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Week Ending: March 15, 2008
Alan Franciscus
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This Issue:
March 8th, 2007
Gibbons Opposed More Health Surveyor Hiring
http://www.kolotv.com
Reporter: Brendan Riley AP
CARSON CITY, Nev. (AP) - Nevada Gov. Jim Gibbons, who wants an all-out effort to prevent clinic practices linked to a hepatitis C outbreak, would have more state staffers for that effort if he hadn't fought approval of additional medical surveyors last year.
As part of his anti-new tax or fee policy, Gibbons cut 10 new surveyor positions from a proposed state Bureau of Licensure and Certification budget during the 2007 legislative session.
Lawmakers challenged the first-term Republican governor, who had threatened to veto any tax or fee increases, and in the end approved six new positions. That brought the division's total of surveyors, whose pay is covered by fees paid by clinics that get surveyed, to 49.
Even with the mid-2007 approvals, however, the bureau is running short-staffed. Thirteen surveyor positions remain vacant, although several may be filled by April. The explanation for the vacancies is the difficulty in finding qualified applicants, rather than a state hiring freeze ordered by Gibbons in response to a looming revenue shortfall.
"The governor's position on not allowing these new positions was wrong during the 2007 session," said Assemblywoman Sheila Leslie, D-Reno, who chairs a panel looking into the hepatitis C issue. "It's almost criminal that all these inspectors weren't added simply because he didn't want to raise a fee."
"The public's health has been jeopardized because we don't have sufficient inspectors in the field," Leslie said Friday. "It's a horrifying situation."
To get the statewide inspections done quickly, Nevada is getting help from the federal Centers for Disease Control. The first CDC staffers are due Tuesday, and more are expected later in the week.
Gibbons spokesman Daniel Burns countered, "As far as finger-pointing and who fought who during the 2007 legislative session, we're not even going there now. We have a problem in March 2008 and we're dealing with that now."
"We can finger-point all we want after we take care of the health and safety of the people of the state of Nevada," Burns said.
Burns also said "everything will be on the table" in planning to prevent any future problems with clinic practices. But, he added, "There are other ways to do that than raising taxes and fees."
Six cases of acute hepatitis, a potentially deadly virus that attacks the liver, have been traced to the Endoscopy Center of Southern Nevada. Another 40,000 patients have been notified that they are at risk and should be tested for hepatitis and HIV. The clinic has been temporarily closed and fined $3,000.
Health officials believe the virus was spread when clinic nurses used the same syringe twice to administer anesthesia, contaminating the vial. The staff also was found treating multiple patients with vials of medication intended for a single patient only.
The Bureau of Licensure and Certification, in charge of inspections at outpatient clinics, has begun reviewing all other ambulatory surgical centers in the state and turned up several infractions.
The bureau has been criticized for falling behind on its inspection schedule. The Endoscopy Center had not received a full inspection since December 2001, despite a bureau policy of inspecting ambulatory surgical centers every three years.
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March 9th, 2007
Doctors focus on liver disease linked to obesity
http://www.charlotte.com
Karen Garloch
kgarloch@charlotteobserver.com
Could Overtake Other Causes
Today's most common liver diseases are cirrhosis from alcohol abuse and hepatitis C, a viral infection often transmitted through sharing of contaminated needles or blood.
But a third liver disease is about to make it to the top.
Nonalcoholic fatty liver disease, which can lead to cirrhosis and liver failure, is on the rise. It's linked to the country's obesity epidemic.
"That will be the most common form of chronic liver disease in the next decade," predicted Dr. Mark Russo, a liver specialist at Carolinas Medical Center.
Russo is planning a research project, with CMC's bariatric surgeons Tim Kuwada and Keith Gersin, to address the problem. They want to see if a medically supervised liquid diet can help obese patients, who are not candidates for surgery, lose enough weight to treat their liver disease.
"It takes a long time for liver disease to develop," Russo said. "You can be obese, drink alcohol or have hepatitis C for years. But eventually the liver may become scarred throughout."
Russo is one of a half dozen new liver specialists who have been hired by CMC in the past two years as it develops a Center for Liver Diseases and Transplantation.
Part of the expansion is in educational programs. CMC already offers residency training in 15 specialties, including general surgery. Over the next year and a half, the hospital will add fellowships in liver-related specialties.
Russo and other new specialists will teach those doctors-in-training while also expanding patient care and research. Among the newcomers are Dr. David Iannitti, a liver surgeon from Brown University in Rhode Island; Dr. Andrew Dries, a gastroenterologist from Baylor College of Medicine in Houston who specializes in endoscopic ultrasound; and Dr. John Martinie, also from Chapel Hill, a surgeon who specializes in robotic surgery for pancreatic disease.
Dr. Herbert Bonkovsky, the hospital's new vice president for research from the University of Connecticut, is also a renowned liver specialist. He brought with him $1.4 million in grants from the National Institutes of Health, along with a team of researchers, including Weihong Hou and Jianyu Zheng.
CMC also recently hired other basic scientists, Iain McKillop and Eugene Sokolov, formerly with UNC Charlotte's biology department, and Nury Steuerwald, who remains an associate professor at UNCC. Their studies include a $350,000 project about the effects of milk thistle on alcoholic liver disease.
Through studies led by Russo and Bonkovsky, Charlotte-area patients can now receive new drug treatments for liver cancer, hepatitis B, hepatitis C and hemochromatosis, a disorder of iron metabolism.
Another study will create a registry of patients whose livers were damaged by certain medications. One example of drug-induced liver injury involved Ketek, an antibiotic found to cause problems in some patients two years after it received federal approval.
"Liver injury is the major reason why drugs are abandoned during early development or withdrawn once they've been approved," Bonkovsky said.
Keep your liver healthy
• Exercise and eat right to maintain a normal body mass index.
• If you drink alcohol, do so only in moderation -- fewer than four drinks per day for men, two for women.
• Have children immunized against hepatitis B, a viral infection spread by sexual intercourse.
• Check for a family history of liver disease. Hemochromatosis is a common genetic disorder in Caucasians and can be treated by donating blood regularly.
Source: Dr. Mark Russo of CarolinasMedicalCenter
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Liver patients offered hope
http://www.myrtlebeachonline.com
By Karen Garloch - McClatchy Newspapers
Doctor opens up options at N.C. hospital
CHARLOTTE, N.C. --At noon in Operating Room 4 at Carolinas Medical Center, Dr. David Iannitti starts his second liver operation of the day.
The patient is sedated, and Iannitti slits the man's abdomen, making an incision that curves to the right like a hockey stick.
The surgeon and his assistant grip the man's ribs with a device that looks like something built with an Erector set.
They crank his chest open, creating a cavity the size of a bathroom sink.
"There's his liver right there," Iannitti announces. "That's a beautiful looking liver."
