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Tak WY, Chuang WL, Chen CY, Tseng KC, Lim YS, Lo GH, Heo J, Agarwal K, Bussey L, Teo SL, Tria A, Brown A, Anderson K, Vardeu A, O'Brien S, Kopycinski J, Rutkowski K, Kolenovska R, Barnes E, Evans TG. Phase 1b/2a randomized study of heterologous ChAdOx1-HBV/MVA-HBV therapeutic vaccination (VTP-300) as monotherapy and combined with low-dose nivolumab in virally-suppressed patients with chronic hepatitis B. J Hepatol 2024:S0168-8278(24)02333-X. [PMID: 38972484 DOI: 10.1016/j.jhep.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND AND AIM The induction of effective CD8+ T cells is thought to play a critical role in the functional cure of chronic hepatitis B (CHB). Additionally, the use of checkpoint inhibitors is being evaluated to overcome T cell dysfunction during CHB. APPROACH AND RESULTS A chimpanzee adenoviral vector (ChAdOx1-HBV) and a Modified vaccinia Ankara boost (MVA-HBV) encoding the inactivated polymerase, core, and S region from a consensus genotype C HBV were studied. The trial enrolled 55 patients with virally-suppressed CHB virus infection and HBsAg <4,000 IU/mL Group 1 received MVA-HBV intramuscularly (IM) on Day 0 and 28, Group 2 received ChAdOx1-HBV on Day 0/MVA-HBV on Day 28 (VTP-300), Group 3 received VTP-300 + low-dose nivolumab (LDN) on Day 28, and Group 4 received VTP-300 plus LDN with both injections. VTP-300 alone and in combination with LDN was well tolerated with no treatment-related serious adverse events. Reductions of HBsAg were demonstrated in the VTP-300 group 2: 3 of 18 patients with starting HBsAg < 50 IU/ml had durable log10 declines > 0.7 log10 2 months post last-dose. Group 3 (N=18) had reductions in HBsAg of 0.76 log10 and 0.80 log10 3 (p<0.001) at 2 and 7 months post last dose. Two developed persistent non-detectable HBsAg levels. CD4+ and CD8+ antigen-specific T cell responses were generated and there was a correlation between IFN-y ELISpot response and HBsAg decline in Group 2. CONCLUSIONS VTP-300 induced CD4+ and CD8+ T cells and lowered HBsAg in a subset of patients with baseline values below 100 IU/ml. The addition of LDN resulted in significant reduction in surface antigen. VTP-300 is a promising immunotherapeutic to move forward alone or in combination therapies. IMPACT AND IMPLICATIONS The induction of potent, durable CD8+ T cells may be critical to achieving a functional cure in chronic hepatitis B virus infection. A prime-boost immunotherapeutic consisting of an adenoviral-vector encoding hepatitis B antigens followed by a pox virus boost was shown to induce CD8+ T cells and to lower HBsAg in CHB patients, either alone or more impactfully when administered in conjunction with a checkpoint inhibitor. The use of immunotherapeutics CLINTRIALS: NCT047789.
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Affiliation(s)
- W Y Tak
- School of Medicine, Kyungpook National University, Kyungpook National University Hospital
| | - W-L Chuang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - C-Y Chen
- Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - K-C Tseng
- Dalin Tzu Chi General Hospital, Hualien, Taiwan
| | - Y-S Lim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - G-H Lo
- E-Da Hospital, Kaohsiung, Taiwan
| | - J Heo
- Department of Internal Medicine, College of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - K Agarwal
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London UK
| | | | | | | | - A Brown
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| | | | | | | | | | | | | | - E Barnes
- Nuffield Department of Medicine, Oxford University, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford Hospitals NHS Trust, Oxford, UK
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Stephan AS, Kosinska AD, Mück-Häusl M, Muschaweckh A, Jäger C, Röder N, Heikenwälder M, Dembek C, Protzer U. Evaluation of the Effect of CD70 Co-Expression on CD8 T Cell Response in Protein-Prime MVA-Boost Vaccination in Mice. Vaccines (Basel) 2023; 11:vaccines11020245. [PMID: 36851121 PMCID: PMC9966001 DOI: 10.3390/vaccines11020245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Here, we investigate the potential of CD70 co-expression during viral vector boost vaccination to improve an antigen-specific T cell response. To determine the chance of activating antigen-specific T cells by CD70, we used the HBV core antigen as a model antigen in a heterologous protein-prime, Modified Vaccinia virus Ankara (MVA) boost vaccination scheme. Both the HBV core and a CD70 expression cassette were co-expressed upon delivery by an MVA vector under the same promoter linked by a P2A site. To compare immunogenicity with and without CD70 co-expression, HBV-naïve, C57BL/6 (wt) mice and HBV-transgenic mice were prime-vaccinated using recombinant HBV core antigen followed by the MVA vector boost. Co-expression of CD70 increased the number of vaccine-induced HBV core-specific CD8 T cells by >2-fold and improved their effector functions in HBV-naïve mice. In vaccinated HBV1.3tg mice, the number and functionality of HBV core-specific CD8 T cells was slightly increased upon CD70 co-expression in low-viremic, but not in high-viremic animals. CD70 co-expression did not impact liver damage as indicated by ALT levels in the serum, but increased the number of vaccine-induced, proliferative T cell clusters in the liver. Overall, this study indicates that orchestrated co-expression of CD70 and a vaccine antigen may be an interesting and safe means of enhancing antigen-specific CD8 T cell responses using vector-based vaccines, although in our study it was not sufficient to break immune tolerance.
