EXPERIMENTAL MEDICINE RESEARCH DIVISION

The Experimental Medicine Research Division is primarily involved in research on hepatic and gastro-intestinal diseases. The division is investigating the prevalence of hepatitis B and hepatitis C infections in different geographical areas and population groups and the associated factors with the aim of determining the burden of hepatitis B and hepatitis C infections and to identify ways of controlling it. The division is also concerned with the diagnosis and management of hepatitis B and hepatitis C carriers who are attending the Hepatitis Carrier Clinic.

RESEARCH PROJECTS

1. COMMUNICABLE DISEASES

1. VIRAL HEPATITIS

1.1. Genotype patterns of hepatitis B surface antigen carriers residing in Yangon

Serum samples have been collected from 304 HBsAg carrier subjects attending the Hepatitis Carrier Clinic. Confirmation of HBsAg was done by ELISA method and all samples are tested for HBeAg. Twenty three percent (70/304) are positive for both HBsAg and HBeAg which implies active viral replication. Alpha fetoprotein was high in 8 subjects (range 12 to 350 ng/mL). DNA extraction has been performed from sera samples for PCR assay.

1.1.2. Molecular diagnosis of hepatitis B infection in a selected population in Yangon Region

Total of 565 serum samples were collected from four townships in Yangon region. In Khanaungto Township, 8.70% (16/184) of samples were HBsAg positive with screening test (SD ICT). In South Okkalapa Township, 12.87% (22/171) of samples were HBsAg positive; in Twante Township, 16.04% (17/106) were HBsAg positive and in Sanchaung Township 3.85% (4/104) showed HBsAg positive. Among 565 samples, HBsAg was positive in 59 samples (10.44%). Extraction of DNA from sera samples was performed to proceed to PCR assay.

1.1.3. Effectiveness of hepatitis B immunization in 3-5-year-old children from Mon State (WHO-APW)

Coordinating meeting with immunization and disease control officials from Department of Health was carried out in Naypyitaw and survey plan was arranged. Preliminary survey to the Mon state (Mawlamyaing and Thaton) was performed. During this survey, discussions were made with the health personnel of the Mon State, personnel from Mawlamyaing and Thaton Districts to obtain the list of 3-5-year-old children who had been immunized with three doses of hepatitis B vaccine under EPI programme. A total of 772 from the urban area of Mawlamyaing District and 2746 from rural area of Thaton District were compiled and out of which 1200 will be selected for collection of blood sample in March, 2011. Regarding the opinion of the guardians of the immunized children and midwives towards hepatitis B immunization, literature-based semi-structured questionnaire was developed and tested. Pre-test of questionnaires and respondents’ understanding of the questions was conducted with 10 mothers, 5 each from Mawleimyaing and Thaton, and 5 midwives, 3 from Mawleimyaing and 2 from Thaton respectively. While doing pre-testing with the parents and guardians, the possible answers for closed-type category, new questions to be added such as transmission of hepatitis B were explored. Accordingly, the questionnaire was revised. Questionnaire for midwives was also modified based on their responses and suggestions. Questions relating to immunization process and support obtained were put together where they answered it in a combination way.