The self-described "Liver Guy" should know.
A renowned surgeon from New England, Iannitti came to work at Carolinas Medical Center in 2006.
He was wooed by doctors and administrators who share the goal of building a program that will attract other liver specialists, increase the hospital's prestige and bottom line, and offer more treatment options for patients who haven't had many.
Since Iannitti's arrival at the hospital, the number of liver operations performed at CMC has jumped from 26 in 2005 to 202 last year.
Because of Iannitti and the medical personnel he has helped recruit, patients with liver disease can now get a wider range of treatments, from medicines to surgery to transplants, without leaving the Charlotte area.
Among the new options is a treatment for advanced liver cancer called microwave ablation that Iannitti pioneered at Brown University in Rhode Island.
It's the procedure he used that day in OR 4, to burn away liver tumors with microwave energy.
He had done the surgery more than 100 times since 2003.
But on that day in February 2007, he was unusually excited.
It was the first time he'd done the procedure in the Southeast.
And it was the realization of a dream.
Like the Carolinas Heart Institute, which focuses on diseases of the heart, the hospital's new effort is aimed at a specific organ - that flat, triangular blob beloved by the Liver Guy.
Before Iannitti, most Charlotte-area patients who needed major liver or pancreas surgery traveled to other cities.
That's because CMC had no faculty doctors who specialized in caring for liver patients who didn't need transplants.
The hospital depended on community doctors who are also busy with private practices.
With his hiring, Iannitti was the first CMC surgeon who operated on the liver or pancreas daily and exclusively.
He and Dr. Daniel Hayes, CMC's liver transplant surgeon for 15 years, have since brought in about a half dozen more liver specialists.
With more doctors, more patients are staying in - and even traveling to - Charlotte for treatment of liver disease.
CMC is one of only four centers in the United States where microwave ablation is available.
Since the first procedure on Kevin Heslin, Iannitti has performed about 20 in Charlotte.
In total, liver patients at CMC - surgical and nonsurgical -- rose from 150 in 2006 to more than 700 in 2007.
The liver
At 4 to 6 pounds, the liver is the largest internal organ in the body. It's also one of the most vascular, thickly embedded with arteries and veins that handle a half-gallon of blood every minute.
Livers filter toxins from the blood and break down chemicals, hormones and medicines. They process glucose, carbohydrates and fats. They create proteins that help the blood clot. And they regulate the immune system.
Liver diseases:
Today's most common liver diseases are cirrhosis from alcohol abuse and hepatitis C, a viral infection often transmitted through sharing of contaminated needles or blood.
A third liver disease is about to make it to the top. Nonalcoholic fatty liver disease, which can lead to cirrhosis and liver failure, is on the rise. It's linked to the country's obesity epidemic.
Source: Dr. Mark Russo of CarolinasMedicalCenter
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Day 1: How liver surgeries cut short patients’ lives
http://www.pittsburghlive.com
By Luis Fabregas and Andrew Conte
TRIBUNE-REVIEW
Hundreds of patients each year undergo liver transplants when they don't need them, and possibly never will, a four-month Pittsburgh Tribune-Review investigation found.
One in 10 of those patients dies when they could have lived longer without the transplant. The rest - all at the rock-bottom of waiting lists - must resign themselves to an early battle with the burdensome risks of anti-rejection drugs and complications that can follow: infections, cancers, kidney damage, and high blood sugar.
What's worse, a third of those patients get the worst available livers, organs sometimes rejected by surgeons for thousands of sicker patients across the country.
The University of Pittsburgh Medical Center and three other centers head the list of hospitals doing such surgeries.
The founding fathers of organ transplantation - including pioneer Dr. Thomas E. Starzl at UPMC - warned more than a decade ago against transplanting livers into the least sick.
Starzl and many others haven't changed their minds.
"It is undoubtedly true that there are transplants being done that shouldn't be done," said Starzl, 81, and just now moving toward retirement at UPMC.
The Trib investigation found:
• Despite a federal rule designed to limit the number of liver transplants in patients who aren't critically ill, four of the nation's 128 programs have done half of the 846 such transplants since 2005. The programs, by volume of transplants, are Clarian Health in Indianapolis, Pittsburgh's UPMC, Mayo Clinic in Jacksonville and Strong Memorial Hospital in Rochester, N.Y. Most other centers do not give livers to less-critically ill patients, except in rare cases.
• Transplants among least ill patients mean big money for medical centers facing increased competition. By doing transplants no one else will do, centers tap into a pool of some 8,500 patients worth an estimated $4 billion in potential charges. They typically get paid the same, no matter how sick the patients are.
• No federal rules exist on the use of marginal or inferior livers for transplantation. Individual surgeons decide whether an organ is suitable. However, when an organ comes from a high-risk donor, physicians are required by federal regulation to make that clear to the patient.
• Liver transplant programs sometimes bypass the sickest patients because their reduced survival odds can hurt overall center success rates.
• Of the 16,000 people on the national liver transplant waiting list, only about 3,400 are so sick that having a transplant would increase their odds of surviving.
• People at the bottom of waiting lists rarely get sicker quickly. Only five percent of the 5,800 people in the lowest segment of the list get so sick within a year that they absolutely need a transplant.
The Trib's investigation comes amid questions about UPMC's highly regarded liver transplant program. UPMC's chief of transplantation, Dr. Amadeo Marcos, abruptly resigned last Monday.
**To read the rest of this story the rest of this excellent series go to: http://www.pittsburghlive.com/x/
pittsburghtrib/s_556307.html
Some of the titles are:
Risk versus benefit
- How liver surgeries cut short patients' lives
- Offer of a liver only the beginning of a long road
- Rejected livers often land in Indianapolis
- MELD 15 hasn't become magic number
Clash of philosophies
- Treat sickest first, or give livers to the less ill?
- Starzl institute: 'Nobody has a unit like this'
- 'The sicker they are ... you see a miracle'
- Medical ethics issue focuses on 'doing no harm' to patients
Medical ethics vs. medical economics
- Doing fewer transplants cuts money, prestige
- Surgeons, others see a need for changes
- Summing up the series
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4.1 million in U.S. have hepatitis C
http://www.delawareonline.com
By Hiran Ratnayake, The News Journal
Dying 18 months after infection rare, experts say
Hepatitis C is the most common chronic blood-borne infection in the United State and is associated with a litany of physical symptoms -- weakness, stomach pain, jaundice and anemia. An estimated 4.1 million Americans have been infected, and 30,000 new cases are reported each year, according to the Centers for Disease Control and Prevention.
Of the people who have hepatitis C, about 3.2 million are chronically infected, meaning the virus has stayed in their systems. There were 1,591 Delaware cases of chronic hepatitis C in 2006, the most recent year for which statistics are available.
