Analysis of the hepatitis B virus genome and immune response in HBsAg, anti-HBs positive chronic hepatitis

Molecular, immunological and clinical properties of mutated hepatitis B viruses

Hepatitis B virus (HBV) is at the origin of severe liver diseases like chronic active hepatitis, liver cirrhosis and hepatocellular carcinoma. There are some groups of patients with high risk of generation of HBV mutants: infected infants, immunosuppressed individuals (including hemodialysis patients), patients treated with interferon and lamivudine for chronic HBV infection. These groups are the target for molecular investigations reviewed in this paper. The emergence of lamivudine- or other antiviral-resistant variants, rises concern regarding long term use of these drugs. Infection or immunization with one HBV subtype confers immunity to all subtypes. However, reinfection or reactivation of latent HBV infection with HBV mutants have been reported in patients undergoing transplant and those infected with HIV. Mutations of the viral genome which are not replicative incompetent can be selected in further course of infection or under prolonged antiviral treatment and might maintain the liver disease. Four open reading frames (ORF) which are called S-gene, C-gene, X-gene and P-gene were identified within the HBV genome. Mutations may affect each of the ORFs. Mutated S-genes were described to be responsible for HBV-infections in successfully vaccinated persons, mutated C-genes were found to provoke severe chronic liver diseases, mutated X-genes could cause serious medical problems in blood donors by escaping the conventional test systems and mutated P-genes were considered to be the reason for chemotherapeutic drug resistance. This paper reviews molecular, immunological and clinical aspects of the HBV mutants.

Structural and functional heterogeneity of naturally occurring hepatitis B virus variants

Most organisms have developed sophisticated machineries to preserve their genomic integrity. On the contrary hepatitis B virus (HBV), like a lot of other viruses can undergo rapid and drastic sequence changes, especially if the virus has to cope with natural or therapy induced antiviral mechanisms in the host. Here, we try to summarize possible implications for the molecular pathogenesis of HBV based on the extensive research on the genetic variants of HBV.

Natural and iatrogenic variation in hepatitis B virus

The existence of HBV as quasispecies is thought to be favoured by the infidelity of HBV RT, which would account for the emergence of the many natural mutants with point substitutions. RT infidelity may also underlie the hypermutation phenomenon. Indeed, the oft-reported point mutation in the preC gene that leads to failure of HBeAg synthesis may be driven by a hypermutation-related mechanism. The presence of mutants with deletions and insertions involving single nucleotides and oligonucleotides at specific positions in the genome, and of mutants with deletions of even longer stretches particularly in the C gene, suggests that other mutagenic mechanisms operate. Candidates include slippage during mispairing between template and progeny DNA strand, the action of cellular topoisomerase I, and gene splicing using alternative donor and acceptor sites. Natural substitutions, deletions or insertions involving the Cp/ENII locus in the X gene can significantly alter the extent of viral replicative activity. Similar mutations occurring at other locations of Cp/ENII, and at B-cell epitope sites of the S gene are associated with failure to detect serological markers of HBV infection. HBV variation can also arise from recombination between coinfecting strains. S gene mutations that become evident following HBIG administration and HBV vaccination are all point substitutions, as are mutations in functional RT domains of the P gene after treatment with viral RT-inhibitory drugs. Widespread and long-term use of prophylactic and therapeutic agents may potentially generate serologically occult HBV variants that might become difficult to eradicate.

A revised secondary structure model for the 3'-end of hepatitis B virus pregenomic RNA

The polymerase encoded by human hepatitis B virus, which has reverse transcriptase and RNase H activity, binds to its pregenomic RNA template in a two-step process involving a terminal redundancy. Both first strand and second strand DNA synthesis involve primer translocation and second strand synthesis involves a template jump. Three parts of the genome, including the so-called core promoter, are known to show deletions in strains usually arising after long-standing HBV infection, but also in some patients treated with interferon. A computer-based study of RNA template folding in the core promoter region, accommodating well-known point mutations, has generated a model for the 3' DR1 primer binding site as being part of a superstructure encompassing an already well-established stem-loop. Depending on the identity of nucleotides 1762 and 1764, the DR1 region may assume two alternative secondary structures which stabilize it as a primer binding site to different extents. Remarkably, one of these structures includes a pronounced loop which coincides with at least 12 related deletions seen in HBV DNA from different patients. Thus according to the model, the 5'- and 3'-ends of pregenomic RNA, which share primary sequences but have separate functions, are not structural equivalents. An RNA superstructure near the 3'-end of all HBV transcripts could have far-reaching implications for the modulation of both genome replication and post-transcriptional processing.