1.1.4. Clinical Trial of Fekalin 80 (Heat-treated Enterococcus faecalis) in the management of hepatitis C virus carriers

The study is conducted in collaboration with Okayama University to determine the role of Fekalin 80 (heat-treated Enterococcus faecalis FK 23) in the management of chronic hepatitis C infection. Two hundred and sixty anti-HCV positive subjects have been screened for the study. To date, 45 subjects (22 males and 23 females) have been recruited and are taking 2700mg of Fekalin 80 per day (1packet 3 times daily) by oral route. A significant reduction of mean alanine aminotransferase (ALT) was found from 64.1±16.6 IU/mL to 35.1±11.1 IU/mL after 3 months, to 29.7±12.7 IU/mL after 6 months, to 34.5±13.6 IU/mL after 9 months, to 32.1±11.8 IU/mL after 12 months, to 40.0±19.8 IU/mL after 15 months, to 23.36±6.77 IU/mL after 18 months, to 23.37±5.37 IU/mL after 21 months. A significant reduction of mean aspartate aminotransferase (AST) was found from 64.7±30.4 IU/mL to 45.1±11.7 IU/mL after 12 months, to 42.7±13.2 IU/mL after 15 months, to 41.7±13.9 IU/mL after 18 months, to 38.3±8.84 IU/mL after 21 months. No significant changes were noted in the mean haemoglobin level, mean platelet count and mean urea levels at 6 months, 12 months and 18 months of therapy. Apart from the complaint of headache, giddiness and constipation there are no serious side effects.

1.1.5. Hepatitis C virus genotype patterns among Injecting Drug Users (IDUs) at Drug Dependency Treatment Centers in Yangon Division, Mandalay Division and Kachin State

This study was performed in collaboration with Drug Dependency Treatment Unit, Department of Health and Okayama University. A total of 100 samples were selected according to their respective sero-prevalence rate from 236 left-over anti-HCV positive sera samples. RNA extraction for RT PCR assay was performed by Simple Step method from all selected samples.

1.1.6. Prevalence and associated factors of Hepatitis C infection among commercial sex workers

A cross sectional descriptive study was conducted on commercial sex workers (CSWs) attending the Sexually Transmitted Disease clinics in Yangon General Hospital and North Okkalapa Township Health Center. A total of 150 CSWs, age ranging from 18 to 50 years were recruited from July 2009 to June 2010. Screening for HCV infection with immuno-chromatographic test and confirmation with anti-HCV ELISA 3.0 (Standard Diagnostic Inc, Korea) were performed. According to anti-HCV ELISA test, 4.67% (7/150) were positive. It was found that the knowledge and practice of condom usage was low among CSWs. The knowledge about prevention of hepatitis B and C infection and about hepatitis B vaccine was also needed to improve in CSWs.

NON-COMMUNICABLE DISEASES

2.1. CANCER

2.1.1. Serial determination of alpha-fetoprotein in hepatitis B and C infected patients Serial determination of serum alphafetoprotein (AFP) and ultrasonography was carried out in chronic hepatitis B or hepatitis C and patients at the Hepatitis Carrier Clinic, DMR (Lower Myanmar) and Liver Unit, Yangon General Hospital. Determination of AFP level was performed every 6 months. A total of 246 patients, 59 HBsAg positive patients (30 male and 29 female with mean age of 33.83 ±13.08 yrs), 113 HCV positive patients (57 males and 56 female with mean age of 43.13 ± 11.76 yrs) and 74 clinical and ultrasound proved chronic hepatitis or cirrhosis patients (with mean age of 53.94 ± 12.16 yrs) were studied for 12 months period. Initial mean alphafetoprotein level of HBsAg positive patients, anti-HCV positive patients and those with chronic hepatitis and cirrhosis of liver showed 10 ng/mL, 16.99 ± 18.03 ng/mL and 57.36 ±131.38 ng/mL respectively. No elevation of AFP (>20ng/ml) was recorded in the HBsAg positive patients. Among the anti-HCV positive patients, elevated AFP level (>20 ng/mL) was found in 4.4% (5/113). One of these patients had high AFP level (236 ng/mL). Among the chronic hepatitis and cirrhotic patients, 23.0% (17/74) showed elevated AFP levels. Four of these patients had high AFP level (>500 ng/mL) on initial screening test, which is diagnostic for hepatocellular carcinoma. The patients with high AFP level were referred to the Physician of the Liver Unit, Yangon General Hospital.

SERVICES PROVIDED

ACADEMIC

LABORATORY

LABORATORY(Quality Control Tests for DMR Plasma-derived HB Vaccine)

LABORATORY(Quality Control Tests for Avian Russell’s viper anti-venom)