274 ACUTE AND CHRONIC DELTA HEPATITIS IN WOODCHUCKS INOCULATED WITH HIGHLY

DILUTED HDV-CONTAINING WOODCHUCK SERA.

C Hele(1), M Rapicetta(2), B Forzani(1), R Rasshofer(3), AN Di Rienzo(2), C La-

varini(1), MF Bonetti(4), G Morace(2), M RoEEendorf(3), F Callea(4), G Verme(1),

A Ponzetto(1). (1)Molinette Hospital,Torino. (2)Ist.Sup.Sanit~,Roma. (3)Max-von-

Pettenkofer-Inst.,Wdnchen. (4)Spedali Civili, Brescia.

The Eastern woodchuck (Mar~ota monax) has been shown susceptible to the infection by the

Hepatitis Delta Virus (HDV), an ominous human pathoEen known for its deadly potential.

The therapeutic approach to HDV-induced liver disease could be Ereatly ameliorated by the

use of an animal model. We therefore started to characterize the natural history of chronic

HDV infection in the woodchuck animal model. Here we report the establish~ent_~ ofl~cute_~ and

chronic Delta Hepatitis induced by inoculation with serial dilutions (i0 to I0 ) of HDV-

containin E woodchuck serum.

Seven wild cauEht Woodchuck Hepatitis Virus cart}St animals were injected. Delta infection

occurred constantly in each animal up to the I0 serum dilution. Delta hepatitis was ~ndis-

tinEuishable from the acute and chronic disease observed either in humans and chimpanzess.

HDVl~A was detected by molecular l~ybridisation 4 to 6 weeks after inoculation with I0 to

i0 serum dilution and persisted in circulation throughout the entire follow-up of 3 to i0

months post-inoculation.

All available liver biopsy samples resulted HDAg-positive durinE both acute and chronic

phase of infection. HistoloEy demonstrated early development of chronic active hepatitis

with features identical to those observed in human Delta patients.

Delta hepatitis in woodchucks is therefore an ideal model for the therapeutic approach to

this eludent pathogen.

275 LACTITOL Vs. LACTULOSE IN THE TREATMENT OF CHRONIC RECURRENT PORTAL SYSTEMIC ENCEPHALOPATHY (PSE)

D. Heredia, J. Ter~s, N. Orteu, J. Rod,s. Liver Unlt, Hospital Clinic i Provin- cial, Medical School. Barcelona. Spain.

Previous data suggested that lac t i to l (beta-galactoside-sorbitol), a new synthetic non absorbable dissacharide, has beneficial effects on chronic and acute PSE. To compare the efficacy and patient acceptability of lac t i to l vs. lactulose in chronic recurrent PSE, 25 cirrhotic patients with history of repeated episodes of PSE who required chronic administra- tion of lactulose, were included in a controlled cross-over cl inical t r i a l in which patients received at random lact i to l (at an i n i t i a l dosage of lOg./6h.) or lactulose (15 ml/6h) during a three months period and then crossed-over to the alternative treatment for the following three months. Doses were adjusted to obtain two bowel movements per day. During the study period the daily protein intake was 40-60 g. Clinical and analytical data ( in- cluding amonia levels) as well as EEG, number connection test and PSE index, were collected before treatment and monthly unti l the end of the treatment. During treatment patients f i l l ed a questionnaire with daily dosage, stool frequency and consistency, acceptability (very poor, poor, mild, very good) and other incidences. Five patients had to be excluded to the analysis because of early death or lack of follow-up. No significant differences were found between lac t i to l and lactulose on the neurological and biological parameters, suggesting that the two treatments could be considered as equally effective. Lactitol was signif icantly better accepted than lactulose (p=.02) the taste of which being assessed too sweet and provoking nausea. In conclusion, lac t i to l is a good alternative to lactulose in patients with chronic recurrent PSE, spetial ly in those who intolerate the excessive sweetness of lactulose.

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