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Affiliation(s)
- Ann-Sophie Stephan
- Institute of Virology, Technical University of Munich, Helmholtz Zentrum München, 81675 Munich, Germany
| | - Anna D. Kosinska
- Institute of Virology, Technical University of Munich, Helmholtz Zentrum München, 81675 Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, 81675 Munich, Germany
| | - Martin Mück-Häusl
- Institute of Virology, Technical University of Munich, Helmholtz Zentrum München, 81675 Munich, Germany
| | - Andreas Muschaweckh
- Institute for Experimental Neuroimmunology, Technical University of Munich School of Medicine, 81675 Munich, Germany
| | - Clemens Jäger
- Institute of Virology, Technical University of Munich, Helmholtz Zentrum München, 81675 Munich, Germany
| | - Natalie Röder
- Institute of Virology, Technical University of Munich, Helmholtz Zentrum München, 81675 Munich, Germany
| | - Mathias Heikenwälder
- Institute of Virology, Technical University of Munich, Helmholtz Zentrum München, 81675 Munich, Germany
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ) Heidelberg, 69120 Heidelberg, Germany
| | - Claudia Dembek
- Institute of Virology, Technical University of Munich, Helmholtz Zentrum München, 81675 Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, 81675 Munich, Germany
- Correspondence: (C.D.); (U.P.); Tel.: +49-89-4140-6821 (U.P.)
| | - Ulrike Protzer
- Institute of Virology, Technical University of Munich, Helmholtz Zentrum München, 81675 Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, 81675 Munich, Germany
- Correspondence: (C.D.); (U.P.); Tel.: +49-89-4140-6821 (U.P.)
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Li S, Li N, Yang S, Deng H, Li Y, Wang Y, Yang J, Lv J, Dong L, Yu G, Hou X, Wang G. The study of immune checkpoint inhibitors in chronic hepatitis B virus infection. Int Immunopharmacol 2022; 109:108842. [DOI: 10.1016/j.intimp.2022.108842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/19/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022]
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Sun YD, Zhang H, Chen YQ, Wu CX, Chen ML, Xu HR, Wang S, Liu JZ, Han JJ. Overweight with HBV infection limited the efficacy of TACE in hepatocellular carcinoma by inhibiting the upregulated HMGB1. BMC Cancer 2021; 21:1063. [PMID: 34583662 PMCID: PMC8480082 DOI: 10.1186/s12885-021-08783-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023] Open
Abstract
Background Transarterial chemoembolization (TACE) is an effective treatment for patients with hepatocellular carcinoma (HCC). However, the impact of hepatitis B viral (HBV) infection and body mass index (BMI) on TACE is controversial. The present study aimed to compare the influence of HBV and high BMI on TACE outcomes in advanced HCC. Methods Based on HBV infection history and BMI, patients were assigned to different subgroups. Blood samples were collected and analyzed by an enzyme-linked immunosorbent assay (ELISA) kit. The primary endpoint was progression-free survival (PFS) and the overall survival (OS) in the population. Results Compared to overweight combined HBV patients who received TACE, people with normal weight or no viral infection had significantly better OS and PFS. Sex, age, portal vein tumor thrombus, BCLC, ECOG, and tumor diameter are the main risk factors affecting PFS and OS. Except for the postoperative fever, no significant difference was detected in adverse reactions. Irrespective of TACE, the average expression of HMGB1 in hepatitis or obesity patients was higher than that in normal individuals and did not show upregulation after TACE. Patients without overweight or HBV infection had a low expression of serum HMGB1 that was substantially upregulated after TACE. Conclusions In this study, overweight combined HBV infection patients had shorter PFS and OS than other HCC patients. Thus, HBV and BMI maybe two factors affecting the efficacy of TACE via upregulated HMGB1. 1. High BMI combined with HBV infection has a negative impact on the PFS and OS of HCC patients treated with TACE. 2. Irrespective of TACE, the average HMGB1 in hepatitis and obesity patients was higher than that in normal individuals, which was not upregulated after TACE. 3. Patients without overweight and HBV infection had a low level of serum concentration of HMGB1 before TACE that was upregulated after TACE. Compared to others, these patients have severe changes in HMGB1 in the peripheral blood after treatment, indicating a higher risk of acute liver injury. 4. Upregulated HMGB1 elevated the prognosis after TACE, but obesity and HBV infection resulted in the negative effect by inhibiting HMGB1 expression. 5. For advanced HCC, overweight combined HBV infection, PVTT, multiple lesions, and larger tumor diameter are negative factors for TACE.
