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1.  Non-B hepatitis in Melbourne: a serological study of hepatitis A virus infection. 
British Medical Journal  1977;1(6055):193-195.
A study was performed to establish the value of immune adherence haemagglutination tests for antibody to hepatitis A virus in the diagnosis of non-B hepatitis. Infection with hepatitis A virus was confirmed in 14 out of 16 patients from six families and seven out of nine patients in whom the source of infection was unknown. One additional patient, who had had two episodes of jaundice, was shown to have had an attack of hepatitis A followed by an attack of hepatitis B. In patients with acute hepatitis A antibody detectable by immune adherence haemagglutination becomes detectable three or four weeks after the onset of symptoms and reaches peak levels about five weeks later.
PMCID: PMC1604371  PMID: 188515
2.  Recent advances in the identification of hepatitis viruses. 
Postgraduate Medical Journal  1977;53(621):364-373.
Resulting directly from the discovery of virus-related antigens, rapid progress has marked the last decade of viral hepatitis research. The hepatitis B virion has been tentatively identified as a DNA virus with an endogenous DNA polymerase, and new serological markers for type B hepatitis have been discovered. Hepatitis A antigen has been identified on a virus-like particle thought to be the hepatitis A virion. Progressively more sophisticated assays for hepatitis antigens and antibodies have been applied to the study of viral hepatitis epidemiology and biochemical-biophysical characterization of the agents. Most recently, knowledge learned from such studies has been exploited to develop a prototype non-infectious but immunogenic hepatitis B vaccine using hepatitis B surface antigen (HBsAg) purified in large quantities from chronic HBsAg carriers. Especially exciting is the prospect, suggested by serological studies of viral hepatitis, that hepatitis viruses besides hepatitis A and B viruses will be identified.
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PMCID: PMC2496671  PMID: 196274
3.  Inhibition of Lymphocyte Cytotoxicity by Serum from Patients with Alcoholic Liver Disease: Partial Characterization of Serum Inhibitors 
Studies were performed to explore the effect on normal lymphocyte function of serum derived from patients with alcohol-induced liver injury and healthy controls. We examined the effect of such serum on the generation of both spontaneous and Concanavalin A (Con A)-induced lymphocyte cytotoxicity for Chang target cells. Normal lymphocytes, when incubated in the presence of 5% serum from patients with alcoholic liver disease, showed a marked (20.75 ± 5.1% mean ± SEM) reduction in the capacity to generate spontaneously cytotoxic cells compared to 5% control serum (3.2 ± 1.9%) (p < 0.001). Similar results were found in studies of Con A-stimulated cytotoxicity (36 ± 7.2% vs. 5 ± 2.3%; p < 0.001). Fractionation of serum by gel chromatography demonstrated the presence of inhibitory activity of various molecular weights, although a major peak of inhibitory activity (approximately 270,000 daltons) was identified in severe alcoholic hepatitis. Thus, this study demonstrates the presence of serum inhibitors in alcoholic liver disease which influence normal lymphocyte function.
PMCID: PMC2595598  PMID: 313125
4.  Hepatitis B virus precore mutation and fulminant hepatitis in the United States. A polymerase chain reaction-based assay for the detection of specific mutation. 
Journal of Clinical Investigation  1994;93(2):550-555.
Hepatitis B virus (HBV) variants with precore mutation(s) resulting in the absence of HBeAg production have been associated with the occurrence of fulminant hepatitis in Japan, Israel, and southern Europe, where the prevalence of this HBV strain appears common. In areas such as United States, where HBV infection is not endemic, the role of this mutant virus in fulminant hepatitis is unknown. We developed an amplification refractory mutation detection system to detect specifically the presence of the G to A mutation at nucleotide position 1898, which is the most frequently observed mutation resulting in a precore stop codon. In addition, this method provided a quantitative measurement of the relative ratio of one strain to the other. Using this system, we tested HBV strains for the presence of the stop codon mutation in sera from 40 cases of fulminant hepatitis B occurring in the United States. Serum HBV DNAs from 28 patients were analyzed successfully. A mixture of wild-type and mutant strains in various ratios were observed in 15 patients, wild type exclusively in 11, and mutant exclusively in 2. Four of these patients had undergone liver transplantation for HBV-associated cirrhosis and developed fulminant HBV-associated hepatitis after transplantation. Pre- and posttransplant serum samples from one patient were analyzed: a mixture of wild-type and mutant HBV strains was detected in both samples. Our study demonstrated that both wild-type and mutant HBV strains are associated with fulminant hepatitis, and that in some patients in the United States, factors other than precore mutations contribute to the development of fulminant hepatitis.
