Ruth Adler

Ablation of persistent hepatitis B by bone marrow transplantation from a hepatitis B-immune donor

Chronic hepatitis B virus (HBV) infection is still a major cause of liver disease for which no definite therapy is available. We describe here a hepatitis B surface antigen (HBsAg) carrier patient with active viral replication (HBV DNA positive) who was treated for leukemia by bone marrow transplantation (BMT) from an HBV immune donor. Following BMT from the antibody to hepatitis B core antigen (anti-HBc) positive/anti-HBs positive bone marrow donor, immune reconstitution of the recipients bone marrow resulted in clearance of the circulating HBsAg, as well as HBV DNA. The patient acquired immunity against HBV, which lasted for more than 8 months posttransplantation. Therefore, this report provides evidence that adoptive transfer of specific immunity against HBV through allogeneic BMT may lead to clearance of persistent HBV infection. Furthermore, the data support the hypothesis that the HBsAg carrier state is most probably the result of an inefficient immune response against HBV, implying that clearance of HBV may be facilitated by adoptive cellular immunotherapy.

Improved immunogenicity in mice of a mammalian cell-derived recombinant hepatitis B vaccine containing pre-S1 and pre-S2 antigens as compared with conventional yeast-derived vaccines

The widely used hepatitis B virus (HBV) vaccines consist of the small hepatitis B surface (SHBs) protein produced in transfected yeast cells. The frequency of non-responders, especially among immunocompromised patients, has increased the demand for a more immunogenic vaccine. We evaluated the immunogenicity of recombinant HBs 20 nm particles secreted by transfected Chinese hamster ovary (CHO) cells, Bio-Hep-B (BioTechnology General Ltd, Israel), and compared it with yeast-derived vaccines. The CHO-derived vaccine contains the small hepatitis B surface antigen (SHBs protein) as the major component, as well as the middle HBs (MHBs, pre-S2) and the large HBs (LHBs, pre-S1) antigens. Nine groups of ten female Balb/c mice, 4-6 weeks old, were injected once intraperitoneally (i.p.) with 0.09, 0.27 or 0.81 micrograms of each of three vaccines: Bio-Hep-B or two conventional yeast-derived recombinant vaccines, Engerix-B (SmithKline Beecham, Belgium) and H-B-Vax II (Merck, Sharp & Dohme, USA) containing only non-glycosylated SHBs antigen. After 30 days, 40% of the mice injected with 0.09 microgram Bio-Hep-B had seroconverted, but none of the mice receiving the same dose of the other vaccines. The immunogenic dose in 50% of the mice at day 14 after injection was 0.13 microgram for Bio-Hep-B, but over 0.81 microgram for the other two vaccines. Mice of the strain B10/M (which are unresponsive to SHBs and MHBs antigens at the T-cell level) developed 100-fold higher anti-HBs titres after immunization with 1 microgram of Bio-Hep-B i.p., as compared with mice receiving the same amount of yeast-derived HBsAg vaccines.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of immunogenicity of two hepatitis A vaccines — VAQTA® and HAVRIX® — in young adults

Two new hepatitis A vaccines have been developed, and their immunogenicity tested using different immunoassays. The present study was designed to compare the immunogenicity of these two hepatitis A virus (HAV) vaccines--VAQTA and HAVRIX--as determined by seroconversion rates and anti-HAV titers, and using the same immunoassay. Healthy volunteers (15-30 y), seronegative for anti-HAV, were randomized in an open single center study to four groups of 20-21 vaccinees each, to receive either a 25 U or a 50 U dose of VAQTA, or HAVRIX at 720 EU or 1440 EU/dose, administered at 0, 1 and 6 m or at 0 and 6 m, respectively. Four weeks after primary immunization, seroconversion rates were 100% for VAQTA and 95% for HAVRIX, following injection of 50 U or 1440 EU, respectively (p = NS) and anti-HAV GMTs were 40 and 37 mIU/ml for VAQTA and HAVRIX, respectively. At 6 months, prior to the booster dose, seroconversion rates were 100% for both vaccines, with anti-HAV GMTs of 111 and 70 mIU/ml for VAQTA and HAVRIX, respectively (P < 0.05). At month 7, four weeks after the only booster injection, using the two dose regimen, anti-HAV titers were 2212 and 1511 mIU/ml for VAQTA and HAVRIX, respectively (P < NS). Using three doses of 25 U/dose of VAQTA or 720 EU/dose of HAVRIX at 0, 1 and 6 m did not produce any clinically evaluable advantage over the two dose regimen for either vaccine. No significant adverse events were observed using either vaccine. In summary, both vaccines have similar immunogenicity demonstrated using identical immunoassays for evaluation. These results also confirm the outstanding immunogenicity of a single dose of either of the HAV vaccines and support their use in pre- and possibly postexposure prophylaxis against hepatitis A virus infection.

