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Endnu En Nobelpris Baseret På Dyreforsøg – Denne Gang for Opdagelsen Af Hepatitis C-Virus

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Endnu En Nobelpris Baseret På Dyreforsøg – Denne Gang for Opdagelsen Af Hepatitis C-Virus Forsøgsdyr Endnu en Nobelpris baseret på dyreforsøg – denne gang for opdagelsen af hepatitis c-virus TEKST AAGE KRISTIAN OLSEN ALSTRUP / SPECIALDYRLÆGE, PH.D. & FREELANCEJOURNALIST en 5. oktober 2020 transmit- den, for Nobelkomiteen offentliggør terede Nobelkomiteen live ikke deres interne overvejelser før fra Stockholm, at årets No- mange år efter uddelingerne. Også danskere har modtaget Nobelpriser Dbelpris i fysiologi eller medicin går til for dyreforsøg de tre videnskabsmænd, der opdage- En ukendt dræber var på spil de hepatitis c-virus hos mennesker. Det var tilbage i 1970’erne og I alt er Nobelprisen i fysiologi eller En sygdom, der fører til kronisk he- 1980’erne, at de tre forskere gjorde de- medicin givet til fem danskere. Fire patitis og undertiden levercancer, og res epokegørende indsats i hepati- af dem har fået prisen på baggrund som stadig koster op mod en halv tis-forskningen. Smitsom leverbe- af dyreforsøg og en enkelt på bag- million mennesker livet hvert år. tændelse var en frygtet sygdom, og grund af menneskeforsøg. Den før- Tidligere samme morgenen var de man kendte til eksistensen af to virus, ste var Niels Ryberg Finsen (1860- 1904), der i 1903 modtog tre forskere blevet ringet op af Nobel- nemlig hepatitis a og hepatitis b. Nobelprisen for sin behandling af komiteen for at få den gode nyhed – Imidlertid opdagede den første af hudtuberkolose med lysterapi. Han så tidligt, at komiteen måtte ringe prisvinderne, Harvey Alter i 1975, at udførte ikke dyreforsøg, formentlig dem op flere gange, før der var forbin- en stor del af hepatitis-patienterne, fordi forskningen foregik så tidligt, delse. Modtagerne var meget overra- hverken havde a- eller b-virus. Der at man endnu fandt det etisk accep- skede og tillige meget glade og beære- måtte derfor findes en tredje og tabelt at afprøve nye behandlinger de og kan nu se frem til at modtage ukendt type hepatitis, som han valgte direkte på patienter uden først at prisen den 10. december, som er at kalde for »non-A, non-B hepatitis«. have testet virkningen i forsøgsdyr. Den næste var August Krogh dødsdagen for prisens indstifter Al- Harvey Alter kunne sammen med (1874-1949), der fik Nobelprisen i fred Nobel (1833-1896), ved en konge- sine kollegaer vise, at den ukendte 1920 for opdagelsen af blodregule- lig Nobelceremoni i Stockholm. De smitte kunne overføres til chimpan- ringen i muskulatur, og til dette for- tre forskere er Harvey Alter (født ser via blodtransfusion fra hepati- mål havde han få år forinden udført 1935 i New York), Michael Houghton tis-patienter. Denne ukendte infekti- forsøg på frøer og gnavere. Heref- (født 1949 i England) og Charles Rice on udgjorde en betydelig andel af de ter modtog Johannes Fibiger (født 1952 i Californien), og de får transfusionsoverførte hepatitis-til- (1867-1928) i 1927 Nobelprisen for hver en tredjedel af prisen og deler de fælde hos mennesker, og derfor blev sine rottestudier over mulige sam- menhænge mellem parasitter og cirka ti millioner svenske kroner, som alle kræfter sat ind på at finde det an- cancer (resultater, der dog i læng- følger med hæderen. svarlige virus. Men den opgave skulle den viste sig forkerte). Henrik Dam vise sig at blive en uventet hård nød at (1895-1976) modtog i 1943 Nobel- Virusforskere hædres i knække. prisen for at have opdaget k-vita- COVID-19-året min i forbindelse med sine kostfor- Er det en ren tilfældighed, at virusfor- Virus var vanskelig at isolere søg med kyllinger. Og endelig skere får denne præstigefulde hæder Den ukendte virus lod sig ikke identi- modtog Niels Kaj Jerne (1911-1994) i netop i COVID-19-året? Tilmed på et ficere, da virus opførte sig helt ander- 1984 Nobelprisen for sine banebry- tidspunkt, hvor den amerikanske ledes end de kendte virus-typer. Det dende teorier om immunforsvarets funktion, som han blandt andet præsident Donald Trump og mange var nemlig ikke muligt at inficere la- byggede på observationer hos andre med ham behandles for CO- boratorieceller