New nano-technology is being developed to help treat patients with chronic hepatitis. But will it work, wonders Reem Leila The Hepatitis C Virus (HCV) causes an acute and chronic form of the disease. The World Health Organisation (WHO) has declared HCV a global health problem. An estimated three per cent of the world's population is infected with the virus. In the US three million people are thought to have chronic infections, many yet to be diagnosed. In Egypt Infection rates are far higher. Fifteen per cent of the population, i.e. some nine to 11 million people, are thought to be carrying Hepatitis C antibodies, meaning that they either have, or at one time had, the virus. It is estimated that eight million of these are actively infected with HCV. The American University in Cairo (AUC), in collaboration with Egypt's National Research Centre and Medical Research Institute, is developing novel diagnostic tests and therapeutic strategies tailored to the genotype of HCV prevalent in Egypt in an attempt to end the endemic problem. The strategies rely on nano-technology -- nano-crystal and nano-particles. Hassan Azzazi, head of the AUC's Chemistry Department, explains: HCV has many genotypes, the most dangerous of which is the 4A type which is widely spread in Egypt. "Each geographic area has its own kind of genotype of HCV. The 4A type, if not treated, can cause liver cancer and cirrhosis. The team working on new approaches has been exerting great effort to respond to the challenges of chronic disease." The cost of current antiviral drugs is prohibitive. A 24-week course of treatment costs more than LE40,000 and is effective only in 30-50 per cent of cases. Patients also suffer severe side effects, including depression and anaemia. Nano- technology, says Azzazi, holds out the prospect of far greater success rates for less than half of the cost of available treatments. "The new technique is going to be very useful to blood banks as it can detect the presence of the HCV in the blood at extremely low ratios unlike the current Pathogenic Control Routine [PCR]," claims Azzazi. His eight-member team soon plans to test their diagnostic procedures on 300 randomly selected patients. Developing and designing the new drug delivery system, they have concentrated on delivering drugs only to cells already infected with HCV. The genomes of liver cells infected with HCV fold to develop a secondary structure which enables the virus to replicate inside itself. "The virus is mutating all the time. At a certain point -- we call it the hot spot, the genome -- the virus can change its configuration and prevent itself from replicating. We are trying to identify this hot spot, using nano-technology and nano- crystals to capsulate the drug inside a sphere the surface of which will be covered by particular markers that once the drug is released inside the body unite with infected cells and terminate them," explained Azzazi. The prevalence of HCV in Egypt is a result of campaigns in the 1960s to treat bilharzia. The treatment, which involved repeated injections, did not follow strict hygiene standards and allowed HCV to spread throughout the population. Abdel-Rahman Shahin, official spokesman at the Ministry of Health and Population, believes the new technique, while unlikely to lead to the development of new medication, will be useful in detecting the virus ratio in blood. In some patients it can take up to 30 years for HCV symptoms to appear or for the disease to become active. The virus itself was only identified in the 1980s. Deaths due to HCV are likely to increase in Egypt over the next 20 years. "The annual infection rate is more than 70,000 new cases a year, of which at least half are of chronic hepatitis C. By 2020 it is possible that the number of patients suffering liver failure and liver cancer will double," says Manal El-Sayed of the National Hepatitis Programme.
