Research & Treatment News
September 30, 2011
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In the air, nitric oxide is a toxic gas - but in the body it may aid Hepatitis C combination therapy.
by Nicole Cutler, L.Ac.
A gaseous compound found in the body, nitric oxide (NO) holds a bit of irony for those with Hepatitis C. This substance can be toxic, but it also plays a number of important roles in preserving our health. Of special interest to individuals with chronic Hepatitis C, researchers from Egypt have found that higher blood concentrations of NO are associated with better responses to Hepatitis C therapy.
About Nitric Oxide
Nitric oxide is distinct from nitrous oxide (N2O - commonly used by dentists as an anesthetic) and nitrogen dioxide (NO2 a major air pollutant). Although these three nitrogen based compounds are different, nitric oxide quickly oxidizes in the air to nitrogen dioxide.
Denoted by the chemical formula NO, nitric oxide is an important signaling molecule in human physiology. Outside the human body, NO is an air pollutant that is produced by combustion. Nitric oxide is a free radical - a substance known to be toxic because of its ability to damage nearby cells. However, NO is a free radical that is specifically used by the immune system to defend against pathogens - like parasites, cancerous cells, viruses and bacteria. In addition, nitric oxide has a host of other valuable functions to the body. NO:
• relaxes blood vessels, thus reducing blood pressure
• regulates the binding and release of oxygen to hemoglobin, thus aiding the supply of oxygen to generate energy
• stimulates the production of new mitochondria, thus increasing a cell's energy production capability
Due to its healthful characteristics, supplementing with nitric oxide is growing in popularity for a variety of health concerns.
Nitric Oxide and Hepatitis C Treatment
Due to its antiviral effects, one of the applications the medical community is finding for nitric oxide is in infectious diseases. As published in a December 2010 edition of the Journal of Gastrointestinal and Liver Diseases, Egyptian researchers sought to determine if nitric oxide levels in the blood could predict the outcome of Hepatitis C treatment.
For 56 people with chronic Hepatitis C genotype 4, the researchers tested nitric oxide levels before and during antiviral treatment with pegylated interferon and ribavirin. They found the following:
• Before Treatment - Nitric oxide levels were significantly higher in sustained responders (those who were successful in eliminating Hepatitis C) compared to relapsers (those who initially cleared the Hepatitis C virus but then the virus returned) and non-responders (those who were not successful in eliminating Hepatitis C).
• During Treatment - Again, nitric oxide levels were significantly higher in sustained responders compared to relapsers and non-responders.
The authors concluded that in people with chronic Hepatitis C genotype 4, nitric oxide levels appeared to be associated with the outcome of antiviral treatment. Furthermore, they proposed that a nitric oxide-based therapy could potentially improve the therapeutic outcome of Hepatitis C treatment.
Despite the pollution threat nitric oxide poses to the environment upon oxidation, its presence in the bloodstream seems to be a blessing in the battle against Hepatitis C. Even though the Egyptian NO study focused only on Hepatitis C genotype 4, their data could translate to the other genotypes. Either way, the results are encouraging and warrant more research into the role nitric oxide might have in the treatment of chronic Hepatitis C.
References:
http://biology.unm.edu/toolson/biotox/nitric_oxide.ppt, Toxic effects of Nitric Oxide, Martha Gutierrez, Malerie Mock, Retrieved January 2, 2011, University of New Mexico, 2011.
http://en.wikipedia.org/wiki/Nitric_oxide, Nitric Oxide, Retrieved January 2, 2011, Wikimedia Foundation, Inc., 2011.
http://www.cvphysiology.com/Blood%20Flow/BF011.htm, Nitric Oxide, Retrieved January 2, 2011, Richard E. Klabunde, PhD, 2011.
http://www.jgld.ro/2010/4/8.html, Nitric Oxide Levels and Sustained Virological Response to Pegylated-Interferon alpha2a plus Ribavirin in Chronic HCV Genotype 4 Hepatitis: a Prospective Study, Ibrahim, M, et al, Retrieved January 2, 2011, Journal of Gastrointestinal and Liver Diseases, December 2010.
