At about 5:34 p.m. on October 5, Beijing time, the 2020 Nobel Prize in physiology or medicine was announced. American and British scientists HarveyJ.Alter Michael Houghton and Charles mrice won awards in recognition of their discovery of hepatitis C virus.
This years single Nobel Prize was increased to 10 million SEK (about 7.6 million yuan), an increase of 1 million Swedish kronor over 2019.
Written by Guo Xiaoqiang
Editor Jin YANAN
Hepatitis, as the name suggests, is an inflammatory disease that occurs in the liver. Hepatitis was described as early as Hippocrates B.C., known as epidemic jaundice.. During the Second World War, hepatitis broke out in the army through blood transfusion and yellow fever vaccine injection, which caused great concern.
In 1947, F.O. MacCallum, an expert on liver diseases in Britain, concluded through analysis that there were at least two types of hepatitis, one of which was transmitted through feces, known as hepatitis A (hepatitis A); the other was transmitted through blood, known as hepatitis B (hepatitis B). This conclusion laid the foundation and direction of hepatitis research.
Discovery of hepatitis virus
If you want to prevent or treat hepatitis, the first step is to find the pathogen. More than ten years after McCullens conclusion about hepatitis, many laboratory researchers around the world tried, but failed. In the mid-1960s, the research was in a deadlock, and most researchers were not optimistic about the prospect of hepatitis. At this time, an accidental discovery changed the status quo. The reason why it is accidental is that the heros original intention is not to study hepatitis.
Baruch Samuel Blumberg, a scientist with both medical and biochemical background, was initially interested in the reasons behind the differences in diseases among different populations, so he collected a large number of blood samples from all over the world. In 1963, when brenberg screened blood samples, he accidentally found that the serum (containing antibody) of a hemophilia patient could react with the blood of an Australian aborigine. Therefore, this unknown component in the blood was called Australian antigen (Australian antibody).
At first, brenberg thought that Australian antibody was a marker of hemophilia. Further screening found that a large number of hepatitis B patients were also positive for Australian antibody. Finally, it was determined that Australian antibody was the component of hepatitis B virus and was renamed as hepatitis B virus antigen. However, the name of Australian antibody is still used today. Brenbergs discovery cleared the way for the study of hepatitis B virus, and he shared the 1976 Nobel Prize in physiology or medicine for his discovery.
In 1973, scientists at the National Institutes of Health (NIH), under the leadership of Steven feinstone, identified hepatitis A virus from the feces of prisoners. So far, both known types of hepatitis viruses have been found.
The identification of the two viruses is of great significance. The first is the establishment of detection methods to ensure the reduction of virus pollution. For example, in 1977, the proportion of blood transmission of hepatitis B caused by hepatitis B virus in the United States was almost zero; the second was the successful development of vaccines. Around the 1980s, Maurice Hillman, an American microbiologist, developed hepatitis A and hepatitis B vaccines successively, which further strengthened the prevention of hepatitis.
At a time when everyone was confident that the hepatitis problem had been basically solved and that they could rest assured in the future, new problems appeared.
Discovery of hepatitis C virus
Harvey James alter, a physician and virologist, was involved in the Australian anti-virus discovery with brenberg. He joined NIH in the 1970s to participate in blood bank quality control to reduce the transmission of hepatitis through blood transfusion. However, in his work, orte found that despite the elimination of hepatitis B virus, blood transfusion can still lead to a large proportion of hepatitis. The detection results of hepatitis A and hepatitis B virus in these infected patients were also negative, thus denying the omission of virus detection. In 1975, orte named this new type of hepatitis as non-A, non hepatitis B, and did not directly call hepatitis C for careful consideration. Orte and others worked with chimpanzees to further prove that the virus that causes the hepatitis is a new type of virus.
The discovery of a new type of hepatitis has prompted scientists around the world to look for pathogens. At first, it was optimistic that virus identification would be completed soon, but it took more than ten years to find the virus. In 1987, Michael Houghton team of Chiron Corporation and Bradley of CDC in USAuff08 DanielW.Bradley uff09A new type of virus was discovered by molecular cloning. In 1988, aults team confirmed that the new virus was present in blood samples from patients with non-A, non-hepatitis B infection. In 1989, the Horton team officially identified the new virus and renamed it hepatitis C virus (HCV).
The discovery of HCV is the first breakthrough in the history of hepatitis C research, and soon established the detection method of HCV virus to avoid the infection of the disease to the greatest extent. In 1990, routine hepatitis C test was started in blood bank, and in 1992, highly sensitive detection method was further used. As a result, HCV was basically eliminated from the blood bank and the transmission of hepatitis C through blood transfusion was reduced.
