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[Production of interferon and alpha 2-macroglobulin involvement in immune response during human viral hepatitis A (author's transl)].

In viral hepatitis A, we could distinguish between monophasic and polyphasic forms. Monophasic and polyphasic hepatitis A induce the production of plasma interferon. Interferon level, elevated as early as the first days following the appearance of clinical signs, decreases and reaches a minimum value on the seventh day. A new rise of interferon is characterized by a maximum level on the twelfth day and a minimum level on the thirtieth. Beyond the first month we could still detect the presence of interferon. In the two forms of hepatitis, a complement system is activated both by classical and alternate pathways. IgM levels increase early, IgA levels remain unchanged. On the other hand, IgG levels, only slightly elevated in monophasic hepatitis A, are highly increased in polyphasic hepatitis A beyond the first month. Alpha 2-macroglobulin reaches levels above normal during convalescence in monophasic hepatitis A; on the contrary, in polyphasic hepatitis A, alpha 2-macroglobulin levles are above normal as early as the thirty first days of illness and remain above normal for several months. Elevated levels in alpha 2-macroglobulin may inhibit cellular immunity which is accountable for immunological injury of virus infected hepatocytes. We wonder whether this earlier increase in alpha 2-macroglobulin is responsible for the lasting character of viral infection observed in polyphasic hepatitis A.

Hepatitis, Viral, Human

The three type of human viral hepatitis.

Infections with hepatitis A and B viruses are common in all parts of the world and constitute a major public health problem. The identification of specific antigenic markers of these viruses has led to the development of sensitive laboratory tests. These, in turn, have resulted in a better understanding of the epidemiology, pathogenesis, immunology, and the nature of these common infections. In the case of hepatitis type B, laboratory tests revealed a persistent carrier state of the surface antigen in some 120-175 million people and established the significance of hepatitis B virus in the pathogenesis of serious chronic liver disease, including a strong association with primary hepatocellular carcinoma in tropical and some subtropical regions. In addition, the specific diagnosis of hepatitis types A and B has revealed a previously unrecognized form of hepatitis which is clearly unrelated to either type. This new form of infection of the liver is now the most common type of hepatitis after the transfusion of blood and blood products in some areas of the world and it also appears to be an important cause of sporadic hepatitis, particularly among adults.

Animals

Undifferentiated patterns of key carbohydrate-metabolizing enzymes in injured livers. II. Human viral hepatitis and cirrhosis of the liver.

Activities of key carbohydrate-metabolizing enzymes were determined on biopsied liver tissues obtained from patients with acute and chronic viral hepatitis and postnecrotic cirrhosis of the liver. The results indicated that the activities of fetal or prototype enzymes, low-Km hexokinases, glucose-6-phosphate dehydrogenase and pyruvate kinase type M2 increased, while those of adult type liver enzymes, glucokinase, glucose-6-phosphatase, fructose-1, 6-diphosphatase and pyruvate kinase type L decreased in livers of these cases. Phosphofructokinase activity tended to increase only acute hepatitis. Principal component analysis revealed that the enzyme patterns of acute hepatitis and liver cirrhosis were most deviated from the control and closely resembled those of hepatocellular carcinomas.

Carcinoma, Hepatocellular

Transmission of non-A, non-B hepatitis.

In studies conducted in the early 1950s, sera from six asymptomatic blood donors, implicated in the transmission of viral hepatitis, were inoculated into 10 to 20 volunteers each. Five of these "implicated" donor sera transmitted clinically apparent hepatitis to the recipients. The stored serum samples from these studies have been reanalyzed using serologic markers for hepatitis B virus and hepatitis A virus infection. Two of the donor sera were hepatitis B surface antigen (HBsAg)-positive, and both transmitted hepatitis B virus infection to all susceptible recipients, half of whom showing clinical symptoms. The remaining three infectious donors were HBs-Ag-negative, yet were icterogenic to 10% to 47% of recipients. Testing of serum samples from these recipients with hepatitis showed no evidence of hepatitis B virus or hepatitis A virus infection. This study and other recent evidence suggest that there is a third type of human viral hepatitis--non-A, non-B hepatitis--which is due to a transmissible agent and may well be associated with a chronic carrier state.

Adult

Nonhuman primate-associated viral hepatitis type A. Serologic evidence of hepatitis A virus infection.

Since 1961, viral hepatitis has been recognized as an occupational hazard among handlers of newly imported chimpanzees and other nonhuman primates. To determine whether previously reported cases were caused by human viral hepatitis type A, we tested paired serum samples from two outbreaks for antibody to hepatitis A antigen (anti-HA) by immune adherence hemagglutination (IAHA), recently available test. In both outbreaks, one of hepatitis transmitted from chimpanzee to man (Michigan, 1964), the second from chimpanzee to chimpanzee, man, and woolly monkey (Connecticut, 1971), serologic data documented recent hepatitis A virus infection among contacts-human and nonhuman primate-of implicated chimpanzees. This confirms serologically a previously noted epidemiologic association between nonhuman primate-associated hepatitis and human viral hepatitis, type A.

Animals

Molecular forms of cobalt-activated acylase in human tissues and serum of patients with viral hepatitis.

Two molecular forms of cobalt-activated acylase present in human tissues and one or three in sera of patients with viral hepatitis were noted. They have different substrate specificity. Only form 2 is strongly inhibited by alpha-hydroxyisocaproyl-tyrosine and -phenylalanine. Electrophoretic migrations of all enzyme forms are different from those of aminoacylase. Immunoglobulin antiform 2 of the acylase does not precipitate other forms of cobalt-activated acylase or aminoacylase.

