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Shen Y, Wu SD, Chen Y, Li XY, Zhu Q, Nakayama K, Zhang WQ, Weng CZ, Zhang J, Wang HK, Wu J, Jiang W. Alterations in gut microbiome and metabolomics in chronic hepatitis B infection-associated liver disease and their impact on peripheral immune response. Gut Microbes 2023; 15:2155018. [PMID: 36519342 PMCID: PMC9757487 DOI: 10.1080/19490976.2022.2155018] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Gut dysbiosis has been reported in chronic hepatitis B (CHB) infection, however its role in CHB progression and antiviral treatment remains to be clarified. Herein, the present study aimed to characterize gut microbiota (GM) in patients with chronic hepatitis B virus infection-associated liver diseases (HBV-CLD) by combining microbiome with metabolome analyses and to evaluate their effects on peripheral immunity. Fecal samples from HBV-CLD patients (n = 64) and healthy controls (n = 17) were collected for 16s rRNA sequencing. Fecal metabolomics was measured with untargeted liquid chromatography-mass spectrometry in subgroups of 58 subjects. Lineage changes of peripheral blood mononuclear cells (PBMCs) were determined upon exposure to bacterial extracts (BE) from HBV-CLD patients. Integrated analyses of microbiome with metabolome revealed a remarkable shift of gut microbiota and metabolites in HBV-CLD patients, and disease progression and antiviral treatment were found to be two main contributing factors for the shift. Concordant decreases in Turicibacter with 4-hydroxyretinoic acid were detected to be inversely correlated with serum AST levels through host-microbiota-metabolite interaction analysis in cirrhotic patients. Moreover, depletion of E.hallii group with elevated choline was restored in patients with 5-year antiviral treatment. PBMC exposure to BE from non-cirrhotic patients enhanced expansion of T helper 17 cells; however, BE from cirrhotics attenuated T helper 1 cell count. CHB progression and antiviral treatment are two main factors contributing to the compositional shift in microbiome and metabolome of HBV-CLD patients. Peripheral immunity might be an intermediate link in gut microbe-host interplay underlying CHB pathogenesis.
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Affiliation(s)
- Yue Shen
- Department of Gastroenterology & Hepatology, Zhongshan Hospital of Fudan University, Shanghai, China,Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai, China
| | - Sheng-Di Wu
- Department of Gastroenterology & Hepatology, Zhongshan Hospital of Fudan University, Shanghai, China,Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai, China,Department of Gastroenterology& Hepatology, Zhongshan Hospital Xiamen Branch of Fudan University, Xiamen, China
| | - Yao Chen
- Department of Emergency Medicine, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Xin-Yue Li
- Department of Medical Microbiology & Parasitology, MOE/NHC/CAMS Key Laboratory of Medical Molecular Virology, School of Basic Medical Sciences, Fudan University Shanghai Medical College, Shanghai, China
| | - Qin Zhu
- Department of Gastroenterology & Hepatology, Zhongshan Hospital of Fudan University, Shanghai, China,Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai, China
| | - Kiyoko Nakayama
- Department of Gastroenterology & Hepatology, Zhongshan Hospital of Fudan University, Shanghai, China,Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai, China
| | - Wan-Qin Zhang
- Department of Gastroenterology & Hepatology, Zhongshan Hospital of Fudan University, Shanghai, China,Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai, China
| | - Cheng-Zhao Weng
- Department of Gastroenterology& Hepatology, Zhongshan Hospital Xiamen Branch of Fudan University, Xiamen, China
| | - Jun Zhang
- Department of Gastroenterology& Hepatology, Zhongshan Hospital Xiamen Branch of Fudan University, Xiamen, China
| | - Hai-Kun Wang
- CAS Key Laboratory of Molecular Virology and Immunology, Institute Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Jian Wu
- Department of Gastroenterology & Hepatology, Zhongshan Hospital of Fudan University, Shanghai, China,Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai, China,Department of Medical Microbiology & Parasitology, MOE/NHC/CAMS Key Laboratory of Medical Molecular Virology, School of Basic Medical Sciences, Fudan University Shanghai Medical College, Shanghai, China,Jian Wu Department of Medical Microbiology, Key Laboratory of Medical Molecular Virology, Fudan University School of Basic Medical Sciences, 138 Yixue Yuan Road, P. O. Box 228, Shanghai, China
| | - Wei Jiang
- Department of Gastroenterology & Hepatology, Zhongshan Hospital of Fudan University, Shanghai, China,Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai, China,Department of Gastroenterology& Hepatology, Zhongshan Hospital Xiamen Branch of Fudan University, Xiamen, China,CONTACT Wei Jiang Department of Gastroenterology & Hepatology Zhongshan Hospital of Fudan University, Zhongshan Hospital Xiamen Branch of Fudan University,180 Fenglin Road, Shanghai, China
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Fiorino S, Carusi A, Hong W, Cernuschi P, Gallo CG, Ferrara E, Maloberti T, Visani M, Lari F, de Biase D, Zippi M. SARS-CoV-2 vaccines: What we know, what we can do to improve them and what we could learn from other well-known viruses. AIMS Microbiol 2022; 8:422-453. [PMID: 36694588 PMCID: PMC9834075 DOI: 10.3934/microbiol.2022029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/24/2022] [Accepted: 11/06/2022] [Indexed: 11/18/2022] Open
Abstract
In recent weeks, the rate of SARS-CoV-2 infections has been progressively increasing all over the globe, even in countries where vaccination programs have been strongly implemented. In these regions in 2021, a reduction in the number of hospitalizations and deaths compared to 2020 was observed. This decrease is certainly associated with the introduction of vaccination measures. The process of the development of effective vaccines represents an important challenge. Overall, the breakthrough infections occurring in vaccinated subjects are in most cases less severe than those observed in unvaccinated individuals. This review examines the factors affecting the immunogenicity of vaccines against SARS-CoV-2 and the possible role of nutrients in modulating the response of distinct immune cells to the vaccination.
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Affiliation(s)
- Sirio Fiorino
- Internal Medicine Unit, Budrio Hospital, Budrio (Bologna), Azienda USL, Bologna, Italy,* Correspondence:
| | - Andrea Carusi
- Internal Medicine Unit, Budrio Hospital, Budrio (Bologna), Azienda USL, Bologna, Italy
| | - Wandong Hong
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang, The People's Republic of China
| | - Paolo Cernuschi
- Internal Medicine Unit, Quisana Private Hospital, Ferrara, Italy
| | | | | | - Thais Maloberti
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna-Molecular Diagnostic Unit, Azienda USL di Bologna, Bologna, Italy,Solid Tumor Molecular Pathology Laboratory, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michela Visani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna-Molecular Diagnostic Unit, Azienda USL di Bologna, Bologna, Italy
| | - Federico Lari
- Internal Medicine Unit, Budrio Hospital, Budrio (Bologna), Azienda USL, Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy,Solid Tumor Molecular Pathology Laboratory, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
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A broad-spectrum nanobody targeting the C-terminus of the hepatitis B surface antigen for chronic hepatitis B infection therapy. Antiviral Res 2022; 199:105265. [DOI: 10.1016/j.antiviral.2022.105265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 12/16/2022]
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Schreiber S, Honz M, Mamozai W, Kurktschiev P, Schiemann M, Witter K, Moore E, Zielinski C, Sette A, Protzer U, Wisskirchen K. Characterization of a library of 20 HBV-specific MHC class II-restricted T cell receptors. Mol Ther Methods Clin Dev 2021; 23:476-489. [PMID: 34853796 PMCID: PMC8605085 DOI: 10.1016/j.omtm.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/27/2021] [Accepted: 10/27/2021] [Indexed: 02/07/2023]
Abstract
CD4+ T cells play an important role in the immune response against cancer and infectious diseases. However, mechanistic details of their helper function in hepatitis B virus (HBV) infection in particular, or their advantage for adoptive T cell therapy remain poorly understood as experimental and therapeutic tools are missing. Therefore, we identified, cloned, and characterized a comprehensive library of 20 MHC class II-restricted HBV-specific T cell receptors (TCRs) from donors with acute or resolved HBV infection. The TCRs were restricted by nine different MHC II molecules and specific for eight different epitopes derived from intracellularly processed HBV envelope, core, and polymerase proteins. Retroviral transduction resulted in a robust expression of all TCRs on primary T cells. A high functional avidity was measured for all TCRs specific for epitopes S17, S21, S36, and P774 (half-maximal effective concentration [EC50] <10 nM), or C61 and preS9 (EC50 <100 nM). Eight TCRs recognized peptide variants of HBV genotypes A to D. Both CD4+ and CD8+ T cells transduced with the MHC II-restricted TCRs were polyfunctional, producing interferon (IFN)-γ, tumor necrosis factor (TNF)-α, interleukin (IL)-2, and granzyme B (GrzB), and killed peptide-loaded target cells. Our set of MHC class II-restricted TCRs represents an important tool for elucidating CD4+ T cell help in viral infection with potential benefit for T cell therapy.
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Buschow SI, Jansen DTSL. CD4 + T Cells in Chronic Hepatitis B and T Cell-Directed Immunotherapy. Cells 2021; 10:cells10051114. [PMID: 34066322 PMCID: PMC8148211 DOI: 10.3390/cells10051114] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 12/17/2022] Open
Abstract
The impaired T cell responses observed in chronic hepatitis B (HBV) patients are considered to contribute to the chronicity of the infection. Research on this impairment has been focused on CD8+ T cells because of their cytotoxic effector function; however, CD4+ T cells are crucial in the proper development of these long-lasting effector CD8+ T cells. In this review, we summarize what is known about CD4+ T cells in chronic HBV infection and discuss the importance and opportunities of including CD4+ T cells in T cell-directed immunotherapeutic strategies to cure chronic HBV.
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Narayanan S, Au VB, Khakpoor A, Yan C, Ahl PJ, Kaliaperumal N, Lee B, Xiang WW, Wang J, Lee C, Tay A, Lim SG, Connolly JE. Bayesian analysis of cytokines and chemokine identifies immune pathways of HBsAg loss during chronic hepatitis B treatment. Sci Rep 2021; 11:7455. [PMID: 33811250 PMCID: PMC8018960 DOI: 10.1038/s41598-021-86836-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
Our objective was to examine differences in cytokine/chemokine response in chronic hepatitis B(CHB) patients to understand the immune mechanism of HBsAg loss (functional cure) during antiviral therapy. We used an unbiased machine learning strategy to unravel the immune pathways in CHB nucleo(t)side analogue-treated patients who achieved HBsAg loss with peg-interferon-α(peg-IFN-α) add-on or switch treatment in a randomised clinical trial. Cytokines/chemokines from plasma were compared between those with/without HBsAg loss, at baseline, before and after HBsAg loss. Peg-IFN-α treatment resulted in higher levels of IL-27, IL-12p70, IL-18, IL-13, IL-4, IL-22 and GM-CSF prior to HBsAg loss. Probabilistic network analysis of cytokines, chemokines and soluble factors suggested a dynamic dendritic cell driven NK and T cell immune response associated with HBsAg loss. Bayesian network analysis showed a dominant myeloid-driven type 1 inflammatory response with a MIG and I-TAC central module contributing to HBsAg loss in the add-on arm. In the switch arm, HBsAg loss was associated with a T cell activation module exemplified by high levels of CD40L suggesting T cell activation. Our findings show that more than one immune pathway to HBsAg loss was found with peg-IFN-α therapy; by myeloid-driven Type 1 response in one instance, and T cell activation in the other.