Hepatitis C is most commonly spread by intravenous drug use, which accounts for 50 percent of chronic cases. Prisoners are at a higher risk of getting this infection. So are those who get tattoos or body piercings with contaminated equipment. Health care workers and others who come into frequent contact with blood are also at higher risk.
Besides the liver, hepatitis C can damage the kidney, eyes, skin and blood. About 80 percent of the people exposed to the virus have a chance of developing chronic hepatitis C.
About 20 percent of people exposed to the virus are disease-free, since it spontaneously clears their bloodstream.
While difficult to quantify, the likelihood of an inmate contracting the virus through a contaminated vial is "theoretically possible," said hepatitis expert Dr. Robert Fontana.
But it would be extremely rare for him to fall ill and die within 1 1/2 years of getting this infection, he said. Hepatitis C destroys the liver over a lifetime. Patients end up dying of liver failure or liver cancer.
"Very few patients even get acute symptoms after they're exposed and they die after they've had the infection for decades, not for months," said Fontana, an associate professor of internal medicine and medical director for liver transplant at the University of Michigan in Ann Arbor.
Hepatitis B can also be transmitted through needles. But the majority of people who get it have it cleared through their system. Though not as prevalent as hepatitis C, a severe form of hepatitis B will kill a victim within three to six months. It would not take 1 1/2 years, Fontana said. There were 244 Delaware cases of hepatitis B in 2006.
"Once in a while, people who have it can get really sick and get acute liver failure," he said.
Contact Hiran Ratnayake at 324-2547 or hratnayake@delawareonline.com
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March 10th, 2007
Nurse accused of infecting Army patients with hepatitis
http://www.chron.com
By Alicia A. Caldwell
Associated Press
Authorities also say former anesthetist stole drugs from the victims at FortBliss
EL PASO — A former Army hospital employee is accused of infecting at least three patients with hepatitis C, federal authorities said Monday.
Jon Dale Jones, a 45-year-old former nurse anesthetist at William Beaumont Army Medical Center at Fort Bliss, was arrested Thursday in Miami. He was indicted last month on three counts each of assault, aggravated assault and possession of a controlled substance by fraud.
Jones was released from jail after posting 5 percent of his $200,000 bail.
His Miami lawyer, Edward O'Donnell, did not immediately return a phone message seeking comment Monday.
Federal prosecutors said Jones infected at least three patients with hepatitis C, a blood-born disease that can lead to cirrhosis of the liver or liver cancer, while siphoning drugs from them during surgeries at the Army hospital in 2004.
Jones, a civilian, is also accused of stealing the drug fentanyl, a powerful pain killer often used for anesthesia, from the three patients.
Authorities are unsure of how or why he infected them.
Prosecutors charged that Jones stole the fentanyl from three patients from August to October 2004 by getting keys from a subordinate to a locked container that held the drugs. He is accused of assaulting the three patients by infecting them with hepatitis C on the same days he is accused of stealing their medication.
During a bail hearing in federal court in Miami last week, Jones denied he was infected with hepatitis C.
But prosecutors told a judge there that Jones was linked to the patients by officials at the U.S. Centers for Disease Control and Prevention who identified a strain of hepatitis C that Jones and all three patients were allegedly infected with.
Army hospital spokesman Clarence Davis said Jones worked there from July 2004 to June 2005. He said it was unclear if Jones was fired or resigned from his job.
Jones' alleged crimes were initially discovered by Army officials in October 2004, Davis said, and forwarded to the FBI because he was a civilian employee.
"It is my understanding that the patients have been notified who may have been victims," Davis said.
The Fort Bliss hospital, just outside El Paso, treats active and retired military personnel, their dependents and others eligible for Veterans Administration benefits, Davis said. It is also a trauma center that accepts some patients from the community.
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March 11th, 2007
HIV-positive gay men being infected with HCV soon after HIV; cases of HCV superinfection reported
www.aidsmap.com
Michael Carter
Many gay men are being infected with hepatitis C virus soon after they contract HIV, according to a study conducted in London and published in the March 12th edition of AIDS. The study, conducted at St Mary’s Hospital, found that 7% of gay men diagnosed with HIV at the hospital between 1999 and 2006 went on to become infected with hepatitis C virus through sex.
A separate study published in the same edition of AIDS described two cases of hepatitis C-superinfection in HIV-positive gay men.
Several outbreaks of sexually transmitted hepatitis C virus have been reported in HIV-positive gay men. HIV treatment guidelines in the UK recommend that patients should be tested for hepatitis C infection soon after their HIV is diagnosed and at intervals after that according to their risk.
The guidelines do not, however, define what this risk is, and investigators were concerned that this could mean that patients with recent hepatitis C infection were going undiagnosed. The response to anti-hepatitis C treatment in patients with HIV is approximately 66% in those who receive such treatment soon after they are infected with hepatitis C, but only 33% in patients who receive treatment when they have chronic hepatitis C infection.
Primary HIV infection in gay men is associated with unprotected sex and the presence of other sexually transmitted infection such as gonorrhoea and syphilis. As unprotected sex and sexually transmitted infections have been implicated in the sexual transmission of hepatitis C virus, investigators at St Mary’s Hospital hypothesised that patients with primary HIV infection may be vulnerable to infection with hepatitis C virus.
Between 1999 and 2006 a total of 155 gay men were diagnosed with primary HIV infection at the hospital. Sexual histories were obtained from these men and blood samples were taken every three months to monitor liver function and to screen for hepatitis C virus.
A total of eleven men (7%) became infected with hepatitis C virus. No cases were recorded before 2003. But in 2004, one (3%) of the 40 men with primary HIV infection was diagnosed with hepatitis C. A total of 130 cases of primary HIV infection in gay men were seen at the hospital in 2005 and four (3%) of these patients were diagnosed with hepatitis C. Of the 155 gay men diagnosed with primary HIV infection in 2006, six (4%) were also diagnosed with hepatitis C.
The median time between primary HIV infection and the detection of hepatitis C was 23 months. Nine of the patients were diagnosed because of symptoms suggestive of acute hepatitis C infection or because of abnormal liver function. The remaining two patients had normal liver function, but were tested for hepatitis C after mentioning high-risk behaviour.
Analysis of stored blood samples showed that none of the men were infected with hepatitis at the time of primary HIV infection. All the men were infected with the harder-to-treat hepatitis C genotypes 1a and 4. In seven of the men, HIV viral load increased at the time of hepatitis C infection.
None of the men had used intravenous drugs, but in the three months before infection with hepatitis C ten had used recreational drugs, eight reported fisting and four reported sharing sex toys with casual partners.
“This study supports the enhanced surveillance of high-risk groups to identify new hepatitis C virus cases and prevent the onward transmission of both hepatitis C and HIV and to allow the opportunity for early treatment intervention to enhance hepatitis C clearance rates”, write the investigators.