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Affiliation(s)
- Yuan-Dong Sun
- Interventional Radiology Department, Shandong Cancer Hospital and Institute Affiliated Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440, Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Hao Zhang
- Interventional Radiology Department, Shandong Cancer Hospital and Institute Affiliated Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440, Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Ye-Qiang Chen
- Maternal and Child Health Care Hospital of Shandong Province, No 238, Jingshidong Raod, Jinan, 250014, Shandong Province, China
| | - Chun-Xue Wu
- Interventional Radiology Department, Shandong Cancer Hospital and Institute Affiliated Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440, Jiyan Road, Jinan, 250117, Shandong Province, China.,Shandong First Medical University, No. 6699, Qingdao Road, Jinan, 250062, Shandong Province, China
| | - Miao-Ling Chen
- Interventional Radiology Department, Shandong Cancer Hospital and Institute Affiliated Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440, Jiyan Road, Jinan, 250117, Shandong Province, China.,Shandong First Medical University, No. 6699, Qingdao Road, Jinan, 250062, Shandong Province, China
| | - Hui-Rong Xu
- Interventional Radiology Department, Shandong Cancer Hospital and Institute Affiliated Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440, Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Shuo Wang
- Interventional Radiology Department, Shandong Cancer Hospital and Institute Affiliated Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440, Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Jing-Zhou Liu
- Shandong First Medical University, No. 6699, Qingdao Road, Jinan, 250062, Shandong Province, China.
| | - Jian-Jun Han
- Interventional Radiology Department, Shandong Cancer Hospital and Institute Affiliated Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440, Jiyan Road, Jinan, 250117, Shandong Province, China. .,Shandong First Medical University, No. 6699, Qingdao Road, Jinan, 250062, Shandong Province, China.
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5
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Chiale C, Yarovinsky TO, Mason SW, Madina BR, Menon M, Krady MM, Moshkani S, Chattopadhyay Pal A, Almassian B, Rose JK, Robek MD, Nakaar V. Modified Alphavirus-Vesiculovirus Hybrid Vaccine Vectors for Homologous Prime-Boost Immunotherapy of Chronic Hepatitis B. Vaccines (Basel) 2020; 8:vaccines8020279. [PMID: 32517032 PMCID: PMC7349932 DOI: 10.3390/vaccines8020279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/29/2020] [Accepted: 05/31/2020] [Indexed: 12/12/2022] Open
Abstract
Virus-like vesicles (VLV) are hybrid vectors based on an evolved Semliki Forest virus (SFV) RNA replicon and the envelope glycoprotein (G) from vesicular stomatitis virus (VSV). Previously, we showed that VLV can be used to express protein antigens and generate protective antigen-specific CD8+ T cells. This report describes VLV vectors designed for enhanced protein expression and immunogenicity. Expressing hepatitis B virus (HBV) middle S antigen (MHBs) from VLV using a dual subgenomic promoter significantly increased MHBs-specific CD8+ T cell and antibody production in mice. Furthermore, envelope glycoprotein switch from VSV Indiana to the glycoprotein of Chandipura virus enabled prime-boost immunization and further increased responses to MHBs. Therapeutic efficacy was evaluated in a mouse model of chronic HBV infection initiated by HBV delivery with adeno-associated virus. Mice with lower or intermediate HBV antigen levels demonstrated a significant and sustained reduction of HBV replication following VLV prime-boost immunization. However, mice with higher HBV antigen levels showed no changes in HBV replication, emphasizing the importance of HBV antigenemia for implementing immunotherapies. This report highlights the potential of VLV dual promoter vectors to induce effective antigen-specific immune responses and informs the further development and evaluation of hybrid viral vaccine platforms for preventative and therapeutic purposes.
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Affiliation(s)
- Carolina Chiale
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208, USA; (C.C.); (S.M.); (M.D.R.)
| | - Timur O. Yarovinsky
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, USA; (A.C.P.); (J.K.R.)
- CaroGen Corporation, Farmington, CT 06032, USA; (S.W.M.); (B.R.M.); (M.M.); (M.M.K.); (B.A.)