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Affiliation(s)
- Sriram Narayanan
- Translational Immunology Programme, Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology, and Research, Singapore (A*STAR) Research Entities (RE), 61 Biopolis Drive, Proteos, Singapore, 138673, Singapore
| | - Veonice Bijin Au
- Translational Immunology Programme, Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology, and Research, Singapore (A*STAR) Research Entities (RE), 61 Biopolis Drive, Proteos, Singapore, 138673, Singapore
| | - Atefeh Khakpoor
- Division of Gastroenterology and Hepatology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Yan
- Division of Gastroenterology and Hepatology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Patricia J Ahl
- Translational Immunology Programme, Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology, and Research, Singapore (A*STAR) Research Entities (RE), 61 Biopolis Drive, Proteos, Singapore, 138673, Singapore
| | - Nivashini Kaliaperumal
- Translational Immunology Programme, Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology, and Research, Singapore (A*STAR) Research Entities (RE), 61 Biopolis Drive, Proteos, Singapore, 138673, Singapore
| | - Bernett Lee
- Singapore Immunology Network, A*STAR REs, Singapore, Singapore
| | - Wen Wei Xiang
- IMCB, Tessa Therapeutics Pvt Ltd, Singapore, Singapore
| | - Juling Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chris Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amy Tay
- Division of Gastroenterology and Hepatology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Seng Gee Lim
- Translational Immunology Programme, Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology, and Research, Singapore (A*STAR) Research Entities (RE), 61 Biopolis Drive, Proteos, Singapore, 138673, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - John E Connolly
- Translational Immunology Programme, Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology, and Research, Singapore (A*STAR) Research Entities (RE), 61 Biopolis Drive, Proteos, Singapore, 138673, Singapore. .,Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Institute of Biomedical Studies, Baylor University, Waco, TX, USA.
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Heidari Z, Moudi B, Mahmoudzadeh-Sagheb H. Interferon gamma gene polymorphisms and chronic hepatitis B infections in an Iranian population. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2020; 31:515-521. [PMID: 32897225 PMCID: PMC7480198 DOI: 10.5152/tjg.2020.181024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 10/04/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Chronic hepatitis B is an important health problem in all countries. I Interferon gamma is a pro-inflammatory Th1 cytokines, which can exert antiproliferative and antitumor activity. Some SNPs in IFN-γ and IFN-γR1 genes may influence the susceptibility to HBV. Here, we evaluated the impact of interferon gamma (+874 T/A) and its receptor (-611A/G, +189G/C and +95C/T) polymorphisms and the risk of HBV in Iranian patients. MATERIALS AND METHODS SNPs of interferon gamma and its receptor genotypes were determined in 221 infected patients with HBV and 200 people without HBV using ARMS-PCR and PCR- RFLP method. RESULTS In this study, we showed an obvious relationship between IFN-γ SNPs and susceptibility to chronic HBV. Our findings suggest that IFN-γ-874A allele increases the risk of disease and carriers of the T allele have reduced susceptibility to infection. In addition, there was not any relationship between the -611A/G, +189G/C and +95C/T regions of IFN-γ R1 and HBV. CONCLUSIONS Our observations demonstrate +874 T/A SNP as a predicting factor in patients who have the risk of HBV.
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Affiliation(s)
- Zahra Heidari
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Histology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Bita Moudi
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Histology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamidreza Mahmoudzadeh-Sagheb
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Histology, Zahedan University of Medical Sciences, Zahedan, Iran
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8
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Niehrs A, Altfeld M. Regulation of NK-Cell Function by HLA Class II. Front Cell Infect Microbiol 2020; 10:55. [PMID: 32133304 PMCID: PMC7040486 DOI: 10.3389/fcimb.2020.00055] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/31/2020] [Indexed: 12/11/2022] Open
Abstract
Natural Killer (NK) cells were initially described as part of the innate immune system and characterized by their ability to lyse malignant and virus-infected cells. The cytolytic function of NK cells is tightly controlled by activating and inhibitory receptors expressed on the cell surface. Ligands that interact with a variety of NK-cell receptors include the human leukocyte antigen (HLA) molecules, and the regulation of NK-cell function by HLA class I molecules is well-established. Earlier studies also suggested a role of HLA class II molecules in regulating NK cell activity; yet, interactions between HLA class II molecules and NK cell receptors have not been well-characterized. We recently identified a subset of HLA-DP molecules that can serve as ligands for the natural cytotoxicity receptor NKp44 and activate NK cells. This novel receptor-ligand interaction provides a potential mechanism to explain the strong associations of HLA-DP molecules with HBV infection outcomes, graft-vs.-host disease and inflammatory bowel disease. Furthermore, it adds a new mechanism for NK-cell crosstalk with immune cells expressing HLA class II molecules. In this perspective article, we discuss the potential implications of NK cell receptor interactions with HLA class II molecules for the regulation of immune responses.
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Affiliation(s)
- Annika Niehrs
- Research Department Virus Immunology, Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - Marcus Altfeld
- Research Department Virus Immunology, Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany.,Institute for Immunology, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
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Ning L, Huang X, Xu Y, Yang G, Yang J, Fu Q, Zhang Q, Liu H, Wu X, Wang Z, Luo K. Boosting of Hepatitis B Virus-Specific T Cell Responses After Pegylated-Interferon-α-2a Therapy for Hepatitis B e Antigen-Positive Pediatric Patients. J Interferon Cytokine Res 2019; 39:740-751. [PMID: 31329012 DOI: 10.1089/jir.2019.0042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Treatment of chronic hepatitis B with pegylated-interferon-α-2a (PegIFNα) in pediatric patients can lead to a higher rate of hepatitis B virus (HBV) surface antigen (HBsAg) loss than in adults. However, the mechanism of underlying immune response is not clear. The aim of this study was to explore innate and adaptive immunity, especially HBV-specific T cell responses in hepatitis B e antigen (HBeAg)-positive pediatric patients, who have experienced HBsAg loss. Isolated lymphocytes of 20 HBeAg-positive pediatric patients were collected every 12 weeks until treatment was stopped. The phenotype of T/natural killer (NK) cells and function of HBV-specific T cells were analyzed by flow cytometry. The frequency of CD69 and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) expressed on T cells and TRAIL on CD56hi NK cells in patients with HBsAg loss was remarkably higher compared with nonresponse patients. Furthermore, in vitro peptide stimulation of HBV-specific T cell responses was increased in patients with HBsAg loss when compared with week 0 and 48, and correlated with decline of viral load. The PegIFNα therapy in pediatric patients triggered T/NK cell activation and HBV-specific T cell responses, thereby contributing to successful viral control.
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Affiliation(s)
- Lu Ning
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xuan Huang
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ying Xu
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guifeng Yang
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Juncheng Yang
- Office of Prof. Kangxian Luo, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qunfang Fu
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qi Zhang
- Office of Prof. Kangxian Luo, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hai Liu
- Office of Prof. Kangxian Luo, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoting Wu
- Office of Prof. Kangxian Luo, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhanhui Wang
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kangxian Luo
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Zhu W, Liu H, Zhang X. Toward Curative Immunomodulation Strategies for Chronic Hepatitis B Virus Infection. ACS Infect Dis 2019; 5:703-712. [PMID: 30907080 DOI: 10.1021/acsinfecdis.8b00297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic hepatitis B virus (HBV) infection remains a major cause of morbidity and mortality worldwide. HBV surface antigen loss is considered a functional cure and is an ideal goal for antiviral therapy. However, current treatment regimens, including nucleos(t)ide analogues or interferons monotherapy and combination therapy, rarely achieve this goal in chronic hepatitis B patients. Nucleos(t)ide analogues (NAs), as well as many direct antiviral drugs in ongoing development, are able to inhibit HBV replication and gene expression, but it is hard to achieve immune control and prevent recurrence after therapy cessation. Host immunity, especially HBV-specific T cell response, is proven to play a critical role in control or clearance of HBV infection. Considering HBV chronically infected patients display varying degrees of dysfunction regarding their immune system, novel approaches to enhancing antiviral immune responses are necessary in order to combine with current antiviral agents. In this Review, we focus on the role of innate and adaptive immune responses in HBV immunopathogenesis and discuss attractive strategies or drugs that aim to activate or rebuild antiviral immunity to achieve the goal of an HBV functional cure.
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Affiliation(s)
- Wei Zhu
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, Guangdong 510515, China
| | - Hongyan Liu
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, Guangdong 510515, China
| | - Xiaoyong Zhang
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, Guangdong 510515, China
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11
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Lumley SF, McNaughton AL, Klenerman P, Lythgoe KA, Matthews PC. Hepatitis B Virus Adaptation to the CD8+ T Cell Response: Consequences for Host and Pathogen. Front Immunol 2018; 9:1561. [PMID: 30061882 PMCID: PMC6054973 DOI: 10.3389/fimmu.2018.01561] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/25/2018] [Indexed: 12/11/2022] Open
Abstract
Chronic viral hepatitis infections are a major public health concern, with an estimated 290 million individuals infected with hepatitis B virus (HBV) globally. This virus has been a passenger in human populations for >30,000 years, and remains highly prevalent in some settings. In order for this endemic pathogen to persist, viral adaptation to host immune responses is pre-requisite. Here, we focus on the interplay between HBV infection and the CD8+ T cell response. We present the evidence that CD8+ T cells play an important role in control of chronic HBV infection and that the selective pressure imposed on HBV through evasion of these immune responses can potentially influence viral diversity, chronicity, and the outcome of infection, and highlight where there are gaps in current knowledge. Understanding the nature and mechanisms of HBV evolution and persistence could shed light on differential disease outcomes, including cirrhosis and hepatocellular carcinoma, and help reach the goal of global HBV elimination by guiding the design of new strategies, including vaccines and therapeutics.
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Affiliation(s)
- Sheila F. Lumley
- Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Anna L. McNaughton
- Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Paul Klenerman
- Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Oxford BRC, John Radcliffe Hospital, Oxford, United Kingdom
| | - Katrina A. Lythgoe
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Philippa C. Matthews
- Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Oxford BRC, John Radcliffe Hospital, Oxford, United Kingdom
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12
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Xia Y, Jin X, Yu X, Li X, Du B, Liu Z, Shi Y, Li N, Zhang S. Expression profiles of transcription factors for special CD4+ T-cell subsets in peripheral blood mononuclear cells from patients with hepatitis B virus infection. Medicine (Baltimore) 2018; 97:e11438. [PMID: 30045265 PMCID: PMC6078757 DOI: 10.1097/md.0000000000011438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
This study is to characterize the transcription factor expression profiles for the peripheral CD4 T-cell subsets, and analyze its associations with the clinical measures of the hepatitis B virus (HBV) infection.Totally 275 subjects were included. The expression levels of transcription factors (T-bet, GATA-3, Foxp3, RORγt, and Bcl-6) in the peripheral blood mononuclear cells (PBMCs) were determined by the real-time fluorimetry quantitative PCR (FQ-PCR).Lowest expression levels of all these transcription factors were observed for the HBsAb(-) group, which were higher in the HBsAb(+) and RHB groups. The T-bet/GATA-3 ratios in the CHB and RHB groups were significantly lower than the HBsAb(-) group, whereas the RORγt/Foxp3 ratios in the AHB and RHB groups were significantly higher than the CHB and HBsAb(+) groups. Furthermore, the RORγt mRNA expression levels were significantly different among groups with different disease severities or with different alanine aminotransferase (ALT) levels. The asymptomatic carrier (AsC) group and the group with ALT ≤ 40 had the highest express level. The mRNA expression levels of T-bet, GATA-3, Foxp3, and RORγt varied along with the aspartate aminotransferase (AST) levels, with AST ≤ 40 having the highest expression levels. In addition, significant differences were observed in the transcription factor expression levels between the group with the serum HBV DNA load of (1.000-9.999) × 10 copies/mL and other groups.Expression profile of critical transcription factors for peripheral CD4 T-cell subsets may indicate clinical outcomes of HBV infection.