http://www.medterms.com/script/main/art.asp?articlekey=22508, Definition of Nitric Oxide, Retrieved January 2, 2011, MedicineNet, Inc., 2011.
http://www.ncbi.nlm.nih.gov/pubmed/15979491, Role of nitric oxide (NO) in interferon-alpha therapy for hepatitis C, Hokari A, et al, Retrieved January 2, 2011, The Journal of Infection, July 2005.
http://www.ncbi.nlm.nih.gov/pubmed/21188329, Nitric oxide levels and sustained virological response to pegylated-interferon alpha2a plus ribavirin in chronic HCV genotype 4 hepatitis: A prospective study, Ibrahim M, et al, Retrieved January 2, 2011, Journal of Gastrointestinal and Liver Diseases, December 2010.
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September 28, 2011
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About three months after Victrelis was approved in Europe as the third drug in a triple combination therapy for Hepatitis C, the European Union grants approval to Incivo -Victrelis's only competition.
J&J's hep C drug Incivo approved in Europe
Published on 22/09/11
J&J's potential blockbuster hepatitis C treatment Incivo has been approved in Europe.
Incivo (telaprevir) was approved in combination with peginterferon alfa and ribavirin, having demonstrated significant improvements in cure rates during three phase III studies.
"We are delighted by the European Commission approval of telaprevir and that we can now offer patients a significantly improved treatment option for hepatitis C virus (HCV) compared to the previous standard treatment," said Ramon Polo, Telaprevir Compound Development team leader.
Incivo, known as Incivek in the US where it was approved in May, will now go head-to-head with another groundbreaking hep C medicine, Merck's Victrelis.
Continue reading this entire article:
http://www.inpharm.com/news/167734/jj-hepatitis-c-drug-incivo-approved-europe
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Fatigue is a problem frequently experienced by those with chronic hepatitis. Fortunately, there are several different kinds of approaches that can help mitigate fatigue.
by Nicole Cutler, L.Ac.
As the most common symptom of chronic hepatitis, fatigue is also one of the hardest ones to address. Likely because of the complex combination of cellular and chemical processes involved in producing energy, battling fatigue is best accomplished through a variety of different approaches.
There are a range of mechanisms that may be responsible for the fatigue characteristic of chronic hepatitis - and just as many potential solutions. Some of the theories explaining why fatigue is the number one complaint of people with chronic, viral hepatitis are described below:
• Mitochondrial damage - Understood to be inflicted by either the medications used for treatment or a direct impact from the virus, experts believe that chronic hepatitis viruses damage the cell's mitochondria.
• Energy storage - The liver converts food into glucose, stores it for later use and releases it when the body needs energy. A liver with advanced disease from viral hepatitis is impaired in its ability to produce and store glucose.
• Immune dysfunction - When the body is under physical or emotional stress, such as is often the case in chronic hepatitis, the immune system is weakened. Understood to be due to a reduction in neurotransmitter release and a depletion of the adrenal gland, a weak immune system is frequently a factor behind profound fatigue.
• Depression - Whether due to living with a chronic disease, a side effect of medications or some other reason, those with hepatitis are especially prone to depression. According to a study published in the journal Psychosomatic Medicine, researchers found that people who are depressed are more than four times as likely to develop unexplained fatigue as those who are not depressed.
A physician should always be consulted first to rule out another medical condition responsible for severe tiredness. Even if no other cause of fatigue can be found, there is still hope to increase energy levels in those with chronic hepatitis. Spanning several different energy restoration approaches, the following four practices are just a small sampling of what can help a person with chronic, viral hepatitis beat fatigue:
1. Avoid caffeine overload - While many people turn to caffeine to boost their energy levels, too much can cause blood sugar fluctuations and adrenal gland depletion, both of which increase one's vulnerability to stress. In addition, a caffeine overload can cause severe sleep difficulties - a definitive recipe for fatigue.
