Nobel Prize 2020 Shines Light on Science and Hepatitis C — Understanding the ABC’s of Viral Hepatitis

Joseph R. Anticaglia MD
Medical Advisory Board

On October 5, 2020 three scientists were awarded the Nobel Prize in medicine for their pioneering work in discovering the Hepatitis C virus. Two Americans and one British-born scientist will share this prestigious award as announced by the Nobel Committee at the Karolinska Institute in Stockholm, Sweden.

The announcement named Dr. Harvey J. Alter, Michael Houghton and Charles M. Rice as recipients because of their “decisive contribution to the fight against blood-borne hepatitis.” The judges went on to say, “The discovery of Hepatitis C virus … made possible blood tests and new medicines that have saved millions of lives.”

Hepatitis, or liver inflammation, is a worldwide disease mainly caused by viruses, although other causes include autoimmune disease, alcohol abuse and environmental toxins. The WHO estimates 71 million people around the world have chronic hepatitis C which can progress to cirrhosis and liver cancer. It caused the deaths of 399,000 people in 2016.

Different types of hepatitis are identified by the use of letters and the three most common are:

  • Hepatitis A — transmitted by contaminated food or water
  • Hepatitis B — transmitted by blood
  • Hepatitis C — transmitted by blood

Marty, while at the seashore ate a dozen oysters and a few weeks later complained of fatigue, loss of appetite and abdominal pain. He was diagnosed with having Hepatitis A Virus. He was advised that, his complaints would, most likely, go away in a several weeks and the virus would have little long-term impact on the liver or his health.

Carol, a phlebotomist, accidentally pricked her finger while drawing blood from a patient with Hepatitis B Virus and contracted the disease. She complained of being jaundiced—yellowing of the skin and the whites of the eyes as well as fatigue, fever and dark urine. Most patients fully recover. However, if HBV becomes chronic (lasts more than six months), it increases the likelihood of you developing cirrhosis, liver failure or liver cancer.

Rick was plagued with substance abuse. He shared needles and paraphernalia with others having similar problems. After years of illegal drug use, he was diagnosed with Hepatitis C Virus. This serious viral infection is often asymptomatic for years. When he was diagnosed with HVC, he had many of the symptoms of both hepatitis A & B. Furthermore, he complained of itchy skin, of bruising and bleeding easily, and a ‘bloated stomach’ which turned out to be a buildup of fluid in the abdomen — ascites.

According to the CDC, an estimated 2,4 million people in the United States were living with hepatitis C during 2013–2016. Besides using contaminated blood on needles, HVC can be contracted by receiving blood tainted with the Hepatitis C virus, bodily fluids and unsafe sexual practices. How have the current Nobel Laureates’ work surmounted the challenges and contributed to the diagnostic and treatment of Hepatitis C?

Harvey Alter, Michael Houghton and Charles Rice shared the 2020 Nobel Prize in Physiology or Medicine; Credit: Getty images

Scientists at Work

The discovery of the Hepatitis C virus was the culmination of years of trials and mistakes, dead ends and frustration. “In the 1940’s, it became clear that there are two main types of infectious hepatitis. The first, named hepatitis A, is transmitted by polluted water or food. The second type is transmitted through blood and bodily fluids,” noted the Pulitzer committee.

In the 1960’s, Baruch Blumberg discovered one form of the blood-borne hepatitis virus that became known as hepatitis B. His work led to screening tests for blood transfusions, diagnostic tests and the development of an effective vaccine.

Mystery Virus

Yet, scientists were perplexed by a mysterious bloodborne virus that was neither Hepatitis A nor Hepatitis B. At that time, physicians were hesitant about transfusing blood into patients, because as some said, “It was like playing Russian roulette.”

It took three people to put the final pieces together to solve the blood transfusion puzzle. In 1972, Harvey J. Alter observed that a large number of patients came down with hepatitis who had received blood transfusions. The patients tested negative for the hepatitis A and B. These viruses were not the wrongdoers. Alter described that period as the “Non A and Non B” years. Although the hunt was on, the virus remained a mystery to him for over a decade. He showed his frustrations during those years in a 1988 poem which in part said:

I think I shall never see

The virus called non-A, non-B

A virus I cannot deliver

And yet I know it’s in the liver

Deliverance

Well, deliverance came when the virologist Michael Houghton and his coworkers put in place another missing piece of the puzzle. Houghton successfully identified the mystery virus (the non-A, non-B virus) and following the letter classification, labeled it, Hepatitis C. He discovered how to clone the virus and identified specific antibodies used to fight HCV.

At Last!

After many years of work by these scientists, Charles M. Rice nailed in place the final piece of the puzzle. Using genetic analysis, he investigated whether the virus alone could cause hepatitis? Rice proved that the cloned virus by itself was able to replicate and cause disease. After many years of intense research, at last, the final piece of the puzzle was guided into place. What is the significance of their research?

Today we take for granted the safety of blood transfusions. The work of Alter, Houghton and Rice make possible the identification of hepatic viruses, the use of diagnostic tests to safeguard blood transfusions. In addition, their research led to the development of antiviral drugs that can cure the disease as well as the availability of hepatitis A and Hepatitis B vaccines.

Thomas Perlmann, Secretary of the Nobel Committee, in a video interview said, “It’s hard to find something that is of such benefit to mankind as what we are awarding this year. This discovery … has led to improvements for millions of people around the world.”

References

  1. Diana Sylvestre; Hepatitis C for Addiction Professionals, Addiction Science and Clinical Practice; Dec. 2007
  2. Hofmeister MG, et al. Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013 — 2016. Hepatology, 2018
  3. Harvey J. Alter. The Road Not Taken or How I Learned to Love the Liver; American Association for the Study of Liver Disease, October 9, 2020
  4. WHO. Hepatitis C, July 27, 2020.

Addendum

  • Baruch Blumberg received the Nobel Prize in Medicine or Physiology in 1976.
  • The Hepatitis C virus belongs to a group known as flaviviruses that also includes West Nile virus, dengue virus and yellow fever virus.
  • At this time, there is no vaccine for HCV.

This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.