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Affiliation(s)
- Yan Xia
- Scientific Research Center, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang
| | - Xi Jin
- Scientific Research Center, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang
| | - Xueyuan Yu
- Clinical Laboratory, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Xingku Li
- Scientific Research Center, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang
| | - Bo Du
- Scientific Research Center, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang
| | - Zhen Liu
- Scientific Research Center, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang
| | - Yuguang Shi
- Scientific Research Center, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang
| | - Na Li
- Clinical Laboratory, Suihua First Hospital, Suihua, Heilongjiang, China
| | - Shuyun Zhang
- Scientific Research Center, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang
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13
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Serum Levels of Interleukin-4, Interleukin-10 and Interferon-γ in Patients with Chronic Hepatitis B Infection. HEPATITIS MONTHLY 2018. [DOI: 10.5812/hepatmon.60377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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14
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Shao X, Ma J, Jia S, Yang L, Wang W, Jin Z. Interleukin-35 Suppresses Antiviral Immune Response in Chronic Hepatitis B Virus Infection. Front Cell Infect Microbiol 2017; 7:472. [PMID: 29181338 PMCID: PMC5693856 DOI: 10.3389/fcimb.2017.00472] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/30/2017] [Indexed: 12/13/2022] Open
Abstract
The mechanisms of hepatitis B virus (HBV) persistent infection are not completely understood. Interleukin (IL)-35, which is a newly identified cytokine belongs to IL-12 family, has been demonstrated to induce immunotolerance. Thus, the aim of current study was to investigate the role of IL-35 during chronic HBV infection. A total of 61 patients with chronic HBV infection [37 chronic hepatitis B (CHB) and 24 asymptomatic HBV carriers (ASC)] and 20 healthy individuals were enrolled. IL-35 concentration as well as the modulatory function of IL-35 on CD4+CD25+CD127dim/− regulatory T cells (Tregs) and on HBV antigen-specific CD8+ T cells was investigated. IL-35 expression was significantly increased in both CHB and ASC, and was positively correlated with the levels of HBV DNA. Inhibition of viral replication induced the reduction in serum levels of IL-35. IL-35 stimulation led to inhibition of proinflammatory cytokine productions and elevation of apoptosis in peripheral blood mononuclear cells (PBMCs), but not in HepG2.2.15 cells. Moreover, IL-35 stimulation not only robustly inhibited cellular proliferation, but also up-regulated the production of IL-10 and IL-35 in a HBV antigen-specific and non-specific manner in Tregs/CD4+CD25− T cells coculture system, which indicated enhancement of suppressive function of Tregs. Furthermore, IL-35 also reduced both cytolytic activity (direct lysis of HepG2.2.15 cells) and noncytolytic function (IFN-γ and TNF-α production) of HBV antigen-specific CD8+ T cells. The current data suggested that IL-35 contributed to maintain viral persistence by suppressing antiviral immune responses and reducing inflammatory responses in chronic HBV infection.
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Affiliation(s)
- Xue Shao
- Department of Hepatopancreatobiliary Medicine, Second Hospital, Jilin University, Changchun, China
| | - Jingting Ma
- Department of Hepatopancreatobiliary Medicine, Second Hospital, Jilin University, Changchun, China
| | - Shengnan Jia
- Department of Hepatopancreatobiliary Medicine, Second Hospital, Jilin University, Changchun, China
| | - Lanlan Yang
- Department of Hepatopancreatobiliary Medicine, Second Hospital, Jilin University, Changchun, China
| | - Wudong Wang
- Department of Hepatopancreatobiliary Medicine, Second Hospital, Jilin University, Changchun, China
| | - Zhenjing Jin
- Department of Hepatopancreatobiliary Medicine, Second Hospital, Jilin University, Changchun, China
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Laaribi AB, Bortolotti D, Hannachi N, Mehri A, Hazgui O, Ben Yahia H, Babay W, Belhadj M, Chaouech H, Yacoub S, Letaief A, Ouzari HI, Boudabous A, Di Luca D, Boukadida J, Rizzo R, Zidi I. Increased levels of soluble HLA-G molecules in Tunisian patients with chronic hepatitis B infection. J Viral Hepat 2017; 24:1016-1022. [PMID: 28429836 DOI: 10.1111/jvh.12718] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 04/03/2017] [Indexed: 01/08/2023]
Abstract
Hepatitis B virus (HBV) infection is a global health problem. The mechanisms of immune tolerance in HBV infection are still unclear. The host immune response plays a critical role in determining the outcome of HBV infection. Human leucocyte antigen-G (HLA-G) is involved in immunotolerogenic process and infectious diseases. This study aimed to explore the implication of soluble HLA-G (sHLA-G) and its isoforms in HBV infection. Total sHLA-G (including shedding HLA-G1 and HLA-G5) was analysed by ELISA in 95 chronic HBV patients, 83 spontaneously resolvers and 100 healthy controls (HC). To explore the presence of sHLA-G dimers, we performed an immunoprecipitation and a Western blot analysis on positive samples for sHLA-G in ELISA. The serum levels of sHLA-G were significantly increased in patients with chronic HBV patients compared to spontaneously resolvers and HC (P<.0001). Interestingly, we found an increased level of sHLA-G1 in chronic HBV patients than in spontaneously resolvers and HC (P<.001). In addition, the expression of HLA-G5 seems to be higher in the sera of chronic HBV patients than spontaneously resolvers (P=.026). The analysis of HLA-G dimers showed the presence of homodimers in 93% of chronic HBV patients, 67% in spontaneously resolvers and 60% in HC. These results provide evidence that sHLA-G may have a crucial role in the outcome of HBV infection and could be proposed as a biomarker for infection outcome. Based on its tolerogenic function, HLA-G might be considered as a new promising immunotherapeutic approach to treat the chronic infection with HBV.
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Affiliation(s)
- A B Laaribi
- Laboratory of Microorganisms and Actives Biomolecules, Sciences Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Laboratory of Microbiology and Immunology, UR12SP34, University Hospital Farhat Hached, Sousse, Tunisia.,Sciences Faculty of Bizerte, University of Carthage, Tunis, Tunisia
| | - D Bortolotti
- Section Microbiology and Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - N Hannachi
- Laboratory of Microbiology and Immunology, UR12SP34, University Hospital Farhat Hached, Sousse, Tunisia
| | - A Mehri
- Laboratory of Microbiology and Immunology, UR12SP34, University Hospital Farhat Hached, Sousse, Tunisia.,Sciences Faculty of Bizerte, University of Carthage, Tunis, Tunisia
| | - O Hazgui
- Laboratory of Microbiology and Immunology, UR12SP34, University Hospital Farhat Hached, Sousse, Tunisia
| | - H Ben Yahia
- Laboratory of Microorganisms and Actives Biomolecules, Sciences Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - W Babay
- Laboratory of Microorganisms and Actives Biomolecules, Sciences Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - M Belhadj
- Laboratory of Microbiology and Immunology, UR12SP34, University Hospital Farhat Hached, Sousse, Tunisia
| | - H Chaouech
- Department of Internal Medicine and Infectious Diseases, University Hospital Farhat Hached, Sousse, Tunisia
| | - S Yacoub
- Regional Center of Blood Transfusion, University Hospital Farhat Hached, Sousse, Tunisia
| | - A Letaief
- Department of Internal Medicine and Infectious Diseases, University Hospital Farhat Hached, Sousse, Tunisia
| | - H I Ouzari
- Laboratory of Microorganisms and Actives Biomolecules, Sciences Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - A Boudabous
- Laboratory of Microorganisms and Actives Biomolecules, Sciences Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - D Di Luca
- Section Microbiology and Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - J Boukadida
- Laboratory of Microbiology and Immunology, UR12SP34, University Hospital Farhat Hached, Sousse, Tunisia
| | - R Rizzo
- Section Microbiology and Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - I Zidi
- Laboratory of Microorganisms and Actives Biomolecules, Sciences Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Zhan W, Kang Y, Chen N, Mao C, Kang Y, Shang J. Halofuginone ameliorates inflammation in severe acute hepatitis B virus (HBV)-infected SD rats through AMPK activation. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:2947-2955. [PMID: 29066866 PMCID: PMC5644545 DOI: 10.2147/dddt.s149623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The hepatitis B virus (HBV) has caused acute and chronic liver diseases in ~350 million infected people worldwide. Halofuginone (HF) is a plant alkaloid which has been demonstrated to play a crucial role in immune regulation. Our present study explored the function of HF in the immune response of HBV-infected Sprague Dawley (SD) rats. Plasmid containing pCDNA3.1-HBV1.3 was injected in SD rats for the construction of an acute HBV-infected animal model. Our data showed that HF reduced the high concentrations of serum hepatitis B e-antigen, hepatitis B surface antigen, and HBV DNA induced by HBV infection. HF also reduced the number of T helper (Th)17 cells and the expression of interleukin (IL)-17 compared with the pCDNA3.1-HBV1.3 group. Moreover, pro-inflammatory cytokine levels (IL-17, IL-23, interferon-γ, and IL-2) were downregulated and anti-inflammatory cytokine levels (IL-4 and IL-13) were upregulated by HF. Through further research we found that the expression of AMP-activated protein kinase (AMPK) and IKBA which suppressed NF-κB activation was increased while the expression of p-NF-κB P65 was decreased in pCDNA3.1-HBV1.3+HF group compared with pCDNA3.1-HBV1.3 group, indicating that HF may work through the activation of AMPK. Finally, our conjecture was further verified by using the AMPK inhibitor compound C, which counteracted the anti-inflammation effect of HF, resulting in the decreased expression of AMPK, IKBA and increased expression of p-NF-κB P65 and reduced number of Th17 cells. In our present study, HF was considered as an anti-inflammatory factor in acute HBV-infected SD rats and worked through AMPK-mediated NF-κB p65 inactivation. This study implicated HF as a potential therapeutic strategy for hepatitis B.
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Affiliation(s)
- Weili Zhan
- Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Yanhong Kang
- Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Ning Chen
- Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Chongshan Mao
- Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Yi Kang
- Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Jia Shang
- Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, Henan, China
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Cytotoxic T lymphocytes and CD4 epitope mutations in the pre-core/core region of hepatitis B virus in chronic hepatitis B carriers in Northeast Iran. Indian J Gastroenterol 2017; 36:253-257. [PMID: 28741237 DOI: 10.1007/s12664-017-0767-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 06/30/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUNDS Hepatitis B virus (HBV) is vulnerable to many various mutations. Those within epitopes recognized by sensitized T cells may influence the re-emergence of the virus. This study was designed to investigate the mutation in immune epitope regions of HBV pre-core/core among chronic HBV patients of Golestan province, Northeast Iran. METHODS In 120 chronic HBV carriers, HBV DNA was extracted from blood plasma samples and PCR was done using specific primers. Direct sequencing and alignment of the pre-core/core region were applied using reference sequence from Gene Bank database (Accession Number AB033559). RESULTS The study showed 27 inferred amino acid substitutions, 9 of which (33.3%) were in CD4 and 2 (7.4%) in cytotoxic T lymphocytes' (CTL) epitopes and 16 other mutations (59.2%) were observed in other regions. CONCLUSIONS CTL escape mutations were not commonly observed in pre-core/core sequences of chronic HBV carriers in the locale of study. It can be concluded that most of the inferred amino acid substitutions occur in different immune epitopes other than CTL and CD4.
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18
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Boeijen LL, Hoogeveen RC, Boonstra A, Lauer GM. Hepatitis B virus infection and the immune response: The big questions. Best Pract Res Clin Gastroenterol 2017; 31:265-272. [PMID: 28774408 DOI: 10.1016/j.bpg.2017.05.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 04/26/2017] [Accepted: 05/13/2017] [Indexed: 01/31/2023]
Abstract
Clinical events and the host immune response during hepatitis B virus (HBV) infection are intricately linked. Despite decades of research, important questions concerning the immunopathogenesis of chronic HBV infection remain unanswered. For example, it is unclear which immune parameters facilitate persistence, and if HBV can be completely cleared from the human liver. Recent technological breakthroughs now allow researchers to address these seemingly basic, but essential questions surrounding HBV immunity. It will be important to better define the molecular underpinnings of immune cell function and dysfunction during chronic disease and in controlled infection, with particular focus on the liver, as little information is available on the intrahepatic compartment. In the near future, it may be possible to solve some of the controversy surrounding the immune responses to HBV, and establish the features of both the innate and adaptive arms of the immune system required to achieve sustained control of HBV infection.