Single and booster dose responses to an inactivated hepatitis A virus vaccine: comparison with immune serum globulin prophylaxis

Pre- and postexposure prophylaxis against hepatitis A virus (HAV) infection with immune serum globulin (Ig) is only effective for 4-6 months. We compared the safety, tolerability and immunogenicity of a single i.m. injection of Ig with a single and booster dose of an inactivated hepatitis A virus vaccine (iHAV) in adults. Healthy volunteers (18-50 years) received a single Ig i.m. injection (n = 30), or iHAV i.m. (n = 15) at 0 and 24 weeks, or placebo (n = 4) at the same intervals. Anti-HAV seroconversion was measured by radioimmunoassay (RIA) and neutralizing antibodies by an antigen reduction assay. After Ig injection (0.06 ml/kg), anti-HAV seroconversion occurred in 100% of recipients at week 1, declining to 10% at week 12 and 0% by week 20. In contrast, after a single 25 ng dose, RIA seropositivity in iHAV vaccinees was 80% by week 2, reaching 100% by week 5 and persisted up to week 24, at which time anti-HAV geometric mean titres (GMT) were two fold higher than those seen at week 1 after Ig. Postbooster anti-HAV titres in iHAV recipients rose within 4 weeks to 73-fold greater than the peak GMT seen one week after Ig, and 400-fold higher than GMT at 12 weeks after Ig. Neutralizing antibody titres after iHAV followed a similar pattern, as observed for anti-HAV. iHAV was well tolerated; placebo and vaccine tolerability were indistinguishable, with no serious adverse experiences observed. In conclusion, active vaccination with a single iHAV dose may eventually replace Ig for pre-exposure prophylaxis.(ABSTRACT TRUNCATED AT 250 WORDS)

Safety, tolerability, and immunogenicity of an inactivated hepatitis A vaccine: effects of single and booster injections, and comparison to administration of immune globulin

Hepatitis A virus (HAV) infection in adults is often symptomatic and disabling. The present article summarizes our experience with phase 2 studies of an inactivated hepatitis A virus vaccine. Pre- and post-exposure prophylaxis with immune globulin (IG) is only effective for 4-6 months. We compared the safety, tolerability, and immunogenicity of a single i.m. injection of IG with single and booster doses of an inactivated hepatitis A virus vaccine (iHAV) in adults. A total of 75 healthy volunteers (aged 18-50 years) were evaluated in two separate studies. The first included 15 volunteers who received 25 units iHAV i.m. at 0 and 24 weeks. The second, a randomly controlled study, consisted of three groups receiving 25 units iHAV i.m. at 0, 1, and 6 months, or at 0, 2, and 6 months, or 0.06 ml/kg IG i.m. given once. Anti-HAV seroconversion was measured by radioimmunoassay (RIA). After IG injection, anti-HAV seroconversion occurred in 100% of recipients at week 1, declining to 10% at week 12, and 0% by week 20. In contrast, after a single 25-unit dose, RIA seropositivity in iHAV vaccines was 73% by week 2, reaching 100% by week 5, and persisted in all up to week 24, at which time anti-HAV geometric mean titers (GMT) were 2-fold higher than those seen at week 1 after IG. Administration of a booster dose given 1 or 2 months after primary immunization did not significantly improve the quantitative anti-HAV response at 6 months as compared to the effect of the primary dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Suppression of human hepatoma in mice through adoptive transfer of immunity to the hepatitis B surface antigen.

