COMMENTARY

Hepatitis C: The Pace of Progress

Digestive Disease Week (DDW) 2013

William F. Balistreri, MD

Disclosures

June 06, 2013

In This Article

A Glimpse of Future Treatments

Speakers here also gave us a glimpse of the future. Second-generation protease inhibitors and small-molecule drugs to inhibit other viral enzymes are being evaluated in clinical studies. Drug cocktails that target multiple HCV enzymes simultaneously may ultimately become the standard of treatment. This has certainly been an effective strategy for the management of infection with HIV.

It was also suggested that future strategies will include unique approaches to the treatment of viral hepatitis. One interesting approach is to use RNA interference. Speakers highlighted a recently reported breakthrough -- the use of a microRNA designed to interfere with HCV replication at the intracellular level.[10] An antisense oligonucleotide microRNA binds highly conserved sites in HCV. The liver-expressed microRNA normally serves to protect HCV. By binding to messenger proteins in liver cells, this agent prevents HCV replication and survival and effectively reduces the viral load.

The antisense nucleotide induced a dose-dependent drop in HCV RNA levels, and the biologic effects lasted for weeks, suggesting that agents of this type can be administered infrequently, possibly at monthly intervals. This study offers proof of concept that a new class of RNA interference drugs is possible. Larger studies will determine the safety and effectiveness of this approach.

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