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PMCID: PMC293877  PMID: 8113393
5.  Hepatitis viruses: characterization and diagnostic techniques. 
Two human hypatitis viruses have been identified and characterized, but one or more additional agents exist. Hepatitis B virus (HBV) is a complex 42-nm predominantly double-stranded DNA virus with distinct surface and core antigens and an endogenous DNA polymerase. Hepatitis A virus (HAV) is a 27-nm RNA virus with enterovirus-like properties. Progressively more sensitive and specific immunologic assays have been applied to the study of viral hepatitis and are available for routine diagnostic purposes. As a result we recognize distinct serologic response patterns to infection, new antigenic markers, biochemical-biophysical characteristics of the viruses, and their epidemiologic features. Recombinant DNA technology has permitted the cloning of HBV genetic material and gene products in E. coli, but the virus has not been cultivated in vitro. In contrast, successful in vitro cultivation of HAV has finally been accomplished. Application of sensitive serologic tests for HAV and HBV has revealed that "non-A, non-B" agents account for a substantial proportion of transfusion-associated hepatitis as well as hepatitis occurring in the absence of percutaneous exposure. These agents have been transmitted to chimpanzees, and several putative virus antigen-antibody systems have been described; however, a specific association between these virus antigens and non-A, non-B hepatitis has not been established.
PMCID: PMC2595847  PMID: 6246688
6.  Comparison of serological tests for antibody to hepatitis A antigen, using coded specimens from individuals infected with the MS-1 strain of hepatitis A virus. 
Infection and Immunity  1976;14(4):1000-1003.
To compare serological tests for antibody to hepatitis A antigen (anti-HA), we tested 15 paired serum specimens, submitted under code, from individuals infected with the MS-1 strain of hepatitis A virus. Immune electron microscopy (IEM), immune adherence hemagglutination (IAHA), and solid-phase radioimmunoassay (RIA) tests for anti-HA were performed with hepatitis A antigen (HA Ag) derived from human stool; results were also compared with previously reported titers determined by IAHA with HA Ag derived from marmoset liver. Antibody titers (IAHA and RIA) and ratings (IEM) determined with stool-derived HA Ag compared favorably, and a seroresponse to HA Ag was detected by all three methods for every serum pair tested. Differences in titers were noted between IAHA tests with liver-derived and with stool-derived HA Ag, but the discrepancies could be accounted for by differences in test technique. The agreement found in this study among the three techniques was quite good and confirms the specificity and sensitivity of tests for anti-HA that are done with stool-derived HA-Ag.
PMCID: PMC415484  PMID: 186409
8.  Quantitation of antibody to hepatitis A antigen by immune electron microscopy. 
Infection and Immunity  1976;13(4):1209-1213.
A set of precipitin reactions was performed by immune electron microscopy (IEM) with hepatitis A antigen (HA Ag) and varying quantities of antibody to HA A q (anti-HA). Serial dilution of anti-HA resulted in progressive diminution in IEM antibody rating. These data, together with a highly significant correlation between IEM ratings and immune adherence hemagglutination (IAHA) titers on 92 coded serum samples, confirm that quantitative serology development can be performed by IEM. To demonstrate the different kinetics of antibody development by IEM and IAHA, we used both techniques to test for anti-HA in longitudinally collected sera from a chimpanzee experimentally infected with hepatitis A virus. Detection of anti-HA was possible by IEM during acute hepatitis, but IAHA anti-HA was not observed until approximately 4 weeks later. Six weeks after acute illness, IEM ratings reached a plateau beyond which IAHA titers continued to rise gradually. Peak titers were achieved 11 months after inoculation.
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PMCID: PMC420740  PMID: 179951
9.  Purification of hepatitis A antigen from feces and detection of antigen and antibody by immune adherence hemagglutination. 
Infection and Immunity  1976;13(3):898-908.
Hepatitis A antigen (HA Ag) was purified from feces collected during acute illness from patients with naturally occurring viral hepatitis, type A. Positive fecal specimens were identified by immune electron microscopy, but for detection of HA Agduring purification immune adherence hemagglutination (IAHA) and microtiter solid-phase radioimmunoassay were used. Isopycnic banding in cesium chloride, rate-zonal separation in sucrose, and preparative zonal electrophoresis were used in various combinations for successive purification, and the purified antigen was successfully used in a test for antibody by IAHA. Seronconversions to HA Ag were demonstrated by IAHA in 20 instances of hepatitis A virus infection, but in none of six cases of type B hepatitis or three cases of post-transfusion hepatitis unrelated to heaptitis A or B viruses, nor in two individuals without hepatitis. In addition, the temporal pattern of antibody development during type A hepatitis was studied in serial sera from an experimentally infected chimpanzee. Antibody titers by IAHA correlated well with antibody ratings determined by immune electron microscopy.
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PMCID: PMC420693  PMID: 178597

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