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Affiliation(s)
- Lauke L Boeijen
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Ruben C Hoogeveen
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andre Boonstra
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - Georg M Lauer
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Holmes JA, Yu ML, Chung RT. Hepatitis B reactivation during or after direct acting antiviral therapy - implication for susceptible individuals. Expert Opin Drug Saf 2017; 16:651-672. [PMID: 28471314 DOI: 10.1080/14740338.2017.1325869] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The FDA issued a warning following 24 cases of HBV reactivation during DAA therapy for HCV, including individuals with inactive, occult and past HBV infection. Clinical presentations ranged from asymptomatic fluctuations in HBV DNA to fulminant hepatic failure, liver transplantation and death. The mechanism is unknown. Areas covered: HCV/HBV coinfection is common, particularly in regions endemic for HBV. HCV and HBV utilize host factors to support replication; both viruses evade/impair host immunity. Clinical presentations of HBV reactivation during DAAs are summarized. Other causes of HBV reactivation are revisited and recent data regarding HBV reactivation are presented. Expert opinion: HBV reactivation during DAAs for HCV occurs, with life-threatening consequences in some individuals. The risk of HBV reactivation is observed in all HBV stages. The rapid removal of HCV likely alters and liberates host-viral ± viral-viral interactions that lead to increased HBV replication. As immune reconstitution occurs with HCV removal, host recognition of HBV DNA likely ensues followed by vigorous host immune responses leading to liver injury (HBV flare). These cases highlight the importance of HBV testing prior to initiating DAA therapy, the need for close monitoring of HBV during therapy and timely administration of anti-HBV therapy to prevent serious sequelae.
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Affiliation(s)
- Jacinta A Holmes
- a Gastrointestinal Unit , Massachusetts General Hospital , Boston , MA , USA.,b Department of Gastroenterology , St Vincent's Hospital, University of Melbourne , Fitzroy , Australia
| | - Ming-Lung Yu
- a Gastrointestinal Unit , Massachusetts General Hospital , Boston , MA , USA.,c Division of Hepatobiliary, Department of Internal Medicine and Hepatitis Center , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan.,d Graduate Institute of Medicine, College of Medicine , Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Raymond T Chung
- a Gastrointestinal Unit , Massachusetts General Hospital , Boston , MA , USA.,e Department of Medicine , Harvard Medical School , Boston , MA , USA
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20
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Lao TT, Sahota DS. Pregnancy and maternal chronic hepatitis B infection-Evidence of reproductive advantage? Am J Reprod Immunol 2017; 77. [PMID: 28370686 DOI: 10.1111/aji.12667] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/17/2017] [Indexed: 12/14/2022] Open
Abstract
PROBLEM As multiparas have high prevalence of chronic hepatitis B virus (HBV) infection, we examined here the relationship between the number of pregnancies with HBV infection. METHOD OF STUDY Retrospective cohort study examining the prevalence of HBV infection by actual gravidity and parity in 104 242 gravidae managed during 1997-2013. RESULTS Infection rate increased from 8.5% to 10.6% for G1 to G≥6 and from 8.8% to 10.0% for P0 to P≥3 (P<.001). When stratified by parity, correlation with gravidity was maintained in the nulliparous gravidae. For the same gravidity, increasing parity was associated with higher rate of HBV infection for G2 and G3. Multiparas had higher HBV infection prevalence (all >10%) than nulliparas (<10%) for G2 to G≥4. CONCLUSION Prior pregnancies, especially successful ones, are associated with increased HBV infection in an endemic population, which could have enhanced reproduction and in the process facilitated its transmission to the following generations.
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Affiliation(s)
- Terence T Lao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Daljit S Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Effect of HLA-DPA1 alleles on chronic hepatitis B prognosis and treatment response. North Clin Istanb 2017; 3:168-174. [PMID: 28275747 PMCID: PMC5336620 DOI: 10.14744/nci.2016.27870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Chronic hepatitis B (CHB) is a major health problem. The outcome of hepatitis B virus (HBV) infection is associated with variations in HLA-DPA1 alleles. The aim of this study was to investigate possible associations of HLA-DPA1 alleles with treatment response and with hepatitis B virus e antigen (HBeAg) seroconversion. METHODS Eight different HLA-DPA1 alleles from 246 CHB patients were genotyped by polymerase chain reaction with sequence-specific primers at high resolution to investigate the association of HLA-DPA1 alleles with treatment response, development of cirrhosis, HBeAg seroconversion, and disease reoccurrence upon HBeAg loss. RESULTS There was no significant association between HLA-DPA1 alleles and treatment response, development of cirrhosis, or HBeAg seroconversion. However, HLA-DPA1*04:01 allele was significantly more frequently found in patients who redeveloped disease upon HBeAg seroconversion (100% vs 36.8%: p=0.037; Fisher's exact test). CONCLUSION HLA-DPA1*04:01 allele may be a risk factor for reoccurrence of CHB after HBeAg seroconversion.
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Golsaz-Shirazi F, Shokri F. Hepatitis B immunopathogenesis and immunotherapy. Immunotherapy 2016; 8:461-77. [PMID: 26973127 DOI: 10.2217/imt.16.3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Worldwide there are over 248 million chronic carriers of HBV of whom about a third eventually develop severe HBV-related complications. Due to the major limitations of current therapeutic approaches, the development of more effective strategies to improve therapeutic outcomes in chronic hepatitis B (CHB) patients seems crucial. Immune activation plays a critical role in spontaneous viral control; therefore, new modalities based on stimulation of the innate and adaptive immune responses could result in the resolution of infection and are promising approaches. Here, we summarize the HBV immunopathogenesis, and discuss the encouraging results obtained from the promising immune-based innovations, such as therapeutic vaccination, cytokine therapy, cell-based therapies and blocking inhibitory receptors, as current and future immunotherapeutic interventions.
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Affiliation(s)
- Forough Golsaz-Shirazi
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fazel Shokri
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Monoclonal Antibody Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
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23
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Moudi B, Heidari Z, Mahmoudzadeh-Sagheb H. Impact of host gene polymorphisms on susceptibility to chronic hepatitis B virus infection. INFECTION GENETICS AND EVOLUTION 2016; 44:94-105. [DOI: 10.1016/j.meegid.2016.06.043] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 12/15/2022]
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24
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Ghasemian N, Shahbazi M. Interferon Gamma Gene Polymorphism (+874 T > A) and Chronic Hepatitis B in the Population of Gorgan, North-Eastern Iran. Jundishapur J Microbiol 2016; 9:e33639. [PMID: 27800132 PMCID: PMC5080914 DOI: 10.5812/jjm.33639] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 08/09/2016] [Accepted: 08/13/2016] [Indexed: 01/28/2023] Open
Abstract
Background Based on differences in individual immune responses to the hepatitis B virus (HBV), between 5% and 10% of patients become persistently infected with the virus, which leads to the determination of chronic HBV. Cytokines such as interferon gamma (IFN-γ) are secretory proteins that play important roles in both innate and adaptive immune responses. Functional studies have demonstrated that the IFN + 874A/T gene polymorphism can increase or decrease the overall expression of IFN-gamma (γ) and ultimately determine the outcome of the infection. Objectives This study was performed to investigate the relationship between the IFN-γ + 874 gene polymorphism and susceptibility to chronic HBV infection. Methods Polymorphism detection analysis was performed on 598 subjects from North-Eastern Iran. The IFN-γ gene polymorphism (+ 874A/T) was genotyped through a specific sequence primer polymerase chain reaction (SSP-PCR). Results The frequencies of the AA, AT, and TT genotypes were 31%, 51%, and 18% in the chronic HBV patient group, and 40%, 45%, and 15% in the healthy control group, respectively. However, a lack of association of the + 874 polymorphism in the IFN-γ gene of those with chronic HBV infection was found. Evaluation of HBV association with this polymorphism was significant under the dominant genetic model (P = 0.04). Conclusions Ultimately, no association could be characterized between the polymorphism in IFN-γ + 874A/T and susceptibility to chronic HBV infection in this segment of the Iranian population (P > 0.05).
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Affiliation(s)
- Nadia Ghasemian
- Medical Cellular & Molecular Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Majid Shahbazi
- Medical Cellular & Molecular Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
- Corresponding author: Majid Shahbazi, Medical Cellular & Molecular Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran. Tel/Fax: +98-1732421657, E-mail:
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25
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Liu X, Jiao Y, Cui B, Gao X, Xu J, Zhao Y. The potential protective role of hepatitis B virus infection in pristane-induced lupus in mice. Lupus 2016; 25:1180-9. [PMID: 27125291 DOI: 10.1177/0961203316631637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/13/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of this study was to investigate whether hepatitis B virus (HBV) infection plays a role in the regulation of autoimmunity for systemic lupus erythematosus (SLE). METHOD A total of 21 female BALB/c mice and 21 female HBV transgenic BALB/c mice aged two months were randomly divided into four groups: BALB/c mice, HBV(Tg) mice, pristane-injected BALB/c mice, and pristane-injected HBV(Tg) mice. BALB/c mice and HBV(Tg) mice were given an intraperitoneal injection of 0.5 ml normal saline, and the mice in the other two groups were given an intraperitoneal injection of 0.5 ml pristane. ANA and anti-dsDNA levels in serum were detected by indirect immunofluorescence. Interleukin 2 (IL-2), IL-4, IL-6, IL-17, and TNF-α were measured by Luminex technology. The serum BAFF level was measured using an Elisa kit. Twenty-four weeks after pristane administration, kidneys were removed, dissected, and stained with hematoxylin and eosin and periodic-acid Schiff. RESULT At six months after injecting, the ANA titers in pristane-injected HBV(Tg) mice were significantly lower than pristane-injected BALB/c mice. IL-17, TNF-α, and BAFF levels were significantly higher in pristane-injected BALB/c mice than BALB/c mice and pristane-injected HBV(Tg) mice. IL-2, IL-4, and IL-6 levels were much higher in pristane-injected HBV(Tg) mice than pristane-injected BALB/c mice. In pristane-injected HBV(Tg) mice and HBV(Tg) mice, fewer glomerulonephritis changes were found in the kidneys. CONCLUSIONS Our results showed that the incidence of SLE was much lower in HBV(Tg) mice, and that HBV infection helped the SLE mice survive high levels of inflammatory cytokines and severe renal damage. All these findings demonstrated the protective role of HBV in SLE patients via the immunoregulatory networks of the cytokines.
