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Shah AS, Civelli VF, Bali V, Johnson RH, Heidari A. A Case of S-Variant Hepatitis B Virus: An Immune System Escape Artist. J Investig Med High Impact Case Rep 2021; 9:23247096211045450. [PMID: 34521227 PMCID: PMC8447092 DOI: 10.1177/23247096211045450] [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: 11/29/2022] Open
Abstract
Genomic variants of the hepatitis B virus (HBV) preS/S protein are well-known to
occur. Typically, immunity is gained through recovered HBV infection or by
immunization. Very rarely, there are certain mutations that may enable HBV
escape from the immune detection. PreS/S mutants may present with unpredictable
pathobiologic, clinical, and transmittable implications. Standard laboratory
testing for genomic HBV variants is not routinely performed by reference
guidelines. s-variant HBV management remains challenging. Herein is a case of
s-variant chronic HBV infection in a 55-year-old man. Diagnosis and treatment
are described.
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Affiliation(s)
- Amar S Shah
- UCLA at Kern Medical Center, Bakersfield, CA, USA
| | | | - Varun Bali
- UCLA at Kern Medical Center, Bakersfield, CA, USA
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Chen J, Zhu J, Wang G, Groopman JD, Kensler TW. Qidong: a crucible for studies on liver cancer etiology and prevention. Cancer Biol Med 2019; 16:24-37. [PMID: 31119044 PMCID: PMC6528445 DOI: 10.20892/j.issn.2095-3941.2018.0394] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Qidong (Jiangsu, China) has been of interest to cancer epidemiologists and biologists because, until recently, it was an endemic area for liver cancer, having amongst the highest incidence rates in the world. The establishment of the Qidong Cancer Registry together with the Qidong Liver Cancer Institute in 1972 has charted the patterns of liver cancer incidence and mortality in a stable population throughout a period of enormous economic, social, and environmental changes as well as of improvements in health care delivery. Updated incidence trends in Qidong are described. Notably, the China age-standardized incidence rate for liver cancer has dropped by over 50% in the past several decades. Molecular epidemiologic and genomic deep sequencing studies have affirmed that infection with hepatitis B virus as well as dietary exposure to aflatoxins through contamination of dietary staples such as corn, and to microcystins – blue-green algal toxins found in ditch and pond water – were likely important etiologic factors that account for the high incidence of liver cancer in this region. Public health initiatives to facilitate universal vaccination of newborns against HBV and to improve drinking water sources in this rural area, as well as economic and social mandates serendipitously facilitating dietary diversity, have led to precipitous declines in exposures to these etiologic factors, concomitantly driving substantive declines in the liver cancer incidence seen now in Qidong. In this regard, Qidong serves as a template for the global impact that a package of intervention strategies may exert on cancer burden.
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Affiliation(s)
- Jianguo Chen
- Department of Epidemiology, Qidong Liver Cancer Institute, Qidong 226200, China.,Department of Epidemiology, Tumor Hospital, Nantong University, Nantong 226361, China
| | - Jian Zhu
- Department of Epidemiology, Qidong Liver Cancer Institute, Qidong 226200, China
| | - Gaoren Wang
- Department of Epidemiology, Tumor Hospital, Nantong University, Nantong 226361, China
| | - John D Groopman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore 21205, MD, USA
| | - Thomas W Kensler
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore 21205, MD, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle 98109, WA 98109, USA
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Gao J, Xie L, Yang WS, Zhang W, Gao S, Wang J, Xiang YB. Risk factors of hepatocellular carcinoma--current status and perspectives. Asian Pac J Cancer Prev 2012; 13:743-52. [PMID: 22631642 DOI: 10.7314/apjcp.2012.13.3.743] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Hepatocellular carcinoma is a common disorder worldwide which ranks 5th and 7th most common cancer among men and women. In recent years, different incidence trends have been observed in various regions, but the reasons are not completely understood. However, due to the great public efforts in HCC prevention and alternation of lifestyle, the roles of some well documented risk factors played in hepatocarcinogenesis might have changed. This paper summarizes both the environmental and host related risk factors of hepatocellular carcinoma including well established risk factors such as hepatitis virus infection, aflatoxin and alcohol, as well as possible risk factors such as coffee drinking and other dietary agents.
