[Immunohistochemical double labelling studies on liver tissues superinfected with hepatitis C virus and hepatitis B virus]

OBJECTIVE

To explore the relatiship between hepatitis C virus (HCV) and hepatitis B virus (HBV) replication in liver tissue of patients superinfected with HCV and HBV.

METHODS

The expresion and distribution of HCVAg and HBVAg in paraffin-embeded liver tissue from 25 autopsy cases were studied with immunohistochemical double labelling techniques using monoclonal anti-HCV NS3 and anti-HCV NS5 as well as polyclonal anti-HBs and anti-HBc.

RESULTS

HBsAg and HCV NS3 or NS5 antigen were detected at the same section in 11 and 12 cases, and HBcAg and HCV NS3 or NS5 antigen in each 10 cases, respectively. Nearly all of the specimens with single labelling stained positive tissue for HC-VAg or HBVAg were also those positive with double labelling studies for HCVAg and HBVAg. The distribution of HCV and HBV infected hepatocytes was characterized as diffuse and single or cluster scattered in liver lobular. There were no differences in expression related to replication such as membranous, cytoplasmic type of HBsAg or cytoplasmic type of HBcAg and the cases positive for HCV NS3Ag or HCV NS5Ag between the group of HCV superinfected with HBV and the group infected with single HCV or HBV (chi 2 = 0.154 and 0.198, P > 0.05).

CONCLUSION

The results suggested that there was no interference or suppression each other in liver tissues superinfected with HCV and HBV.

Protease-induced infectivity of hepatitis B virus for a human hepatoblastoma cell line

The human hepatoblastoma cell line HepG2 produces and secretes hepatitis B virus (HBV) after transfection of cloned HBV DNA. Intact virions do not infect these cells, although they attach to the surface of the HepG2 cell through binding sites in the pre-S1 domain. Entry of enveloped virions into the cell often requires proteolytic cleavage of a viral surface protein that is involved in fusion between the cell membrane and the viral envelope. Recently, we observed pre-S-independent, nonspecific binding between hepatitis B surface (HBs) particles and HepG2 cells after treatment of HBs antigen particles with V8 protease, which cleaves next to a putative fusion sequence. Chymotrypsin removed this fusion sequence and did not induce binding. In this study, we postulate that lack of a suitable fusion-activating protease was the reason why the HepG2 cells were not susceptible to HBV. To test this hypothesis, virions were partially purified from the plasma of HBV carriers and treated with either staphylococcal V8 or porcine chymotrypsin protease. Protease-digested virus lost reactivity with pre-S2-specific antibody but remained morphologically intact as determined by electron microscopy. After separation from the proteases, virions were incubated with HepG2 cells at pH 5.5. Cultures inoculated with either intact or chymotrypsin-digested virus did not contain detectable levels of intracellular HBV DNA at any time following infection. However, in cultures inoculated with V8-digested virions, HBV-specific products, including covalently closed circular DNA, viral RNA, and viral pre-S2 antigen, could be detected in a time-dependent manner following infection. Immunofluorescence analysis revealed that 10 to 30% of the infected HepG2 cells produced HBV antigen. Persistent secretion of virus by the infected HepG2 cells lasted at least 14 days and was maintained during several reseeding steps. The results show that V8-digested HBV can productively infect tissue cultures of HepG2 cells. It is suggested that proteolysis-dependent exposure of a fusion domain within the envelope protein of HBV is necessary during natural infection.

Undervaccination for Hepatitis B among young men who have sex with men--San Francisco and Berkeley, California, 1992-1993

The evaluation of efforts to prevent hepatitis B virus (HBV) infection in the United States requires accurate measures of hepatitis B vaccination coverage among children and adults at risk for infection. Although vaccination coverage among children is obtained by nationwide surveys, vaccination coverage among adults at risk for HBV infection has not been well characterized. To estimate hepatitis B vaccination coverage among young men who have sex with men (MSM) (a group known to be at high risk for HBV infection and for whom hepatitis B vaccine has been recommended since 1982), CDC analyzed serologic data from the 1992-1993 Young Men's Survey (YMS) conducted by the San Francisco Department of Public Health. This report summarizes the results of that analysis, which indicate low hepatitis B vaccination coverage among young MSM in the San Francisco Bay area.