Intracellular retention of surface protein by a hepatitis B virus mutant that releases virion particles

In the course of chronic infection, hepatitis B virus mutants can sometimes be found circulating in the serum as the predominant species. One class of such mutants contains in-frame deletions in the S promoter region. By transfecting hepatoma cells with wild-type or mutant viral genomic DNA, we have shown that one such mutant gives rise to extremely small amounts of S transcripts, as expected, and therefore expresses very little of the middle and small surface (viral envelope) proteins that are translated from these transcripts. In addition, this mutant gives rise to greater-than-wild-type levels of the preS1 transcripts, which are translated into the large surface protein. Because the large surface protein, unlike the other forms of surface protein, is incompetent for secretion, cells transfected with the mutant viral DNA contain large amounts of 20-nm particles within dilated perinuclear vesicles. Therefore, this and similar S promoter mutants may be one contributing factor in the pathogenesis of ground-glass cells, which are hepatocytes containing nonsecretable viral surface proteins within dilated vesicles and are commonly found during chronic hepatitis B. Interestingly, DNA-containing virion particles are secreted into the medium by cells transfected with the mutant DNA, in amounts that are slightly larger than those secreted from wild-type-transfected cells, apparently because the amount of large surface protein is insufficient to block virion secretion. This finding may explain how such mutants can become the predominant circulating species in the serum, especially if there are selection pressures against the wild-type virus.

Variability in hepatitis B virus DNA: phylogenetic, epidemiological and clinical implications

Hepatitis B virus has the smallest of all known human DNA virus genomes (3.2 kb) and a unique replication strategy with an intermediate reverse transcription step. The naturally occurring genetic variability between different HBV strains provides the basis for phylogenetic analysis. Four main genotypes of HBV have been found, with the possible existence of 1 or 2 more. The different genotypes largely follow a distinctive geographical distribution. Point mutations and nucleotide deletions in the genes (pre-S and S) encoding different forms of the surface protein have been shown to arise both spontaneously and after interferon treatment or vaccination. An immune escape mechanism is believed to be the reason for these mutations. The clinical implications of variations in the HBV X gene have not been widely studied, but these variations may be of importance in the development of hepatocellular carcinoma. Seroconversion from HBeAg to anti-HBe can be correlated with specific changes in the core promoter, and/or with a translational stop in precore codon 28. In both cases the production of HBeAg protein would be shut off. Mutations in the precore region may have a larger impact at another level, by inhibiting or enhancing viral replication through changes in folding of the transcript.

Emergence of hepatitis B virus S gene mutant in a liver transplant recipient

Immunological and genomic analysis of the "a" determinant was carried out in seven patients with concurrent HBsAg and anti-HBs, four of whom were immunized against hepatitis B virus at liver transplant, two with histologically characterized chronic hepatitis B virus infection, and one HBsAg healthy carrier. The immune reactivity of the HBsAg "a" determinant was evaluated by binding to specific monoclonal antibodies, and the corresponding genomic sequence was studied by differential hybridization in microtiter plates and nucleotide sequence analysis. A double mutation generating an amino acid change (glycine to lysine) at residue 145, able to impair recognition by monoclonal antibodies, was observed in the post-transplant serum from one patient. No significant alteration of the "a" determinant sequence or reactivity was detected in the other patients. Amino acid residue 145 appears therefore to be critical for the recognition by anti-HBs antibodies. A previously undescribed glycine to lysine substitution at this level interferes with the immune reactivity of the "a" determinant.