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Affiliation(s)
- Jing Gao
- State Key Laboratory of Oncogene and Related Genes, Shanghai Cancer Institute, Shanghai, China
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Sharma VK, Vouros P, Glick J. Mass spectrometric based analysis, characterization and applications of circulating cell free DNA isolated from human body fluids. INTERNATIONAL JOURNAL OF MASS SPECTROMETRY 2011; 304:172-183. [PMID: 21765648 PMCID: PMC3134299 DOI: 10.1016/j.ijms.2010.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In the past decade, cell free DNA, or circulating cell free DNA, or cell free circulating DNA, isolated from body fluids such as plasma/serum/urine has emerged as an important tool for clinical diagnostics. The molecular biology of circulating cell free DNA is poorly understood but there is currently an increased effort to understand the origin, mechanism of its circulation, and sensitive characterization for the development of diagnostic applications. There has been considerable progress towards these goals using real time polymerase chain reaction technique (rt-PCR). More recently, new attempts to incorporate mass spectrometric techniques to develop accurate and highly sensitive high-throughput clinical diagnostic tests have been reported. This review focuses on the methods to isolate circulating cell free DNA from body fluids, their quantitative analysis and mass spectrometry based characterization in evolving applications as prenatal and cancer diagnostic tools.
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Affiliation(s)
- Vaneet K Sharma
- Department of Chemistry and Chemical Biology, Barnett Institute, Northeastern University, Boston, Massachusetts 02115
| | - Paul Vouros
- Department of Chemistry and Chemical Biology, Barnett Institute, Northeastern University, Boston, Massachusetts 02115
| | - James Glick
- Department of Chemistry and Chemical Biology, Barnett Institute, Northeastern University, Boston, Massachusetts 02115
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Muñoz A, Chen JG, Egner PA, Marshall ML, Johnson JL, Schneider MF, Lu JH, Zhu YR, Wang JB, Chen TY, Kensler TW, Groopman JD. Predictive power of hepatitis B 1762T/1764A mutations in plasma for hepatocellular carcinoma risk in Qidong, China. Carcinogenesis 2011; 32:860-5. [PMID: 21474708 DOI: 10.1093/carcin/bgr055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality with nearly 700,000 deaths occurring annually. Hepatitis B virus (HBV) is a major contributor to HCC and acquired mutations in the HBV genome may accelerate its pathogenesis. In this study, a matched case-control investigation of 345 men who died of HCC and 625 controls were nested within a cohort of male hepatitis B surface antigen (HBsAg) carriers from Qidong, China. Matched preserving odds ratios (ORs) were used as a measure of association and 95% confidence intervals (CIs) as a measure of precision. Real-time polymerase chain reaction allowed for a quantitative comparison of the levels of the HBV 1762(T)/1764(A) mutation in cases and controls. A total of 278 (81%) of the cases were positive for the HBV 1762(T)/1764(A) mutation compared with 250 (40%) of the controls. The matched preserving OR of 6.72 (95% CI: 4.66 to 9.68) strongly indicated that cases were significantly more probably than controls to have the mutation. Plasma levels of DNA harboring the HBV mutation were on average 15-fold higher in cases compared with controls (P < 0.001). Most strikingly, the level of the mutation in the 20 controls who later developed and died of HCC were on average 274-fold higher than controls who did not develop HCC. Thus, within this cohort of HBsAg carriers at high risk of developing HCC, individuals positive for the HBV 1762(T)/1764(A) mutation at enrollment were substantially more probably to subsequently develop HCC, with a higher concentration of the mutation in plasma enhancing predisposition for cancer development.