BACKGROUND/AIMS Adoptive transfer of immunity against hepatitis B surface antigen (HBsAg) has previously been shown to occur in mice and humans through transplantation of bone marrow cells from donors immunized against HBsAg (anti-HBs) to non-immune recipients. In the present study we evaluated the effect of adoptive transfer of immunity to HBsAg on the growth of HbsAg-secreting hepatocellular carcinoma (HCC) xenografts in athymic mice. METHODS Immunocompetent mice were immunized with recombinant HBsAg. Bone marrow cells from anti-HBs+ mice were injected intravenously to irradiated athymic Balb/c mice which had been previously transplanted subcutaneously with Hep3B human hepatoma cells. Treatment groups included mice receiving bone marrow transplantation from HBV-immunized (anti-HBs positive) and non-immunized (anti-HBs negative) donors. RESULTS At 9 weeks post bone marrow transplantation, tumor volume and serum alpha-fetoprotein levels in athymic mice receiving HBV-immune bone marrow cells were 11.5 mm3 and 363 ng/ml, respectively, as compared to 1579 mm3 and 19,000 ng/ml, in recipients of non-immune bone marrow transplantation (p<0.005). T-cell depletion of antiHBs+ immune bone marrow prior to transplantation decreased the anti-tumor effect but did not abolish it. A mild nonspecific, bone marrow-derived, graft versus tumor effect was observed in mice transplanted with human hepatoma cells that do not express HBsAg. CONCLUSIONS Adoptive transfer of immunity to HBV facilitates suppression of experimental human HCC expressing HBsAg. This effect is the result of a combination of specific anti-viral surface antigen effect and a nonspecific graft versus tumor effect.

Hepatitis c virus infection in employees of a large university hospital in Israel.

OBJECTIVE To assess whether hospital work constitutes a risk factor for hepatitis C virus (HCV) infection among employees of a large hospital in Israel. DESIGN Seroprevalence survey. SETTING A 1,006-bed, tertiary-care university hospital in Jerusalem. PARTICIPANTS All 5,444 employees (18-65 years old) were eligible; 4,287 (79%) participated in the survey. METHODS Sera were tested for antibodies to HCV (anti-HCV) using a third-generation enzyme immunoassay. A third-generation strip immunoblot assay was used for confirmation. Participants were interviewed regarding their occupational history, and they completed a self-administered questionnaire covering history of non-occupational exposure to blood and country of birth. Other demographic information was obtained from the personnel department. Rates and odds ratios (ORs) were calculated, and multivariate logistic-regression analyses were performed to adjust for potential confounding variables. RESULTS Anti-HCV was found in 0.9% of employees (37/4,287; 95% confidence interval, 0.6-1.1), ranging from 0.1% among those born in Israel to 5.7% among those born in Central Asia. After age, gender, social status, country of birth, and history of blood transfusion were controlled for in a logistic regression, occupational exposure to blood > or = 10 years was significantly associated with the presence of antibodies (OR, 2.6; P=.01). Presence of anti-HCV also was associated with country of birth (range: Israel OR, 1; West OR, 3.8 [P=.1]; Central Asia OR, 48.6 [P<.0001]) and history of blood transfusion (OR, 2.7; P=.01). No significant associations were found between anti-HCV and age, gender, social status, history of tattoo, acupuncture, current occupation, department, exposure to blood in current occupation, adherence to safety precautions, or history of percutaneous injury. The association with length of exposure was stronger (OR, 3.6; P=.01) when the same logistic regression was run excluding the outlier ethnic group of Central Asia. CONCLUSIONS Hospital work does not seem to constitute a major risk factor for HCV infection in Israel today. A higher prevalence of anti-HCV among employees with longer versus shorter lengths of occupational exposure may be due to a cumulative effect of exposure over the years. Infection control efforts in recent years may have contributed to this association.

Immunotargeting of daunomycin to localized and metastatic human colon adenocarcinoma in athymic mice