Apoptosis induced by tumor necrosis factor-alpha in rat hepatocyte cell lines expressing hepatitis B virus

Three well differentiated SV40-immortalized rat hepatocyte cell lines, CWSV1, CWSV2, and CWSV14, and Hepatitis B Virus (HBV)-producing cell lines derived from them were examined for sensitivity to tumor necrosis factor (TNF)-alpha. CWSV1, CWSV2, and CWSV14 cells were co-transfected with a DNA construct containing a dimer of the HBV genome and the neo gene and selected in G418 to generate stable cell lines. Characterization of these cell lines indicated that they contain integrated HBV DNA, contain low molecular weight HBV DNA compatible with the presence of HBV replication intermediates, express HBV transcripts, and produce HBV proteins. The viability of CWSV1, CWSV2, and CWSV2 cells was not significantly altered when they were treated with TNF-alpha at concentrations as high as 20,000 U/ml. The HBV-expressing CWSV1 cell line, SV1di36, and the HBV-expressing CWSV14 cell line, SV14di208, were also not killed when treated with TNF-alpha. However, the HBV-expressing CWSV2 cell line, SV2di366, was extensively killed when treated with TNF-alpha at concentrations ranging from 200 to 20,000 U/ml. Analysis of several different HBV-producing CWSV2 cell lines indicated that TNF-alpha killing depended upon the level of HBV expression. The TNF-alpha-induced cell killing in high HBV-producing CWSV2 cell lines was accompanied by the presence of an oligonucleosomal DNA ladder characteristic of apoptosis.

[Hepatitis B virus infection and pathogenesis of glomerulonephritis]

In order to investigate the role of hepatitis B virus (HBV) infection in the pathogenesis of HBV associated glomerulonephritis, 50 cases of glomerulonephritis with positive HBV infection marker antigenemia and/or HBAg detected by immunohistochemistry in renal tissue were collected. The distribution and localization of HBV DNA were observed by using in situ hybridization. In addition, Southern blot analysis was performed in 23 of the 50 cases to reveal the state of renal HBV DNA. Thirty Six cases (72%) were found to be HBV DNA positive by in situ hybridization, which was localized in the nucleus of tubular cells. In 26 cases HBV DNA was simultaneously detected in the nucleus of glomerular mesangial and epithelial cells as well as in the mesangial matrix. Seventeen of the 23 cases proved to be HBV DNA positive by Southern blot analysis. In which 3 cases were identified as having non-replicating free HBV DNA, while 14 cases (82%) were of the integrated form. Since there was abundant evidence of the renal tissue being infected with HBV, it was considered that the HBAg deposited on glomeruli not only originated from circulation but also from the HBV infected glomerular cells. In addition to the humoral immune injury mediated by HBAg-HBAb immune complex, the cellular mechanism mediated by target antigen (HBcAg) may be also involved in the pathogenesis of HBV associated glomerulonephritis.

Deletion of integrated hepatitis B virus genome and cellular flanking sequences in hepatocellular carcinoma cells in BALB/c mice