They add, “we recommend the use of targeted sexual histories in conjunction with regular serum ALT and directed hepatitis C virus testing.”
Hepatitis C superinfection
Investigators from Paris report two cases of hepatitis C superinfection in HIV-positive gay men whose only risk factor was unprotected sex.
The first case involved an HIV-positive man who was diagnosed with hepatitis C virus genotype 4a in 2002. Phylogenetic analysis showed that this was part of a cluster of sexually transmitted hepatitis C virus being transmitted amongst HIV-positive gay men in Paris at that time. In December 2003 the patient was also found to be infected with hepatitis C genotype 3. The man had been infected with syphilis on numerous occasions and reported unprotected sex with multiple anonymous partners.
The second HIV-positive patient was diagnosed with hepatitis C genotype 1a and syphilis in 2004. He was provided with therapy for hepatitis C infection and had an undetectable hepatitis C viral load three months after completing this treatment.
However, six months after the completion of treatment, the patient was diagnosed with syphilis and tests also revealed the presence of hepatitis C. Phylogenetic analysis showed that although this infection was with hepatitis C genotype 1a, it was distinct from the virus with which the man had originally been infected and therefore represented superinfection rather than relapse after treatment.
Several cases of hepatitis C reinfection in HIV-positive gay men in London were reported to the recent Conference on Retroviruses and Opportunistic Infections in Boston.
“Hepatitis C virus/HIV-coinfected men who have sex with men with high-risk mucosal traumatic sexual practices should be aware of sexually transmitted hepatitis C virus superinfection”, conclude the investigators.
Reference
- Fox J et al. Increasing incidence of acute hepatitis C in individuals diagnosed with primary HIV in the United Kingdom. AIDS 22: 666 – 668, 2008.
- Ghosn J et al. Sexually transmitted hepatitis C virus superinfection in HIV/hepatitis C virus-coinfected men who have sex with men. AIDS 22: 658 – 661, 2008.
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Research from Wuhan University, College of Life Sciences has provided new data on hepatitis B virus cell biology
http://www.newsrx.com
2008 MAR 10 -- Research findings, “Putative tumor suppressor YueF affects the functions of hepatitis B virus X protein in hepatoma cell apoptosis and p53 expression,” are discussed in a new report. According to a study from Wuhan, People's Republic of China, "Previously, we identified YueF as a novel Hepatitis B virus X protein (HBx)-interacting protein. Herein, we studied the functions of YueF and HBx in hepatocarcinogenesis."
"YueF was expressed at high levels in normal human hepatic cells and tissues, but scarcely found in hepatoma cells or other tumor tissues. Over-expression of YueF, or YueF and HBx could induce cell apoptosis and enhance p53 expression in hepatoma cells, whereas over-expression of HBx alone behaved contrarily," wrote J. Huang and colleagues, Wuhan University, College of Life Sciences.
The researchers concluded: "These results indicate that YueF has tumor suppressor activity and affects the functions of HBx in cell apoptosis and p53 expression in hepatoma cells."
Huang and colleagues published the results of their research in Biotechnology Letters (Putative tumor suppressor YueF affects the functions of hepatitis B virus X protein in hepatoma cell apoptosis and p53 expression. Biotechnology Letters, 2008;30(2):235-42).
For additional information, contact J. Huang, State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan 430072, PR China.
The publisher of the journal Biotechnology Letters can be contacted at: Kluwer Academic Publ, Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands.
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Studies from National Public Health Institute update current data on hepatitis C virus cell biology
http://www.newsrx.com
Researchers detail in “Hepatitis C virus proteins interfere with the activation of chemokine gene promoters and downregulate chemokine gene expression,” new data in hepatitis C virus. "The hepatitis C virus (HCV) non-structural (NS) 3/4A protein complex inhibits the retinoic acid inducible gene I (RIG-I) pathway by proteolytically cleaving mitochondria-associated CARD-containing adaptor protein Cardif, and this leads to reduced production of beta interferon (IFN-beta). This study examined the expression of CCL5 (regulated upon activation, normal T-cell expressed and secreted, or RANTES), CXCL8 (interleukin 8) and CXCL10 (IFN-gamma-activated protein 10, or IP-10) chemokine genes in osteosarcoma cell lines that inducibly expressed NS3/4A, NS4B, core-E1-E2-p7 and the entire HCV polyprotein," investigators in Helsinki, Finland report.
"Sendai virus (SeV)-induced production of IFN-beta, CCL5, CXCL8 and CXCL10 was downregulated by the NS3/4A protein complex and by the full-length HCV polyprotein. Expression of NS3/4A and the HCV polyprotein reduced the binding of interferon regulatory factors (IRFs) 1 and 3 and, to a lesser extent, nuclear factor (NF)-kappaB (p65/p50) to their respective binding elements on the CXCL10 promoter during SeV infection. Furthermore, binding of IRF1 and IRF3 to the interferon-stimulated response element-like element, and of c-Jun and phosphorylated c-Jun to the activator protein 1 element of the CXCL8 promoter, was reduced when NS3/4A and the HCV polyprotein were expressed. In cell lines expressing NS3/4A and the HCV polyprotein, the subcellular localization of mitochondria was changed, and this was kinetically associated with the partial degradation of endogenous Cardif," wrote M. Sillanp and colleagues, National Public Health Institute.
The researchers concluded: "These results indicate that NS3/4A alone or as part of the HCV polyprotein disturbs the expression of IRF1-and IRF3-regulated genes, as well as affecting mitogen-activated protein kinase kinase-and NF-kappaB-regulated genes."
Sillanp and colleagues published their study in the Journal of General Virology (Hepatitis C virus proteins interfere with the activation of chemokine gene promoters and downregulate chemokine gene expression. Journal of General Virology, 2008;89(Pt 2):432-43).
For additional information, contact M. Sillanp, National Public Health Institute, Dept. of Viral Diseases and Immunology, FIN-00300 Helsinki, Finland.
The publisher of the Journal of General Virology can be contacted at: Society General Microbiology, Marlborough House, Basingstoke Rd., Spencers Woods, Reading RG7 1AG, Berks, England.
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March 12th, 2007
Peginterferon-Ribavirin Safe, Effective for Children With HCV
www.medscape.com
NEW YORK (Reuters Health) Mar 06 - Treatment with pegylated interferon alfa-2b (PEG-IFN-alpha-2b) plus ribavirin results in virologic control in children with chronic hepatitis C virus (HCV) infection and is "reasonably well-tolerated," a Spanish team reports in the February issue of The Pediatric Infectious Disease Journal.
Investigators at Children's University Hospital "La Paz" in Madrid, Spain, studied 30 children between 3 and 16 years of age with detectable hepatitis C virus (HCV) RNA, elevated alanine aminotransferase values and disease duration of more than 3 years.