med den nye virus, og kaniner i forsøg. Hertil kommer, at VID-19 med remdesivir, et lægemid- dermed kunne man heller ikke finde Nobelprisen i kemi i 1997 blev givet del som er udviklet imod netop hepa- virus. Gennembruddet kom først i til Jens Christian Skou (1918-2018), titis c og derfor er baseret på de tre 1988, da det lykkedes for den anden som ved hjælp af krabber havde prismodtageres indsats? Det ville No- prisvinder, Michael Houghton, at klo- fundet den vigtige natrium-kali- belkomiteen ikke direkte svare på. Så ne virus ud fra fragmenter hentet fra um-pumpe i cellemembranen. om der reelt er en sammenhæng, får en blodprøve, der stammede fra en vi nok først opklaret langt ud i fremti- smittet chimpanse. De fleste frag- 44 | DVT 10 2020 Årets Nobelpris bliver givet for forskning, der bygger på forsøg med chimpanser. menter i blodprøven stammede fra chimpansens eget genom, men der måtte også være fremmede fragmen- ter, som stammede fra virus. Michael Houghton anvendte anti- stoffer fra hepatitis-patienter til at lo- kalisere de klonede proteiner, der stammede fra det ukendte virus. Der- med kunne han til slut identificeret hepatitis c-virus, som viste sig at til- høre familien af flavivirus. Dermed havde han også bidraget med en ræk- ke nye molekylære teknikker, som si- denhen er blevet flittigt anvendt af andre virusforskere. Med opdagelsen af hepatitis c-virus kunne man nu også diagnosticere og screene blod- prøver for virus. Virus alene forårsagede hepatitis Den sidste prisvinder Charles Rices indsats var at undersøge virus på mo- lekylært niveau, herunder at identifi- cere de proteiner, som virus får cel- lerne til at udtrykke. Han var dermed i stand til at forklare vigtige dele af vi- rus’ livscyklus, og han kunne slå en- degyldigt fast, at virus er årsagen til sygdommen. Dette har siden ført til udvikling af medicin, således at man i dag effektivt kan behandle denne al- vorlige sygdom. Omkring 70 millio- ner mennesker vurderes dog fortsat at være smittet med virus på globalt ni- veau, herunder 20 procent som ikke er blevet diagnoseret endnu. Så selv- om virus er kendt, blodet kan testes, Nobelpriser i fysiologi eller medicin og der findes en god behandling, er det stadig en sygdom med stor betyd- Officielt hedder Nobelprisen »Nobelprisen i fysiologi eller medi- ning for mennesker – særligt i fattige cin«, da den gives for enten store fysiologiske opdagelser eller lande. medicinske landvindinger. Prisen blev første gang uddelt i 1901 og har med få undtagelser været uddelt hvert år siden. Prisen kan gives til en enkelt forsker, eller den kan deles mellem to eller højst Nobelpriser bygger oftest på dy- tre forskere. I alt har 222 forskere således modtaget prisen, hvoraf reforsøg de 186 (84 %) har fået prisen på baggrund af dyreforsøg. Hoved- Årets Nobelpris bliver givet for forsk- parten af disse forsøgsdyr har været hvirveldyr, og blandt disse ning, der bygger på forsøg med chim- tegner musen sig for en meget stor andel. panser. Det er der ikke noget nyt i, da hovedparten af de tidligere Nobelpri- De seneste 10 års Nobelpriser i fysiologi eller medicin, og hvilke ser i fysiologi eller medicin også har dyr som blev anvendt: bygget på forsøg med dyr (se boksen). 2011 – Studier af det medfødte immunforsvar (mus) På trods af en mængde alternativer til 2012 – Opdagelsen af at specialiserede celler kan blive pluropo- tente (mus, frø) dyreforsøg, såsom reagensglasforsøg 2013 – Reguleringen af vecikeltransport til cellerne (mus, hamstre) og cellekulturer, er der stadig brug for 2014 – Hjernens indre GPS-system (rotter) at teste hypoteserne på levende dyr, 2015 – Behandling er parasitsygdomme (mus, hunde, kvæg, får, inden resultaterne kan overføres til primater, kyllinger) mennesker. Sådan var det for hundre- 2016 – Mekanismerne bag autofagi (mus) de år siden, og sådan er det også i dag. 2017 – Det molekylære ur (bananfluer) Vi skal faktisk helt tilbage til 1983 for 2018 – Immunterapi til behandling af cancer (mus) at finde et år, hvor Nobelprisen blev 2019 – Cellernes autoregulering i forhold til iltindhold (mus) 2020 – Opdagelsen af hepatitis c (chimpanser). givet på baggrund af forsøg, der ikke involverede dyr overhovedet. ♦ DVT 10 2020 | 45.
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