We have previously reported the establishment of well-differentiated BALB/c mouse liver (ML) cell lines. Transfection of these cell lines with hepatitis B virus (HBV) DNA led to the expression of HBV-specific antigens and integration of HBV sequences in the cellular genome. Two cloned HBV-transfected ML cell lines, ML-2(HBV) and ML-3(HBV), expressed viral antigens and were highly tumorigenic in nude mice. However, the tumorigenicity of the two cell lines was significantly reduced in BALB/c mice. Southern blot analyses showed that the integrated HBV sequences were retained in tumors growing in nude mice but deleted in tumors growing in BALB/c mice. Furthermore, the deletion of HBV DNA was accompanied by deletion of chromosomal sequences flanking the HBV integration sites. In ML-2(HBV) cells, a significant reduction in chromosomal number was also observed. These results suggest that the immune response of BALB/c mice selected against hepatocellular carcinoma (HCC) cells expressing viral antigens and led to the proliferation of cells with deleted HBV sequences and concomitant chromosome aberrations. By using this mechanism, HCC cells escape the immune surveillance and gain the advantage of cell growth.

[Pre S1 antigen in different forms of hepatitis B virus infection]

Pre S1 antigen was measured using an ELISA technique in patients with different forms of hepatitis B virus infection. It was detected in 10 of 19 patients with acute hepatitis B (53%), 12 of 15 chronic hepatitis B virus carriers (80%), 9 of 11 patients with chronic hepatitis B (82%) and 3 of 4 patients with hepatoma and positive markers of hepatitis B virus infection. Pre S1 remained positive beyond 150 days in two patients with acute hepatitis that evolved to chronicity. Among subjects with chronic hepatitis B that received interferon, pre S1 antigen negativized only in the patient that had a complete response. Pre S1 detection is an index of hepatitis B virus replication and its persistence determines chronicity. Its negativization after antiviral therapy should have a predictive value.

Association between an MHC class II allele and clearance of hepatitis B virus in the Gambia

BACKGROUND

The course of hepatitis B virus (HBV) infection does not appear to be determined by variations in viral virulence and may be influenced by the host immune response. We studied the distribution of human leukocyte antigens in children and adult men in the Gambia who spontaneously recovered from HBV infection as compared with the distribution of these antigens in subjects with persistent infection.

METHODS

In a two-stage, case-control study, we analyzed the frequency of MHC class I antigens and class II haplotypes in people with either transient or persistent HBV infection. MHC class I typing was performed by microlymphocytotoxicity assays. MHC class II typing was performed with analysis of restriction-fragment-length polymorphisms (RFLPs), supplemented by other techniques.

RESULTS

In the first stage (the study of children up to the age of 10 years), the RFLP pattern 25-1, which includes the class II allele HLA-DRB1*1302, was found in 58 of 218 subjects with transient HBV infection (26.6 percent) and 30 of 185 subjects with persistent infection (16.2 percent) (relative risk of carrying the 25-1 pattern in the persistently infected group as compared with the transiently infected group, 0.53; 95 percent confidence interval, 0.32 to 0.90; P = 0.012). In the second stage (the study of adults), HLA-DRB1*1302 was found in 50 of 195 subjects with transient HBV infection (25.6 percent) and in 3 of 40 subjects with persistent infection (7.5 percent) (relative risk, 0.24; 95 percent confidence interval, 0.04 to 0.80; P = 0.012). The RFLP pattern 13-2, which includes the class II allele DRB1*1301, was less frequent in children with persistent infection than in those with transient infection, an association that was neither confirmed nor excluded by the data on adults. Possible associations with HLA class I antigens found in children were not supported by the data on adults.

CONCLUSIONS

The MHC class II allele DRB1*1302 was associated with protection against persistent HBV infection among both children and adults in the Gambia.