Children received PEG-IFN-alpha-2b, 1.0 mcg/kg weekly, plus ribavirin, 15 mg/kg daily. Children with HCV genotype 2/3 received 24 weeks of treatment. Those with genotype 1/4 received 48 weeks of combination therapy.
Sustained virologic response occurred in 50% of children, Dr. Paloma Jara and colleagues report. After 12 weeks of treatment, 52% of patients were HCV RNA negative and 72% had a more than 2 log10 decrease in viral load over baseline.
Treatment had to be discontinued in three patients because of adverse events. Severe neutropenia that required a reduction in dose of PEG-IFN-alpha-2b occurred in 23% of patients. No patient required a reduction in dose of ribavirin.
The investigators conclude that the combination of ribavirin and PEG-IFN-alpha-2b is effective for children with chronic HCV infection and results in a sustained viral response in the majority of patients treated. Viral response at 12 weeks is a predictor of future response.
The combination is "reasonably well tolerated, with no unexpected or permanent adverse effects" the investigators note. The rate of adverse effects was similar to that of INF-alpha alone.
Studies are now needed to determine the optimum combination treatment regimen for children with chronic HCV infection, Dr. Jara's team concludes.
Pediatr Infect Dis J 2008;27:142-148.
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DA raids office of Dix Hills doc in Hep C probe
http://www.newsday.com
Michael Amon |
michael.amon@newsday.com
The Nassau County district attorney's office raided Dr. Harvey Finkelstein's office yesterday as part of a probe into whether the Dix Hills physician caused two cases of hepatitis C and not one as state health authorities previously believed, according to court records, medical documents and interviews.
Investigators seized medical records and a computer hard drive from Finkelstein's Plainview medical office on Old Country Road yesterday morning. Prosecutors are considering whether they can bring felony charges. They could include second-degree assault, apparently for causing the infections, and falsifying business records and offering a false instrument, for changing or withholding records from the state Department of Health, according to an affidavit for the search warrant.
Finkelstein has not been charged. His attorney, Peter Chavkin of Manhattan, declined to comment on yesterday's search and potential charges. "We're cooperating with the investigation in every way imaginable," he said. "At no time has he withheld any information."
The search warrant made blanket demands for business and medical records but also asked for specific patient charts for three hepatitis C patients who received pain medication injections on July 15, 2004.
The first of those patients was Steve Corrado, 53, a Florida man who says he has had hepatitis C for nearly a decade. His medical records - portions of which his attorney gave to Newsday - show that Finkelstein knew of Corrado's diagnosis as far back as 1999.
Two patients who received injections after Corrado - Raymond Bookstaver of Hicksville, and a 66-year-old Syosset man - say they subsequently developed hepatitis C. The three men's disease strains share the same genotype of 1B, though the three have not been definitively linked genetically.
But the Health Department did not learn of Corrado's records until November and had by then concluded that the hepatitis was passed from Bookstaver to the Syosset man, the affidavit said. That conclusion was incorrect, said Jeffrey Kimmel, a Manhattan attorney for both Bookstaver and Corrado.
"To me, Steve Corrado is the known hepatitis C patient who saw Finkelstein that day and was potentially the first link in the chain of contamination," Kimmel said.
The state Department of Health is also reviewing Corrado's medical records and told the district attorney's office about him, said spokeswoman Claudia Hutton. Health authorities have said they were frustrated by what they saw as Finkelstein's reluctance to turn over records. They expanded the investigation to more than 10,000 patients after smaller lists turned out to be incomplete.
Corrado, a former carpenter now living on disability, said he began receiving injections from Finkelstein in the mid-1990s after a work injury left him with debilitating back pain. In 1999, Corrado said he became ill and was diagnosed with hepatitis C. He said he immediately called Finkelstein, with whom he had become close.
"He told me it was probably all of the tattoos I got in the '70s," Corrado said. In a July 20, 1999, medical document, Finkelstein notes Corrado's diagnosis: "Hep C x 20 years."
Five years later, on July 15, 2004, in a procedure that ended at noon, Finkelstein injected Corrado with medications and dyes. About 35 minutes later, Bookstaver was injected with the same four medications - triamcinolone, a steroid; lidocaine and bupivacaine, both local anesthetics; and ketorolac, an anti-inflammatory drug, according to medical records. The Syosset man was injected with the same at 1 p.m., records show.
How story unfolded
Key dates in the syringe mess
Nov. 13, 2007 About 630 patients of Dr. Harvey Finkelstein are notified by the state that they are at risk for HIV and hepatitis B and C - state and county health officials say he was reusing syringes while issuing injections. At least one of the doctor's patients had already contracted hepatitis C.
Nov. 14 As hundreds of people begin getting the letters, controversy erupts over the health department's decision to wait three years to begin notifying the public - only after its investigation was complete.
Nov. 19 The probe widens. The state moves to review more than 250 records gathered from Finkelstein's offices after authorities receive calls over the previous week from former patients. They were not among the original 628 patients notified.
Nov. 20 Probe widens again. State moves to get records on Finkelstein patients dating back to 1994 and urges testing for patients dating from then.
Nov. 21 Nassau district attorney's office opens investigation.
Dec. 4 Finkelstein announces he is taking a "temporary leave of absence" from three of the hospitals and clinics where he had privileges.
Feb. 29 Sen. Hillary Rodham Clinton urges the Food and Drug Administration to address the risk posed by multidose medicine vials.
March 11 DA's office seizes documents from Finkelstein's office.
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Warning: Taking hepatitis B drug with interferon potentially dangerous: Health Canada
http://ca.news.yahoo.com
The Canadian Press
OTTAWA - Health Canada is warning consumers being treated with Sebivo (telbivudine) for hepatitis B not to combine the medication with any interferon products because of potentially serious drug interactions.
Taking both Sebivo (telbivudine) and interferon may increase the risk of peripheral neuropathy, a condition marked by weakness, numbness, tingling and burning sensations in the arms and-or legs.
The anti-viral agent is authorized by Health Canada for use alone, not in combination with any interferon products, including standard or pegylated types of interferon alfa (marketed under brand names such as Pegasys, Pegatron, Intron A, Unitron Peg, Rebetron, Roferon A, and Infergen) and of interferon beta, (marketed under brand names such as Rebif, Betaseron and Avonex).
The drug's maker, Novartis Pharmaceuticals Canada Inc., said that in a small clinical trial testing the use of both Sebivo and the interferon product Pegasys (peginterferon alfa-2a), serious peripheral neuropathy occurred in five out of 48 patients (10 per cent), and was occasionally disabling. The condition usually started about three months after treatment began.
Health Canada said Wednesday it is not yet known if this adverse event is reversible once treatment is stopped, or whether it might also occur when the drug is used with interferon products other than Pegasys.
Consumers are advised to tell their doctors if they are taking Sebivo and an interferon product, but should not discontinue or modify Sebivo without first consulting their physician, due to the risk of worsening the hepatitis B infection.
