Background Hepatitis C virus (HCV) causes chronic liver disease that often leads to cirrhosis and hepatocellular carcinoma. In animal studies, chimpanzees were protected against chronic infection following experimental challenge with either homologous or heterologous HCV genotype 1a strains which predominates in the USA and Canada. We describe a first in humans clinical trial of this prophylactic HCV vaccine. Methods HCV E1E2 adjuvanted with MF59C.1 (an oil-in-water emulsion) was given at 3 different dosages on day 0 and weeks 4, 24 and 48 in a phase 1, placebo-controlled, dose escalation trial to healthy HCV-negative adults. Results There was no significant difference in the proportion of subjects reporting adverse events across the groups. Following vaccination subjects developed antibodies detectable by ELISA, CD81 neutralization and VSV/HCV pseudotype neutralization. There was no significant difference between vaccine groups in the number of responders and geometric mean titers for each of the three assays. All subjects developed lymphocyte proliferation responses to E1E2 and an inverse response to increasing amounts of antigen was noted. Conclusions The vaccine was safe and generally well tolerated at each of the 3 dosage levels and induced anti-body and lymphoproliferative responses. A larger study to further evaluate safety and immunogenicity is warranted.

Extracellular ATP is a potent signaling factor that modulates a variety of cellular functions through the activation of P 2 purinergic receptors in the plasma membrane. These receptors are widely distributed among different liver cell types, including hepatocytes, cholangiocytes, macrophages, and endothelial cells, but the physiologic roles have not been fully defined. Cells release ATP in response to both osmotic and mechanical stimuli, and one mechanism may involve opening of a channel-like pathway (1, 2). In respiratory epithelia, ATP release stimulated by cytosolic cAMP activates outwardly rectified Cl Ϫ channels coupled to P 2U receptors and enhances Cl Ϫ secretion (3).Recent studies in a model liver cell line support an alternative pathway where increases in cell volume induce conductive ATP efflux. In these cells, removal of extracellular ATP or P 2 receptor blockade prevents both Cl Ϫ channel activation and volume recovery (1). These findings suggest functional interactions between ATP release, P 2 receptor stimulation, and Cl Ϫ channel opening in epithelial secretion and volume regulation.Members of the ATP-binding cassette (ABC) 1 protein family are likely to be relevant to this volume regulatory pathway for two reasons. First, while the molecular basis for the transmembrane ATP conductance has not been established, heterologous expression or up-regulation of ABC family members in some cell models is associated with enhanced electrodiffusional ATP release. In cystic fibrosis respiratory epithelia, cAMP fails to stimulate channel-mediated ATP efflux, a response that is present in native epithelia; CFTR gene transfer restores the ATP conductance (3, 4). In other cell lines, ATP release is proportional to the expression of mammalian and Drosophila Mdr1 P-glycoproteins (5, 6). Second, in some but not all cell types, Mdr1 P-glycoproteins regulate swelling-activated Cl Ϫ currents (I Cl-swell ). Effects include enhancement of I Cl-swell and endowment of Cl Ϫ channel sensitivity to protein kinase C (mdr1 gene transfer) and increase in I Cl-swell for a given hypotonic stress (P-glycoprotein overexpression) (7,8). The cellular mechanisms involved in these responses and the implications for other cell types have yet to be clarified.In hepatocytes, P-glycoproteins transport both amphipathic compounds and phospholipids across canalicular membranes into bile (9, 10). However, the functions of multiple other ABC members present in liver cells are unknown. In light of the putative association of certain ABC proteins with channelmediated ATP and Cl Ϫ transport, we sought to investigate the role of hepatocellular ABC proteins in these processes. Findings in rat HTC hepatoma cells were compared with those in a selected population of HTC cells (HTC-R) that overexpress both endogenous and novel Mdr proteins (11). These studies demonstrate that inhibition of P-glycoprotein transport prevents recovery from swelling and that overexpression of Mdr proteins is associated with enhanced ATP release, volume recovery, and cell surv...

A B S T R A CT(a) hepatic uptake determined by direct tissue measurement could be accurately estimated from the plasma disappearance data; (b) saturation of hepatic uptake with increasing dose was readily demonstrated for each of these three organic anions, and in each instance a plot of V versus dose took the form of a rectangular hyperbola analyzable in terms of Michaelis-Menten kinetics; (c) for BR, the saturable uptake process showed a V.a. more than 100 times the normal net transfer rate from plasma to bile; (d) hepatic uptake of BR, BSP, and ICG showed relatively selective, mutually competitive inhibition; glycocholic acid did not inhibit hepatic uptake of any of these substances; and (e) "countertransport" could be demonstrated for each of the three test substances. These data are compatible with the existence of a carrier-mediated transport process for hepatic uptake of each of these three organic anions and clarify the relationship of hepatic BR uptake to its overall transport from plasma to bile.

Cerebral edema and intracranial hypertension, commonly present in fulminant hepatic failure, may lead to brainstem herniation and limit the survival of comatose patients awaiting liver transplantation before a donor organ becomes available. Also, they are likely responsible for postoperative neurological morbidity and mortality. Although intracranial pressure monitoring has been proposed to aid clinical decision making in this setting, its use in the prevention of brainstem herniation preoperatively, in the selection of patients for liver transplantation who have the potential for neurological recovery and in the maintenance of cerebral perfusion during liver transplantation has not been examined in detail. To address these issues, we established a protocol for intracranial pressure monitoring in comatose patients with fulminant hepatic failure as part of their preoperative and intraoperative management. Twenty adults and three children underwent intracranial pressure monitoring. Ten patients required preoperative medical therapy with mannitol, barbiturates or both for a rise in intracranial pressure above 25 mm Hg. Four patients had a sustained lowering of intracranial pressure, three of whom survived hospitalization. Six patients had intracranial hypertension refractory to medical management, were removed from a waiting list for a donor organ and died with brainstem herniation. Of the remaining 17 patients, 3 died of other causes while awaiting a donor organ, 2 recovered spontaneously without neurological sequelae and 12 underwent liver transplantation. All but one patient undergoing liver transplantation had transient intraoperative intracranial hypertension develop, requiring medical treatment. The 12 patients who had transplants recovered neurologically and were discharged from the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

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