title: Rapid reduction of hepatitis C virus-Core protein in the peripheral blood improve the immunological response in chronic hepatitis C patients.
abstract: OBJECTIVE
  The extracellular hepatitis C virus (HCV)-antigen, including HCV-Core protein, can suppress immune cells. Recently, the efficacy of double filtration plasmapheresis (DFPP) for chronic hepatitis C (CHC) was reported. However, the mechanism of efficacy of DFPP might not be only the reduction of HCV but also the effect of immune cells via direct and/or indirect mechanisms. The aim of this study is to analyze the virological and immunological parameters of difficult-to-treat HCV patients treated with DFPP combined with Peg-interferon and RBV (DFPP/Peg-IFN/RBV) therapy.
  
  
  METHODS
  Twelve CHC patients were enrolled and treated with DFPP/Peg-IFN/RBV therapy. The immunological, virological and genetic parameters were studied.
  
  
  RESULTS
  All patients (4/4) treated with the major IL28B allele (T/T) could achieve complete early virological response (EVR). The amounts of HCV-Core antigen in the peripheral blood of EVR patients treated with DFPP/Peg-IFN/RBV rapidly declined in comparison to those of late virological response (LVR) patients treated with DFPP/Peg-IFN/RBV and EVR patients treated with Peg-IFN and RBV (Peg-IFN/RBV). The amount of IFN-γ produced from peripheral blood gradually increased. On the other hand, the amount of IL10 gradually decreased in the EVR patients. The frequencies of HCV-Core binding on CD3+ T cells rapidly declined in EVR patients treated with DFPP/Peg-IFN/RBV therapy. Moreover, the distributions of activated CD4(+) and CD8(+)  T cells and CD16-CD56 high natural killer cells were significantly changed between before and after DFPP.
  
  
  CONCLUSIONS
  The rapid reduction of HCV-Core antigens and changes in the distribution of lymphoid cells could contribute to the favorable immunological response during DFPP/Peg-IFN/RBV therapy.
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine             Tohoku University Graduate School of Medicine, Aobaku, Sendai, Japan.
authors.forename: Yasuteru
authors.initials: Y
authors.lastname: Kondo
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ueno
authors.forename: Yuta
authors.initials: Y
authors.lastname: Wakui
authors.forename: Masashi
authors.initials: M
authors.lastname: Ninomiya
authors.forename: Eiji
authors.initials: E
authors.lastname: Kakazu
authors.forename: Jun
authors.initials: J
authors.lastname: Inoue
authors.forename: Koju
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Obara
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa