Composition of peripheral blood lymphocyte populations during different stages of chronic infection with hepatitis B virus

Association between HLA-DRB1*11/14 alleles and HBV-related liver diseases

AIM: To investigate the association between HLA-DRB1*11/14 alleles and hepatitis B virus (HBV)-related diseases in the Guangxi population.

METHODS: A total of 320 patients with HBV infection and 150 normal control subjects were included in this study. The frequencies of HLA-DRB1* 11/14 alleles were measured by polymerase chain reaction/sequence specific primer (PCR/SSP).

RESULTS: The frequency of the HLA-DRB1*11 allele in patients with liver cirrhosis was markedly higher than that in the normal control group (18.9% vs 7.3%, P = 0.007, OR = 0.340). The frequencies of the HLA-DRB1*14 allele in chronic asymptomatic hepatitis B virus carriers, patients with chronic hepatitis B, liver cirrhosis, or hepatocellular carcinoma were all higher than that in the normal control group (36.0% vs 19.3%, 30.7% vs 19.3%, 32.2% vs 19.3%, 35.0% vs 19.3%; P = 0.016, 0.025, 0.024, 0.035, OR = 0.426, 0.541, 0.504, 2.247).

CONCLUSION: The HLA-DRB1*11 allele is associated with susceptibility to liver cirrhosis, and the HLA-DRB1*14 allele is associated with susceptibility to chronic asymptomatic hepatitis B, chronic hepatitis B, liver cirrhosis and hepatocellular carcinoma in patients with HBV infection.

Changes in plasma levels of soluble E-selectin, T lymphocyte subsets and NK cells in patients with chronic HBV infection

AIM: To evaluate serum and hepatic levels of E-selectin in patients with chronic HBV infection and to analyze their relationship with T lymphocyte subsets and natural killer (NK) cells.

METHODS: Serum samples from 270 patients with chronic HBV infection, including 101 patients with chronic hepatitis, 121 with liver cirrhosis and 48 with hepatocellular carcinoma, and from 281 healthy controls, were used in this study. Circulating levels of soluble E-selectin were measured by enzyme-linked immunosorbent assay (ELISA). T lymphocyte subsets and NK cells were measured by flow cytometry (FCM). Immunohistochemistry (IHC) was used to detect the expression of E-selectin in liver tissue specimens from patients with chronic HBV infection.

RESULTS: Serum levels of soluble E-selectin were higher in patients with chronic hepatitis or liver cirrhosis than in those with hepatocellular carcinoma and healthy controls (68.94 ± 34.09, 43.39 ± 18.00 vs 16.69 ± 8.27, 13.96 ± 7.50, all P < 0.01). Immunohistochemistry analysis showed that the positive rates of E-selectin expression in endothelial cells in patients with chronic hepatitis and those with liver cirrhosis were 83.3% and 57.1% (χ² = 6.242, P = 0.012), respectively, and no positive E-selectin staining was detected in patients with hepatocellular carcinoma or healthy controls. The percentages of CD4⁺ T cells and NK cells decreased significantly in patients with chronic HBV infection than in controls (29.11 ± 6.79 vs 37.02 ± 7.05; 23.57 ± 7.33 vs 27.37 ± 7.03, both P < 0.01). The percentages of CD3⁺, CD8⁺, CD4⁺ T cells and NK cells decreased significantly in patients with liver cirrhosis or hepatocellular carcinoma than in controls (all P < 0.01). Soluble E-selectin levels were positively related to the percentages of CD3⁺ and CD8⁺ cells (r = 0.548, 0.715; both P < 0.01), but negatively related to the percentages of CD4+ cells and NK cells (r = -0.429, -0.672; both P < 0.01).

CONCLUSION: Varying degrees of immune dysfunction is present in patients with chronic HBV infection, and high expression of E-selectin is associated with the development of chronic hepatitis and liver cirrhosis. These results suggest that E-selectin can be used as a useful marker for evaluation of hepatic inflammatory activity.

Relationship between serum HBsAg level, HBV DNA level, and peripheral immune cells in patients with chronic hepatitis B virus infection

BACKGROUND

The chronicity of hepatitis B virus (HBV) infection is attributed to inappropriate functioning of cell-mediated immunity. Besides the importance of measuring serum HBV DNA and HBV surface antigen (HBsAg) as markers of viral replication and exposure, respectively, studies regarding their influence on immune cell status in chronic HBV infection are still scarce. Because such studies of chronic HBV patients have not been reported for India, we attempted to evaluate the relationship between serum concentrations of HBsAg, HBV DNA, and percentage of immune cells in peripheral blood of Indian subjects with chronic HBV infection.

METHODS

Thirty-one HbsAg-positive subjects were evaluated for serum HBe antigen (HBeAg), anti-HBe, and alanine transferase status by standard enzyme-linked immunosorbent assay (ELISA) and biochemical procedures. Serum HBV DNA level was determined by real-time TaqMan® polymerase chain reaction assay. Serum HBsAg level was measured by a third-generation sandwich ELISA kit. Peripheral immune cell profiling was done by multifluorometric flow cytometry analysis, for which 21 healthy subjects were included as controls.

RESULTS

The majority (93.5%) of the study subjects were HBeAg-negative and anti-HBeAg-positive. Mean viral load, HBsAg, and alanine transferase levels were 4.20 ± 1.96 log copies/mL, 5.98 ± 4.62 log IU/mL, and 74.5 ± 110 IU/mL, respectively. In comparison with controls, total T cell and cytotoxic T cell populations were significantly (P < 0.05) reduced in HBV-infected subjects, while the status of B cells, natural killer cells, T helper cells, and ratio of T helper to cytotoxic cells remained unaltered.

CONCLUSION

Suppression of the peripheral cytotoxic T cell population in chronic HBeAg-negative chronic HBV infection is influenced by increased viral load. Serum HBsAg concentration appeared independent of serum HBV DNA level and immune cell status. Nonelevation of natural killer cell and T helper cell numbers in subjects harboring lower to moderate HBV loads is further indicative of noninduction of innate as well as a coordinated adaptive immune response favoring chronicity of the disease.

Peripheral T-lymphocyte subpopulations in different clinical stages of chronic HBV infection correlate with HBV load

AIM

To characterize the peripheral T-cell subpopulation profiles and their correlation with hepatitis B virus (HBV) replication in different clinical stages of chronic HBV infection.

METHODS

A total of 422 patients with chronic HBV infection were enrolled in this study. The patients were divided into three stages: immune-tolerant stage, immune active stage, and immune-inactive carrier stage. Composition of peripheral T-cell subpopulations was determined by flow cytometry. HBV markers were detected by enzyme-linked immunosorbent assay. Serum HBV DNA load was assessed by quantitative real-time polymerase chain reaction.

RESULTS

CD8(+) T-cells were significantly higher in patients at the immune-tolerant stage than in patients at the immune-active and -inactive carrier stages (36.87 +/- 7.58 vs 34.37 +/- 9.07, 36.87 +/- 7.58 vs 28.09 +/- 5.64, P < 0.001). The peripheral blood in patients at the immune-tolerant and immune active stages contained more CD8(+) T-cells than CD4(+) T-cells (36.87 +/- 7.58 vs 30.23 +/- 6.35, 34.37 +/- 9.07 vs 30.92 +/- 7.40, P < 0.01), whereas the peripheral blood in patients at the immune-inactive carrier stage and in normal controls contained less CD8(+) T-cells than CD4(+) T-cells (28.09 +/- 5.64 vs 36.85 +/- 6.06, 24.02 +/- 4.35 vs 38.94 +/- 3.39, P < 0.01). ANOVA linear trend test showed that CD8(+) T-cells were significantly increased in patients with a high viral load (39.41 +/- 7.36, 33.83 +/- 7.50, 31.81 +/- 5.95 and 26.89 +/- 5.71, P < 0.001), while CD4(+) T-cells were significantly increased in patients with a low HBV DNA load (37.45 +/- 6.14, 33.33 +/- 5.61, 31.58 +/- 6.99 and 27.56 +/- 5.49, P < 0.001). Multiple regression analysis displayed that log copies of HBV DNA still maintained its highly significant coefficients for T-cell subpopulations, and was the strongest predictors for variations in CD3(+), CD4(+) and CD8(+) cells and CD4(+)/CD8(+) ratio after adjustment for age at HBV-infection, maternal HBV-infection status, presence of hepatitis B e antigen and HBV mutation.

CONCLUSION

Differences in peripheral T-cell subpopulation profiles can be found in different clinical stages of chronic HBV infection. T-cell impairment is significantly associated with HBV load.

Peripheral blood lymphocyte populations in end-stage liver diseases

GOALS/BACKGROUND

The aim of this study was to decipher whether end-stage liver failure modifies peripheral blood lymphocytes (PBL) in a homogeneous manner, independently of the base pathology, or, if on the contrary, PBL subsets show a different profile in each hepatic disease.

METHODS

We studied PBL subsets in 71 patients with end-stage liver disease, before liver transplant, and 74 healthy controls by flow cytometry. The results were statistically compared between patients and controls, and cohorts of patients classified according to their base pathology.

RESULTS

We observed lower absolute numbers in all lymphocyte populations in patients compared with controls. We found an increment of CD3+ activated cells (P<10) and CD45RO+CD4+ (P<10) in chronic hepatitis C virus versus controls; hepatitis B virus showed high TCRgammadelta+ and CD8+ T cells with respect to controls (P=0.008 and P=0.029, respectively); alcoholic cirrhotic patients showed low CD8+, mainly CD45RA+CD8+ (P=0.007) and high CD45RO+CD4+ (P<10) compared with the normal population; autoimmune diseases showed lower CD3+ and TCRalphabeta+ (P=0.002 and P=0.0001) than controls.

CONCLUSIONS

Regardless of the base pathology, patients with end-stage liver disease show a low absolute number of lymphocyte populations compared with controls. However, PBL profiles are different, characteristic, and specific of every disease causing chronic liver failure.

Association between hepatitis B virus infection and HLA-DRB1 genotyping in Shaanxi Han patients in northwestern China

Hepatitis B virus (HBV) infection is a major public health problem worldwide. The mechanism of susceptibility to chronic persistent HBV infection is not well clarified, while the outcome of HBV infection mainly depends on the host immune response. Human leukocyte antigen (HLA) class II molecule is an integral component of the immune response on which majority of host genetic studies have concentrated. Many different HLA class II alleles have been demonstrated to play roles in HBV infection. In this study, the association between HBV infection and HLA-DRB1 alleles in Han individuals in northwestern China was studied for the first time. Two hundred and fifty Shaanxi Han individuals were categorized into three different groups: the HBV-infected patient group (n = 108), the spontaneously cleared control group (n = 108) and the unexposed group (n = 34). DRB1*04, DRB1*09, DRB1*12 and DRB1*15 were the most common genotypes in all the groups. The allele frequencies of HLA-DRB1*03 [10.6% of HBV-infected patients vs 3.7% of spontaneously cleared controls, odds ratios (OR) = 3.10, Pc = 0.008, P < 0.05] and HLA-DRB1*07 (17.6% of HBV-infected patients vs 9.3% of spontaneously cleared controls, Pc = 0.016, OR = 2.09, P < 0.05) were markedly higher in the HBV-infected group. But the allele frequencies of HLA-DRB1*15 (6.9% of HBV-infected patients vs 13.4% of spontaneously cleared controls Pc = 0.039, OR = 0.48, P < 0.05) were obviously lower than that of the spontaneously cleared controls. The above data indicate that HLA-DRB1*03 and HLA-DRB1*07 are related to susceptibility to chronic HBV infection, and DRB1*15 is negatively related to persistence to chronic HBV infection among people in northwestern China. Similar results were got for DRB1*03 and 15 alleles between the HBV-infected patients (n = 108) and 46 HBV seronegative spouses of the HBV patients, who were high-risk group for HBV infection. The above results suggest that host HLA class II gene is an important factor in determination of the outcome of HBV infection.

Quantum dot semiconductor nanocrystals for immunophenotyping by polychromatic flow cytometry

Immune responses arise from a wide variety of cells expressing unique combinations of multiple cell-surface proteins. Detailed characterization is hampered, however, by limitations in available probes and instrumentation. Here, we use the unique spectral properties of semiconductor nanocrystals (quantum dots) to extend the capabilities of polychromatic flow cytometry to resolve 17 fluorescence emissions. We show the need for this power by analyzing, in detail, the phenotype of multiple antigen-specific T-cell populations, revealing variations within complex phenotypic patterns that would otherwise remain obscure. For example, T cells specific for distinct epitopes from one pathogen, and even those specific for the same epitope, can have markedly different phenotypes. The technology we describe, encompassing the detection of eight quantum dots in conjunction with conventional fluorophores, should expand the horizons of flow cytometry, as well as our ability to characterize the intricacies of both adaptive and innate cellular immune responses.

Antiviral reactivities of gammadelta T cells

The complex antiviral immune mechanisms involve both adaptive and innate reactions mediated by γδ T lymphocytes, whose unique immunosurveillance contributions are analyzed here in different clinical and experimental settings. It is beyond any doubt that the fast, potent, cytotoxic as well as non-cytolytic antiviral activities of γδ T cells are critical in protecting the host against diverse viral pathogens.

Association between HLA class II gene and susceptibility or resistance to chronic hepatitis B

AIM: To investigate the association between the polymorphism of HLA-DRB1, -DQA1 and -DQB1 alleles and viral hepatitis B.

METHODS: HLA-DRB1, -DQA1 and -DQB1 alleles in 54 patients with chronic hepatitis B, 30 patients with acute hepatitis B and 106 normal control subjects were analyzed by using the polymerase chain reaction/sequence specific primer (PCR/SSP) technique.

RESULTS: The allele frequency of HLA-DRB1*0301 in the chronic hepatitis B group was markedly higher than that in the normal control group (17.31% vs 5.67%), there was a significant correlation between them (χ² = 12.3068, Pc = 0.0074, RR = 4.15). The allele frequency of HLA-DQA1*0501 in the chronic hepatitis B group was significantly higher than that in the normal control group (25.96% vs 13.68%), there was a significant correlation between them (χ² = 9.2002, Pc = 0.0157, RR = 2.87). The allele frequency of HLA-DQB1*0301 in the chronic hepatitis B group was notably higher than that in the normal control group (35.58% vs 18.87%), there was a significant correlation between them (χ² = 15.5938, Pc = 0.0075, RR = 4.07). The allele frequency of HLA-DRB1*1101/1104 in the chronic hepatitis B group was obviously lower than that in the normal control group (0.96% vs 13.33%), there was a significant correlation between them (χ² = 11.9206, Pc = 0.0145, RR = 18.55). The allele frequency of HLA-DQA1*0301 in the chronic hepatitis B group was remarkably lower than that in the normal control group (14.42% vs 30%), there was a significant correlation between them (χ² = 8.7396, Pc = 0.0167, RR = 0.35).

CONCLUSION: HLA-DRB1*0301, HLA-DQA1*0501 and HLA-DQB1*0301 are closely related with susceptibility to chronic hepatitis B, and HLA-DRB1*1101/1104 and HLA-DQA1*0301 are closely related with resistance to chronic hepatitis B. These findings suggest that host HLA class II gene is an important factor determining the outcome of HBV infection.

Detection of T lymphocyte subsets and mIL-2R on surface of PBMC in patients with hepatitis B

AIM: To study the levels of T lymphocyte subsets and membrane interleukin-2 receptor (mIL-2R) on surface of peripheral blood mononuclear cells (PBMCs) of patients with hepatitis B and its role in the pathogenesis of hepatitis B.

METHODS: The levels of T lymphocyte subsets and mIL-2R in PBMC before and after being stimulated with PHA were detected by biotin-streptavidin (BSA) technique in 196 cases of hepatitis B.

RESULTS: In patients with hepatitis B, the levels of CD₃⁺, CD₄⁺ cells, and the ratio of CD₄⁺ cells/CD₈⁺ cells were lower, but the level of CD₈⁺ cells was higher than those in normal controls (42.20 ± 6.01 vs 65.96 ± 6.54, 38.17 ± 5.93 vs 41.73 ± 6.40, 0.91 ± 0.28 vs 1.44 ± 0.31, 39.86 ± 6.36 vs 30.02 ± 4.54, P < 0.01). The total expression level of mIL-2R in PBMC before and after being stimulated with PHA was also lower than those in normal controls (3.47 ± 1.55 vs 4.52 ± 1.49, 34.03 ± 2.94 vs 37.95 ± 3.00, P < 0.01). In all the patients with hepatitis B, the levels of T lymphocyte subsets and mIL-2R in PBMC with HBV-DNA (+) were lower than those with HBV-DNA (-), which were significantly different (39.57 ± 7.11 vs 44.36 ± 5.43, 34.36 ± 7.16 vs 40.75 ± 5.87, 37.82 ± 6.54 vs 41.72 ± 6.21, 0.88 ± 0.33 vs 0.99 ± 0.27, 2.82 ± 1.62 vs 3.85 ± 1.47, 31.56 ± 3.00 vs 35.84 ± 2.83, P < 0.01). In addition, the levels of CD₃⁺, CD₄⁺, CD₈⁺ cells, the ratio of CD₄⁺ cells/CD₈⁺ cells and mIL-2R among different courses of hepatitis B were all significantly different (F = 3723.18, P < 0.01. F = 130.43, P < 0.01. F = 54.01, P < 0.01. F = 2.99, P < 0.05. F = 7.16, P < 0.01).

CONCLUSION: Both cellular and humoral immune functions are obviously in disorder in patients with hepatitis B, which might be closely associated with the chronicity in patients.

Decreased ratio of CD4/CD8 lymphocytes might be predictive for successful interferon alpha and lamivudine combined therapy in childhood chronic hepatitis B infection: A preliminary study

BACKGROUND

In the development of chronic hepatitis with hepatitis B virus infection and in response to therapy, the immune status of the infected host plays a critical role. In this study, immunological variables were assessed in patients before interferon alpha and lamivudine therapy to determine if any pretreatment immunological parameter could be an indicator of response to therapy in childhood chronic hepatitis B infection.

METHODS

Forty-four patients with chronic hepatitis B virus infection, aged 9.0 +/- 3.9 years, were enrolled in the study. The pretreatment clinical features, biochemical test results, histological activity indexes and immunological parameters were evaluated. All patients received interferon alpha for 6 months and lamivudine for 52 weeks. Four patients who could not be followed up were excluded from the study. The other 40 patients have been followed for a mean period of 27.5 +/- 9.7 months after therapy discontinuation.

RESULTS

Seventeen patients showed loss of hepatitis B early antigen (HBeAg) with appearance of anti-HBe (42.5%) and six of those who responded also showed loss of hepatitis B surface antigen (HBsAg) with the presence of anti-HBs (15%). Except elevated aspartate aminotransferase levels, there was no significantly correlation between response and sex, age, pretreatment duration of disease and histological activity indexes. Pretreatment immunoglobulins (Ig), IgG subclasses, complement C3, C4 and secretory IgA levels were also not found to be significantly related to response. The evaluation of lymphocyte subsets showed that therapy responders had significantly reduced pretreatment ratios of CD4/CD8+ lymphocytes due to prominent increased percentages of CD8+ cells. The other cellular immunity parameters and some cell surface adhesion molecules were similar in both groups.

CONCLUSION

This study emphasizes the importance of increased pretreatment CD8+ lymphocyte percentages leading to a significant decrease in CD4/CD8 ratio in chronic hepatitis B virus infection of childhood as an immunological factor predicting response to treatment.

CD45RA and CD45RO isoforms in infected malnourished and infected well-nourished children

The aim of this study was to determine if the distribution in vivo of CD4(+)CD45RA(+)/CD45RO(-) (naive), CD4(+)CD45RA(+)/CD45RO(+) (Ddull) and CD4(+)CD45RO(+) (memory) lymphocytes differs in malnourished infected and well-nourished infected children. The expression of CD45RA (naive) and CD45RO (memory) antigens on CD4(+) lymphocytes was analysed by flow cytometry in a prospectively followed cohort of 15 malnourished infected, 12 well-nourished infected and 10 well-nourished uninfected children. Malnourished infected children showed higher fractions of Ddull cells (11.4 +/- 0.7%) and lower fractions of memory cells (20.3 +/- 1.7%) than the well-nourished infected group (8.8 +/- 0.8 and 28.1 +/- 1.8%, respectively). Well-nourished infected children showed increased percentages of memory cells, an expected response to infection. Impairment of the transition switch to the CD45 isoforms in malnourished children may explain these findings, and may be one of the mechanisms involved in immunodeficiency in these children.

Quantitative monitoring of serum hepatitis B virus DNA and blood lymphocyte subsets during combined prednisolone and interferon-alpha therapy in patients with chronic hepatitis B

Several investigators have reported a significantly reduced CD4/CD8 ratio, as defined by monoclonal antibodies, in the peripheral blood of Caucasian patients with chronic active hepatitis B (CAHB). In Asian patients with chronic hepatitis B, quantitative analyses of subpopulations of peripheral blood lymphocytes have not been able to confirm these findings. In this work, we analysed the frequency of peripheral blood lymphocyte subsets in 10 Chinese patients with histologically proven CAHB and seven healthy Chinese individuals. Four of the 10 CAHB patients received combined prednisolone/interferon-alpha2b (IFN-alpha2b) therapy. Peripheral blood samples were consecutively collected for analysis of lymphocyte subpopulations using an indirect immunofluorescence (IF) method, and hepatitis B virus (HBV) DNA was quantified by a chemiluminescent, molecular-hybridization assay. Peripheral blood mononuclear cells from seven Chinese control individuals comprised 63 +/- 3% CD3+ cells, of which 41 +/- 4% were of CD4+ and 23 +/- 2% of CD8+ subsets. The mean CD4/CD8 ratio in the healthy controls was 1.9 (95% confidence interval = 1.1-2.7). The CD4/CD8 ratios were significantly reduced (P < 0.01) in the 10 patients with chronic hepatitis B, compared with those of the controls, owing to a significant increase in the number of CD8+ cells (P < 0.005). During the treatment with prednisolone, a significant increase in the CD4/CD8 ratio was observed in all treated patients. This increase was mainly caused by a decrease in the number of CD8+ cells and was accompanied by an increase in serum HBV DNA levels, which peaked during the latter part of the prednisolone cycle. During the treatment with IFN-alpha2b, a second increase in the CD4/CD8 ratio was observed, which was caused by an increase in CD4+ cells. A marked decrease in viral load was observed, during treatment with IFN-alpha2b, in patients with HBV DNA levels below 10 000 pg ml-1. Our data indicate that the CD4/CD8 ratios in Chinese CAHB patients do not differ from those of Caucasian patients with CAHB, when analysed using similar methods for the enumeration of lymphocyte subsets. Profound effects on cellular distribution and viral replication were noted during the combined prednisolone/IFN-alpha2b therapy. Additional studies of the modulatory effect of the combined therapy on the distribution of lymphocyte subsets and cytokine profiles in relation to the therapeutic outcome of HBV infection are warranted.