Biomedical subjects

S Marchelli

Publications and source records attributed to S Marchelli.

7 recordsLinked to original sources

PubMed1996

Multiple changes in thyroid function in patients with chronic active HCV hepatitis treated with recombinant interferon-alpha.

OBJECTIVE: Recombinant human interferon-alpha (r-IFN-alpha) is often successfully used in the treatment of patients with chronic viral hepatitis B and C. Thyroid dysfunction has been reported to occur with variable frequency during r-IFN-alpha therapy especially in patients with preexisting thyroid autoimmunity. We have prospectively evaluated the effect of r-IFN-alpha on various aspects of thyroid function in patients with HCV chronic hepatitis. DESIGN: Thirty-two patients with HCV chronic active hepatitis were studied prospectively before and during r-IFN-alpha therapy. Serum TSH, FT4, FT3, and thyroid receptor (TSR) and thyroid peroxidase (TPO) antibodies, and the iodide-perchlorate discharge test (I-C10(4)) to detect subtle defects in the thyroid organification of iodide were carried out during the study. Thyroid radioactive iodine uptakes (RAIU) were obtained in patients who developed thyrotoxicosis. RESULTS: All patients were clinically and biochemically euthyroid prior to r-IFN-alpha therapy with negative I-C10(4) discharge tests. Four patients became thyrotoxic, 3 secondary to destructive or inflammatory thyroiditis with a low thyroid RAIU, and 1 patient developed hypothyroidism. The I-C10(4) discharge test became positive in 7 of the 32 patients studied prospectively; 5 of these patients did not develop other evidence of thyroid dysfunction and did not have positive TPO antibodies. In these 5 patients the test became negative after r-IFN-alpha was discontinued. Appropriate therapy of the patients with thyrotoxicosis (methylprednisolone for 3 patients with destructive thyroiditis and methimazole for 1 patient with hyperthyroidism) or with hypothyroidism (L-thyroxine) was successful. CONCLUSIONS: Thyroid dysfunction, especially destructive or silent thyroiditis resulting in thyrotoxicosis, is not infrequently observed in patients receiving r-IFN-alpha therapy for chronic active hepatitis. Although underlying autoimmune thyroid disease appears to predispose patients to develop thyroid dysfunction, other patients become thyrotoxic or hypothyroid in the absence of baseline positive TPO-Ab. Subtle defects in the thyroidal organification of iodine as determined by the I-C10(4) discharge test, in the absence of autoimmune thyroid disease, was observed in 5 patients who remained euthyroid, suggesting that r-IFN-alpha directly reduces the intrathyroidal organification of iodine.

Adult↗

PubMed1994

Hepatitis C virus viremia following clinical resolution of acute hepatitis C.

Clinical resolution of acute hepatitis C occurs in a limited proportion of cases. However, the rate of hepatitis C virus persistence remains unclear. For this purpose, we conducted a serial study of 60 patients with hepatitis C virus infection from the early stage of the disease for 24 to 80 months (average 50 months). Fourteen cases who recovered from acute hepatitis were selected from this group for prospective analysis of the behavior of liver enzymes, anti-HCV antibodies (RIBA II, Ortho Diagnostic System) and hepatitis C virus-RNA in serum and in peripheral blood lympho-mononuclear cells by nested polymerase chain reaction. Primers were derived from the 5'-untranslated region of the hepatitis C virus genome and the amplified products were detected by gel electrophoresis and a DNA enzyme immunoassay. All patients except two showed early recovery from acute hepatitis that occurred within 3 months from clinical onset. Transaminase normalization was always preceded by clearance of serum hepatitis C virus-RNA, which remained negative throughout follow-up. During the resolution phase of the disease a progressive decline in the antibody response was observed in most of the patients. At the end of the study anti-C100 was negative in half the cases, while anti-C33 and anti-C22 became negative or borderline in five cases. Hepatitis C virus-RNA was found in the peripheral blood lympho-mononuclear cells, but not in the serum, of only one of eight patients tested.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed1992

Immune pathogenesis of hepatitis B.

Available information about the immune pathogenesis of HBV infection in man is very limited. However, the present availability of recombinant sources of the different HBV antigens expressed in the appropriate forms to induce activation of either HLA class I or HLA class II-restricted T cells, provides the necessary tools to investigate directly the mechanisms of liver damage, the role of the different cellular components of the immune system in HBV clearance and the specific nature of the immune defects potentially responsible for the chronic evolution of HBV infection. In addition, improved knowledge of HBV biology suggests a dynamic interpretation of the HBV-immune system interactions, based on which viral mutations as well as direct interferences of HBV with specific immune functions are believed to play a relevant role with respect to the outcome of HBV infection.