[Analysis of hepatitis B virus X antigen expression in chronic hepatitis B and cirrhosis]

It has been shown that hepatitis B virus (HBV) X antigen (HBxAg) functioned as a transactivating element which can act on the enhancer of HBV in an in vitro system and elevate the transcriptional level of HBV. In this study we investigate the relationship between HBxAg expression and HBV replication in patients with chronic hepatitis B and cirrhosis. Rabbit IgG against recombinant HBxAg which was synthesized in E. coli were prepared and used for the detection of HBxAg. HBV DNA was amplified by polymerase chain reaction technique by using primers from HBx gene sequence. Liver tissue samples and sera from the patients were examined immunohistochemically for HBxAg and serologically for HBxAg/anti-HBx respectively. We focused on its expression in these samples in comparison with markers of HBV replication. It was found that in liver HBxAg was present in 72.7% of the patients with chronic active hapatitis (CAH) and 92.6% of those with cirrhosis, while the positivity rate of HBcAg in cirrhosis patients was only 47.8%. In the sera of the patients with CAH, chronic persistant hepatitis and cirrhosis HBxAg was present in 44.4%, 66.6% and 33.3% respectively. It was similar to that observed with HBeAg. Moreover in these HBxAg positive sera HBV DNA can also be detected. It was shown that higher rate of positivity of HBxAg was found in patients with replicative markers (serum HBeAg, serum HBV DNA or liver tissue HBcAg positive). Our results indicate that expression of HBxAg is closely correlated with HBV replication and HBxAg may be an important marker in chronic HBV infection.

[Expression of c-myc, c-erbB-2, insulin-like growth factor II andepidermal growth factor receptor in hepatitis B, cirrhosis and hepatocellular carcinoma]

In order to get a better understanding of expressions of multiple oncogenes and their possible roles in human hepatocarcinogenesis, 379 cases of liver tissues were investigated immunohistochemically. EGF receptors were immunolocalized mainly in the sinusoidal endothelial cells. They might not take part in the development of hepatocellular carcinoma (HCC), c-myc protein was showed to be expressed in cancer cells and the hepatocytes in the so-called "large-cell dysplasia" and in ductular metaplasia (DM). Its expression was also observed in some zone II hepatocytes of hepatic accini in 21% of normal liver tissues, which indicated that c-myc expression might also be related to the proliferation of mature hepatocytes. The positivity rate of c-erbB-2 product was shown to be highest among the oncogenic genes examined in this study. The positivity was observed in small polygonal liver cells (SPLCs) and the hepatocytes were observed in SCD and in DM. The expression level of c-erbB-2 oncogene in HCC cells was higher significantly than in normal hepatocytes, but lower than in SPLCs, the hepatocytes in SCD and in DM. We suggest that c-erbB-2 gene activation may play an important role not only in HCC genesis, but also in DM. Insulin-like growth factor II (IGF II), an oncofetal hepatocellular growth factor, was immunolocalized in the cancer cells, SPLCs and the hepatocytes in SCD, which indicated that activation and hyperexpression of IGF II gene might be responsible for the prominent proliferation of SPLCs and SCD, a crucial step in malignant transformation of hepatocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Expression and significance of HBV DNA and its 5 antigens in liver cirrhosis]

Hepatitis B virus (HBV) DNA and its 5 antigens were studied in 225 cases of paraffin-embedded sections of human liver cirrhosis obtained by biopsy. HBxAg, pre-S1 and pre-S2 antigens were detected by immunohistochemical ABC method, HBsAg and HBcAg by PAP method. HBV DNA by in situ hybridization, and both HBV DNA and HBsAg, HBxAg or HBcAg by double labelling technique of immunohistochemistry and in situ hybridization respectively. The results showed that the positive rates were 70.0% (128/183) for HBsAg, 64.4% (85/132) for pre-S1 antigen, 61.4% (81/132) for pre-S2 antigen, 75.3% (113/150) for HBxAg, 22.4% (39/174) for HBcAg and 62.4% (58/93) for HBV DNA respectively. The double labelling positive rates were 37.3% (19/51) for both HBV DNA and HBsAg, 86.3% (44/51) for both HBV DNA and HBxAg and 39.2% (20/51) for both HBV DNA and HBcAg respectively. More than 80% of the cases with positive sections for HBV DNA and its 5 antigens were associated with liver cell dysplasia (LCD). The results of this study suggest that the occurrence and development of liver cirrhosis were closely related to chronic infection of HBV in China.