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Affiliation(s)
- X Liu
- Central Laboratory, Shandong Provincial Hospital affiliated to Shandong University, Jinan, PR China
| | - Y Jiao
- Central Laboratory, Shandong Provincial Hospital affiliated to Shandong University, Jinan, PR China
| | - B Cui
- Central Laboratory, Shandong Provincial Hospital affiliated to Shandong University, Jinan, PR China
| | - X Gao
- Center of Laboratory Medicine, Yuhuangding Hospital, Yantai, PR China
| | - J Xu
- Immune Cell Research Laboratory, School of Medicine, Tsinghua University, Beijing, PR China
| | - Y Zhao
- Central Laboratory, Shandong Provincial Hospital affiliated to Shandong University, Jinan, PR China
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Rafiei A, Ajami A, Mohammad Mirabi A, Saffar MJ, Amjadi O, Haghshenas MR, Abedian F, Khaje-Enayati P. Serum Levels of Soluble CD26, A Novel Prognostic Marker for Hepatitis E Infection. Jundishapur J Microbiol 2016; 9:e31110. [PMID: 27127593 PMCID: PMC4842250 DOI: 10.5812/jjm.31110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 11/11/2015] [Accepted: 12/01/2015] [Indexed: 12/11/2022] Open
Abstract
Background: Even without treatment, most acute hepatitis E virus (HEV) infected patients resolve HEV but sometimes the disease leads to acute liver failure, chronic infection, or extrahepatic symptoms. The mechanisms of HEV pathogenesis appear to be substantially immune mediated. However, the immune responses to HEV are not precisely identified. Objectives: This study aimed to evaluate the Th1/Th2 ratio by investigating serum soluble markers from Th1 and Th2 cells in acute HEV infected patients. Patients and Methods: This case-control study included 35 acute HEV infected patients and 35 age and gender matched anti-HEV negative healthy controls. The serum levels of Interferon (IFN)-γ, IL-4, soluble CD26 (sCD26) and sCD30 were determined by the enzyme-linked immunosorbent assay. Results: The results showed a significant difference in IFN-γ and sCD26 (P < 0.0001 and P = 0.001) yet not IL-4 and sCD30 (P = 0.354 and P = 0.159) between acute HEV patients and controls, respectively. There was a positive direct correlation between serum levels of sCD26 and IFN-γ in acute HEV patients (r = 0.64, P = 0.001). In addition, the ratio of sCD26/sCD30 in the acute HEV group was more than two folds higher than in the HEV negative controls. Conclusions: Acute HEV infection shows a pattern of Th1-type immune response, and the direct significant positive correlation between the serum level of sCD26 and IFN-γ in acute HEV infected patients, suggests that the trend of sCD26 levels is a valuable marker for predicting hepatic inflammation in hepatitis E.
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Affiliation(s)
- Alireza Rafiei
- Molecular and Cell Biology Research Center, Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Abolghasem Ajami
- Molecular and Cell Biology Research Center, Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Araz Mohammad Mirabi
- Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
- Corresponding author: Araz Mohammad Mirabi, Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran. Tel: +98-1133543614, E-mail:
| | - Mohammad Jafar Saffar
- Department of Infectious Diseases, Buali Hospital, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Omolbanin Amjadi
- Molecular and Cell Biology Research Center, Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Mohammad Reza Haghshenas
- Molecular and Cell Biology Research Center, Department of Microbiology and Virology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Farshideh Abedian
- Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Pouya Khaje-Enayati
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
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27
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Godon O, Evlachev A, Bourgine M, Meritet JF, Martin P, Inchauspe G, Michel ML. Recognition of core-derived epitopes from a novel HBV-targeted immunotherapeutic by T-cells from patients infected by different viral genotypes. Vaccine 2015. [PMID: 26209840 DOI: 10.1016/j.vaccine.2015.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Hepatitis B virus (HBV) infects millions of people worldwide and is a leading cause of liver cirrhosis and hepatocellular carcinoma. Current therapies based on nucleos(t)ide analogs or pegylated-interferon-α lead to control of viral replication in most patients but rarely achieve cure. A potential strategy to control chronic hepatitis B is to restore or induce functional anti-HBV T-cell immune responses using HBV-specific immunotherapeutics. However, viral diversity is a challenge to the development of this class of products as HBV genotypes display a sequence diversity of up to 8%. We have developed a novel HBV-targeted immunotherapeutic, TG1050, based on a non-replicative Adenovirus vector encoding a unique and large fusion protein composed of multiple antigenic regions derived from a HBV genotype D sequence. Using peripheral blood mononuclear cells from 23 patients chronically infected by five distinct genotypes (gt A, B, C, D and E) and various sets of peptides encompassing conserved versus divergent regions of HBV core we have measured ability of TG1050 genotype D core-derived peptides to be recognized by T-cells from patients infected by various genotypes. Overall, PBMCs from 78% of genotype B or C- and 100% genotype A or E-infected patients lead to detection of HBV core-specific T-cells recognizing genotype D antigenic domains located both in conserved and variable regions. This proof-of-concept study supports the clinical development of TG1050 in large patient populations independently of infecting genotypes.
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Affiliation(s)
- Ophelie Godon
- Laboratoire de Pathogenèse des virus de l'hépatite B, Département de Virologie, Institut Pasteur, 28, rue du Docteur Roux, Paris Cedex 15 75724, France
| | - Alexei Evlachev
- Transgene SA, Department of Infectious Diseases, Lyon, France
| | - Maryline Bourgine
- Laboratoire de Pathogenèse des virus de l'hépatite B, Département de Virologie, Institut Pasteur, 28, rue du Docteur Roux, Paris Cedex 15 75724, France
| | | | - Perrine Martin
- Transgene SA, Department of Infectious Diseases, Lyon, France
| | | | - Marie-Louise Michel
- Laboratoire de Pathogenèse des virus de l'hépatite B, Département de Virologie, Institut Pasteur, 28, rue du Docteur Roux, Paris Cedex 15 75724, France; INSERM U994, Département de Virologie, Institut Pasteur, Paris, France.
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28
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Karra VK, Gumma PK, Chowdhury SJ, Ruttala R, Polipalli SK, Chakravarti A, Kar P. IL-18 polymorphisms in hepatitis B virus related liver disease. Cytokine 2015; 73:277-82. [PMID: 25802197 DOI: 10.1016/j.cyto.2015.02.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/13/2015] [Accepted: 02/14/2015] [Indexed: 12/17/2022]
Abstract
Interleukine-18 (IL-18) was originally called interferon (INF-γ) inducing factor and plays a critical dual role in Th1 polarization and viral clearance. We aimed to explore whether single-nucleotide promoter polymorphisms (SNPs) are associated with the outcome of hepatitis B virus (HBV) infection. 271 HBV infected patients were recruited in this study out of these 109 were spontaneously recovered and 162 were diagnosed to be having persistent HBV infection which includes 48 chronic hepatitis, 84 liver cirrhosis, 30 HCC cases and were compared with 280 healthy controls. IL-18 promoter genotyping was performed with sequence-specific primers. The results demonstrated the significant involvement of genotype AA at position -607 in healthy controls (38.6%) when compared to cases (26.0%) (OR=0.54 (0.385-0.797)) and also associated with spontaneous clearance (37.6%) compared to persistent HBV infections (17.9%) (OR=2.76 (1.582-4.832)). Whereas, genotype CC at position -607 in cases (18.0%) when compared to healthy controls (6.7%) (OR=3.03 (1.734-5.303)) also associated with persistent HBV infections (24.1%) compared to spontaneous clearance (9.2%) (OR=0.31 (0.151-0.67)). And genotype GC at position -137 in cases (49.5%) compared to healthy controls (38.5%) (OR=1.55 (1.11-2.18)). Whereas, genotype GG at position -137 in healthy controls (56.8%) compared to cases (45.4%) (OR=0.63 (0.451-0.885)). No significant difference at position -137 was observed between spontaneous clearance and persistent HBV infections. These polymorphisms of the IL-18 gene promoter region at position -607 and -137 could be associated with different outcomes of HBV infection. The people with allele A at position -607 may be protected against HBV infection; moreover AA genotype is associated with spontaneous clearance.
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Affiliation(s)
- Vijay Kumar Karra
- PCR Hepatitis Lab, Dept. of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi 110002, India
| | - Phani Kumar Gumma
- PCR Hepatitis Lab, Dept. of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi 110002, India
| | - Soumya Jyoti Chowdhury
- PCR Hepatitis Lab, Dept. of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi 110002, India
| | - Rajesh Ruttala
- PCR Hepatitis Lab, Dept. of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi 110002, India
| | - Sunil Kumar Polipalli
- PCR Hepatitis Lab, Dept. of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi 110002, India
| | - Anita Chakravarti
- Department of Medical Microbiology, Maulana Azad Medical College, University of Delhi, New Delhi 110002, India
| | - Premashis Kar
- PCR Hepatitis Lab, Dept. of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi 110002, India.
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29
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TIPE2 protein negatively regulates HBV-specific CD8+ T lymphocyte functions in humans. Mol Immunol 2015; 64:204-9. [DOI: 10.1016/j.molimm.2014.11.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 11/15/2014] [Accepted: 11/25/2014] [Indexed: 12/25/2022]
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30
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Koh S, Bertoletti A. Circumventing failed antiviral immunity in chronic hepatitis B virus infection: triggering virus-specific or innate-like T cell response? Med Microbiol Immunol 2014; 204:87-94. [PMID: 25511870 DOI: 10.1007/s00430-014-0377-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 09/15/2014] [Indexed: 02/07/2023]
Abstract
Therapeutic vaccination for the treatment of chronic hepatitis B has thus far been unsatisfactory. In this review, we discuss potential new therapeutic vaccination strategies and other immunotherapeutic approaches that aim to achieve efficient restoration of HBV immunity in chronically infected patients.
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Affiliation(s)
- Sarene Koh
- Viral Hepatitis Unit, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore,
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31
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Tang S, Yue M, Wang J, Zhang Y, Yu R, Su J, Peng Z, Wang J. Associations of IFN-γ rs2430561 T/A, IL28B rs12979860 C/T and ERα rs2077647 T/C polymorphisms with outcomes of hepatitis B virus infection: a meta-analysis. J Biomed Res 2014; 28:484-93. [PMID: 25469118 PMCID: PMC4250527 DOI: 10.7555/jbr.28.20130162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 11/28/2013] [Accepted: 04/07/2014] [Indexed: 01/04/2023] Open
Abstract
Several studies investigated associations of IFN-γ rs2430561 T/A, IL28B rs12979860 C/T and ERα rs2077647 T/C gene polymorphisms with outcomes of hepatitis B virus (HBV) infection, but the results were controversial. Therefore, we performed a meta-analysis of all published observational studies to address this inconsistency. Literature was searched in online database and a systematic review was conducted based on the search results. A total of 24 studies were included and dichotomous data were presented as odds ratio (OR) with a 95% confidence interval (CI). The rs2430561 T allele was associated with reduced persistent HBV infection risk (T vs. A: OR, 0.690; 95% CI, [0.490, 0.971]), while the rs2077647 T allele significantly increased the risk of persistent HBV infection (T vs. C: OR, 1.678; 95% CI, [1.212, 2.323]). Rs 2077647 CC might play a role in protecting individuals against HBV persistence (TT vs. CC: OR, 4.109; 95% CI, [2.609, 6.473]). Furthermore, carriers of the rs2430561 TT genotype were more likely to clear HBV spontaneously compared with those of the AA genotype (TT vs. AA: OR, 0.555; 95% CI, [0.359, 0.856]). For rs12979860 C/T polymorphism, no significant correlation with HBV infection outcomes was found. In subgroup analyses, the results were similar to those of overall analysis. However, for rs2077647 TT vs. TC+CC, significantly increased risks were observed in the Asian and hospital-based population, but not in the overall analysis. IFN-γ rs2430561 T/A and ERα rs2077647 T/C genetic polymorphisms were associated with outcomes of HBV infection, but no association was found between IL28B rs12979860 C/T and HBV infection.
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Affiliation(s)
- Shaidi Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Ming Yue
- Department of Infectious Diseases, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jiajia Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yun Zhang
- Institute of Epidemiology and Microbiology, the Institute of Military Medicine of Nanjing Command, Nanjing, Jiangsu 210002, China
| | - Rongbin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jing Su
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Zhihang Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jie Wang
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu 210029, China. ; Department of General Practice, Kangda College, Nanjing Medical University, Nanjing, Jiangsu 210029, China
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32
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Loggi E, Gamal N, Bihl F, Bernardi M, Andreone P. Adaptive response in hepatitis B virus infection. J Viral Hepat 2014; 21:305-13. [PMID: 24674098 DOI: 10.1111/jvh.12255] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/06/2014] [Indexed: 02/06/2023]
Abstract
Hepatitis B virus (HBV) is a major cause of acute and chronic liver inflammation worldwide. The immune response against the virus represents a key factor in determining infection outcome, in terms of both viral clearance and the perpetuation of liver damage. Significant advances have recently been achieved regarding the functions of antiviral CD8+ T cells, leading to a better understanding of their abnormalities during chronic infection as well as the pathways to be manipulated to reverse the immune impairment of chronic infection. In this review, we aimed to analyse the patterns of adaptive immunity that develop during acute infection and the profiles in chronic infection. In addition to CD8+ T cells, which are the best-described subset to date, we reviewed and commented on the direct and indirect roles of CD4+ T cells and B cells.