- Correspondence: (T.O.Y.); (V.N.)
| | - Stephen W. Mason
- CaroGen Corporation, Farmington, CT 06032, USA; (S.W.M.); (B.R.M.); (M.M.); (M.M.K.); (B.A.)
| | - Bhaskara R. Madina
- CaroGen Corporation, Farmington, CT 06032, USA; (S.W.M.); (B.R.M.); (M.M.); (M.M.K.); (B.A.)
| | - Manisha Menon
- CaroGen Corporation, Farmington, CT 06032, USA; (S.W.M.); (B.R.M.); (M.M.); (M.M.K.); (B.A.)
| | - Marie M. Krady
- CaroGen Corporation, Farmington, CT 06032, USA; (S.W.M.); (B.R.M.); (M.M.); (M.M.K.); (B.A.)
| | - Safiehkhatoon Moshkani
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208, USA; (C.C.); (S.M.); (M.D.R.)
| | - Anasuya Chattopadhyay Pal
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, USA; (A.C.P.); (J.K.R.)
| | - Bijan Almassian
- CaroGen Corporation, Farmington, CT 06032, USA; (S.W.M.); (B.R.M.); (M.M.); (M.M.K.); (B.A.)
| | - John K. Rose
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, USA; (A.C.P.); (J.K.R.)
| | - Michael D. Robek
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208, USA; (C.C.); (S.M.); (M.D.R.)
| | - Valerian Nakaar
- CaroGen Corporation, Farmington, CT 06032, USA; (S.W.M.); (B.R.M.); (M.M.); (M.M.K.); (B.A.)
- Correspondence: (T.O.Y.); (V.N.)
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6
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Zheng J, Ou Z, Xu Y, Xia Z, Lin X, Jin S, Liu Y, Wu J. Hepatitis B virus-specific effector CD8 + T cells are an important determinant of disease prognosis: A meta-analysis. Vaccine 2019; 37:2439-2446. [PMID: 30935741 DOI: 10.1016/j.vaccine.2019.03.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV)-specific effector CD8+ T cells are critical for viral clearance. To determine the effects of HBV-specific effector CD8+ T cells on HBV infection, we performed a meta-analysis of the available literature. METHODS Electronic database searches identified appropriately designed studies that detected specific CD8+ T cells in HBV-infected patients. Our main endpoints were the course of infection, seroconversion of HBV "e" antigen (HBeAg), the level of HBVDNA, and alanine aminotransferase (ALT) activity. We used a fixed/random model for analysis, according to the results of a heterogeneity test (P value of Q-squared, I2). RESULTS Our searches found five eligible articles. Pooled estimation of the reported results showed that levels of specific CD8+ T cells were significantly higher in patients with acute hepatitis B than in patients with chronic hepatitis B (odds ratio [OR] = 76.30, 95% confidence interval [CI]: 15.37-378.70). With respect to chronic hepatitis B, patients with <107 copies/ml HBVDNA had higher levels of specific CD8+ T cells relative to patients with >107 copies/ml HBVDNA, but the difference had no statistics significance (OR: 3.89, 95% CI: 0.71-21.33). Patients with negative HBeAg or positive anti-HBeAg antibody (anti-HBe) results had significantly higher levels of specific CD8+ T cells versus patients with positive HBeAg results (OR: 5.82, 95% CI: 1.41-24.13). There were no significant associations between the levels of specific CD8+ T cells and serum ALT activity (OR = 0.86, 95% CI: 0.01-74.15). CONCLUSION HBV-specific effector CD8+ T cells influence the disease activity in HBV-infected patients in various ways and determine prognosis by eliminating the virus. Therefore, efforts of studying HBV-specific effector CD8+ T cells focused vaccine are potentially needed.
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Affiliation(s)
- Juzeng Zheng
- Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Zhanfan Ou
- Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Yilun Xu
- Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Ziqiang Xia
- Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Xianfan Lin
- Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Sisi Jin
- Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Yang Liu
- Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Jinming Wu
- Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
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Abstract
With high morbidity and mortality worldwide, there is great interest in effective therapies for chronic hepatitis B (CHB) virus. There are currently several dozen investigational agents being developed for treatment of CHB. They can be broadly divided into two categories: (1) direct-acting antivirals (DAAs) that interfere with a specific step in viral replication; and (2) host-targeting agents that inhibit viral replication by modifying host cell function, with the latter group further divided into the subcategories of immune modulators and agents that target other host functions. Included among the DAAs being developed are RNA interference therapies, covalently closed circular DNA (cccDNA) formation and transcription inhibitors, core/capsid inhibitors, reverse transcriptase inhibitors, hepatitis B surface antigen (HBsAg) release inhibitors, antisense oligonucleotides, and helioxanthin analogues. Included among the host-targeting agents are entry inhibitors, cyclophilin inhibitors, and multiple immunomodulatory agents, including Toll-like receptor agonists, immune checkpoint inhibitors, therapeutic vaccines, engineered T cells, and several cytokine agents, including recombinant human interleukin-7 (CYT107) and SB 9200, a novel therapy that is believed to both have direct antiviral properties and to induce endogenous interferon. In this review we discuss agents that are currently in the clinical stage of development for CHB treatment as well as strategies and agents currently at the evaluation and discovery phase and potential future targets. Effective approaches to CHB may require suppression of viral replication combined with one or more host-targeting agents. Some of the recent research advances have led to the hope that with such a combined approach we may have a functional cure for CHB in the not distant future.