[Concurrence of HBs antigen and anti-HBs antibodies in children infected with HBV]

Two cases of concurrence of HBs antigen and antibodies in boys, who acquired HBV infection within the first two years of life are described. Authors discuss possible explanation of that fact.

[Treatment of chronic viral hepatitis B in children with moderate doses of alpha interferon]

AIM

The alpha interferon treatment criteria have not been established in children with chronic hepatitis B. We report the results of a prospective study.

METHODS

Between 1988-1992 14 children (2 girls and 12 boys) with chronic hepatitis B received 3 million U/m2 of interferon alpha three times a week for 6 months. All patients underwent a liver biopsy that showed a pattern of chronic active hepatitis. One patient had cirrhosis. Hepatitis B surface antigen, hepatitis Be antigen and hepatitis B virus DNA had been positive in the serum in all for at least 6 months and anti-delta antibodies were negative in all. Pretreatment aminotransferase levels were at least 1.5 times the upper limit of normal.

RESULTS

After treatment patients were followed up for at least one year (mean: 21.5 +/- 8.3 months). At the end of treatment HBV DNA was negative in 13 out of 14 patients and reappeared in one; HBeAg seroconversion was observed in 11 patients with the appearance of anti-HBe antibodies. Six patients lost the HBs antigen within 1 to 14 months after treatment. Anti-HBs antibodies did not appear in any patients and aminotransferase level normalized in 13 patients. Thirteen patients underwent liver biopsy after treatment which showed improvement in 12.

CONCLUSIONS

Treatment with alpha interferon at doses of 3 MU/m2 is effective in children with active hepatitis B. Long-term follow up is needed to evaluate the effectiveness of this therapy.

An autopsy survey of hepatitis B in Sydney

AIM

1) To determine the prevalence of hepatitis B in Sydney autopsies and 2) to determine the relationship between seroprevalence, hepatitis B risk factors and histological changes in the liver.

METHODS

One hundred autopsy subjects were studied for evidence of past or present hepatitis B infection, using RIA to detect the HBV antigens and antibodies in the serum and peroxidase-antiperoxidase technique to detect HBsAg and HBcAg in the liver. Both serum and liver were examined for the presence of HBV DNA.

RESULTS

Markers of hepatitis B virus infection were detected in either serum and/or liver of 29 subjects. Four subjects (4%) were seropositive for HBsAg. Eight subjects had been recently infected, 7 were chronically infected and 14 had recovered.

CONCLUSION

The 29% prevalence of HBV infection is higher than expected. In four cases the serum was either free of HBV markers or showed conventional evidence of recovery, yet the liver still contained HBsAg. There were few histopathological changes despite the presence of HBsAg in the liver. The only epidemiological factors possibly predisposing to HBV infection were tattooing and drug abuse.

Hepatic expression of interferon-alpha in chronic hepatitis B virus infection

Hepatic expression of interferon-alpha (IFN-alpha) was examined by immunohistochemistry in 90 Chinese patients (M/F 67:23, age: 14-69) with a spectrum of hepatitis B virus (HBV)-related chronic liver diseases. Immunoreactive IFN-alpha was detected in sinusoidal cells in 79 patients (88%) and in mononuclear cells in 59 patients (65.6%). Patients with active liver diseases (chronic active hepatitis, active cirrhosis, N = 55) had a higher level of IFN-alpha expression compared to patients with inactive histology (N = 35; sinusoidal cells, P < 0.01; mononuclear cells, P < 0.01). Cytoplasmic HBsAg, nuclear HBcAg, and cytoplasmic HBcAg were detected in 79 (88%), 42 (47%), and 23 (27%) patients respectively. Expression of IFN-alpha in mononuclear cells correlated with the expression of cytoplasmic HBcAg (P < 0.05) but not with nuclear HBcAg or cytoplasmic HBsAg. When the patients were divided into four different phases according to the natural history of chronic HBV infection, patients in the active liver disease phase had higher IFN-alpha expression compared to the immunotolerant and late phase patients (P < 0.01). Using double immunohistochemical staining, both IFN-alpha and cytoplasmic HBcAg were frequently detected near inflammatory infiltrates but no correlation existed between the hepatic expression of HBsAg and IFN-alpha. These data indicate that IFN-alpha is expressed in the liver in HBV-related active liver diseases and that the reported suboptimal production of IFN-alpha by PBMC in HBV-related chronic active liver diseases may be due to a redistribution of the IFN-alpha-producing mononuclear cells into the liver, the site of inflammation.