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Affiliation(s)
- Alvaro Muñoz
- Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
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Xu L, Qian G, Tang L, Su J, Wang JS. Genetic variations of hepatitis B virus and serum aflatoxin-lysine adduct on high risk of hepatocellular carcinoma in Southern Guangxi, China. J Hepatol 2010; 53:671-6. [PMID: 20650537 PMCID: PMC6022746 DOI: 10.1016/j.jhep.2010.04.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 03/18/2010] [Accepted: 04/08/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS Southern Guangxi area is one of the endemic areas for hepatocellular carcinoma (HCC) in China. This study evaluates the roles of genetic variations of hepatitis B virus (HBV) and aflatoxin B(1) (AFB(1)) exposure in the formation of HCC in this high-risk area. METHODS The study recruited 60 HCC patients and 120 age-, gender-, and residency-matched controls. HBV genotype and basic core promoter (BCP) mutations were determined by nested-PCR/direct sequencing. Serum AFB(1)-lysine adduct was measured by high performance liquid chromatography-fluorescence detection. RESULTS HBV genotype C was predominant in 75.0% of cases and 84.2% of controls. The 1762(T)/1764(A) double mutations, 1753(V) mutations, and 1752(V) mutations were associated with HCC risk evidenced by the adjusted odds ratio (OR) [95% confidence interval (95% CI)] of 3.89 (1.40-10.77), 2.87 (1.49-5.49), and 5.96 (1.75-20.25), respectively. The adjusted OR (95% CI) was 6.94 (1.68-27.78) for subjects with 1762(T)/1764(A) double mutations and high AFB(1)-lysine adduct level; 2.01 (0.24-14.29), for those with only 1762(T)/1764(A) double mutations; and 4.26 (1.16-15.38) for those with only high AFB(1)-lysine adduct level, respectively. The adjusted OR was 5.13 (1.79-14.71) for subjects with 1753(V) mutations and high AFB(1)-lysine adduct level; 1.20 (0.47-3.08) for those with only 1753(V) mutations, and 2.28 (1.01-5.31) for those with high AFB(1)-lysine adduct level, respectively. CONCLUSIONS These data confirmed the association of BCP mutations with HCC risk and the additive effects of 1762(T)/1764(A) double mutations and 1753(V) mutations with dietary AFB(1) exposure in this high-risk area for HCC.
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Affiliation(s)
- Li Xu
- Department of Environmental Health Science, College of Public Health, The University of Georgia, Athens, GA 30602, USA
| | - Guoqing Qian
- Department of Environmental Health Science, College of Public Health, The University of Georgia, Athens, GA 30602, USA
| | - Lili Tang
- Department of Environmental Health Science, College of Public Health, The University of Georgia, Athens, GA 30602, USA
| | - Jianjia Su
- Guangxi Cancer Institute, Nanning, Guangxi 530021, China
| | - Jia-Sheng Wang
- Department of Environmental Health Science, College of Public Health, The University of Georgia, Athens, GA 30602, USA
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Yin J, Zhang H, He Y, Xie J, Liu S, Chang W, Tan X, Gu C, Lu W, Wang H, Bi S, Cui F, Liang X, Schaefer S, Cao G. Distribution and hepatocellular carcinoma-related viral properties of hepatitis B virus genotypes in Mainland China: a community-based study. Cancer Epidemiol Biomarkers Prev 2010; 19:777-86. [PMID: 20160279 DOI: 10.1158/1055-9965.epi-09-1001] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Hepatitis B virus (HBV) genotypes, replication status, and mutations have been associated with the risk of hepatocellular carcinoma (HCC). Our aim was to study the distribution and HCC-related viral properties of HBV genotypes/subgenotypes in Mainland China. METHODS A multistage cluster probability sampling method was applied to select 81,775 participants between 1 and 59 years at 160 national disease surveillance points. We examined hepatitis B surface antigen, HBV genotypes and subgenotypes, hepatitis B e antigen, viral load, and mutations in the PreS and core promoter regions of HBV genome. RESULTS HBV subgenotypes B2 (27.3%), C1 (10.7%), and C2 (58.0%) were predominant. Genotype D (D1, 80.8%) was frequent in the Uygur. We identified a new subgenotype, C9, mainly in Tibetans. Compositions of subgenotypes B2 and C1 and genotype mixture increased from the North to Central South, which was consistently associated with the increasing prevalence of hepatitis B surface antigen. Hepatitis B e antigen positivity and viral loads were higher in the young with genotype B and declined more rapidly with increasing age than those with genotype C. In contrast to G1896A, PreS deletion, T31C, T1753V, and A1762T/G1764A were more frequent in subgenotype C2 than in subgenotype B2. A1762T/G1764A, T1753V, C1653T, and G1896A, except PreS deletion, consecutively increased with increasing age. CONCLUSION HBV subgenotypes B2, C1, and C2 are endemic in Mainland China. HBV genotype C exhibits less replication activity in the young and harbors higher frequencies of the HCC-associated mutations than genotype B. IMPACT These basic data could help evaluate the association of HBV variations with HCC.
