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Ji F, Tran S, Ogawa E, Huang CF, Suzuki T, Wong YJ, Toyoda H, Jun DW, Li L, Uojima H, Nozaki A, Chuma M, Tseng CH, Hsu YC, Ishigami M, Honda T, Atsukawa M, Haga H, Enomoto M, Trinh H, Preda CM, Vutien P, Landis C, Lee DH, Watanabe T, Takahashi H, Abe H, Asai A, Eguchi Y, Li J, Wang X, Li J, Liu J, Liang J, Lam CPM, Huang R, Ye Q, Pan H, Zhang J, Cai D, Wang Q, Huang DQ, Wong G, Wong VWS, Li J, Do S, Furusyo N, Nakamuta M, Nomura H, Kajiwara E, Yoon EL, Ahn SB, Azuma K, Dohmen K, An J, Song DS, Cho HC, Kawano A, Koyanagi T, Ooho A, Satoh T, Takahashi K, Yeh ML, Tsai PC, Yasuda S, Zhao Y, Liu Y, Okubo T, Itokawa N, Jun MJ, Ishikawa T, Takaguchi K, Senoh T, Zhang M, Zhao C, Alecu RI, Xuan Tay W, Devan P, Liu JK, Kozuka R, Vargas-Accarino E, Do AT, Maeda M, Chuang WL, Huang JF, Dai CY, Cheung R, Buti M, Niu J, Xie W, Ren H, Lim SG, Wu C, Yuen MF, Shang J, Zhu Q, Ueno Y, Tanaka Y, Hayashi J, Yu ML, Nguyen MH. Real-world Effectiveness and Tolerability of Interferon-free Direct-acting Antiviral for 15,849 Patients with Chronic Hepatitis C: A Multinational Cohort Study. J Clin Transl Hepatol 2024; 12:646-658. [PMID: 38993510 PMCID: PMC11233980 DOI: 10.14218/jcth.2024.00089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/08/2024] [Accepted: 05/22/2024] [Indexed: 07/13/2024] Open
Abstract
Background and Aims As practice patterns and hepatitis C virus (HCV) genotypes (GT) vary geographically, a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HCV elimination goal. This study aimed to assess the effectiveness and tolerability of DAA treatment in routine clinical practice in a multinational cohort for patients infected with all HCV GTs, focusing on GT3 and GT6. Methods We analyzed the sustained virological response (SVR12) of 15,849 chronic hepatitis C patients from 39 Real-World Evidence from the Asia Liver Consortium for HCV clinical sites in Asia Pacific, North America, and Europe between 07/01/2014-07/01/2021. Results The mean age was 62±13 years, with 49.6% male. The demographic breakdown was 91.1% Asian (52.9% Japanese, 25.7% Chinese/Taiwanese, 5.4% Korean, 3.3% Malaysian, and 2.9% Vietnamese), 6.4% White, 1.3% Hispanic/Latino, and 1% Black/African-American. Additionally, 34.8% had cirrhosis, 8.6% had hepatocellular carcinoma (HCC), and 24.9% were treatment-experienced (20.7% with interferon, 4.3% with direct-acting antivirals). The largest group was GT1 (10,246 [64.6%]), followed by GT2 (3,686 [23.2%]), GT3 (1,151 [7.2%]), GT6 (457 [2.8%]), GT4 (47 [0.3%]), GT5 (1 [0.006%]), and untyped GTs (261 [1.6%]). The overall SVR12 was 96.9%, with rates over 95% for GT1/2/3/6 but 91.5% for GT4. SVR12 for GT3 was 95.1% overall, 98.2% for GT3a, and 94.0% for GT3b. SVR12 was 98.3% overall for GT6, lower for patients with cirrhosis and treatment-experienced (TE) (93.8%) but ≥97.5% for treatment-naive patients regardless of cirrhosis status. On multivariable analysis, advanced age, prior treatment failure, cirrhosis, active HCC, and GT3/4 were independent predictors of lower SVR12, while being Asian was a significant predictor of achieving SVR12. Conclusions In this diverse multinational real-world cohort of patients with various GTs, the overall cure rate was 96.9%, despite large numbers of patients with cirrhosis, HCC, TE, and GT3/6. SVR12 for GT3/6 with cirrhosis and TE was lower but still excellent (>91%).
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Affiliation(s)
- Fanpu Ji
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Sally Tran
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA
| | - Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung
| | - Takanori Suzuki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yu Jun Wong
- Gastroenterology & Hepatology, Changi General Hospital, Singhealth, Singapore
- Singhealth Duke-NUS Medicine Academic Clinical Program, Singapore
| | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University, College of Medicine, Seoul, Korea
- Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Korea
| | - Liu Li
- Department of Hepatology, The Third People's Hospital of Kunming City, Kunming, Yunnan, China
| | - Haruki Uojima
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Akito Nozaki
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Chuma
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Cheng-Hao Tseng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung
| | - Yao-Chun Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanori Atsukawa
- Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan
| | - Hiroaki Haga
- Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masaru Enomoto
- Department of Transfusion Medicine and Department of Hepatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Huy Trinh
- San Jose Gastroenterology, San Jose, CA, USA
| | - Carmen Monica Preda
- Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Phillip Vutien
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA
| | - Charles Landis
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA
| | - Dong Hyun Lee
- Department of Gastroenterology, Good Gang-An Hospital, Busan, Korea
| | - Tsunamasa Watanabe
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hirokazu Takahashi
- Liver Center, Saga University Hospital, Saga, Japan
- Division of Metabolism and Endocrinology, Saga University Faculty of Medicine, Saga, Japan
| | - Hiroshi Abe
- Division of Gastroenterology and Hepatology, Shinmatsudo Central General Hospital, Chiba, Japan
| | - Akira Asai
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yuichiro Eguchi
- Liver Center, Saga University Hospital, Saga, Japan
- Locomedical General Institute, Locomedical Eguchi Hospital, Saga, Japan
| | - Jie Li
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Xiaozhong Wang
- Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jia Li
- Department of Gastroenterology and Hepatology, The Second People's Hospital of Tianjin, Tianjin, China
| | - Junping Liu
- Department of Infectious Diseases, Henan Provincial People's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Jing Liang
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin, China
| | - Carla Pui-Mei Lam
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Qing Ye
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin, China
| | - Hongying Pan
- Department of Hepatology, Zhejiang Provincial People's Hospital Affiliated to Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiajie Zhang
- Department of Hepatology, Zhejiang Provincial People's Hospital Affiliated to Zhejiang University, Hangzhou, Zhejiang, China
| | - Dachuan Cai
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Wang
- Center of liver diseases, Beijing Ditan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Daniel Q Huang
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Grace Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Junyi Li
- Department of Hepatology, The Third People's Hospital of Kunming City, Kunming, Yunnan, China
| | - Son Do
- Digestive Health Associates of Texas, Dallas, TX, USA
| | | | - Makoto Nakamuta
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hideyuki Nomura
- Department of Internal Medicine, Haradoi Hospital, Fukuoka, Japan
| | - Eiji Kajiwara
- Hepatology Clinic, Kajiwara Clinic, Kitakyushu, Japan
| | - Eileen L Yoon
- Department of Internal Medicine, Hanyang University, College of Medicine, Seoul, Korea
- Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Korea
| | - Sang Bong Ahn
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Koichi Azuma
- Department of Medicine, Kyushu Central Hospital, Fukuoka, Japan
| | - Kazufumi Dohmen
- Department of Internal Medicine, Chihaya Hospital, Fukuoka, Japan
| | - Jihyun An
- Department of Internal Medicine, Hanyang University, College of Medicine, Guri Hospital, Guri, Korea
| | - Do Seon Song
- Division of Hepatology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyun Chin Cho
- Departments of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Akira Kawano
- Department of Medicine, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | | | - Aritsune Ooho
- Department of Hepatology, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Takeaki Satoh
- Center for Liver Disease, National Hospital Organization Kokura Medical Center, Kitakyushu, Japan
| | | | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung
| | - Pei-Chien Tsai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung
| | - Satoshi Yasuda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yunyu Zhao
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yishan Liu
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Tomomi Okubo
- Division of Gastoroentelorogy, Nippon Medcal School Chiba Hokusoh Hospital, Chiba, Japan
| | - Norio Itokawa
- Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan
| | - Mi Jung Jun
- Department of Gastroenterology, Good Gang-An Hospital, Busan, Korea
| | - Toru Ishikawa
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Koichi Takaguchi
- Department of Hepatology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Tomonori Senoh
- Department of Hepatology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Mingyuan Zhang
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Changqing Zhao
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Raluca Ioana Alecu
- Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Wei Xuan Tay
- Gastroenterology & Hepatology, Changi General Hospital, Singhealth, Singapore
| | - Pooja Devan
- Gastroenterology & Hepatology, Changi General Hospital, Singhealth, Singapore
| | - Joanne Kimiko Liu
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA
| | - Ritsuzo Kozuka
- Department of Hepatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | - Ai-Thien Do
- Digestive Health Associates of Texas, Dallas, TX, USA
| | - Mayumi Maeda
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Maria Buti
- Liver Diseases Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Liver Unit, Department of Internal Medicine, Hospital Universitari Valle d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Junqi Niu
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Wen Xie
- Center of liver diseases, Beijing Ditan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hong Ren
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Seng Gee Lim
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Man-Fung Yuen
- Department of Medicine, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China
| | - Jia Shang
- Department of Infectious Diseases, Henan Provincial People's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Qiang Zhu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan, Shandong, China
| | - Yoshiyuki Ueno
- Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yasuhito Tanaka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Jun Hayashi
- Kyushu General Internal Medicine Center, Haradoi Hospital, Fukuoka, Japan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
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3
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Clark PJ, Valery PC, Strasser SI, Weltman M, Thompson AJ, Levy M, Leggett B, Zekry A, Rong J, Angus P, George J, Bollipo S, McGarity B, Sievert W, Macquillan G, Tse E, Nicoll A, Wade A, Chu G, Harding D, Cheng W, Farrell G, Roberts SK. Liver Disease and Poor Adherence Limit Hepatitis C Cure: A Real-World Australian Treatment Cohort. Dig Dis Sci 2023; 68:291-303. [PMID: 35552941 PMCID: PMC9883319 DOI: 10.1007/s10620-022-07483-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIMS In 2016, direct-acting antiviral (DAA) treatment for hepatitis C (HCV) became available through Australia's universal health care system, with the aim of HCV elimination. We report real-world effectiveness of DAA HCV treatment in Australia from a clinically well-informed cohort, enriched for cirrhosis and prior HCV treatment. METHODS 3413 patients were recruited from 26 hospital liver clinics across Australia from February 2016 to June 2020. Clinical history and sustained viral response (SVR) were obtained from medical records and data linkage to the Australian Pharmaceutical Benefits Scheme. Factors associated with SVR were assessed by multivariable logistic regression (MVR). RESULTS At recruitment, 32.2% had cirrhosis (72.9% Child Pugh class B/C), and 19.9% were treatment experienced. Of the 2,939 with data, 93.3% confirmed SVR. 137 patients received second-line therapy. Patients with cirrhosis had lower SVR rate (88.4 vs. 95.8%; p < 0.001). On MVR, failure to achieve SVR was associated with Genotype 3 (adj-OR = 0.42, 95%CI 0.29-0.61), male gender (adj-OR = 0.49, 95%CI 0.31-0.77), fair/poor adherence (adj-OR = 0.52, 95%CI 0.28-0.94), cirrhosis (adj-OR = 0.57, 95%CI 0.36-0.88), FIB-4 > 3.25 (adj-OR = 0.52, 95%CI 0.33-0.83) and MELD score ≥ 20 (adj-OR = 0.25, 95%CI 0.08-0.80). Consistent results were seen in cirrhotic sub-analysis. CONCLUSIONS Excellent SVR rates were achieved with DAAs in this real-world cohort of patients with chronic HCV infection. More advanced liver disease and clinician impression of poor adherence were associated with HCV treatment failure. Supports to improve liver fibrosis assessment skills for non-specialist DAA prescribers in the community and to optimize patient adherence are likely to enable more effective pursuit of HCV elimination in Australia.
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Affiliation(s)
- Paul J Clark
- Department of Gastroenterology, Princess Alexandra and Mater Hospitals, and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Martin Weltman
- Hepatology Services, Nepean Hospital, Penrith, NSW, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Miriam Levy
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, NSW, Australia
| | - Barbara Leggett
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Amany Zekry
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, NSW, Australia
| | - Julian Rong
- Gippsland Gastroenterology, Latrobe Regional Hospital, Traralgon, VIC, 3844, Australia
| | - Peter Angus
- Department of Gastroenterology and Hepatology, Austin Hospital, Melbourne, VIC, Australia
| | - Jacob George
- Storr Liver Unit, Westmead Hospital, Westmead, NSW, Australia
| | - Steven Bollipo
- Gastroenterology Department, John Hunter Hospital, New Lambton, NSW, Australia
| | - Bruce McGarity
- Bathurst Liver Clinic Bathurst Hospital, Bathurst, NSW, Australia
| | - William Sievert
- Gastrointestinal and Liver Unit, Monash Health, Melbourne, VIC, Australia
| | - Gerry Macquillan
- Liver Transplant Unit Sir Charles Gairdner Hospital, Nedlands Perth, WA, Australia
| | - Edmund Tse
- Department of Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Amanda Wade
- Barwon Health Liver Clinic University Hospital, Geelong, VIC, Australia
| | - Geoff Chu
- Orange Liver Clinic, Orange Hospital, Orange, NSW, Australia
| | - Damian Harding
- Department of Gastroenterology & Hepatology, Lyell McEwin Hospital, Vale, SA, Australia
| | - Wendy Cheng
- Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, WA, Australia
| | - Geoff Farrell
- Gastroenterology & Hepatology Unit Canberra Hospital, Canberra, ACT, Australia
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4
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Huang N, Zhou R, Chen H, Zhang S, Li J, Wei W, Sun J, Ren S, Li B, Deng H, Yang J, Ji F, Li Z. Splenic CD4 + and CD8 + T-cells highly expressed PD-1 and Tim-3 in cirrhotic patients with HCV infection and portal hypertension. Int J Immunopathol Pharmacol 2021; 35:20587384211061051. [PMID: 34930041 PMCID: PMC8725229 DOI: 10.1177/20587384211061051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: The spleen plays an important role in regulating the immune response to infectious pathogens. T-cells dysfunction and exhaustion have been reported in patients with hepatitis B/C virus (HBV/HCV) infection, which contributes to persistent virus infection. The aims of this study were to investigate spleen-related evidence of immunosuppression and immune tolerance in HCV cirrhotic patients with portal hypertension (PH). Methods: The expression of programmed cell death 1 (PD-1), T-cell immunoglobulin domain and mucin domain-containing molecule-3 (Tim-3) and its ligand PD-L1/2, and Galectin-9 in the spleens and livers of HCV cirrhotic patients (n = 15) was analyzed using real-time PCR and immunohistochemistry. Flow cytometry was used to evaluate the expression of PD-1 and Tim-3 on splenic T-cells and the peripheral blood T-cells before and after splenectomy (n = 8). Results: Spleens from patients with PH showed significantly increased mRNA levels of PD-L2, Tim-3, Galectin-9, CD80, and CD86, and decreased levels of CD28 compared to control spleens (spleens removed due to traumatic injury) (all p < 0.05). Additionally, protein expression of inhibitory signaling molecules was significantly increased in both the spleens and livers of cirrhotic patients compared with controls (all p < 0.05). Peripheral blood and splenic CD4+ and CD8+ T-cells also expressed higher protein levels of PD-1, Tim-3, and CTLA-4 in cirrhotic patients as compared with healthy controls (all p < 0.05). The proportion of PD-1+CD4+T lymphocytes (26.2% ± 7.12% vs. 21.0% ± 9.14%, p = 0.0293) and Tim-3+CD8+ T lymphocytes (9.4% ± 3.04% vs. 6.0% ± 2.24%, p = 0.0175) in peripheral blood decreased followed splenectomy. Conclusion: The CD4+ and CD8+ T-cells in spleen and peripheral blood highly expressed PD-1 and Tim-3 in HCV-infected and cirrhotic patients with portal hypertension. Highly expressed PD-1 and Tim-3 in peripheral blood T-lymphocytes can be partly reversed following splenectomy.
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Affiliation(s)
- Na Huang
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Rui Zhou
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Haiyan Chen
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shu Zhang
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jun Li
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei Wei
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Oncology Surgery, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jin Sun
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Song Ren
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Baohua Li
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hong Deng
- Department of Infectious Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jun Yang
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Pathology, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fanpu Ji
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Infectious Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, 117799Xi'an Jiaotong University, Ministry of Education of China, Xi'an, China
| | - Zongfang Li
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, 117799the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases, 117799Xi'an Jiaotong University, Ministry of Education of China, Xi'an, China
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