SummaryA monoclonal antibody (designated SF25), which recognizes a protein antigen expressed on a large number of human colon carcinomas, was used for drug targeting. Daunomycin-antibody conjugates were prepared by two previously described procedures. In one, the drug was bound to the antibody through a spacer of small molecular mass (cis-aconitic acid), while in the other a dextran bridge served as the link between drug and antibody. High substitution rates of drug to antibody were obtained using the latter binding procedure. Both conjugates were tested in vitro against two human colon carcinoma cell lines, LS180 and KM-12. The efficacy of a daunomycin-dextran-SF25 antibody conjugate was tested against colon carcinoma LS180 tumors transplanted at different sites into athymic mice. The specific conjugate was significantly more inhibitory to a subcutaneous tumor growth than its components or their mixture. SF25 antibody alone showed antitumoral effects against all three forms of transplanted tumor tested, namely, local, metastatic or intrahepatic, whereas daunomycin, on its own, was effective only against the subcutaneous tumor. Binding of daunomycin to dextran partially improved its inhibitory activity against the metastatic tumor. The conjugate, daunomycin-dextran-SF25 antibody reduced the number of metastatic foci, increased the survival rate and delayed death. Yet against lymph node metastases it was not significantly better than a mixture of both constituents. However, results obtained with an intrahepatic tumor, a model that mimics the natural progression of the disease, resembled those described with the subcutaneous tumor. Daunomycin-dextran-SF25 antibody was significantly more effective than all components separately and than a mixture of drug and antibody, provided a highly drug-substituted conjugate was used.

Conjugates between monoclonal antibodies to HBsAg and cytosine arabinoside

Chemotherapeutic agents such as cytosine arabinoside (ARA-C) and adenine arabinoside (ARA-A) have been shown to eliminate or suppress replication of some DNA viruses. These effects were however associated with systemic side-effects to the treated hosts. We are currently exploring a strategy to construct conjugates between these antiviral agents and monoclonal antibodies directed against viral surface proteins. Such conjugates should enable specific delivery of the antiviral agents to their preferred site of action. In the present study, monoclonal antibodies to hepatitis B virus surface antigen (HBsAg) of the IgG2a and IgM isotypes were conjugated to ARA-C via a dextran bridge. The use of dextran enables the binding of a high number of drug molecules to the antibody with minimal loss of activity. Briefly, partially oxidized dextran was coupled to ARA-C and then to monoclonal anti-HBs. Following the conjugation process, the IgG2a anti-HBs-(dex)-ARA-C conjugate retained its capacity to bind to HBsAg fixed to a solid matrix as compared to non-conjugated homologous antibodies. Conjugates between ARA-C and IgM anti-HBs lost a significant degree of their binding activity to purified HBsAg. However, conjugates containing anti-HBs of both isotypes bound specifically to PLC/PRF/5 human hepatoma cells that express HBsAg on their cell surface. Conjugates containing non relevant monoclonal antibodies did not bind to target cells. Pharmacologic activity of the various compounds was assessed by an [3H]thymidine incorporation assay in hepatoma cells in culture. IgM and IgG2a containing conjugates caused suppression of [3H]thymidine incorporation into PLC/PRF/5 cells. This effect was more pronounced for conjugates containing monoclonal IgM anti-HBs.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatitis A Prophylaxis

Hepatitis A virus (HAV) infection, once endemic in children in most continents and usually asymptomatic, is now declining. As a result, more and more adult populations worldwide are becoming susceptible to HAV infection, which is frequently symptomatic and disabling in those above 12 to 15 years of age. Traditionally, serum immunoglobulins containing high-titre antibodies to HAV (anti-HAV) have been used effectively during the past 50 years for post- or pre-exposure prophylaxis. However, decreasing prevalence of individuals with anti-HAV has led to a worldwide decline in anti-HAV titres in blood donors and, as a result, to a shortage of immunoglobulin. Meanwhile, several excellent vaccines have been developed from attenuated HAV propagated in tissue culture and inactivated by formaldehyde. These vaccines are highly efficacious and immunogenic, and so far have an excellent record of safety and tolerability. Currently, a single dose of these HAV vaccines will prime the immune system in children and young adults, affording rapid protection against clinical HAV-induced disease within 3 to 5 weeks of administration and lasting for more than 6 months. Booster doses will prolong protection for several years. To date, some federal health agencies believe that cost-benefit analysis still favours immunoglobulin administration over active immunisation for hepatitis A prophylaxis. However, once the cost of the new vaccines drops, immunisation is expected to gain worldwide acceptance by national healthcare authorities. Available data already suggest that 2 to 3 doses of the new vaccines will provide long term immunity against HAV, thus reducing the discomfort and unknown long term risks associated with immunoglobulin injection. Thus, regardless of economic considerations, travel medicine experts and primary care physicians in most Western countries recommend active immunisation against HAV for individuals at risk if they can afford to cover the cost.