House S7EP06 “Office Politics”
I enjoy watching House, MD when new episodes are on; now that the World Series is over, there should be several new episodes through the end of the semester. Monday’s episode started with the campaign manager for the New Jersey Senatorial campaign exhibiting signs of an infectious agent, with spots appearing up and down his arm. As the opening sequence developed, the spots grew larger and more numerous, prompting a trip to Princeton Plainsboro Hospital. Uh oh!
The diagnostic team immediately was drawn into Cuddy’s new ploy to
dominate rein in House, the introduction of her candidate to replace the absent Thirteen (who has been away filming movies, most notably Tron: Legacy which will be out this Holiday season. I saw the original Tron in the theaters many years ago.) Hilarity and highjinks ensue, as the patient gets gradually worse through the episode and goes into liver failure and faces certain death. The final diagnosis was Hepatitis C infection (diagnosis confirmed by serological tests on another patient) and a very poor prognosis. Newbie Dr. Masters suggests Hepatitis A therapy, with the premise that infection with Hepatitis A will stimulate the immune system to fight off the Hep C infection, and offers the following odds: 100 percent mortality for no treatment (certain death) and 85% mortality (15% chance of survival) for trying this experimental treatment. The guy beats the odds, and we roll credits.
The treatment might seem a bit bogus; patient with disease ‘X’ is infected with disease ‘Y’ as a cure for the original disease, but let’s break it down. Recall from the chapter on innate immunity what our general antiviral response is: production of interferons from virally infected cells, which makes uninfected cells more resistant to infection. This comes at a cost, and signs/symptoms of interferon production include the general malaise associated with virus infections. Hepatitis C infections many times do not resolve by the innate response, and frequently develop into a chronic (and many times subclinical) infection that can persist for many months to years. Treatment for chronic Hepatitis C infection is a recombinant (man-made) version of interferon, which will be administered for many weeks. In the latter stages of infection when liver failure due to cirrhosis is imminent, this treatment is unlikely to resolve the infection. The patient is also not a candidate for liver transplant, as they would still have the infection present in their body post-transplant.
So consider what is going on in this House episode. They propose to infect the patient with another, novel but unrelated, virus. The pathology of Hepatitis A virus is not cytotoxicity, unlike Hep C infection, and is likely immune-related, although this is not entirely clear today. This means that infection of Hepatitis A will lead to a localized immune response at the site where the virus is multiplying, which in this case is the site of the body where the first infection (Hep C) is also occuring. Immune stimulation is occuring where it can potentially do the most good, as opposed to an injection of therapeutic interferons which will end up having broad systemic effects.
So is this reasonable? I did a quick search for this, but turned up nothing that looked particularly promising with respect to imminent treatments for this pandemic-level viral infection. The premise seems sound though, and remember that the House writers do have a team of physician/scientists that they run the premise by before going to air. My final verdict? Sounds possible; I did not throw the remote at the TV in disgust.