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Affiliation(s)
- E Loggi
- Institute for Research in Biomedicine, Bellinzona, Switzerland; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Rodriguez-Frias F, Buti M, Tabernero D, Homs M. Quasispecies structure, cornerstone of hepatitis B virus infection: Mass sequencing approach. World J Gastroenterol 2013; 19:6995-7023. [PMID: 24222943 PMCID: PMC3819535 DOI: 10.3748/wjg.v19.i41.6995] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 07/23/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) is a DNA virus with complex replication, and high replication and mutation rates, leading to a heterogeneous viral population. The population is comprised of genomes that are closely related, but not identical; hence, HBV is considered a viral quasispecies. Quasispecies variability may be somewhat limited by the high degree of overlapping between the HBV coding regions, which is especially important in the P and S gene overlapping regions, but is less significant in the X and preCore/Core genes. Despite this restriction, several clinically and pathologically relevant variants have been characterized along the viral genome. Next-generation sequencing (NGS) approaches enable high-throughput analysis of thousands of clonally amplified regions and are powerful tools for characterizing genetic diversity in viral strains. In the present review, we update the information regarding HBV variability and present a summary of the various NGS approaches available for research in this virus. In addition, we provide an analysis of the clinical implications of HBV variants and their study by NGS.
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Circulating cytokines and histological liver damage in chronic hepatitis B infection. HEPATITIS RESEARCH AND TREATMENT 2013; 2013:757246. [PMID: 24288603 PMCID: PMC3833406 DOI: 10.1155/2013/757246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/03/2013] [Accepted: 09/20/2013] [Indexed: 12/27/2022]
Abstract
Each phase of hepatitis B infection stimulates distinct viral kinetics and host immune responses resulting in liver damage and hepatic fibrosis. Our objective has been to correlate host inflammatory immune response including circulating Th1 and Th2 cytokines in patients with chronic hepatitis B infection with liver histopathology. Sixty-four patients with chronic hepatitis B without previous treatment were recruited. The liver histology and histological activity index were assessed for various degrees of necroinflammation and hepatic fibrosis. We determined circulating levels of the Th1 and Th2 cytokines. Forty-six males and 18 females at a median age of 34.5 years were studied. HBeAg was present in 28/64 (43.75%) of the patients. In patients negative for HBeAg, IL-10 and IFN-gamma were significantly correlated with degrees of necroinflammation (r = 0.34, r = 0.38, resp.; P < 0.05). Moreover, TNF-alpha was significantly correlated with degrees of fibrosis (r = 0.35; P < 0.05), and IL-10 and TNF-alpha were significantly correlated with significant fibrosis (r = 0.39, r = 0.35, resp.; P < 0.05). These correlations were found in the HBeAg negative group as opposed to the HBeAg positive group. In HBeAg negative patients, circulating cytokines IL-10 and IFN-gamma were correlated with degrees of necroinflammation, whereas IL-10 and TNF-alpha were correlated with significant fibrosis.
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35
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Wong DKH, Watanabe T, Tanaka Y, Seto WK, Lee CK, Fung J, Lin CK, Huang FY, Lai CL, Yuen MF. Role of HLA-DP polymorphisms on chronicity and disease activity of hepatitis B infection in Southern Chinese. PLoS One 2013; 8:e66920. [PMID: 23825586 PMCID: PMC3692552 DOI: 10.1371/journal.pone.0066920] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/12/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND AIMS The association between HLA-DP single nucleotide polymorphisms (SNPs) and chronic hepatitis B virus (HBV) infection varies between different populations. We aimed to study the association between HLA-DP SNPs and HBV infection and disease activity in the Chinese population of Hong Kong. METHODS We genotyped SNPs rs3077 (near HLA-DPA1) and rs9277378 and rs3128917 (both near HLA-DPB1) in 500 HBV carriers (hepatitis B surface antigen [HBsAg]-positive), 245 non-HBV infected controls (HBsAg- and antibody to hepatitis B core protein [anti-HBc]-negative), and 259 subjects with natural HBV clearance (HBsAg-negative, anti-HBc-positive). Inactive HBV carriers state was defined by HBV DNA levels <2,000 IU/ml and persistently normal alanine aminotransferase level for least 12 months. RESULTS Compared to the non-HBV infected subjects, the HBV carriers had a significantly lower frequency of the rs3077 T allele (p = 0.0040), rs9277378 A allele (p = 0.0068) and a trend for lower frequency of rs3128917 T allele (p = 0.054). These alleles were associated with an increased chance of HBV clearance (rs3077: OR = 1.41, p = 0.0083; rs9277378: OR = 1.61, p = 0.00011; rs3128917: OR = 1.54, p = 0.00017). Significant associations between HLA-DP genotypes and HBV clearance were also found under different genetic models. Haplotype TAT was associated with an increased chance of HBV clearance (OR = 1.64, p = 0.0013). No association was found between these SNPs and HBV disease activity. CONCLUSION HLA-DP SNPs rs3077, rs9277378 and rs3128917 were associated with chronicity of HBV disease in the Chinese. Further studies are required to determine whether these SNPs influence the disease endemicity in different ethnic populations.
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Affiliation(s)
- Danny Ka-Ho Wong
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Tsunamasa Watanabe
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasuhito Tanaka
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Wai-Kay Seto
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Cheuk-Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Hospital Authority, Hong Kong
| | - James Fung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Che-Kit Lin
- Hong Kong Red Cross Blood Transfusion Service, Hospital Authority, Hong Kong
| | - Fung-Yu Huang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ching-Lung Lai
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Man-Fung Yuen
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong
- * E-mail:
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Kosinska AD, Zhang E, Johrden L, Liu J, Seiz PL, Zhang X, Ma Z, Kemper T, Fiedler M, Glebe D, Wildner O, Dittmer U, Lu M, Roggendorf M. Combination of DNA prime--adenovirus boost immunization with entecavir elicits sustained control of chronic hepatitis B in the woodchuck model. PLoS Pathog 2013; 9:e1003391. [PMID: 23785279 PMCID: PMC3681757 DOI: 10.1371/journal.ppat.1003391] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 04/15/2013] [Indexed: 12/21/2022] Open
Abstract
A potent therapeutic T-cell vaccine may be an alternative treatment of chronic hepatitis B virus (HBV) infection. Previously, we developed a DNA prime-adenovirus (AdV) boost vaccination protocol that could elicit strong and specific CD8+ T-cell responses to woodchuck hepatitis virus (WHV) core antigen (WHcAg) in mice. In the present study, we first examined whether this new prime-boost immunization could induce WHcAg-specific T-cell responses and effectively control WHV replication in the WHV-transgenic mouse model. Secondly, we evaluated the therapeutic effect of this new vaccination strategy in chronically WHV-infected woodchucks in combination with a potent antiviral treatment. Immunization of WHV-transgenic mice by DNA prime-AdV boost regimen elicited potent and functional WHcAg-specific CD8+ T-cell response that consequently resulted in the reduction of the WHV load below the detection limit in more than 70% of animals. The combination therapy of entecavir (ETV) treatment and DNA prime-AdV boost immunization in chronic WHV carriers resulted in WHsAg- and WHcAg-specific CD4+ and CD8+ T-cell responses, which were not detectable in ETV-only treated controls. Woodchucks receiving the combination therapy showed a prolonged suppression of WHV replication and lower WHsAg levels compared to controls. Moreover, two of four immunized carriers remained WHV negative after the end of ETV treatment and developed anti-WHs antibodies. These results demonstrate that the combined antiviral and vaccination approach efficiently elicited sustained immunological control of chronic hepadnaviral infection in woodchucks and may be a new promising therapeutic strategy in patients. Chronic hepatitis B virus (HBV) infection is one of the major causes of liver cirrhosis and liver cancer worldwide. Recommended treatment regimens of chronic hepatitis B based on interferon alpha and nucleot(s)ide analogues do not lead to the satisfactory results. Over the last 20 years, continuous efforts have been undertaken to develop new immunotherapeutic approaches for the treatment of chronic hepatitis B, however, without satisfactory results. We proposed here that the combination of potent antivirals with a prime-boost vaccination protocol that is inducing appropriate virus-specific T-cell responses may restore immune control over HBV. To test this hypothesis we performed a proof-of-principle experiment using woodchucks, a widely accepted animal model of chronic HBV infection. We pretreated animals with entecavir to suppress viral replication and immunized them by a prime-boost regimen with DNA vaccines expressing woodchuck hepatitis virus (WHV) surface and core antigens and adenoviral vectors expressing WHV core antigen. Consistent with our hypothesis, the combination therapy achieved a stronger antiviral effect than the monotherapy alone, leading to sustained immunological control of chronic WHV infection and viral clearance in some animals. These data are encouraging and implicate the feasibility and usefulness of the immunotherapeutic strategies for the treatment of chronically HBV-infected patients.
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MESH Headings
- Adenoviridae
- Animals
- CD4-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/immunology
- Cells, Cultured
- Disease Models, Animal
- Hepatitis B Vaccines/genetics
- Hepatitis B Vaccines/immunology
- Hepatitis B Vaccines/pharmacology
- Hepatitis B, Chronic/genetics
- Hepatitis B, Chronic/immunology
- Hepatitis B, Chronic/prevention & control
- Humans
- Immunity, Cellular/drug effects
- Immunity, Cellular/genetics
- Immunity, Cellular/immunology
- Immunization, Secondary
- Marmota
- Mice
- Mice, Transgenic
- Vaccines, DNA/genetics
- Vaccines, DNA/microbiology
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Affiliation(s)
- Anna D. Kosinska
- Institute of Virology, University Hospital of Essen, Essen, Germany
| | - Ejuan Zhang
- Institute of Virology, University Hospital of Essen, Essen, Germany
- Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, People's Republic of China
| | - Lena Johrden
- Department of Molecular and Medical Virology, Institute of Microbiology and Hygiene, Ruhr-University Bochum, Bochum, Germany
| | - Jia Liu
- Institute of Virology, University Hospital of Essen, Essen, Germany
| | - Pia L. Seiz
- Institute of Medical Virology, National Reference Centre for Hepatitis B and D Viruses, Justus-Liebig University, Giessen, Germany
| | - Xiaoyong Zhang
- Institute of Virology, University Hospital of Essen, Essen, Germany
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Zhiyong Ma
- Institute of Virology, University Hospital of Essen, Essen, Germany
| | - Thekla Kemper
- Institute of Virology, University Hospital of Essen, Essen, Germany
| | - Melanie Fiedler
- Institute of Virology, University Hospital of Essen, Essen, Germany
| | - Dieter Glebe
- Institute of Medical Virology, National Reference Centre for Hepatitis B and D Viruses, Justus-Liebig University, Giessen, Germany
| | - Oliver Wildner
- Paul-Ehrlich-Institut, Division of Medical Biotechnology, Langen, Germany
| | - Ulf Dittmer
- Institute of Virology, University Hospital of Essen, Essen, Germany
| | - Mengji Lu
- Institute of Virology, University Hospital of Essen, Essen, Germany
| | - Michael Roggendorf
- Institute of Virology, University Hospital of Essen, Essen, Germany
- * E-mail:
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Akbar SMF, Al-Mahtab M, Khan MSI. Non-antigen-specific and antigen-specific immune therapies for chronic hepatitis B: evidences from laboratory benches and patient's bedsides. Expert Opin Biol Ther 2013; 13:1063-74. [PMID: 23581572 DOI: 10.1517/14712598.2013.789016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Due to unsatisfactory therapeutic efficacy and considerable side effects of antiviral drugs in patients with chronic hepatitis B (CHB), immunotherapy has emerged as an alternative approach. CHB immunotherapy may be categorized into two main types: i) non-antigen-specific immune therapy and ii) hepatitis B virus (HBV) antigen-specific immune therapy. Although different immune modulators have been used in CHB patients for the last two to three decades, the nature and design of ongoing regimens of immunotherapeutic approaches need considerable modifications. AREAS COVERED In this review, the authors have outlined the relevant immunotherapies for CHB patients that have been used for the last two to three decades. The mechanisms underlying the limited therapeutic efficacy of available therapeutic agents for CHB patients have been discussed to aid in the development of an effective therapeutic approach for these patients. EXPERT OPINION Circumstantial evidence indicates that a better regimen of immunotherapy may be developed using different HBV-related antigens or combinations of two or more HBV-related antigens, or combinations of HBV-related antigens and antiviral drugs. However, the capacity of 'inducible immunity' by immune modulators to cure or block progression of liver diseases in CHB patients needs to be addressed.