2. Supplementing with Siberian ginseng - Siberian ginseng helps normalize bodily functions by inhibiting the adrenal stress response and stimulating the immune system. It is particularly useful for fighting the effects of stress and depression, two known sources of fatigue. In addition, Siberian ginseng may be helpful to those with chronic hepatitis because it aids the liver in the detoxification process.
3. Lipid replacement therapy - Lipid replacement therapy helps prevent mitochondrial cell membrane damage, thus averting the loss of energy on a cellular level. By replacing the damaged lipids with phospholipids and fatty acids essential to the structure and function of biological membranes, lipid replacement therapy helps restore the mitochondria's boundaries. This strategy has been shown to be extremely effective in restoring energy levels of those with chronic disease.
4. Reduce stress levels - According to Paul Baard, PhD, a sports psychologist at Fordham University in the Bronx, NY, one of the biggest energy zappers is stress. Including more relaxation activities into one's day helps reduce stress, which consequently improves energy levels. Stress relief is highly individual and may be achieved through exercise, listening to music, reading a good book, meditating or socializing. "Whatever is relaxing for you will reduce tension and that will help increase energy," says Baard.
The source of fatigue in anyone, including someone with chronic hepatitis can have many different sources. Assuming there is not another medical solution for a person's fatigue, practices like avoiding caffeine overload, supplementing with Siberian ginseng, lipid replacement therapy and stress reduction can have a profound impact on restoring a person with chronic hepatitis's energy levels.
References:
http://www.care2.com/greenliving/7-natural-energy-boosters.html, 7 Natural Energy Boosters, Michelle Schoffro Cook, Retrieved April 18, 2011, Care2.com, Inc., 2011.
http://www.hepatitis-central.com/mt/archives/2007/04/fatigue_and_hep.html, Fatigue and Hepatitis C, Nicole Cutler, L.Ac., Retrieved April 24, 2011, Hepatitis Central, 2011.
http://www.hepatitis-central.com/mt/archives/2009/01/hepatitis_c_fat.html, Hepatitis C, Fatigue and Mitochondria, Nicole Cutler, L.Ac., Retrieved April 18, 2011, Hepatitis Central, 2011.
http://www.hepatitis-central.com/mt/archives/2009/09/can_vitamin_b-1.html, Can Vitamin B-12 Help Hepatitis-Related Fatigue?, Nicole Cutler, L.Ac., Retrieved April 18, 2011, Hepatitis Central, 2011.
http://www.webmd.com/depression/news/20040618/depression-fatigue-fuel-each-other, Depression, Fatigue May Fuel Each Other, Retrieved April 24, 2011, WebMD, LLC, 2011.
http://www.webmd.com/diet/fight-fatigue-energy-foods-6/10-energy-tips, Top 10 Ways to Boost Your Energy, Colette Bouchez, Retrieved April 19, 2011, WebMD, LLC, 2011.
Posted by Editors at 11:44 AM --- Printer-friendly version
September 21, 2011
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Squalamine, a molecule found in the dogfish shark, is showing remarkable potential for fighting several diseases - including Hepatitis B and Hepatitis C.
Shark Molecule Kills Human Viruses, Too
Jennifer Welsh, LiveScience Staff Writer
Date: 19 September 2011
A molecule found in sharks appears to be able to wipe out human liver viruses, such as hepatitis, new research has found.
"Sharks are remarkably resistant to viruses," study researcher Michael Zasloff, of the Georgetown University Medical Center, told LiveScience. Zasloff discovered the molecule, squalamine, in 1993 in the dogfish shark, a small- to medium-size shark found in the Atlantic, Pacific, and Indian Oceans. [See a Gallery of Wild Sharks]
"It looked like no other compound that had been described in any animal or plant before. It was something completely unique," Zasloff said. The compound is a potent antibacterial and has shown efficacy in treating human cancers and an eye condition known as macular degeneration, which causes blindness.
Continue reading this entire article:
http://www.livescience.com/16126-shark-molecule-kills-viruses.html
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September 20, 2011
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Using response-guided therapy, the new three drug regimen can cure Hepatitis C in just six months.