Several scientists have also received many awards from the scientific community for this contribution (Figure 1). In 2000, ault and Horton shared the famous Lasker Clinical Medicine Award in the United States; in 2013, ault and Bradley shared the Canadian galdena International Award (Holden himself refused).
Figure 1. Three famous HCV Discoverers
Establishment of HCV culture system in vitro
Although the discovery of HCV can reduce the chance of infection, it has not fundamentally eliminated hepatitis C. the development of vaccines and drugs is fundamental. If we want to solve these problems, we need to have a comprehensive understanding of this new virus.
Charles rice, a famous American virologist, began to study the basic characteristics and survival mode of HCV in the early 1990s. At the beginning, rice team found that the reason why HCV was difficult to proliferate in chimpanzee hepatocytes was that some special structures of its genome were not fully understood. After making up for these defects, they finally realized the large-scale preparation of HCV in chimpanzees in 1997, which opened a door for understanding this new type of virus. However, due to the problems of chimpanzee feeding and cost, it is not suitable for large-scale research, so it is necessary to develop a simpler HCV culture system.
Ralf bartenschlager, a virologist at the University of Heidelberg in Germany, and student Volker Lohmann are also interested in HCV. Lohmann is full of confidence in the establishment of HCV training system, risking the risk of failing to graduate normally, so he chose the research topic, which is quite desperate. After many attempts, in 1999, on the basis of Rices discovery, a HCV in vitro culture system was developed, which can reproduce in human hepatoma cells, greatly simplifying the experimental operation. The rapid acquisition of a large number of HCV from hepatoma cells in vitro has greatly promoted the research of HCV.
With the help of in vitro culture technology, scientists have a clear understanding of the characteristics, life cycle and fatal weakness of HCV (which can be used as a target for drug treatment), which lays a solid foundation for the next vaccine development and drug development. Rice and Butler Schaller also shared the 2016 Lasker prize for clinical medicine for this contribution (Figure 2).
Figure 2. Founder of HCV in vitro culture (image from Lasker prize website)
The first trial of knife
Vaccine development is considered to be the basic problem to solve HCV. Unfortunately, HCV is highly variable, which brings great challenges to vaccine development. The 30-year research course shows that the research on hepatitis C vaccine is very difficult. Because the hepatitis C vaccine has not yet been successfully developed, it is regarded as the three major models of vaccine development failure together with HIV vaccine and influenza virus vaccine.
The failure of vaccine development has forced researchers to try to develop therapeutic drugs, but the road is also full of thorns. The treatment of hepatitis C began before the identification of HCV. In the mid-1980s, the application of u03b1 - interferon treatment achieved certain results. In 1992, the FDA officially approved the application of interferon u03b1 in the treatment of hepatitis C; in 1998, the FDA further approved the combination of interferon u03b1 and ribavirin (ribavirin) in the treatment of hepatitis C. There are many problems in this treatment, such as low cure rate, easy recurrence, high drug resistance and many side effects. In spite of these shortcomings, it was adopted as an expedient measure under the condition of no drug available, and became the standard treatment mode for the next 20 years, until the birth of new drugs.
In 1998, two scientists from Emory University, Raymond schanizi and Dennis Liotta, set up a small pharmaceutical company, pharmaset, which is committed to the development of antiviral drugs, and hepatitis C drugs are an important part.
Fig. 3. Mechanism of sofibovir inhibiting hepatitis C virus
For this reason, famaset began to screen nucleotide analogues with HCV in vitro culture system to inhibit HCV RNA production. These candidates were collectively referred to as pharmaset small molecule inhibitor (PSI), and different compounds were numbered. Under the leadership of chemist Jeremy Clark, psi-6130 was finally screened out, which can be converted into a compound very similar to UTP in liver cells (similar to stupid and indistinct), and finally achieve the purpose of inhibiting HCV reproduction (Fig. 3). Famaset then tested it on animal models, and the results were surprisingly good. It almost completely inhibited the reproduction of HCV with few side effects.
This gratifying achievement naturally prompted famaset to carry out phase I clinical practice, but this time the results were disappointing. After oral administration, a large proportion of psi-6130 is metabolized and inactivated in the intestinal tract, which can not enter the human body to play a therapeutic effect, which means that psi-6130 has no clinical practical value. Seeing that this perfect compound was about to die, the fate of psi-6130 was saved by the participation of a scientist at the critical moment.
Michael Sofias strong chemical background was the key to his ultimate success. Sofia received a bachelors degree in chemistry from Cornell University in 1980 and a doctors degree in organic chemistry from the University of Illinois at Urbana Champaign in 1984. He mainly studied the design, synthesis and mechanism of serine protease inhibitors, which laid the foundation for future drug research and development. Sofia has always been interested in drug research and development, and then spent his career mainly in the company. Since 1986, Sofia has successively carried out new drug research in Lilai company and Bristol Myers Squibb Company, and participated in the development process of cholesterol lowering drugs and asthma related inflammation drugs. These rich experiences guarantee the success of the next step.
