines, chemical synthesis and toxin processing is lowest while the liver's production of bile is highest.

· Because bile is needed for food processing, the liver makes a greater proportion during the day - and less at night.

· Bile production is assumed to be at its highest at 9am and lowest at 9pm.

· After 9pm, the liver switches to its other primary functions, synthesizing chemicals and processing accumulated toxins.

· The cycle begins shifting around 3am, when the liver slows chemical synthesis and readies itself for bile production.

· The liver cycle shifts again around 3pm, when chemical synthesis begins to increase and bile production decreases.

Thus, the liver is most prepared to aid digestion with its synthesis of bile between 9am and 9pm. This is important information for those with chronic Hepatitis C who want to work with - and not against their liver.

Practical Application of the Liver Clock
Although our busy lifestyles often dictate when we eat and when we sleep, those with Hepatitis C could benefit from scheduling necessities around their liver's needs. Since bile production is down late at night, eating a big meal past 9pm puts an additional strain on the liver. Thus, experts advise eating the last meal of the day long before the nine o'clock hour.

In addition, the liver's schedule of producing chemicals and detoxification (crucial for liver health) is best accomplished without additional demands. For this reason, most experts suggest retiring for the night close to 9pm whenever possible. Although this seems extremely early for many adults, those who try it report achieving a deeper and more restful sleep.

The liver's clock may not mesh with a modern, busy schedule. However, eating early and going to bed early cooperates with your liver's natural rhythm. By taking small steps to conform to your liver's cycle, those with Hepatitis C can remove the extra challenge that multitasking can place on their liver.

References:

Buhner, Stephen Harrod, Herbs for Hepatitis C and the Liver, Storey Publishing, North Adams, MA, 2000: p 18-19.

http://focus.hms.harvard.edu/2008/092608/research_briefs.shtml, Peripheral Circadian Clocks Take Center Stage in Homeostasis, Alyssa Kneller, Retrieved September 21, 2009, Focus, Harvard Medical, Dental and Public Health Schools, September 2008.

http://www.healthsystem.virginia.edu/uvahealth/adult_liver/liver.cfm, The Liver: Anatomy and Functions, Retrieved September 21, 2009, The University of Virginia, 2009.

http://www.hepatitis.org.uk/s-crina/liver-f3-main3.htm, Key Liver Functions, Retrieved September 18, 2009, hepatitis.org.uk, 2009.