Tailored Hepatitis C Therapy May Cut Treatment Time in Half
Patients taking new three-drug regimen were cured at 24 weeks instead of 48, study says
By Madonna Behen
HealthDay Reporter
WEDNESDAY, Sept. 14 (HealthDay News) -- Patients infected with hepatitis C virus who have an early favorable response to a new three-drug regimen can be cured of the disease in half the normal time, a new study says.
In the multinational study, researchers showed that tailoring patients' treatment regimen to their response to the drugs, which is known as response-guided therapy, enabled many patients to cut treatment time in half and still achieve the same cure rates.
Continue reading this entire article:
http://health.usnews.com/health-news/family-health/digestive-disorders/articles/2011/09/14/tailored-hepatitis-c-therapy-may-cut-treatment-time-in-half
Posted by Editors at 9:32 AM --- Printer-friendly version
September 14, 2011
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Upon identifying weaknesses in the Hepatitis C virus, Australian researchers believe their discovery could lead to a vaccine.
Hep C weaknesses could lead to vaccine
Sep 12 2011
Lauren Stanford
Australian researchers have discovered two "Achilles heels" in the hepatitis C virus that could help protect people against infection.
A team from the University of New South Wales says the discovery of these weaknesses could lead to the creation of an effective vaccine.
Continue reading this entire article:
http://news.ninemsn.com.au/health/8297634/hep-c-weaknesses-could-lead-to-vaccine
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September 8, 2011
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With the recent approval of the direct acting antivirals (DAA) Incivek and Victrelis, Hepatitis C treatment is improving. However, the next crop of DAAs has the potential to make Hepatitis C treatment even better.
Dramatic Changes in Hepatitis C Treatment Expected to Continue
Steve Worland 9/6/11
Earlier this year the FDA approved telaprevir (Incivek) from Vertex Pharmaceuticals and boceprevir (Victrelis) from Merck for the treatment of hepatitis C. Both agents are protease inhibitors and represent the first approvals of direct acting antivirals for hepatitis C. Direct acting antivirals are a broad class of agents that act to block the growth of viruses by directly disrupting essential viral functions. The benefit of these drugs for hepatitis C follows the dramatic success of this class over the last 15 years in HIV. Now the future advances of direct acting antiviral therapy for hepatitis C is expected to follow a central theme of their use in HIV: that combination of multiple antivirals in a single treatment regimen will provide greater benefit than use of any one antiviral drug alone.
Continue reading this entire article:
http://www.xconomy.com/san-diego/2011/09/06/dramatic-changes-in-hepatitis-c-treatment-expected-to-continue/
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As their popularity with the aging population grows, assisted living facilities have a duty to prevent the spread of viral hepatitis.
by Nicole Cutler, L.Ac.
Americans are living longer than ever before in our history. As the population ages, an increasing number of elderly people are choosing to reside in assisted living facilities. While these complexes have much to offer senior citizens, there is a concern regarding hepatitis transmission that residents and assisted living facility employees should be aware of.
About Assisted Living Facilities
Assisted living is a residential option for seniors who want or need help with some of the activities of daily living, but don't need the 24-hour medical care and supervision of a nursing home. People typically chose an assisted living facility when they need more personal care services than you can get at home or an independent living retirement community - like cooking meals, getting to the bathroom in the middle of the night, house cleaning and maintenance and traveling to appointments. Some of the advantages of assisted living facilities include:
• Safety and security
• Easy access to support and care
• Encouragement of privacy and independence
• Environment conducive to socializing
• Help managing medications (in some states)
Health Care in an Assisted Living Facility
Although they don't have extensive medical capabilities, assisted living complexes typically have staff members who assist with residents' basic health needs. Each state has its own specific licensing requirements for these facilities, so those concerned with health care are urged to investigate what services are provided in their state. When it comes to hepatitis, this is especially important. Those with chronic Hepatitis B and Hepatitis C may not require intensive medical treatment, but there is concern about preventing viral hepatitis transmission amongst residents.
