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World J Gastroenterol. Nov 21, 2014; 20(43): 16184-16190
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16184
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16184
Ribavirin induced hemolysis: A novel mechanism of action against chronic hepatitis C virus infection
Kaartik Soota, Department of Internal Medicine, Unity Health System, Rochester, NY 14626, United States
Benedict Maliakkal, Department of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14642, United States
Author contributions: Soota K and Maliakkal B contributed to this paper.
Correspondence to: Benedict Maliakkal, MD, Department of Gastroenterology and Hepatology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, United States. benedict_maliakkal@urmc.rochester.edu
Telephone: +1-585-2754711 Fax: +1-585-2761285
Received: May 22, 2014
Revised: July 11, 2014
Accepted: July 24, 2014
Published online: November 21, 2014
Revised: July 11, 2014
Accepted: July 24, 2014
Published online: November 21, 2014
Core Tip
Core tip: Innate immune tolerance leads to chronic hepatitis C virus (cHCV) infection even as a pro-inflammatory state develops within the liver. The suppression of heme oxygenase-1 (HMOX1) by HCV plays a major role in perpetuating the infection and inflammation. Ribavirin (RBV) therapy, which increases heme delivery to the liver, can overcome this inhibition. HMOX1 induction in Kupffer cells reduces the pro-inflammatory state produced by HCV, whereas HMOX1 induction in hepatocytes decreases viral multiplication and apoptosis. HMOX1-induced in the liver by hemolysis, results in higher sustained viral response (SVR) rates when RBV is used with interferon (IFN) in the treatment of cHCV.