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Affiliation(s)
- Sheikh Mohammad Fazle Akbar
- Toshiba General Hospital, Department of Medical Sciences, Higashi Oi 6-3-22, Shinagawa, Tokyo 140-8522, Japan.
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Schmidt J, Blum HE, Thimme R. T-cell responses in hepatitis B and C virus infection: similarities and differences. Emerg Microbes Infect 2013; 2:e15. [PMID: 26038456 PMCID: PMC3630955 DOI: 10.1038/emi.2013.14] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 02/13/2013] [Accepted: 02/17/2013] [Indexed: 01/05/2023]
Abstract
Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are global health problems affecting 600 million people worldwide. Indeed, HBV and HCV are hepatotropic viruses that can cause acute and chronic liver disease progressing to liver cirrhosis and even hepatocellular carcinoma. Furthermore, co-infections of HBV and HCV with HIV are emerging worldwide. These co-infections are even more likely to develop persistent infection and are difficult to treat. There is growing evidence that virus-specific CD4+ and CD8+ T-cell responses play a central role in the outcome and pathogenesis of HBV and HCV infection. While virus-specific T-cell responses are able to successfully clear the virus in a subpopulation of patients, failure of these T-cell responses is associated with the development of viral persistence. In this review article, we will discuss similarities and differences in HBV- and HCV-specific T-cell responses that are central in determining viral clearance, persistence and liver disease.
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Affiliation(s)
- Julia Schmidt
- Department of Medicine II, University Hospital Freiburg , D-79106 Freiburg, Germany
| | - Hubert E Blum
- Department of Medicine II, University Hospital Freiburg , D-79106 Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II, University Hospital Freiburg , D-79106 Freiburg, Germany
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Li N, Zhu Q, Li Z, Han Q, Zhang G, Chen J, Lv Y, Xing F, Chen Y, Zeng X, Liu Z. IL17A gene polymorphisms, serum IL-17A and IgE levels, and hepatocellular carcinoma risk in patients with chronic hepatitis B virus infection. Mol Carcinog 2012; 53:447-57. [PMID: 23280722 DOI: 10.1002/mc.21992] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 10/08/2012] [Accepted: 11/27/2012] [Indexed: 12/15/2022]
Abstract
Interleukin (IL)-17A plays important roles in hepatitis B virus (HBV)-induced liver diseases. This study aims to investigate IL17A single nucleotide polymorphisms (SNPs) and the predispositions to chronic HBV infection and hepatocellular carcinoma (HCC) risk and the correlations to IL-17A and IgE levels. Three hundred ninety-five chronic HBV patients, 75 HBV infection resolvers, and 174 healthy controls were included. IL17A SNPs rs8193036 (C/T) and rs2275913 (A/G) and serum IL-17A and IgE levels were determined. HBV infection resolvers had higher rs8193036 allele T and allele T-containing genotypes than HBV patients or controls. Compared with chronic hepatitis, HCC patients had more frequent rs2275913 genotype GG (odds ratios [OR] 3.317, 95% confidence interval [CI] 1.663-6.617, P = 0.001) and allele G (OR 1.844, 95% CI 1.311-2.595, P < 0.001), and more frequent haplotypes CG (OR 1.868, 95% CI 1.256-2.778, P = 0.002) and TG (OR 1.788, 95% CI 1.031-3.101, P = 0.037) of rs8193036 and rs2275913. Comparison of HCC patients with cirrhosis yielded similar findings. Apart from male gender and older ages, IL-17A level (OR 1.020, 95% CI 1.003-1.036, P = 0.019) and rs2275913 genotypes AG and GG (OR 1.704, 95% CI 1.214-2.390, P = 0.006) were factors significantly associated with HCC risk in multivariate analysis in comparison with HBV patients without HCC. These factors remained significant in multivariate analysis in relation to cirrhosis. IL17A rs2275913 genotype GG was associated with significantly increased IL-17A and IgE levels. IL17A polymorphisms may influence HCC risk in chronic HBV infection via regulating IL-17A production.
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Affiliation(s)
- Na Li
- Department of Infectious Diseases, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
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Khanizadeh S, Ravanshad M, Mohebbi SR, Naghoosi H, Abrahim Tahaei M, Mousavi Nasab SD, Romani S, Azimzadeh P, Sanati A, Zali MR. Polymorphisms within the Promoter Region of the Gamma Interferon (IFN-γ) Receptor1 Gene are Associated with the Susceptibility to Chronic HBV Infection in an Iranian Population. HEPATITIS MONTHLY 2012; 12:e7283. [PMID: 23300496 PMCID: PMC3539059 DOI: 10.5812/hepatmon.7283] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 08/15/2012] [Accepted: 09/15/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND chronic hepatitis B virus (HBV) infection is a multifactorial disease that can result in serious clinical complications. Host genetic background especially the genes that encode immunologic factors like INF-γ and its receptor (IFN-γ R) are critical in the pathogenesis of infection. OBJECTIVES The current study aimed to investigate the association between two single nucleotide polymorphisms (SNPs) at positions -611 and -56 within the promoter region of gamma interferon receptor1 gene (IFN-γ R1) and chronic HBV infection. MATERIALS AND METHODS Genomic DNA from peripheral blood samples of 200 chronically HBV infected patients and 200 healthy blood donors, as controls, were collected and genomic DNA was extracted by phenol-chloroform method and DNA analysis genotype identification was performed by PCR-RFLP. RESULTS The results indicated that both SNP's frequency had a significant difference in the patient and control groups. At position -56, TT genotype was associated with patient group and P value was 0.002 and at position -611, GG genotype was further observed in control group and P value was 0.006. CONCLUSIONS Presence of G allele at position -611 within promoter of IFN-γ R1 gene in the enrolled population for the study was related to lower risk of disease, and presence of T allele at position -56 was also related to susceptibility to chronic HBV infection. Men had higher frequency of chronic HBV infection, which might be the result of high risk behavior.
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Affiliation(s)
- Sayyad Khanizadeh
- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
| | - Mehrdad Ravanshad
- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
- Corresponding author: Mehrdad Ravanshad, Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box: 14115-331, Tehran, IR Iran. Tel.: +98-2182883836, Fax: +98-2182883581, E-mail:
| | - Seyed Reza Mohebbi
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Seyed Reza Mohebbi, Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, IR Iran. P.O. Box: 14115-331, Tehran, IR Iran. Tel.: +98-2122432515, Fax: +98-2122432516, E-mail:
| | - Hamed Naghoosi
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mohamad Abrahim Tahaei
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, IR Iran
| | | | - Sara Romani
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Pedram Azimzadeh
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Azar Sanati
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Zali
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran, IR Iran
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DNA prime-adenovirus boost immunization induces a vigorous and multifunctional T-cell response against hepadnaviral proteins in the mouse and woodchuck model. J Virol 2012; 86:9297-310. [PMID: 22718818 DOI: 10.1128/jvi.00506-12] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Induction of hepatitis B virus (HBV)-specific cytotoxic T cells by therapeutic immunization may be a strategy to treat chronic hepatitis B. In the HBV animal model, woodchucks, the application of DNA vaccine expressing woodchuck hepatitis virus (WHV) core antigen (WHcAg) in combination with antivirals led to the prolonged control of viral replication. However, it became clear that the use of more potent vaccines is required to overcome WHV persistence. Therefore, we asked whether stronger and more functional T-cell responses could be achieved using the modified vaccines and an optimized prime-boost vaccination regimen. We developed a new DNA plasmid (pCGWHc) and recombinant adenoviruses (AdVs) showing high expression levels of WHcAg. Mice vaccinated with the improved plasmid pCGWHc elicited a stronger WHcAg-specific CD8(+) T-cell response than with the previously used vaccines. Using multicolor flow cytometry and an in vivo cytotoxicity assay, we showed that immunization in a DNA prime-AdV boost regimen resulted in an even more vigorous and functional T-cell response than immunization with the new plasmid alone. Immunization of naïve woodchucks with pCGWHc plasmid or AdVs induced a significant WHcAg-specific degranulation response prior to the challenge, this response had not been previously detected. Consistently, this response led to a rapid control of infection after the challenge. Our results demonstrate that high antigen expression levels and the DNA prime-AdV boost immunization improved the T-cell response in mice and induced significant T-cell responses in woodchucks. Therefore, this new vaccination strategy may be a candidate for a therapeutic vaccine against chronic HBV infection.
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Chen SH, Wu HL, Kao JH, Hwang LH. Persistent hepatitis B viral replication in a FVB/N mouse model: impact of host and viral factors. PLoS One 2012; 7:e36984. [PMID: 22615863 PMCID: PMC3353969 DOI: 10.1371/journal.pone.0036984] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 04/11/2012] [Indexed: 01/04/2023] Open
Abstract
The mechanism underlying the chronicity of hepatitis B virus (HBV) infection has long been an interesting question. However, this mechanism remains unclear largely due to the lack of an animal model that can support persistent HBV replication and allow for the investigation of the relevant immune responses. In this study, we used hydrodynamic injection to introduce HBV replicon DNA into the livers of three different mouse strains: BALB/c, C57BL/6, and FVB/N. Interestingly, we found that an HBV clone persistently replicated in the livers of FVB/N mice for up to 50 weeks but was rapidly cleared from the livers of BALB/c and C57BL/6 mice. Flow cytometric analysis and quantitative reverse transcription PCR analysis of the mouse livers indicated that after DNA injection, FVB/N mice had few intrahepatic activated cytotoxic T lymphocytes (CTLs) and produced low levels of alanine aminotransferase, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, and the CXCL9 and CXCL10 chemokines. These findings were in sharp contrast with those observed in BALB/c and C57BL/6 mice, reflecting a strong correlation between the degree of liver inflammation and viral clearance. Mutational analysis further demonstrated that a change of Asn-214 to Ser-214 in the HBV surface antigen rendered the persistent HBV clone clearable in FVB/N mice, which was accompanied by increased levels of activated CTL and upregulated expression of IFN-γ, CXCL9, and CXCL10 in the livers. These results indicate that the heterogeneity of the host factors and viral sequences may influence the immune responses against HBV. An inadequate activation of immune or inflammatory responses can lead to persistent HBV replication in vivo.
