A trio of scientists who have identified and characterized the virus responsible for many cases of hepatitis and liver disease ̵
Winners are Harvey Alter of the US National Institutes of Health in Bethesda, Maryland; Michael Houghton, now at the University of Alberta in Canada; and Charles Rice, now at Rockefeller University in New York City. Their work on the hepatitis C virus has paved the way for effective treatments against the infection that are now available.
The World Health Organization (WHO) estimates that 71 million people worldwide are chronically infected with hepatitis C, which causes nearly 400,000 deaths annually, mainly from cirrhosis and liver cancer.
The award is well deserved, says Ellie Barnes, who studies liver medicine and immunology at the University of Oxford in the UK. “It stands out as an emblem of great science,” he says. “We have gotten to a point where we can cure most of the people who are infected.” The winners will share a prize of 10 million crowns (1.1 million dollars).
In the 1970s, Alter studied the transmission of hepatitis, or inflammation of the liver, following blood transfusions. Previous work had identified hepatitis A and B viruses, but Alter showed that a third blood-borne viral pathogen could transmit the disease to chimpanzees.
Houghton, then working at the Chiron Corporation in Emeryville, California, and his colleagues identified the virus based on the genetic material of infected chimpanzees, showing that it was a new type of RNA virus that belonged to the Flavivirus family. They called it the hepatitis C virus.
A team led by Rice, then based at Washington University in St. Louis, Missouri, used genetic engineering techniques to characterize a portion of the hepatitis C genome responsible for viral replication, demonstrating its role in causing liver disease. .
Some researchers had considered the virologist Ralf Bartenschlager of the University of Heidelberg a candidate for a Nobel Prize in hepatitis C, for his research on ways to propagate the pathogen in the laboratory. But Bartenschlagerhe says the Nobel committee made a reasonable choice. “It’s a really tough decision,” he says. “I think the way they approached is quite understandable.”
In the past, Houghton has been a vocal critic of science awards limiting the number of recipients; the maximum number of winners for a single Nobel Prize is three. In 2013, he turned down a prestigious Canada Gairdner Award – which came with a $ 100,000 award – because the award did not recognize his collaborators Qui-Lim Choo and George Kuo to Chiron. “He always wants to see his discovery as a team approach,” says Thomas Baumert, a virologist and hepatologist at the University of Strasbourg in France.
Difficulty with vaccines
The result of the search for winners and others has led to significant improvements in hepatitis testing and treatment. Over the past decade, harsh and poorly effective treatments for the infection have been replaced by drugs that directly block the virus. These drugs have the potential to cure the vast majority of hepatitis C infections, but their high cost has limited access in many low- and middle-income countries.
Treatment requires following a drug regimen for 8-12 weeks, Barnes says. “Many of the people living with hepatitis C remain in vulnerable environments or are IV drug addicts, where it is actually quite difficult to provide drugs to those affected.”
Bartenschlager says he hopes the Nobel will bring attention to the “silent epidemic” of hepatitis C around the world.
WHO has set a goal of eradicating the hepatitis C virus by 2030, which Barnes says could be achievable. But to do that, he adds, a vaccine may be needed.
Progress in developing such a vaccine has been slow, in part due to little investment in effort and the shrewd nature of the virus itself. The genetics of each strain of the hepatitis C virus differs dramatically: Barnes estimates that hepatitis C is ten times more diverse than HIV and “infinitely” more than the SARS-CoV-2 coronavirus, which causes COVID-19. And it is difficult to conduct clinical trials in the populations most vulnerable to the hepatitis C virus.
None of these problems are insurmountable, Barnes says. “The virus was discovered 30 years ago and we don’t have a vaccine yet,” he adds. “We still have people who are infected and dying of hepatitis C. From that point of view, the story isn’t over.”
Baumert adds that with the availability of better treatments, the misconception has emerged that the hepatitis C problem has been solved and that funders and journals seem less interested in the disease. The Nobel Prize could be an opportunity to remind the world that hepatitis C remains a problem. “This will revive it and bring attention back to the vaccine,” he says.