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Affiliation(s)
- Altaf Dawood
- Department of Internal Medicine, Section of Gastroenterology, University of Nevada School of Medicine, Las Vegas, NV, USA
| | - Syed Abdul Basit
- Department of Internal Medicine, Section of Gastroenterology, University of Nevada School of Medicine, Las Vegas, NV, USA
| | - Mahendran Jayaraj
- Department of Internal Medicine, Section of Gastroenterology, University of Nevada School of Medicine, Las Vegas, NV, USA
| | - Robert G Gish
- Department of Internal Medicine, Section of Gastroenterology, University of Nevada School of Medicine, Las Vegas, NV, USA.
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, CA, USA.
- Hepatitis B Foundation, Doylestown, PA, USA.
- Asian Pacific Health Foundation, San Diego, CA, USA.
- National Viral Hepatitis Roundtable, Washington, DC, USA.
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Huang D, Sansas B, Jiang JH, Gong QM, Jin GD, Calais V, Yu DM, Zhu MY, Wei D, Zhang DH, Inchauspé G, Zhang XX, Zhu R. Recognition of Core- and Polymerase-derived immunogenic peptides included in novel therapeutic vaccine by T cells from Chinese chronic hepatitis B patients. J Viral Hepat 2017; 24 Suppl 1:66-74. [PMID: 29082648 DOI: 10.1111/jvh.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 08/24/2017] [Indexed: 12/09/2022]
Abstract
Chronic hepatitis B (CHB) is one of the major public health challenges in the world. Due to a strong interplay between specific T-cell immunity and elimination of hepatitis B virus (HBV), efforts to develop novel immunotherapeutics are gaining attention. TG1050, a novel immunotherapy, has shown efficacy in an animal study. To support the clinical development of TG1050 in China, specific immunity to the fusion antigens of TG1050 was assessed in Chinese patients. One hundred and thirty subjects were divided into three groups as CHB patients, HBV spontaneous resolvers, and CHB patients with HBsAg loss after antiviral treatment. HBV-specific T-cell responses to pools of HBV Core or Polymerase genotype D peptides included in TG1050 were evaluated. HBV Core- or Polymerase-specific cells were detected in peripheral blood mononuclear cells (PBMCs) from the different cohorts. The frequencies and intensities of HBV Core-specific immune responses were significantly lower in CHB patients than in HBsAg loss subjects. In CHB patients, a dominant pool derived from Polymerase (Pol1) was the most immunogenic. CHB patients with low viral loads (<106 IU/mL) were more likely to have a positive response specific to the Core peptide pool. Overall, genotype D-derived peptides included in TG1050 could raise broad and functional T-cell responses in PBMCs from Chinese CHB patients infected with genotype B/C isolates. Core-specific immunogenic domains appeared as "hot spots" with the capacity to differentiate between CHB vs HBsAg loss subjects. These observations support the extended application and associated immune monitoring of TG1050 in China.
