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The Nobel Prize in Medicine, hepatitis and viruses – The Chronicle of Today

A text by our collaborator on the speed with which progress is made in the investigation of diseases such as hepatitis, compared to that of SARS-CoV-2

When I said goodbye to her, I knew I would never see her again. He had several years of evolution with liver cirrhosis due to a hepatitis “not A, not B” that surely happened to him in one of the many surgeries that he had under his belt. I was going to Boston to do graduate school, and she stayed home to wait for the inevitable evolution.

A year and a half later my mother called me one day and said: Your grandmother got sick, she’s in the Nutrition ER. I spoke with the resident and he said: “You have a hepatoma doctor, it seems that it has burst.” I said, “Don’t do too much to her anymore please. IV solution, keep her sedated and wait for her death. No way do anything heroic,” I pleaded. The next day my maternal grandmother; That grandmother, who is the ultimate in life, died of a disease that at the time had no name or known cause, no way to detect it, much less to cure it.

30 years after this disease is called hepatitis C, it can be prevented, it can be diagnosed and it can be cured. A few days ago the 2020 Nobel Prize in Medicine and Physiology was announced for Drs Harvey J. Alter, Michael Houghton and Charles M. Rice for their work on the discovery of the hepatitis C virus. I couldn’t agree more with the Foundation Nobel for this success.

Hepatitis is an inflammation of the liver that can be generated by various viruses. The virus A produces a generally benign hepatitis since it is self-limited (it heals itself) and does not evolve towards chronicity. It is spread by food contaminated with the virus and is endemic in many places. It often occurs in childhood and in many cases goes unnoticed, because not everyone who suffers from it turns yellow (jaundice). If the kind reader got hepatitis in childhood, it was surely due to virus A.

Hepatitis B is a much more serious disease. The virus that produces it is transmitted by body fluids such as blood and, therefore, also by sexual contact. It produces acute hepatitis that can range from asymptomatic to severe fulminant liver failure that leads to death. A very high percentage of patients do not shed the virus and then it leads to a chronic form of hepatitis that progresses to liver cirrhosis and the development of hepatoma (liver cancer). The virus that produces it was discovered in 1960 by Barush Blomberg, which is why he received the Noble Prize for Physiology and Medicine in 1976.

But not all hepatitis patients have form A or form B. When I studied medicine and during my residency, many hepatitis patients had what we called the “no A, no B” form. This is similar to B, because it is transmitted in a similar way (by blood or human fluids). It is more common than B and unfortunately goes unnoticed more often and, therefore, generates chronic forms that lead to liver cirrhosis and the development of cancer. It is a disease that has been responsible for shortening the lives of many people. According to the World Health Organization, about 400 thousand people die a year from hepatitis C.

The 2020 Nobel Prize in Medicine and Physiology will be awarded in December to three researchers who contributed independently, with a piece of history, that made it possible to call this disease hepatitis C and that opened the possibility of detecting the disease and now curing it.

Harvey Alter, in the United States, conducted clinical studies in the 1970s that showed that there was transfusion hepatitis that was not due to the well-known viruses A and B, and he was the one who called it “not A, not B”. In 1989 Michael Houghton, who worked in a private company in California, published the results of a very arduous and complex work in molecular biology that led him to identify the virus that produces this form of hepatitis, which was renamed C. Later, Charles Rice, also from the United States, in 1997 succeeded in cloning the entire virus and demonstrating, in chimpanzees, that the virus alone is the cause of hepatitis C.

With the identification of the virus, useful tests could be generated for its detection, which has considerably reduced the rate of infections. This also allowed in the last decade to develop drugs against various parts of the virus, which today, administered correctly, cure hepatitis C in twelve weeks, in such a way that every patient who has a chronic form of hepatitis C , particularly before it develops into cirrhosis of the liver or cancer, it can be cured.

The treatment is still very expensive, but various efforts in the world and in Mexico have been made to try to make it less. In addition to this, there is already a vaccine against hepatitis B. The goal that has been set is the elimination of hepatitis in the world by 2030. Governments know that, although the treatment is expensive, in the end it is cheaper than what chronic forms of hepatitis cost.

The reader may wonder, what does all this have to do with COVID, which is the subject of my editorials on Mondays? I bring this information in today’s editorial because it is encouraging. Done for hepatitis has taken many years, limited in part by the funds dedicated to it and the number of interested researchers. In the case of COVID, the speed with which progress is being made in the investigation of this disease is much faster. I am confident that in a few years we will be commenting in an editorial similar to this one on the Nobel Prize awarded to those who have been key in generating the information that allows us to control the SARS-CoV-2 pandemic.

Dr. Gerardo Gamba

National Institute of Medical Sciences and Nutrition Salvador Zubirán and

Institute of Biomedical Research, UNAM.

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