Peripheral neuropathy has been reported in five out of 2,000 patients (less than one per cent) using telbivudine alone in clinical trials. The disorder also is a common adverse reaction of Pegasys (reported on average in one to five out of 100 patients in clinical trials).
The risk of developing peripheral neuropathy is increased when a patient receives telbivudine in combination with Pegasys, compared to either treatment alone, Health Canada said.
Consumer information for telbivudine is being updated and Novartis has issued a letter to health professionals advising them of the new safety information.
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Caring Ambassadors Hepatitis C Program Launches Internet-Based Hep C Discussion Point(TM) to Assist People Living with Hepatitis C
http://biz.yahoo.com
VANCOUVER, WA--(MARKET WIRE)--Mar 11, 2008 -- The Caring Ambassadors Hepatitis C Program (CAP Hepatitis C), a national nonprofit organization, announces the Internet release of its new interactive medical management tool, Hep C Discussion Point™ at www.HepCChallenge.org. Hep C Discussion Point(TM) takes the user through a guided series of questions about their hepatitis C experience. Custom-built software analyzes the user's responses and generates a report with information and topics specific to the user's inputs. The report is designed to be used as both a learning tool for the patient and as a guide to facilitate communication and enhance the health care partnership between people living with hepatitis C and their doctors.
Hep C Discussion Point(TM) was developed by CAP Hepatitis C in conjunction with leading experts in the field of hepatology to help facilitate, inform, and enhance the therapeutic decision-making process by providing discussion points on state-of-the-art hepatitis C management. Hep C Discussion Point(TM) is a groundbreaking effort, and is the only tool of its kind designed exclusively for hepatitis C clients and their health care providers.
According to Lorren Sandt, the Hepatitis C Program Director, many of the calls CAP Hepatitis C receives are from patients who are confused by conflicting information they read or hear about regarding hepatitis C management. "When we designed Hep C Discussion Point(TM), we tried to address the most common and relevant questions we receive from those living with hepatitis C."
"We are excited about the launch of Hep C Discussion Point(TM) and are very pleased to offer this tool to the hepatitis C community, which includes both patients and their health care providers," said Dr. Tina St. John, Executive Director and Medical Director of the Caring Ambassadors Program. "Hep C Discussion Point(TM) represents a new and innovative approach to CAP Hepatitis C's commitment to ensuring that all persons living with hepatitis C have accurate and adequate information by which to make decisions that match their personal medical circumstances and health care goals."
Hepatitis C is the most common chronic, blood-borne viral infection in the United States. An estimated 5 million Americans are infected with the hepatitis C virus (HCV), the most common cause of chronic liver disease and adult liver transplantation in the U.S. No vaccine is available to prevent chronic hepatitis C but medications are available to clear the hepatitis C virus from the body in up to 50% of people treated.
About Caring Ambassadors Hepatitis C Program
The Caring Ambassadors Program is a 501(c)(3) nonprofit public charity dedicated to helping people with chronic and/or life-threatening diseases through information/education, awareness, public advocacy, and support. Founded in 2001, the organization is headquartered in Vancouver, Washington, U.S.A.
The Caring Ambassadors Hepatitis C Program (CAP Hepatitis C) is devoted exclusively to meeting the needs of the hepatitis C community. The CAP Hepatitis C mission is to improve the lives of people living with hepatitis C through information and awareness.
For additional information about the Caring Ambassadors Hepatitis C Program and Hep C Discussion Point(TM), contact Lorren Sandt at 360.816.4186 or Lorren@HepCChallenge.org .
Contact:
Lorren Sandt
360.816.4186
Source: Caring Ambassadors Program
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March 13th, 2007
Warning: Prezista Linked to Liver Problems, New Warnings Added
http://www.newsinferno.com
Prezista, a drug used to treat HIV, has been associated with serious liver injuries, the Food & Drug Administration (FDA) has warned. Johnson & Johnson’s Tibotec Therapeutics, the maker of Prezista, has modified the drug’s prescribing information to include a warning on hepatotoxicity.
Prezista, a protease inhibitor, was granted accelerated approval by the FDA in 2006 to treat people with HIV. Prezista is co-administered with 100 mg ritonavir (PREZISTA/rtv) and with other antiretroviral agents, and is indicated for antiretroviral treatment-experienced adult patients, such as those with HIV-1 strains resistant to more than one protease inhibitor.
According to a Tibotec spokesperson, fifteen cases of liver problems were reported during clinical trials. The spokesperson also told Reuters that the company did not provide information on post-marketing cases reported after the drug’s U.S. approval in 2006.
According to a “Dear Healthcare Provider” letter recently sent out by Tibotec, in clinical trials and postmarketing experience, drug induced hepatitis (e.g., acute hepatitis, cytolytic hepatitis) has been reported in patients receiving combination therapy with Prezista. The new Prezista warning says drug induced hepatitis (e.g., acute hepatitis, cytolytic hepatitis) has been reported with Prezista. During the clinical development program for Prezista hepatitis has been reported in 0.5% of patients receiving combination therapy with Prezista. Patients with preexisting liver dysfunction, including chronic active hepatitis B or C, have an increased risk for liver function abnormalities including severe hepatic adverse events.
The company also said that postmarketing cases of liver injury, including some fatalities, have been reported. These have generally occurred in patients with advanced HIV1 disease taking multiple concomitant medications, having comorbidities including hepatitis B or C coinfection, and/or developing immune reconstitution syndrome.
The letter said doctors should test patients before starting treatment with Prezista and continuing monitoring liver enzymes to look for signs of possible liver injury. The letter also advised interrupting or stopping treatment in patients if there’s evidence of new or worsening liver dysfunction.
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Despite decades of trauma to her body, Hudgeons has reasons to feel fortunate
http://www.lubbockonline.com/
By Kristen Hackney-redman
Avalanche-Journal
Doctors told Bonnie Hudgeons' family if she survived surgery following a heart attack she would have brain damage.
"But I'm fine," she said with a giggle.
Hudgeons, now 75, has endured a lot in the 22 years since her heart attack. Now her kidneys are functioning at 40 percent, and she and her doctor are working to prevent further kidney damage.
But Hudgeons' story really begins in 1986 when she had an angioplasty in Lubbock. Her heart stopped during the procedure, and she was rushed to emergency bypass surgery. She required a blood transfusion because of complications following the surgery.
According to the National Institutes for Health, doctors could not test transfused blood for hepatitis C prior to July 1992. Hudgeons contracted hepatitis C from the blood transfusion.
She began experiencing nausea and vomiting in 1997, and her doctors discovered she had cirrhosis of the liver caused by hepatitis C.
"It was a nightmare for three years after that," Hudgeons said.