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Affiliation(s)
- D Huang
- Department of Infectious Diseases, Institute of Infectious and Respiratory Diseases, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - B Sansas
- Transgene S.A. Smart Data Lab, Illkirch Graffenstaden, France
| | - J H Jiang
- Department of Infectious Diseases, Institute of Infectious and Respiratory Diseases, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Q M Gong
- Department of Infectious Diseases, Institute of Infectious and Respiratory Diseases, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - G D Jin
- Department of Infectious Diseases, Institute of Infectious and Respiratory Diseases, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - V Calais
- Transgene S.A. Smart Data Lab, Illkirch Graffenstaden, France
| | - D M Yu
- Department of Infectious Diseases, Institute of Infectious and Respiratory Diseases, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - M Y Zhu
- Department of Infectious Diseases, Institute of Infectious and Respiratory Diseases, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - D Wei
- Department of Infectious Diseases, Institute of Infectious and Respiratory Diseases, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - D H Zhang
- Department of Infectious Diseases, Institute of Infectious and Respiratory Diseases, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - G Inchauspé
- Transgene S.A. Department of Infectious Diseases, Lyon, France
| | - X X Zhang
- Department of Infectious Diseases, Institute of Infectious and Respiratory Diseases, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Translational Medicine Research Center, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - R Zhu
- Transgene Biopharmaceutical Technology (Shanghai) Co., Ltd, Shanghai, China
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9
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Salpini R, Piermatteo L, Gill U, Battisti A, Stazi F, Guenci T, Giannella S, Serafini V, Kennedy PTF, Perno CF, Svicher V, Ciotti M. Quantification of intrahepatic total HBV DNA in liver biopsies of HBV-infected patients by a modified version of COBAS ® Ampliprep/COBAS ®TaqMan HBV test v2.0. Med Microbiol Immunol 2017; 206:295-299. [PMID: 28401351 DOI: 10.1007/s00430-017-0504-3] [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: 03/01/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
Intrahepatic total HBV DNA (it-HBV DNA) level might reflect the size of virus reservoir and correlate with the histological status of the liver. To quantitate it-HBV DNA in a series of 70 liver biopsies obtained from hepatitis B chronic patients, a modified version of the COBAS®Ampliprep/COBAS®TaqMan HBV test v2.0 was used for this purpose. The linearity and reproducibility of the modified protocol was tested by quantifying serial dilutions of a full-length HBV containing plasmid and it-HBV DNA from a reference patient. A good linear trend between the expected values and those generated by the assay was observed at different concentrations of both plasmid and reference patient (R 2 = 0.994 and 0.962, respectively). Differences between the values obtained in two independent runs were ≤0.3 log IU for the plasmid and ≤0.6 log IU/mg for the reference patient, showing a high inter-run reproducibility. In the 70 liver biopsies, it-HBV DNA level ranged from 1.4 to 5.4 log IU/mg, with a good linearity and reproducibility between the values obtained in two runs [R 2 = 0.981; median (IQR) difference of it-HBV DNA 0.05 (0.02-0.09) IU/mg]. The modified COBAS®Ampliprep/COBAS®TaqMan HBV test v2.0 allows an accurate quantitation of it-HBV DNA. Its determination may have prognostic value and may be a useful tool for the new therapeutic strategies aimed at eradicating the HBV infection.
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Affiliation(s)
- Romina Salpini
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Lorenzo Piermatteo
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Upkar Gill
- Hepatology, Centre for Immunobiology, Blizard Institute, Barts and The London SMD, QMUL, London, UK
| | - Arianna Battisti
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Francesca Stazi
- Laboratory of Molecular Virology, Polyclinic Tor Vergata Foundation, Viale Oxford 81, 00133, Rome, Italy
| | - Tania Guenci
- Laboratory of Molecular Virology, Polyclinic Tor Vergata Foundation, Viale Oxford 81, 00133, Rome, Italy
| | - Sara Giannella
- Laboratory of Molecular Virology, Polyclinic Tor Vergata Foundation, Viale Oxford 81, 00133, Rome, Italy
| | - Valentina Serafini
- Laboratory of Molecular Virology, Polyclinic Tor Vergata Foundation, Viale Oxford 81, 00133, Rome, Italy
| | - Patrick T F Kennedy
- Hepatology, Centre for Immunobiology, Blizard Institute, Barts and The London SMD, QMUL, London, UK
| | - Carlo Federico Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.,Laboratory of Molecular Virology, Polyclinic Tor Vergata Foundation, Viale Oxford 81, 00133, Rome, Italy
| | - Valentina Svicher
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Marco Ciotti
- Laboratory of Molecular Virology, Polyclinic Tor Vergata Foundation, Viale Oxford 81, 00133, Rome, Italy.
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10
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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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11
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Lumley S, Noble H, Hadley MJ, Callow L, Malik A, Chua YY, Duffey OJ, Grolmusova N, Kumar A, Ravenscroft S, Spencer JI, Neumann-Haefelin C, Thimme R, Andersson M, Klenerman P, Barnes E, Matthews PC. Hepitopes: A live interactive database of HLA class I epitopes in hepatitis B virus. Wellcome Open Res 2016; 1:9. [PMID: 27976751 PMCID: PMC5142601 DOI: 10.12688/wellcomeopenres.9952.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Increased clinical and scientific scrutiny is being applied to hepatitis B virus (HBV), with focus on the development of new therapeutic approaches, ultimately aiming for cure. Defining the optimum natural CD8+ T cell immune responses that arise in HBV, mediated by HLA class I epitope presentation, may help to inform novel immunotherapeutic strategies. Therefore, we have set out to develop a comprehensive database of these epitopes in HBV, coined ‘Hepitopes’. This undertaking has its foundations in a systematic literature review to identify the sites and sequences of all published class I epitopes in HBV. We also collected information regarding the methods used to define each epitope, and any reported associations between an immune response to this epitope and disease outcome. The results of this search have been collated into a new open-access interactive database that is available at
http://www.expmedndm.ox.ac.uk/hepitopes. Over time, we will continue to refine and update this resource, as well as inviting contributions from others in the field to support its development. This unique new database is an important foundation for ongoing investigations into the nature and impact of the CD8+ T cell response to HBV.