Aminopeptidases

Serologic comparison of hepatitis A antigen to echovirus 25 isolate CR69(076) recovered from a patient with viral hepatitis.

A serologic comparison was performed by immune electron microscopy between hepatitis A antigen (related to the MS-1 strain of hepatitis A virus) and a viral isolate, CR69(076), from the stool of a patient in Costa Rica with viral hepatitis. CR69(076) was not antigenically related to hepatitis A antigen but was related to echovirus 25. Thus, it is unrelated to the MS-1 strain of hepatitis A virus.

Antigen-Antibody Reactions

Experimental infection of chimpanzees with antihemophilic (factor VIII) materials: recovery of virus-like particles associated with non-A, non-B hepatitis.

Non-A, non-B viral hepatitis was transmitted to four colony-born chimpanzees by infusion of three lots of antihemophilic factor (factor VIII) implicated in the transmission of non-A, non-B hepatitis to two human recipients. All four inoculated animals showed histopathological evidence of viral hepatitis, and all demonstrated significant ALT elevations between seven and one-half weeks after inoculation. Acute-phase plasma from one of the infected chimpanzees (no. 771) was shown to induce non-A, non-B hepatitis in two other chimpanzees approximately three weeks after their inoculation. In addition, an acute-phase open liver wedge biopsy obtained from animal no. 771 was processed and examined by immune electron microscopy (IEM) for virus-like particles with convalescent serum from a serologically confirmed case of non-A, non-B hepatitis. Twenty-five to 30 nm (mean = 27 nm) diameter virus-like particles that were either "full" or "empty" were identified in this liver preparation by IEM. Two additional chimpanzees inoculated with a cesium chloride gradient fraction of an isopycnically banded liver homogenate (animal no. 771) also developed elevated ALT activity two to two and one-half weeks later. Our findings have experimentally verified that commercially produced factor VIII materials can induce non-A, non-B hepatitis in champanzees and that the disease can be subpassaged in these animals by inoculation of either acute-phase plasma or liver. These results also provide evidence for the association of 27 nm-diameter virus-like particles with non-A, non-B viral hepatitis.

Adult

Extrinsic modulation of human T-lymphocyte E rosette function associated with prolonged hepatocellular injury after viral hepatitis.

Defective T-lymphocyte E rosette (ER) function associated with viral hepatitis A and B may be due to mechanisms extrinsic or intrinsic to the target lymphocyte. The extrinsic defect is induced by an immunoregulatory plasma lipoprotein (RIF) and has the capacity to regenerate ER function in vitro. The intrinsic defect is refractory to regeneration and is not associated with RIF. Although both mechanisms occur with high frequency during the acute phase of viral hepatitis they tend to segregate in accordance with progression of hepatocellular injury at later stages of the disease. The extrinsic defect was observed in 7 out of 8 patients with longstanding chronic active hepatitis and in 10 out of 10 patients with unresolved hepatitis 12 wk after the onset of jaundice. In contrast, none of nine patients with resolved hepatitis had extrinsically defective ER function 12 wk after the onset of jaundice whereas eight of them displayed an intrinsic defect of ER function at that time. Among the various viral and liver diseases studied RIF appeared to be specific for hepatitis A and B viral infections. None of 64 sera from a variety of viral infections including Epstein-Barr virus cytomegalovirus mononucleosis with associated hepatitis nor 15 sera from patients with several chronic nonviral liver diseases were positive for RIF. RIF and its associated extrinsic defect in ER function therefore appear to correlate with a particular type of hepatocellular injury initiated by the hepatitis A and B viruses that may have a propensity for persistence and(or) progression to an aggressive form of chronic hepatitis.

Acute Disease

Solid-phase enzyme-linked immunosorbent assay for detection of hepatitis A virus.

An enzyme-linked immunosorbent assay (ELISA) was developed for the detection of hepatitis A virus in human fecal specimens. Investigations with 88 fecal specimens from 77 patients with suspected viral hepatitis and 8 of their household contacts showed that ELISA was as specific and sensitive as radioimmunoassay and almost as sensitive as immune electron microscopy. The ELISA is quick and simple to perform, does not require sophisticated technical equipment, and can be read with the naked eye, making it suitable for field work and rapid diagnosis.

Antigen-Antibody Reactions

Adenovirus hepatitis in an immunosuppressed adult patient.

The role of adenovirus as an etiologic agent of hepatic damage has been controversial. A fatal case of adenovirus infection with fulminant hepatitis in a young immunosuppressed adult patient is presented. Intranuclear inclusions were confined to the liver. Electron microscopy revealed crystalline arrays of virions within hepatocytes. This is apparently the first reported case of adenovirus hepatitis occurring in an adult. Adenovirus hepatitis represents another hazard for the immunosuppressed patient.

Adenoviridae Infections

Human ISG.

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Dose-Response Relationship, Drug

Fecal excretion of hepatitis A virus in humans.

To define more completely the period of fecal excretion of virus during hepatitis A virus infection, we studied 24 fecal samples from six children with clinical illness during an epidemic of type A hepatitis. As determined by immune electron microscopy, the six patients had detectable viral excretion before or by the time of the first abnormality in serum glutamic-pyruvic transaminase (alanine aminotransferase). Viral excretion reached a peak early and declined to undetectable levels before levels of serum enzyme reached a peak. These data accord with epidemiologic evidence that the person who already has symptoms and signs of type A hepatitis is unlikely to transmit the infection to others. Immune electron microscopy, therefore, may be a better index to the period of communicability than studies of experimental infection in human subjects. This conclusion would imply that precautions against fecal contamination are not usually necessary for patients hospitalized with type A hepatitis.

Adolescent