She was so sick that Fred, her husband of 57 years, had to help her with basic tasks most people take for granted, such as showering and dressing.
"If it hadn't have been for him, I couldn't have done it, because he had to do everything," she said.
She was placed on the waiting list to receive a liver, and on March 4, 2000, Hudgeons was lying on the couch when the phone rang. Doctors found a liver for her.
"I was really blessed," she said. "Fred didn't think I would live over another week or two if I hadn't gotten it when I got it."
Recovery from the transplant was not easy for Hudgeons. She spent a month in the hospital after the transplant. Fred said the medications she was given to prevent her body from rejecting her new liver caused her to develop diabetes, and she had always had high blood pressure.
According to Dr. Joel "Trey" Starnes, a Lubbock nephrologist, diabetes and high blood pressure are the most common risk factors for kidney disease.
Hudgeons' kidneys shut down, and she required dialysis.
She saw an announcement in The Avalanche-Journal for the National Kidney Foundation's free Kidney Early Evaluation Program screenings in November 2007 and went.
"It was very, very helpful and very interesting really," she said. "They found that I had protein in my urine, which can be dangerous."
At the KEEP screening, Hudgeons met a nephrologist whom she now sees regularly to prevent further kidney damage.
"Many patients we see have never been seen by a primary care doctor until the damage has been done," Starnes said. "Oftentimes by then it is too late to do any prevention, and many people require hospitalization and oftentimes dialysis."
KEEP screenings test for risk factors of kidney disease and are free to those at increased risk. The foundation suggests people older than 18 with high blood pressure, diabetes or a family member with kidney disease or diabetes attend KEEP screenings. The screenings aim to prevent or delay kidney damage in those at risk.
"If you have high blood pressure, or are diabetic, or have family members with kidney disease, please talk to your family doctor or make an appointment with a nephrologist," Starnes said. "Screening and prevention are the only ways we are going to prevent the epidemic of kidney disease that we are now facing in this country."
To comment on this story:
kristen.hackney@lubbockonline.com 766-8713 shelly.gonzales@lubbockonline.com 766-8747
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PAKISTAN: Unsafe blood transfusions pose HIV, hepatitis risk
http://www.irinnews.org/
Receiving a blood transfussion in Pakistan can be risky
MULTAN, 13 March 2008 (IRIN) - In her second storey home in Multan, Punjab Province, Raheela Ahmed, aged 25, gasps for breath as she struggles up the stairs carrying her youngest child, Kulsoom. “I have been sick since she was born. I often feel weak and dizzy,” Raheela told IRIN.
A blood transfusion the mother-of-three received during the Caesarian section carried out to deliver her daughter is the reason for her illness. Raheela has been diagnosed with Hepatitis-C, a potentially fatal viral infection which affects the liver. Despite several courses of treatment with a variety of drugs she has not fully recovered.
She is not alone. According to estimates by experts at a seminar in Karachi in December 2007, 90 percent of the blood donated in Pakistan is provided by “commercial” or “non-voluntary” donors, who most often sell a pint of blood at prices ranging from US$5-10. Rarer blood groups attract higher prices.
While data is unavailable, these “commercial” donors are known to include drug users, who often sell blood to pay for their addiction.
The Joint UN Programme on HIV/AIDS (UNAIDS) says Pakistan, a country of some 160 million people, has one of the highest rates of drug use in the world – with about 450,000 drug users nationwide. Sixty-four percent of injecting drug users say they use non-sterile needles.
The World Health Organization (WHO) and UNAIDS has reported an HIV transmission rate of 10 percent among those injecting drugs.
Hepatitis infections are even more common among drug users. This is unsurprising given that 10-15 percent of Pakistanis, according to the Pakistan Medical Association, a professional body of doctors, are carriers of one of the hepatitis viruses.
The lack of blood screening facilities adds to the hazards. According to UNAIDS, only 50 percent of the 1.5 million bags of blood transfused annually in Pakistan is screened.
From 2004 to 2006, at least 91 blood banks were closed down in Pakistan’s largest city, Karachi, in Sindh Province, after it was found they were not adhering to safe practices. Sindh Blood Transfusion Authority secretary Zahid Hussain Ansari said “78 of these were privately owned, and the others run by various NGOs [non-governmental organisations].”
The situation is feared to be worse in smaller towns across Pakistan, where virtually no screening or monitoring facilities are in place.
The lack of awareness also means patients and their families rarely ask questions about the treatment they are receiving or the safety of blood they may need to receive.
“We are now told the blood made me sick. I never knew this could happen and neither did my husband and mother,” said Raheela.
Reluctance by family members to donate blood, fearing “weakness”, aggravates the problem.
Medical equipment re-used
The fact that medical equipment, including intravenous bags, syringes and other items, is frequently reused compounds the risks.
The existence of mafias based at hospitals, which facilitate the sale of used equipment, has been widely reported in the media and in reports by organisations such as the Human Rights Commission of Pakistan (HRCP).
Laws intended to curb this practice, however, remain poorly enforced.
UN estimates 85,000 living with HIV
Currently, UN and government estimates put the number of people living with HIV at around 85,000, while a far smaller number are reported, according to Pakistan’s National AIDS Control Programme, due to a lack of awareness and the stigma associated with the disease.
Despite a prevalence rate of 0.1 percent amongst the general population, the World Bank has reported that lack of awareness in Pakistan, and high risk factors including low condom use and unscreened use of blood make the situation fertile for AIDS to become a major health issue.
Whereas heterosexual contact accounts for 40 percent of reported cases, contact with blood or blood products, according to the Pakistan Red Crescent Society (PRCS), is responsible for 19 percent of such infections. Most cases go unreported.
“We have a high hepatitis infection rate. The mode of transmission of HIV is very similar to this disease, so the risks are immense,” said Shafiq Khan, a medical practitioner based in Multan.
People who need regular blood transfusions, including haemophiliacs, are among those most at risk.
However, the lack of safe blood, the limited screening facilities and the widespread practice of using blood provided by drug addicts and other high risk groups mean that anyone requiring blood is at risk. The growth in the number of people infected by HIV increases the dangers.
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Benitec licensee's deal to commercialise Hep C drug
http://www.tradingmarkets.com
Sydney, Mar 13, 2008 (RWE via COMTEX) -- (RWE Australian Business News) Benitec Ltd (ASX:BLT) licensee Tacere Therapeutics Inc of San Jose, California and Oncolys BioPharma Inc of Tokyo have announced a licence agreement to develop and commercialise Tacere's RNA interference (RNAi) based hepatitis C virus (HCV) compound TT-033 throughout Asia.
This agreement resulted from the strategic alliance by Tacere and Oncolys in June 2007, whereby Oncolys was granted an option to acquire the Asian rights for the compound known as TT-033/OBP-701.
The deal is seen as validating the Benitec ddRNAi "expressed" approach for treating chronic infectious diseases including hepatitis C.