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Affiliation(s)
- Sheila Lumley
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | | | | | - Liz Callow
- Bodleian Health Care Libraries, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Amna Malik
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Yi Yi Chua
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, UK
| | - Owen J Duffey
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, UK
| | - Natalia Grolmusova
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, UK
| | - Arvind Kumar
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, UK
| | - Samuel Ravenscroft
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, UK
| | - Jonathan I Spencer
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, UK
| | | | - Robert Thimme
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
| | - Monique Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Paul Klenerman
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.,Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK.,NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Eleanor Barnes
- Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK.,NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Philippa C Matthews
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.,Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK
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12
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Pham EA, Perumpail RB, Fram BJ, Glenn JS, Ahmed A, Gish RG. Future Therapy for Hepatitis B Virus: Role of Immunomodulators. CURRENT HEPATOLOGY REPORTS 2016; 15:237-244. [PMID: 27917363 PMCID: PMC5112294 DOI: 10.1007/s11901-016-0315-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although currently available therapies for chronic hepatitis B virus infection can suppress viremia and provide long-term benefits for patients, they do not lead to a functional cure for most patients. Advances in our understanding of the virus-host interaction and the recent remarkable success of immunotherapy in cancer offer new and promising strategies for developing immune modulators that may become important components of a total therapeutic approach to hepatitis B, some of which are now in clinical development. Among the immunomodulatory agents currently being investigated to combat chronic HBV are toll-like receptor agonists, immune checkpoint inhibitors, therapeutic vaccines, and engineered T cells. The efficacy of some immune modulatory therapies is compromised by high viral antigen levels. Cutting edge strategies, including RNA interference and CRISPR/Cas9, are now being studied that may ultimately be shown to have the capacity to lower viral antigen levels sufficiently to substantially increase the efficacy of these agents. The current advances in therapies for chronic hepatitis B are leading us toward the possibility of a functional cure.
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Affiliation(s)
- Edward A. Pham
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA USA
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA USA
| | - Ryan B. Perumpail
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA USA
| | - Benjamin J. Fram
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA USA
| | - Jeffrey S. Glenn
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA USA
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA USA
- Veterans Administration Medical Center, Palo Alto, CA USA
| | - Aijaz Ahmed
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA USA
| | - Robert G. Gish
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA USA
- Hepatitis B Foundation, Doylestown, PA USA
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13
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Huang C, Lin HH, Wan JB, He C, Hu Y. Research and Development of Hepatitis B Drugs: An Analysis Based on Technology Flows Measured by Patent Citations. PLoS One 2016; 11:e0164328. [PMID: 27727319 PMCID: PMC5058496 DOI: 10.1371/journal.pone.0164328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 09/25/2016] [Indexed: 01/31/2023] Open
Abstract
Despite the existence of available therapies, the Hepatitis B virus infection continues to be one of the most serious threats to human health, especially in developing countries such as China and India. To shed light on the improvement of current therapies and development of novel anti-HBV drugs, we thoroughly investigated 212 US patents of anti-HBV drugs and analyzed the technology flow in research and development of anti-HBV drugs based on data from IMS LifeCycle databases. Moreover, utilizing the patent citation method, which is an effective indicator of technology flow, we constructed patent citation network models and performed network analysis in order to reveal the features of different technology clusters. As a result, we identified the stagnant status of anti-HBV drug development and pointed the way for development of domestic pharmaceuticals in developing countries. We also discussed about therapeutic vaccines as the potential next generation therapy for HBV infection. Lastly, we depicted the cooperation between entities and found that novel forms of cooperation added diversity to the conventional form of cooperation within the pharmaceutical industry. In summary, our study provides inspiring insights for investors, policy makers, researchers, and other readers interested in anti-HBV drug development.