In 2005, Sofia left Bristol Myers Squibb to join famaset, a small company less than 10 years old. The decision is a bit confusing to outsiders, but Sofia is confident about the future. Sofia thinks that large companies are too rigid in drug research and development, and are not suitable for innovation. On the contrary, some small companies are more suitable for new drug research and development. Of course, this also takes great risks, but high risks often bring high returns. In order to stimulate its potential, Sofia is duty bound to quit his enviable job in a large company. The subsequent development shows that this choice is extremely correct.
Sofia first had a comprehensive understanding of the companys new drug research and development, and had a strong interest in psi-6130 which was temporarily in trouble. After careful analysis, it is concluded that psi-6130 is worth rescuing. In Sofias eyes, psi-6130 is a good candidate drug, but there are structural problems. The biggest problem is that it can not reach the designated site (HCV infected hepatocytes) effectively. Therefore, as long as the structure is modified, psi-6130 can pass through the key points of drug absorption and transportation.
Sofia then launched the psi-6130 upgrade program, produced a series of psi-6130 modifications, and tried to screen out more perfect compounds. After two years of efforts, psi-7977 was finally discovered in 2007. Clinical trials have shown that psi-7977 has ideal absorption effect, and can metabolize psi-6130 in the liver. Further large-scale clinical trials found that psi-7977 combined with interferon and ribavirin, or only combined with ribavirin for 12 weeks, patients with hepatitis C can achieve a cure effect, such a magical effect is almost incredible, after all, anti viral treatment such as AIDS can only control the disease but not cure.
On December 6, 2013, the United States FDA officially approved psi-7977 combined with ribavirin for the treatment of hepatitis C. abandoning interferon is a great progress. In memory of Sofias important contribution in the development of psi-7977, the molecule was renamed sofosbuvir (or translated into sofobuvir and other names) (Fig. 4), and the trade name sovaldi. Sofia also shared the 2016 Lasker Clinical Medicine Award for this important contribution.
Figure 4. Sofia and sofibwe
It means a lot
Gilead, a famous manufacturing company, seized the business opportunity and acquired famaset for us $11.2 billion in November 2011. Sofibuvir naturally became the main drug of Gilead. Sofibways sales have brought Gilead a lot of money. In the first quarter of 2014, sofibweys sales exceeded $2 billion, and the annual sales were as high as $10 billion. Gilead has developed a series of hepatitis C treatment combination drugs on the basis of sofibovir, so as to further improve the therapeutic effect.
The introduction of sofibuprovir has undoubtedly brought gospel to many patients with hepatitis C. The number of hepatitis C deaths in the United States once exceeded the number of AIDS deaths. The cure of hepatitis C can be achieved after 12 weeks of medication (1 tablet of sofibuprovir and other combined drugs every day), so that this long-term disease without vaccine and specific drug treatment can be fundamentally solved. Because some patients with hepatitis C can further develop into liver cirrhosis and liver cancer, sofibvir can also be regarded as a preventive drug for liver cancer to a certain extent.
At present, there are more than 100 million patients with hepatitis C in the world and more than 10 million patients in China. The World Health Organization announced in 2016 that viral liver disease would be fundamentally eliminated within 15 years (by 2030). Sofibovir will certainly make an important contribution to this.
Figure 5. Global prevalence of hepatitis C in 1999 (photo from Wikipedia)
Although sofibuprovir has been praised by many patients as a miracle drug for hepatitis C treatment, the high cost still makes many hepatitis C patients flinch. In the United States, the cost of a 12 week treatment with sofibuprovir is as high as $84000, a price that many families find difficult to accept. Fortunately, generic drugs have been sold in India at a price of only $800 to $1000 (a treatment cycle), thus bringing hope to hepatitis C patients in many developing countries.
At present, all parties are making active efforts to make as many hepatitis C patients as possible afford the price of sofibuprovir, so as to make this miracle medicine achieve the purpose of benefiting human beings to the greatest extent.
 Guo Xiaoqiang. Baluch Samuel Blumberg, discoverer of anti hepatitis B Australian antibody. Journal of nature, 2012,34 (5): 308-310
Extended reading just now! The 2020 Nobel Prize in physiology or medicine is announced, and the hidden hepatitis C virus is discovered. The unfinished journey will bring the doomsday to hepatitis C. detailed explanation of the 2020 Nobel Prize in physiology or medicine. Source: Zhang Zutao, editor in charge of the Institute of physics, Chinese Academy of Sciences_ NT5054