Prognostic value of serum soluble interleukin-2 receptor in Egyptian chronic hepatitis c patients treated with pegylated interferon and ribavirin

Hepatitis C virus [HCV] is a major cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma worldwide. A strong Thl response seems to be associated with viral clearance. It is generally accepted that T cell activation is characterized by the synthesis and secretion of interleukin-2 and by the expression of Interleukin-2 receptors [IL-2R] on the cell surface of immune cells. The aim of this study is to determine the evolution of soluble IL-2 receptors [sIL2-R], as an indicator of activation of T cells in HCV patients treated with ribavirin and pegylated interferon and its correlation with outcome of therapy. 53 naive [previously not treated] chronic HCV patients eligible for criteria of therapy according to the international guidelines were recruited. Pegylated interferon alpha-2a [IFNalpha-2a] was used subcutaneously once a week for 48 weeks. Ribavirin tablets in a dose of 13mg/kg were given daily in 2 divided doses Liver function and complete blood picture were monitored weekly for the first month and then monthly in the course of administration of therapy. HCV-RNA was monitored every 3 month. Sera were collected at different time point before and during therapy and tested for level of soluble IL2-R using ELISA techniques. Prior to therapy, mean serum soluble IL-2R level was significantly higher in patients with HCV as compared to controls [3709.05 +/- 291.4 pg/ml versus 1770.6 pg/ml +/- 220.3, p<0.01]. After end of therapy, patients were retrospectively classified into 2 groups, responders and non-responders. In responders, the level of sIL-2R raised significantly after 4 weeks of therapy as compared to pre-treatment level [4501 +/- 309 pg/ml versus 3550 +/- 291 pg/ml p= 0.01]. In non-responders, however, the difference in serum sIL2R before therapy and after 4 weeks of therapy was non-significant [4021 +/- 567 pg/ml versus 3934 +/- 550 pg/ml p=0.9]. The levels of serum sIL2-R significantly correlated in a linear model with ALT levels before starting the therapy. Monitoring of sIL-2R levels may therefore be of value as an adjunct to the measurement of serum ALT and HCV-RNA in predicting the response to interferon therapy in HCV patients

Histopathological features of chronic hepatitis C in Egyptian patients

Chronic liver disease including that caused by the hepatitis C virus progresses in stages. It can range from inflammation, to fibrosis to end stage liver disease or liver cancer. This work aimed to study the histopathological features of chronic hepatitis C infected Egyptian patients followed-up at National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt. The study included 4267 liver biopsies from patients with serological and virological diagnosis of chronic HCV with no other identifiable cause for liver disease, signs of hepatic decomposition, or other significant non-hepatic disease. All biopsies were fixed in formalin, embedded in paraffin, and sectioned by microtome with a thickness of 5 micro m. Routine specimen processing involved staining slides with hematoxylin and eosin [5 levels] and Masson's trichrome stain [5 levels], for a total of 10 levels per specimen. All levels were screened by two pathologists to ensure the histological abnormalities. Ishak scoring system was applied for assessment of fibrosis and necroinflammatory injury. The percentage of hepatocytes involved by fatty changes was used to score the grade of steatosis. The relations between the histopathological findings, age and sex of the patients were carried out. The studied group [n = 4267] involved 3268 males and 999 female, with age ranging from 21 to 60 years and a mean of 41.7 +/- 9.7 years. Necroinflammatory activity of the virus was minimal in 17.88%, mild in 56.41%, moderate in 22.24% and severe in 3.47%. No fibrous tissue deposition was seen in 21 patients [0.49%], 27.32% of the patients had portal and periportal fibrous expansion, 27.91% had fibrous extensions with occasional thin fibrous tissue bridge, 36.28% had frequent broad fibrous tissue septa, while 7.99% of the studied group of patients had cirrhosis. Steatosis was absent in 52.45% of cases, mild in 39.75%, moderate in 7.19% and severe in 0.61% of patients. Non-specific granulomatous reaction was detected in 11 liver biopsies [9 males and 2 females]. Fibrosis and necroinflammation were more frequent in older patients. No significant difference between males and females regarding fibrosis, but females were more exposed to higher grades of necroinflammation [p < 0.001]. Chronic hepatitis C infection is a common and serious health problem that progresses to fibrosis, cirrhosis, liver failure and hepatocelluar carcinoma. Portal lymphoid infiltrate and minor hepatocellular necrosis were present in almost all cases. Necroinflammatory activity was mild in nearly half of the cases. Steatosis was detected in 47.55% of the patients. Fibrosis and necroinflammation were more frequent in older patients. Non-specific granulomas were rarely encountered in association with hepatitis C

Early post-treatment immunoglobulin profile in human schistosomiasis

In a trial at determining the most relevant immunoglobulin isotype that could reflect success of praziquantel treatment, an ELISA using soluble egg antigen [SEA] was applied on sera of Egyptian patients suffering from active intestinal schistosomiasis without hepatic complications determining the levels of IgE, IgA, IgM, IgGl, IgG2, IgG3 and IgG4 raised against the SEA, bot0h pre- and early post-treatment. The positive results obtained to all anti-SEA immunoglobulin isotypes before treatment support the usefulness of this technique in the diagnosis of schistosomiasis. Except for IgG3 subclass, a statistically significant correlation was found between egg output-reflecting intensity of infection-and the different immunoglobulin levels, especially anti-SEA IgG4. When repeating the assay 5-6 months after treatment, the immunoglobulin levels showed either a rise [in case of IgE] or a drop [in case of IgA, IgM and IgG1-4], all of statistical significance; yet IgG1-4 were still positive. So, ELISA could not give a definite indication of cure after anti-bilharzial treatment. IgE, IgG2 and IgG4 were revealed to be the most significant immunoglobulin isotypes at the post-treatment level, both statistically and due to their implications on resistance/susceptibility to re-infection and also due to the correlation of IgG4 with the tendency to develop periportal fibrosis. Conclusively, although not having defined a particular Ig isotype as marker for cure, it exposed the urge for early post-treatment determination of IgE and IgG4 isotypes which could serve as markers for picking up high risk patients susceptible to re-infection or liable to develop bilharzial periportal fibrosis and who might benefit from a second course of specific treatment

Cerebrospinal echinococcosis: serodiagnosis using different hydatid cyst fluid antigens

Cerebrospinal hydatid disease diagnosis may impose some problems as ultrasonography is not applicable and serology may not detect the low antibody titre often associated with intracranial or orbital cystic echinococcosis. Serological tests were performed on 14 cases with intracranial or spinal cystic lesions, out of which 9 were cases of hydatidosis in addition to 26 cases with other parasitic diseases as detected by stool examination. The sensitivity of all tests and antigens used did not exceed 6 out of the 9 positive cases and achieved by the Egl and Eg2 when applied in the ELISA. The specificity of this technique using the two antigens was 92.3% and 76.9%, respectively. Semi-purified Em1 and purified 44 KDa used in the ELISA, crude Egl used for the CIEP and the crude commercial antigen of the IHAT, all gave lower sensitivities than the former two antigens; yet their specificities amounted to 100%. It was concluded that for diagnosis of cerebrospinal hydatidosis the home-prepared EgI antigen is recommended in the ELISA system as it is relatively easily prepared from available resources to be supplemented with radio-imaging techniques, especially magnetic resonance imaging and/or MR spectroscopy; the latter being very helpful in clearly differentiating various types of intracranial cysts

Des-gamma carboxy prothrombin: a useful reliable early marker for detection of hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is one of the most common cancers in the world. The early detection is important in the management of cancer. Des-gamma carboxy prothrombin also called protein induced by vitamin K absence or antagonist II [PIVKA II] has attracted attention as a marker for early diagnosis of HCC. to assess a diagnostic role of PIVKA II for early detection of HCC. The present case control study included 50 patients who fulfilled criteria for inclusion, with an age ranged from 30-60 years of both sexes. They were selected from outpatient clinic of the National Hepatology and Tropical Medicine Research institute [NHTMRI] from January 2003 to July 2004. Twenty age and sex matched subjects were used as controls. Patients were classified into 3 groups: Group I: 22 cases with HCC, Group EL: 15 late cases of decompansated liver cirrhosis, Group III: 13 early cases of liver cirrhosis. All patients were subjected to proper history taking, thorough clinical examination, and Laboratory investigations: complete blood picture [CBC], erythrocyte sedimentation rate [ESR], coagulation profile, liver function test and kidney function test. Determination of plasma PIVKA II, serum alpha fetoprotein [AFP] and serum ferritin were done by an ELISA technique. The collected data were computerized and analyzed statistically. The present study showed that level of- plasma PIVKA II was highly significantly increased in group I compared to the other groups [p < 0.01]. Group III showed a significant difference compared to control group [p < 0.05]. Serum AFP was highly significantly increased in group I compared with other groups [p < 0.01]. Also group II and group III showed a significant difference in serum AFP than control group. Serum ferritin was significantly higher in group I and group II than controls [p < 0.01]. Group II showed a significant increase in serum ferritin than group III [p < 0.05]. Plasma PIVKA II is a reliable marker of HCC that can be used with AFP as a complementry test for early detection of HCC in patients with cirrhosis