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Affiliation(s)
- Chuoji Huang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau SAR, 999078, China
| | - Hui Heng Lin
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau SAR, 999078, China
| | - Jian-bo Wan
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau SAR, 999078, China
| | - Chengwei He
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau SAR, 999078, China
| | - Yuanjia Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau SAR, 999078, China
- * E-mail:
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14
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Hofmann M, Thimme R. Kill, control, or escape: Immune responses in viral hepatitis. Clin Liver Dis (Hoboken) 2016; 8:79-82. [PMID: 31041069 PMCID: PMC6490199 DOI: 10.1002/cld.576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 02/04/2023] Open
Affiliation(s)
- Maike Hofmann
- Department of Internal Medicine II, Clinic for Internal Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious diseases)University Hospital FreiburgFreiburgGermany
| | - Robert Thimme
- Department of Internal Medicine II, Clinic for Internal Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious diseases)University Hospital FreiburgFreiburgGermany
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15
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Matthews PC, Carlson JM, Beloukas A, Malik A, Jooste P, Ogwu A, Shapiro R, Riddell L, Chen F, Luzzi G, Jesuthasan G, Jeffery K, Jojic N, Ndung'u T, Carrington M, Goulder PJR, Geretti AM, Klenerman P. HLA-A is a Predictor of Hepatitis B e Antigen Status in HIV-Positive African Adults. J Infect Dis 2016; 213:1248-52. [PMID: 26655301 PMCID: PMC4799671 DOI: 10.1093/infdis/jiv592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/01/2015] [Indexed: 01/06/2023] Open
Abstract
Outcomes of chronic infection with hepatitis B virus (HBV) are varied, with increased morbidity reported in the context of human immunodeficiency virus (HIV) coinfection. The factors driving different outcomes are not well understood, but there is increasing interest in an HLA class I effect. We therefore studied the influence of HLA class I on HBV in an African HIV-positive cohort. We demonstrated that virologic markers of HBV disease activity (hepatitis B e antigen status or HBV DNA level) are associated with HLA-A genotype. This finding supports the role of the CD8(+) T-cell response in HBV control, and potentially informs future therapeutic T-cell vaccine strategies.
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Affiliation(s)
- Philippa C Matthews
- Nuffield Department of Medicine Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust
| | | | - Apostolos Beloukas
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool
| | - Amna Malik
- Department of Paediatrics, University of Oxford
| | - Pieter Jooste
- Paediatric Department, Kimberley Hospital, Northern Cape
| | - Anthony Ogwu
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Roger Shapiro
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston
| | - Lynn Riddell
- Integrated Sexual Health Services, Northampton General Hospital, Cliftonville
| | - Fabian Chen
- Department of Sexual Health, Royal Berkshire Hospital, Reading
| | - Graz Luzzi
- Department of Sexual Health, High Wycombe Hospital, Buckinghamshire, United Kingdom
| | - Gerald Jesuthasan
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust
| | - Katie Jeffery
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust
| | - Nebojsa Jojic
- Microsoft Research, eScience Group, Redmond, Washington
| | - Thumbi Ndung'u
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine KwaZulu-Natal Research Institute for Tuberculosis and HIV, University of KwaZulu-Natal, South Africa Max Planck Institute for Infection Biology, Berlin, Germany The Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts
| | - Mary Carrington
- The Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Maryland
| | - Philip J R Goulder
- Department of Paediatrics, University of Oxford HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine
| | - Anna Maria Geretti
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool
| | - Paul Klenerman
- Nuffield Department of Medicine Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford
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16
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New antiviral targets for innovative treatment concepts for hepatitis B virus and hepatitis delta virus. J Hepatol 2016; 64:S117-S131. [PMID: 27084032 DOI: 10.1016/j.jhep.2016.02.016] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/06/2016] [Accepted: 02/08/2016] [Indexed: 02/07/2023]
Abstract
Current therapies of chronic hepatitis B (CHB) remain limited to pegylated-interferon-alpha (PegIFN-α) or any of the five approved nucleos(t)ide analogues (NUC) treatments. While viral suppression can be achieved in the majority of patients with the high-barrier-to-resistance new-generation of NUC, i.e. entecavir and tenofovir, HBsAg loss is achieved by PegIFN-α and/or NUC in only 10% of patients, after a 5-year follow-up. Attempts to improve the response by administering two different NUC or a combination of NUC and PegIFN-α have not provided a dramatic increase in the rate of functional cure. Because of this and the need of long-term NUC administration, there is a renewed interest regarding the understanding of various steps of the HBV replication cycle, as well as specific virus-host cell interactions, in order to define new targets and develop new antiviral drugs. This includes a direct inhibition of viral replication with entry inhibitors, drugs targeting cccDNA, siRNA targeting viral transcripts, capsid assembly modulators, and approaches targeting the secretion of viral envelope proteins. Restoration of immune responses is a complementary approach. The restoration of innate immunity against HBV can be achieved, with TLR agonists or specific antiviral cytokine delivery. Restoration of adaptive immunity may be achieved with inhibitors of negative checkpoint regulators, therapeutic vaccines, or autologous transfer of engineered HBV-specific T cells. Novel targets and compounds will readily be evaluated using both relevant and novel in vitro and in vivo models of HBV infection. The addition of one or several new drugs to current therapies should offer the prospect of a markedly improved response to treatments and an increased rate of functional cure. This should lead to a reduced risk of antiviral drug resistance, and to a decreased incidence of cirrhosis and hepatocellular carcinoma (HCC).
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