Hepatitis transmission in assisted living facilities received nationwide publicity in 2010 when an outbreak of Hepatitis B in a North Carolina assisted living home was discovered. State and national experts predicted that the lenient legislation for assisted living staff will increase the commonality of this misfortune.
Due to the reuse of glucometers and other devices, unsafe diabetes care led to six fatal cases of Hepatitis B at Glen Care Mount Olive (a North Carolina assisted living center). Under state and federal law, only highly trained professionals such as registered and licensed practical nurses can administer insulin at nursing homes. However, the state-overseen assisted living residences have much looser guidelines. At these facilities, "med techs," who are unlicensed and may only get one-on-one training from a nurse on diabetes care, are allowed to take blood glucose samples and inject insulin for people with diabetes.
Polly Johnson, former executive director of the state Board of Nursing and now CEO of the nonprofit Foundation for Nursing Excellence describes this problem as a disconnection. According to Johnson, "Part of that disconnect is related to the way assisted living was set up - not as a health-focused system."
The Bigger Issue
Along with our aging population, there is no shortage of people with a strain of viral hepatitis in their blood. Experts estimate that approximately 1 in 60 Americans have been infected with Hepatitis C and as many as 1 in 20 have been infected with Hepatitis B at some point in their lives. Although treatments for these two types of chronic viral hepatitis are improving every year, not everyone is a candidate for treatment - and for those who are - many don't respond to treatment.
Thankfully, following universal precautions can prevent transmitting Hepatitis B and Hepatitis C. Regrettably, too many "med techs" or other staff members at assisted living facilities are not taught and/or do not follow universal precautions - a practice designed to prevent the transmission of infectious diseases. Regardless of the source, universal precautions instruct us to treat all of the following as if they are infectious: blood, tissues, semen and vaginal secretions and the following body fluids (cerebrospinal, synovial, pleural, peritoneal, pericardial and amniotic). Barrier protection and proper disposal and cleaning methods are to be used when handling contaminated materials or surfaces. By assuming that each person is infectious, reuse of any type of equipment coming into contact with body fluids on another person is strictly forbidden.
Since coming into the public eye, many states have developed more stringent guidelines to ensure that universal precautions are mandated in assisted living facilities. Assisted living facilities are often viewed as the best of both worlds for the elderly, having some independence while also receiving assistance for daily activities. Most are superb institutions, as long as the management is stringent with its infection control policies. Since a sizeable proportion of their residents are likely to have Hepatitis B or Hepatitis C, double-checking for adherence to universal precautions is a must for preventing the spread of these illnesses within the walls of assisted living facilities.
References:
http://helpguide.org/elder/assisted_living_facilities.htm, Assisted Living Facilities, Joanna Saisan, MSW, et al, Retrieved August 28, 2011, helpguide.org, 2011.
http://www.assistedlivinginfo.com/Assisted-Living-Care/What-is-Assisted-Living, What is Assisted Living?, Retrieved August 28, 2011, SeniorLiving.net, 2011.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6006a5.htm, Notes from the Field: Deaths from Acute Hepatitis B Virus Infection Associated with Assisted Blood Glucose Monitoring in an Assisted-Living Facility, Retrieved August 28, 2011, Centers for Disease Control and Prevention, 2011.
http://www.natap.org/2010/newsUpdates/123010_06.htm, Diabetes care raises alarm: Deadly hepatitis outbreak at an assisted-living home throws harsh light on training, state's rules, Thomas Goldsmith, Retrieved August 28, 2011, natap.org, 2011.
http://www.ccld.ca.gov/res/pdf/10rcfe02.pdf, Evaluator Manual Transmittal Sheet, Retrieved August 28, 2011, State of California Health and Human Services Agency, 2011.
http://www.cdphe.state.co.us/dc/hepatitis/BeHiptoHep.pdf, Be Hip to Hep - Hepatitis Update for Assisted Living Facilities, Retrieved August 28, 2011, Colorado Department of Public Health and Environment, 2011.
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/HCV%20and%20Aging_09.pdf, Aging & Hepatitis C, Lucinda K. Porter, RN, Retrieved August 28, 2011, Hepatitis C Support Project, 2011.
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