As previously announced, Benitec has an equity holding in Tacere Therapeutics and it also receives milestone and royalty payments.
Under the agreement, Oncolys and Tacere will form a joint steering committee to work with Tacere and Pfizer to oversee preclinical research and development of TT-033/OBP-701.
In addition to an up-front payment, Tacere will be eligible to receive milestone payments through achieving development, approval and commercialisation milestones, resulting in total potential payments to Tacere of up to $US60m.
Upon commercialisation of TT-033/OBP-701, Tacere would be entitled to receive royalties on net sales by Oncolys.
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Lazard Analyst Pulls Vertex Sell Rating
http://www.chron.com
NEW YORK — Shares of Vertex Pharmaceuticals Inc. rose sharply Wednesday after a Lazard Capital Markets analyst removed his "Sell" rating on the stock, saying a pullback in share price somewhat offsets continued competitive threats to experimental Hepatitis C drug telaprevir.
Shares of Vertex Pharma rose 68 cents, or 4.6 percent, to close at $15.50 Wednesday. The stock has fallen dramatically from a 52-week high of $41.42 in September to hit multiyear lows in February after the drug developer said hefty telaprevir R&D costs drove wider fourth-quarter losses and will affect 2008 forecasts.
Vertex plans to start a late-stage study of the hepatitis C drug candidate in March with partner Johnson & Johnson. While some on Wall Street say Vertex has established a leadership position in what could be a multibillion dollar class of drugs, the company could face competition from Schering-Plough Corp., which is conducting midstage studies on its oral treatment boceprevir and already sells the injectable treatment Pegintron.
Brisbane, Calif.-based InterMune Inc., working with Roche, is developing ITMN-191 as a hepatitis C treatment, and other potential rivals also with hepatitis C treatments in development include Rockville, Md.-based Human Genome Sciences Inc., and Cambridge, Mass.-based Idera Pharmaceuticals Inc.
"We expect the central component of our original sell thesis (emerging competition to telaprevir) to continue to play out over the remainder of 2008, and positive data from these competitor trials could lead to increased pressure on Vertex shares," Lazard analyst Terence Flynn said in a note to clients. "However, it is difficult for us to justify a lower price target at this time given the competitive data available to date."
He said each of the competitor protease inhibitors offers the prospect of improved tolerability and, aside from Schering-Plough's boceprevir, the possibility of less frequent dosing than telaprevir. Flynn admits that most of the rivals are in earlier development stages than telaprevir and many direct antivirals have been halted due to safety issues, but even if telaprevir hits the market first, Flynn thinks its potential dominance will be short-lived.
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Blue Foundation grant to fund hepatitis care
http://www.bizjournals.com
Orlando Business Journal
Blue Foundation for a Healthy Florida, Blue Cross and Blue Shield of Florida's philanthropic affiliate, announced it would give $100,000 to the Center for Drug-Free-Living.
The grant will fund the Hepatitis Care Network of Central Florida, which will provide free viral hepatitis prevention and treatment services to the uninsured and underserved in Central Florida.
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Tech professor searches for hepatitis vaccine
http://www.roanoke.com
Greg Esposito
X.J. Meng is a professor of virology in the Virginia-MarylandRegionalCollege of Veterinary Medicine’s department of biomedical sciences and pathobiology at Virginia Tech.
BLACKSBURG -- For X.J. Meng, 2008 has been a very good year. A professor of virology in the Virginia-Maryland Regional College of Veterinary Medicine's department of biomedical sciences and pathobiology at Virginia Tech, he's received one major accolade after another the past couple of months.
In January, he was recognized by academic publisher Thomson Scientific as belonging to the top 1 percent of the most-frequently cited scientists in the world in the past decade in two fields -- microbiology and clinical medicine. In February, he was awarded nearly $3 million in grants from the National Institutes of Health to study the hepatitis E virus with the goal of eventually developing a vaccine to protect people and animals from it. And earlier this month, Meng received word that he will receive an award for research excellence from the Lumina Foundation.
Born and raised in China, Meng received medical degrees and practiced medicine there before coming to the United States in 1991 to receive a doctorate in immunobiology at Iowa State University's college of veterinary medicine.
Four years later he took a position with the National Institutes of Health in Bethesda, Md., and he joined the faculty at Tech in 1999.
Gerhardt Schurig, dean of the veterinary school, referred to Meng as the college's "star researcher" and said Meng's success has attracted the funding and attention to allow the school to build a nucleus of virologists. Meng was the school's only virologist until they hired three more this past year.
"X.J. is the engine, to some extent, for the whole virology team," he said.
Meng credits much of his success to his dual background in human and veterinary medicine. Several recently discovered viruses that affect humans -- such as HIV, SARS and the hantavirus -- can be traced to animals. Whether it's animals or humans, all medicine is connected, he said.
Though Meng didn't feel satisfied or challenged as a medical doctor in China, he said his work treating people there has helped him see beyond the theoretical side of research to the practical application of it. That's why the project funded by the recent grants excites him so much. The potential to create a vaccine to help people sometimes makes the frustrating part of research worthwhile. Hepatitis E, while usually not fatal, is a major problem in developing countries in Asia and Africa and in Mexico. It's also found in the U.S.
Meng and other researchers at Tech recently discovered hepatitis E-related viruses in pigs and birds. The grants will allow researchers, including five other co-investigators at the vet school, to follow up on those discoveries and look into ways to study the virus in those animals with hopes of developing a vaccine for humans. Similar work was done with cows to create a smallpox vaccine.
Meng first began working with swine viruses at Iowa State and his work helped develop a vaccine for a pig virus -- Porcine Circovirus Two -- in 2006. His research on that virus, as well as hepatitis E, is why he's been cited so much by microbiology researchers. The clinical medicine citations are also because of his circovirus research and work he's done on another pig virus -- Porcine Reproductive and Respiratory Syndrome Virus.
The Thomson Scientific recognition meant a lot to Meng because, as a researcher, that's ultimately the reason you publish. His work in the microbiology field has been cited 896 times in the past 10 years while his clinical medicine work has been cited 1,842 times.
"If your publication, nobody reads it, nobody cites it, it doesn't make an impact," he said. "You can say all you want to say."
One of the reasons Meng came to Tech was that it gave him a chance to teach. He teaches courses in virology and emerging infectious disease and will probably teach in the new medical school in Roanoke being planned by Tech and Carilion Clinic. While all of the research awards are great, he said he'd love to receive one for teaching some day.
Likewise, Meng enjoys working with the staff, graduate students and postdoctoral associates in the vet school's Center for Molecular Medicine and Infectious Disease. Nine researchers work there and six more will be added as a result of the grants.
"It's not just me. I'm the one directing the lab, but it's those people in the lab," he said. "They're the ones who did the work."
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