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Affiliation(s)
- Shih-Hui Chen
- Graduate Institute of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan
- Institute of Microbiology and Immunology, National Yang-Ming University, Taipei, Taiwan
- VYM Genome Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Hui-Lin Wu
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jia-Horng Kao
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Lih-Hwa Hwang
- Graduate Institute of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan
- Institute of Microbiology and Immunology, National Yang-Ming University, Taipei, Taiwan
- VYM Genome Research Center, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Park Y, Park Y, Han KH, Kim HS. Serum cytokine levels in patients with chronic hepatitis B according to lamivudine therapy. J Clin Lab Anal 2012; 25:414-21. [PMID: 22086795 DOI: 10.1002/jcla.20495] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cytokines are known to play critical roles in the pathogenesis of chronic hepatitis B (CHB). However, the relationship between cytokines and treatment responses to drugs for CHB is not clearly defined yet. We measured the serum cytokine levels of interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor, interferon-γ, tumor necrosis factor- (TNF-α), macrophage/monocyte chemotactic protein 1, and epidermal growth factor to elucidate the cytokine expression pattern according to the patients' responses to lamivudine. METHODS Fifty-eight specimens from 27 CHB patients and 98 specimens from healthy individuals were tested for 12 kinds of cytokines. The patients were grouped as: before treatment, ongoing treatment, duringmaintaining remission, and patients with viral breakthrough owing to resistance against lamivudine. The Evidence Investigator (Randox, Antrim, UK), a protein chip analyzer, was used to quantify serum cytokines. RESULTS Among 12 cytokines, IL-6, IL-8, IL-10, and TNF-α were significantly elevated in patients with resistance against lamivudine compared with patients maintaining response. IL-8, IL-10, and TNF-α levels also weak to moderate correlated with ALT and HBV-DNA concentrations. CONCLUSIONS Serum cytokine levels would reflect the pathological differences of the individual treatment phases and may become useful indices in monitoring the treatment response of CHB.
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Affiliation(s)
- Younhee Park
- Department of Laboratory Medicine, Kwandong University College of Medicine, Goyang, Korea
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Vermehren J, Lötsch J, Susser S, Wicker S, Berger A, Zeuzem S, Sarrazin C, Doehring A. A common HLA-DPA1 variant is associated with hepatitis B virus infection but fails to distinguish active from inactive Caucasian carriers. PLoS One 2012; 7:e32605. [PMID: 22448225 PMCID: PMC3308944 DOI: 10.1371/journal.pone.0032605] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 01/28/2012] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS Chronic infection with the hepatitis B virus (HBV) is a major health issue worldwide. Recently, single nucleotide polymorphisms (SNPs) within the human leukocyte antigen (HLA)-DP locus were identified to be associated with HBV infection in Asian populations. Most significant associations were observed for the A alleles of HLA-DPA1 rs3077 and HLA-DPB1 rs9277535, which conferred a decreased risk for HBV infection. We assessed the implications of these variants for HBV infection in Caucasians. METHODS Two HLA-DP gene variants (rs3077 and rs9277535) were analyzed for associations with persistent HBV infection and with different clinical outcomes, i.e., inactive HBsAg carrier status versus progressive chronic HBV (CHB) infection in Caucasian patients (n = 201) and HBsAg negative controls (n = 235). RESULTS The HLA-DPA1 rs3077 C allele was significantly associated with HBV infection (odds ratio, OR = 5.1, 95% confidence interval, CI: 1.9-13.7; p = 0.00093). However, no significant association was seen for rs3077 with progressive CHB infection versus inactive HBsAg carrier status (OR = 2.7, 95% CI: 0.6-11.1; p = 0.31). In contrast, HLA-DPB1 rs9277535 was not associated with HBV infection in Caucasians (OR = 0.8, 95% CI: 0.4-1.9; p = 1). CONCLUSIONS A highly significant association of HLA-DPA1 rs3077 with HBV infection was observed in Caucasians. However, as a differentiation between different clinical courses of HBV infection was not possible, knowledge of the HLA-DPA1 genotype cannot be translated into personalized anti-HBV therapy approaches.
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Affiliation(s)
- Johannes Vermehren
- pharmazentrum frankfurt/ZAFES, Institut für Klinische Pharmakologie, Klinikum der J. W. Goethe Universität, Frankfurt am Main, Germany
| | - Jörn Lötsch
- pharmazentrum frankfurt/ZAFES, Institut für Klinische Pharmakologie, Klinikum der J. W. Goethe Universität, Frankfurt am Main, Germany
| | - Simone Susser
- Medizinische Klinik 1, Klinikum der J. W. Goethe Universität, Frankfurt am Main, Germany
| | - Sabine Wicker
- Betriebsärztlicher Dienst, Klinikum der J. W. Goethe Universität, Frankfurt am Main, Germany
| | - Annemarie Berger
- Institut für Medizinische Virologie, Klinikum der J. W. Goethe Universität, Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Medizinische Klinik 1, Klinikum der J. W. Goethe Universität, Frankfurt am Main, Germany
| | - Christoph Sarrazin
- Medizinische Klinik 1, Klinikum der J. W. Goethe Universität, Frankfurt am Main, Germany
| | - Alexandra Doehring
- pharmazentrum frankfurt/ZAFES, Institut für Klinische Pharmakologie, Klinikum der J. W. Goethe Universität, Frankfurt am Main, Germany
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Afroz N, Rizvi M, Azam M, Ajmal MR, Malik A, Shukla I. Role of Interferon-gamma and Interleukin-12 in
the Immunopathogenesis of Hepatitis B Virus Infection. Euroasian J Hepatogastroenterol 2012. [DOI: 10.5005/jp-journals-10018-1022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Zou Q, Yao X, Feng J, Yin Z, Flavell R, Hu Y, Zheng G, Jin J, Kang Y, Wu B, Liang X, Feng C, Liu H, Li W, Wang X, Wen Y, Wang B. Praziquantel facilitates IFN-γ-producing CD8+ T cells (Tc1) and IL-17-producing CD8+ T cells (Tc17) responses to DNA vaccination in mice. PLoS One 2011; 6:e25525. [PMID: 21998665 PMCID: PMC3187796 DOI: 10.1371/journal.pone.0025525] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 09/05/2011] [Indexed: 12/22/2022] Open
Abstract
Background CD8+ cytotoxic T lymphocytes (CTLs) are crucial for eliminating hepatitis B virus (HBV) infected cells. DNA vaccination, a novel therapeutic strategy for chronic virus infection, has been shown to induce CTL responses. However, accumulated data have shown that CTLs could not be effectively induced by HBV DNA vaccination. Methodology/Principal Findings Here, we report that praziquantel (PZQ), an anti-schistoma drug, could act as an adjuvant to overcome the lack of potent CTL responses by HBV DNA vaccination in mice. PZQ in combination with HBV DNA vaccination augmented the induction of CD8+ T cell-dependent and HBV-specific delayed hypersensitivity responses (DTH) in C57BL/6 mice. Furthermore, the induced CD8+ T cells consisted of both Tc1 and Tc17 subtypes. By using IFN-γ knockout (KO) mice and IL-17 KO mice, both cytokines were found to be involved in the DTH. The relevance of these findings to HBV immunization was established in HBsAg transgenic mice, in which PZQ also augmented the induction of HBV-specific Tc1 and Tc17 cells and resulted in reduction of HBsAg positive hepatocytes. Adoptive transfer experiments further showed that PZQ-primed CD8+ T cells from wild type mice, but not the counterpart from IFN-γ KO or IL-17 KO mice, resulted in elimination of HBsAg positive hepatocytes. Conclusions/Significance Our results suggest that PZQ is an effective adjuvant to facilitate Tc1 and Tc17 responses to HBV DNA vaccination, inducing broad CD8+ T cell-based immunotherapy that breaks tolerance to HBsAg.
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Affiliation(s)
- Qiang Zou
- State Key Laboratory for Agro-Biotechnology, College of Biological Science, China Agricultural University, Beijing, People's Republic of China
| | - Xin Yao
- Key Laboratory of Medical Molecular Virology of MOH and MOE, Fudan University Shanghai Medical College, Shanghai, People's Republic of China
| | - Jin Feng
- Center for Infection and Immunity, Institute of Biophysics, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Zhinan Yin
- College of Life Sciences, Nankai University, Tianjin, People's Republic of China
| | - Richard Flavell
- Department of Immunobiology, Yale School of Medicine, New Haven, Conneticut, United States of America
| | - Yanxin Hu
- College of Veterinary Medicine, China Agricultural University, Beijing, People's Republic of China
| | - Guoxing Zheng
- Department of Biomedical Sciences, University of Illinois College of Medicine, Rockford, Illinois, United States of America
| | - Jin Jin
- State Key Laboratory for Agro-Biotechnology, College of Biological Science, China Agricultural University, Beijing, People's Republic of China
| | - Youmin Kang
- State Key Laboratory for Agro-Biotechnology, College of Biological Science, China Agricultural University, Beijing, People's Republic of China
| | - Bing Wu
- State Key Laboratory for Agro-Biotechnology, College of Biological Science, China Agricultural University, Beijing, People's Republic of China
| | - Xiaoxuan Liang
- State Key Laboratory for Agro-Biotechnology, College of Biological Science, China Agricultural University, Beijing, People's Republic of China
| | - Congcong Feng
- State Key Laboratory for Agro-Biotechnology, College of Biological Science, China Agricultural University, Beijing, People's Republic of China
| | - Hu Liu
- State Key Laboratory for Agro-Biotechnology, College of Biological Science, China Agricultural University, Beijing, People's Republic of China
| | - Weiyi Li
- State Key Laboratory for Agro-Biotechnology, College of Biological Science, China Agricultural University, Beijing, People's Republic of China
| | - Xianzheng Wang
- State Key Laboratory for Agro-Biotechnology, College of Biological Science, China Agricultural University, Beijing, People's Republic of China
| | - Yumei Wen
- Key Laboratory of Medical Molecular Virology of MOH and MOE, Fudan University Shanghai Medical College, Shanghai, People's Republic of China
| | - Bin Wang
- State Key Laboratory for Agro-Biotechnology, College of Biological Science, China Agricultural University, Beijing, People's Republic of China
- Key Laboratory of Medical Molecular Virology of MOH and MOE, Fudan University Shanghai Medical College, Shanghai, People's Republic of China
- * E-mail:
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An P, Winkler C, Guan L, O'Brien SJ, Zeng Z. A common HLA-DPA1 variant is a major determinant of hepatitis B virus clearance in Han Chinese. J Infect Dis 2011; 203:943-7. [PMID: 21402545 DOI: 10.1093/infdis/jiq154] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A recent genome-wide study showed that the single nucleotide polymorphisms (SNPs) in the HLA-DP region were associated with chronic hepatitis B virus (HBV) infection in Japanese and Thai persons. We tested the effects of HLA-DP SNPs for all major HBV outcomes in Han Chinese (n = 1742): HBV resistance, clearance, chronic infection, cirrhosis, and hepatocellular carcinoma. HLA - DPA1 rs3077 T was strongly associated with decreased risk of chronic HBV infection (odds ratio, .62; P = .001), consistent with the previous report. We showed for the first time to our knowledge that it is a predictor for HBV clearance (odds ratio, 2.41; P < .001). However, rs3077 was not associated with the development of cirrhosis or hepatocellular carcinoma.
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Affiliation(s)
- Ping An
- Basic Research Laboratory, SAIC-Frederick, Maryland, USA.
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Xi W, Hu Y, Liu Y, Zhang J, Wang L, Lou Y, Qu Z, Cui J, Zhang G, Liang X, Ma C, Gao C, Chen Y, Liu S. Roles of TIPE2 in hepatitis B virus-induced hepatic inflammation in humans and mice. Mol Immunol 2011; 48:1203-8. [DOI: 10.1016/j.molimm.2011.03.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 03/01/2011] [Accepted: 03/01/2011] [Indexed: 01/01/2023]
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50
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An P, Winkler C, Guan L, O'Brien SJ, Zeng Z. A Common HLA–DPA1 Variant is a Major Determinant of Hepatitis B Virus Clearance in Han Chinese. J Infect Dis 2011; 203:943-947. [DOI: https:/doi.org/10.1093/infdis/jiq154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
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