[Preparation of monoclonal antibody directed against hepatitis B virus X protein and detection of reactive antigen in hepatocellular carcinoma]

A mouse monoclonal antibody directed against hepatitis B virus (HBV) X protein (HBxAg) was prepared. The antibody was used to screen by immunohistochemistry 50 liver tissue sections from patients with hepatocellular carcinoma (HCC), and 15 patients with chronic active hepatitis (CAH). 28 of 50(56%) samples were HBxAg positive in tumor tissues. The positive rates of HBxAg only in tumor tissues or in adjacent nontumor tissues were 24% and 16%. HBsAg was detected in 16% of cases in tumor tissues and 74% in surrounding nontumor tissues. In CAH samples, the positive rates of HBxAg and HBsAg were 6.6% and 73.3%. HBcAg was only detected in nontumor surrounding liver tissues, the positive rates being 18%. In CAH samples, no HBcAg was detected. The results showed that HBxAg is a common marker in liver tissue from patients with HBV-related HCC. The findings of HBxAg in the absence of detectable HBsAg and HBcAg in the liver tissues suggested that HBxAg could be independent of HBV replication and implied that the synthesis of HBxAg may be directed from integrated HBV DNA templates. It is possible to use antiHBx monoclonal antibody as a carrier for the targeting therapy of HCC.

[Expression of mutant p53 in chronic HBV infection and hepatocellular carcinoma]

In order to investigate the expression of mutant p53 protein (Mp53) and HBxAg in chronic active hepatitis (CH) and hepatocellular carcinoma (HCC), 30 specimens of HCC with surrounding liver tissues (SL), 15 biopsy specimens from CH were examined with immunohistochemical method (ABC system). The results showed, that 13 (43.3%) specimens of HCC and 15 (50%) of SL were positive for MP53 and HBxAg staining; 3 (16.7%) of HCC and 8 (26.7%) of SL were only MP53 positive, being HBxAg staining negative. On the contrary, 4 (13.3%) of HCC and 1 (3%) of SL were negative for MP53 staining and positive for HBxAg staining (P < 0.05, chi 2 test). In 15 specimens of CH, 3 cases were positive for MP53, 2 for HBxAg. The results indicate that there is a correlation between mutant p53 protein and HBxAg, suggesting that the p53 gene mutation may be closely related with HBV infection, and the mutation of p53 gene would be one of hepatocarcinogenesis mechanisms of HBV.

[A pathogenic study of chronic inflammatory demyelinating polyradiculoneuropathy in a patient with hepatitis B infection]

We immunologically examined the pathogenesis of chronic inflammatory demyelinating polyradiculoneuropathy in a patient with HB hepatitis. A 41-year-old male clerk has been suffered from muscle weakness, tingling and numbness in the distal portion of all limbs. All symptoms were compatible with the typical patterns of chronic inflammatory demyelinating polyradiculoneuropathy. We examined the patient's serum and biopsied sural nerve, using histochemical and immunological techniques. We detected the band that reacted with anti-HBs antibody in the sural nerve in western blotting. The result indicated that HBs antigen was expressed on the peripheral nerves in the patient. There were no anti-peripheral nerve antibodies neither in the sural nerve or serum. There was no increase of immune complex in the serum. No deposition of immunoglobulins and complements were detected in the sural nerve. Immunoadsorption therapy had no effect on this patient, but administration of prednisolone improved his symptoms drastically. These findings suggest that a cytotoxic T cell may had played a more important role than humoral factors in this patient's nerve injury. Though the pathogenesis of chronic inflammatory demyelinating polyradiculoneuropathy remains unclear, our findings seem to be very interesting in that they go some way toward clarifying the pathogenesis of this disease.