Hepatitis B↗

PubMed1992

Fine specificity of the human T cell response to hepatitis B virus core antigen.

The fine specificity of the human T cell response to the hepatitis B virus core antigen (HBcAg) was investigated in 23 patients with acute hepatitis B virus (HBV) infection using a panel of short synthetic peptides covering the entire core region. An immunodominant T cell epitope which was recognized by all except one patient, was identified within the core sequence 50-69. Two further important T cell recognition sites were represented by the amino acid sequences 1-20 and 117-131, which were stimulatory for the T cells of 69% and 73% of the patients, respectively. T cell recognition of the synthetic peptides was HLA class II restricted because the peptide-induced T cell proliferation was inhibited by anti-HLA class II but not by anti-HLA class I monoclonal antibodies. These findings may be relevant to the development of future preventive and therapeutic strategies against HBV infection.

Acute Disease↗

PubMed1992

Prevalence of anti-HCV antibodies in patients with acute nonA-nonB viral hepatitis.

In a group of 55 patients with NANBH, 81% were found to be reactive for HCV antibodies. In addition, many patients who had not been subject to parenteral risk of infection were also found to be reactive. Statistically, HCV positive patients have an increased tendency to develop chronic hepatitis.

Acute Disease↗

PubMed1992

Long-term follow-up of anti-hepatitis C virus antibodies in patients with acute nonA nonB hepatitis and different outcome of liver disease.

We screened 74 patients with nonA nonB acute hepatitis (37 of post-transfusion PTH, and 37 of non-post-transfusion, NPTH, origin) for the presence of anti-HCV by tests detecting either C100-3 antibodies alone (ELISA I) or C100-3 plus C33c plus C22-3 antibodies (ELISA II). Samples were taken at the onset of disease and then serially for a period of time ranging from 12 to 60 months. An increased number of anti-HCV positive cases (86% vs 69%) and an earlier seroconversion were observed with the second compared to the first generation ELISA. Positive samples were confirmed by recombinant immunoblot assay (RIBA), which was also used to study the kinetics of the antibody response to individual HCV antigens. Anti-C33c and anti-C22-3 antibodies were the first detectable markers of HCV infection in 80% and 20% of the patients, respectively. Thirty-two percent of the patients studied showed complete and persistent biochemical recovery, whereas 68% maintained a chronic elevation of the transaminase values. Among the 20 patients who showed early and persistent normalization of the transaminase values, complete disappearance of all antibody reactivities was limited to five of them, whereas in four cases only anti-C100-3 and anti-5-1-1 became negative.

Acute Disease↗

PubMedDate not supplied

Incidence of anti-hepatitis C virus antibodies in non-A, non-B post-transfusion hepatitis in an area of northern Italy.

A total of 210 patients consecutively submitted to heart surgery at the Parma University Hospital and transfused with 1,898 units of blood were followed after transfusion in order to evaluate both the incidence of anti-hepatitis C virus (HCV) seroconversion in non-A, non-B post-transfusion hepatitis (PTH-NANB) cases and the usefulness of the screening for anti-HCV in comparison with that for serum glutamic pyruvic transaminase (SGPT) values in preventing PTH-NANB transmission. Fifteen recipients developed PTH-NANB (group A); ten of them (66.6%) showed anti-HCV seroconversion within 3-12 months. Eight of the ten anti-HCV positive patients developed chronic hepatitis, but none of the five PTH-NANB anti-HCV negative did. None of the 15 controls (group B) randomly chosen among the patient population showed anti-HCV seroconversion. A close correlation with the transmission of PTH was showed by anti-HCV positivity but not by SGPT elevation in blood donors. Eleven of 172 blood products transfused to group A but none of 139 products transfused to group B were anti-HCV positive. The incidence of elevated SGPT values was similar between the two groups of the transfused blood products. Nevertheless, the correlation observed between anti-HCV positivity and SGPT levels in the blood products involved in PTH confirms the need to exclude blood donors with abnormal SGPT values. On the whole, anti-HCV screening of donors showed a predictive value higher than that of SGPT (100% vs. 53.3%), allowing a minor blood donation exclusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Alanine Transaminase↗