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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

      

New database to help fight against hepatitis C By Leslie Hoffman, Associated Press
ALBUQUERQUE - Patricia Monaghan wishes there was a better way to vanquish the invader attacking her liver.

For now, she copes with a treatment that forces the 46-year-old lawyer and mother of two to ration her life, predicting the days she'll feel well enough to venture out or be too sick to leave her house.

Monaghan is among the estimated 4 million Americans with hepatitis C, the most common blood-borne viral infection in the United States. It kills around 10,000 Americans annually, with that toll expected to triple by 2010.

In New Mexico, roughly 32,000 people are infected with the virus. The state also has the country's highest rate of deaths due to chronic liver disease and cirrhosis - which both can be caused by hepatitis C.

The standard 48-week treatment is only about 45% effective for those with the most common form of hepatitis C and can cause nasty side effects.

"They say it's flu-like symptoms, but I tell people it's death," said Monaghan, who began the treatment regiment in September.

But help for patients like Monaghan could be on the way thanks to a new research tool developed at Los Alamos National Laboratory.

The lab has launched an Internet-based hepatitis C genetic database designed to help researchers better understand the chameleon-like virus, one known for its genetic variability.

    



"It will be very valuable in anti-viral drug design, in clinical treatment of hepatitis C and in designing a vaccine," said Steven Jenison, the physician administrator of the state Department of Health's Infectious Disease Bureau. "It's really the design and use of hep C specific anti-viral drugs, which we don't have yet, and a vaccine, which we don't have yet, that holds the real hope for bringing hep C under control."

The database is the only one of its kind in the Americas, said Carla Kuiken, a Los Alamos molecular epidemiologist and one of the chief architects of the database. Two others are in Japan and France, but she said the lab's version is better funded.

The heart of the lab's database is an electronic library that serves as a storehouse for thousands of pieces of hepatitis C's genetic recipe.

Researchers have already plugged about 20,000 genetic sequences of the virus into the database, which was launched in September. Of those, only 200 to 250 are complete genetic recipes; the rest are just genetic fragments of the virus.

What makes the Los Alamos database special is the tools it offers to interpret its genetic information. One of them is a feature called TreeMaker, which allows users to do what bascially amounts to genealogical research, but tracing genetic history instead of family history.

The feature spits out what looks like alphabet soup to the untrained eye. But it allows a researcher to compare one patient's viral form against others to figure out, for instance, where that patient's virus may have come from.

Kuiken said the site's tools are based on technology the lab developed for HIV databases. The HIV work began 20 years ago and has resulted in four databases covering HIV genetics, immunology, vaccine trials and the virus' genetic mutations that make it resistant to drugs.

    



"We've had to develop a whole set of tools to study HIV because of its variability and hepatitis C is the same," Kuiken said.

Variability means the two blood-borne viruses mutate quickly, forcing researchers to try to hit a moving genetic target when designing drugs and vaccines to either prevent or kill the virus.

"When you're talking about hep C, you're not talking about one thing," Jenison said. "You're talking about a family of related viruses" because of its constant genetic mutation.

Overall, there are six recognized genotypes of hepatitis C. About 70% of those infected have the first type. The standard treatment, which requires a weekly self-administered shot of one drug and daily tablet doses of another, is only about 45% effective for those folks.

About thirty percent have the second and third types, of which 75% to 80% respond to the treatment.

"We need more research to get better medication," said Monaghan, who contracted the virus through blood transfusions after a severe car accident in 1989. Blood screening for the virus didn't begin until 1992.

Los Alamos' database is the first step in a five-year lab project funded by the National Institutes of Health. The second step is a database that catalogues immunology information about hepatitis C, again mirroring the technology Kuiken and her fellow scientists developed for the HIV immunology database. The hepatitis C immunology database should be up and running next year.

In the meantime, Monaghan said she's committed to educating the public about the virus and helping those infected get better access to information and treatment. The promise of future advances gives her hope.

"The more resources out there, I think, are important," she said.

Los Alamos National Laboratory's hepatitis C database is online at: Hepatitis C Virus.lanl.gov or Hepatitis C Virus-db.org.