Displacement of hepatitis B virus by hepatitis C virus as the cause of continuing chronic hepatitis

BACKGROUND/AIMS

It has been shown that hepatitis C virus (HCV) superinfection may suppress hepatitis B virus (HBV) leading to hepatitis B surface antigen (HBsAg) clearance and that hepatitis may persist after HBsAg clearance in a few patients. The role of HCV in continuing hepatitis after termination of chronic HBsAg antigenemia remains to be explored in a series of patients.

METHODS

HCV markers were studied using second generation enzyme immunoassay and polymerase chain reaction with reverse transcription and were compared between 41 patients with persistent alanine aminotransferase (ALT) elevation (hepatitis group) and 82 age/sex-matched patients with normal ALT (control group) after HBsAg clearance.

RESULTS

Twenty-six (63%) of the 41 hepatitis group patients were seropositive for antibodies to HCV (anti-HCV) compared with only 4 (5%) of 82 controls (P < 0.0001). Six patients of the hepatitis group and 1 control had an episode of acute hepatitis C with seroconversion of anti-HCV 1-68 months before HBsAg clearance. Of those seropositive for anti-HCV, serum HBV DNA was not detectable, and serum HCV RNA was detected in 23 (88.5%) of the 26 hepatitis patients but none of the 4 controls (P < 0.001). Liver biopsy in 6 anti-HCV positive patients with continuing hepatitis showed features compatible with chronic hepatitis C. HCV RNA, but not HBV DNA, was detected in liver tissues of these 6 patients.

CONCLUSIONS

The results suggest that HCV may usurp the role of HBV in chronic hepatitis and act as the major cause of continuing hepatitis or ALT elevation after HBV/HBsAg clearance.

Primary glomerulonephritis with detectable glomerular hepatitis B virus antigens

The glomerular pathology and hepatitis B virus (HBV) antigens in renal biopsies were investigated in 100 consecutive patients with both primary glomerulonephritis and positive serology for hepatitis B surface antigen (HBsAg). Glomerular HBV antigens including HBsAg, hepatitis B core antigen (HBcAg), and hepatitis B e antigen (HBeAg) were examined in frozen tissue using both polyclonal and monoclonal antibodies. HBV serology and glomerular antigens were correlated. Using monoclonal antibodies, at least one of the three HBV antigens was detectable in glomeruli in 39% of the cases. These findings correspond mainly to detectable glomerular HBsAg and HBeAg in 22.3 and 28.4% of cases, respectively. A good correlation was found between glomerular and serum HBeAg but not observed for HBsAg. Serum HBcAg was not examined and not correlated with glomerular staining. When the diagnosis of HBV-related glomerulonephritis was based strictly on detectable glomerular antigens, three distinctive morphologies were identified: membranous nephropathy, mesangiocapillary glomerulonephritis, and mesangial proliferative glomerulonephritis with immunoglobulin A (IgA) deposits (IgA nephropathy). Each of these lesions may be seen in pure form or occasionally in overlapping form leading to double glomerulopathies. Glomerular HBeAg and HBsAg were associated with subepithelial and mesangial immune complexes, respectively. Rare overlap between membranous nephropathy and IgA nephropathy further emphasized the distinctive pathology of HBV-related glomerulonephritis and the independent etiological role of HBeAg and HBsAg. In other glomerulonephritis, which rarely demonstrated glomerular HBV antigens, the pathogenetic role of chronic HBV infection remains to be proven.