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Affiliation(s)
- Jianhua Yin
- Department of Epidemiology, 3rd Hospital, Second Military Medical University, Shanghai, China
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Taylor BC, Yuan JM, Shamliyan TA, Shaukat A, Kane RL, Wilt TJ. Clinical outcomes in adults with chronic hepatitis B in association with patient and viral characteristics: A systematic review of evidence. Hepatology 2009; 49:S85-95. [PMID: 19399797 DOI: 10.1002/hep.22929] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We systematically reviewed the literature on the extent to which population characteristics or clinical features predict groups of individuals likely to develop advanced liver disease or die from chronic infection with hepatitis B virus (HBV). We searched Medline to include studies with reported cirrhosis, liver failure, liver cancer, or death outcomes after at least 1 year of follow-up from the measurement of predictive factors (age, age at infection, geographic location, race/ethnicity, sex, positive family history, presence of coinfections, HBV viral level, change in hepatitis B e antigen [HBeAg] status, genotype, HBV mutations, nonalcoholic fatty liver disease, alcohol consumption, liver enzymes, and liver biopsy finding). Evidence from 41 included articles suggested that cirrhosis, higher HBV viral level, and male sex were consistently associated with significantly increased risk of death and liver cancer. Evidence about the role of HBV genotype, HBeAg status, age and duration of infection, coinfections with hepatitis C virus, human immunodeficiency virus, hepatitis delta virus, and alanine aminotransferase levels were limited and inconsistent, but were deemed promising to identify patients at higher risk of clinical outcomes. Adults with chronic hepatitis B had increased risk for poorer health outcomes compared to the general population; however, the magnitude of risk varied greatly depending on baseline patient and disease characteristics, and typically clinical outcomes required many years to become manifest. Many adults with chronic hepatitis B had low absolute risks of clinical outcomes and likely would not benefit from immediate treatment. Baseline patient and disease characteristics provide important information about the risk of clinical outcomes and should be incorporated into monitoring or treatment decisions.
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Affiliation(s)
- Brent C Taylor
- Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
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Yuan JM, Ambinder A, Fan Y, Gao YT, Yu MC, Groopman JD. Prospective evaluation of hepatitis B 1762(T)/1764(A) mutations on hepatocellular carcinoma development in Shanghai, China. Cancer Epidemiol Biomarkers Prev 2009; 18:590-4. [PMID: 19190166 DOI: 10.1158/1055-9965.epi-08-0966] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Chronic infection with the hepatitis B virus (HBV) is the most important risk factor for hepatocellular carcinoma (HCC). However, determinants of HCC risk in infected individuals are not well understood. We prospectively evaluated the association between acquired HBV 1762(T)/1764(A) double mutations and HCC risk among 49 incident HCC cases and 97 controls with seropositive hepatitis B surface antigen at baseline from a cohort of 18,244 men in Shanghai, China, enrolled during 1986 to 1989. Compared with HBV carriers without the mutations, chronic HBV carriers with the HBV 1762(T)/1764(A) double mutations experienced an elevated risk of HCC (odds ratio, 2.47; 95% confidence interval, 1.04-5.85; P = 0.04). Risk increased with increasing copies of the double mutations; men with > or =500 copies/microL serum had an odds ratio of 14.57 (95% confidence interval, 2.41-87.98) relative to those without the double mutations (P(trend) = 0.004). Thus, the HBV 1762(T)/1764(A) double mutation is a codeterminant of HCC risk for people chronically infected with HBV.
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Affiliation(s)
- Jian-Min Yuan
- The Masonic Cancer Center and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA.
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Guo X, Jin Y, Qian G, Tu H. Sequential accumulation of the mutations in core promoter of hepatitis B virus is associated with the development of hepatocellular carcinoma in Qidong, China. J Hepatol 2008; 49:718-25. [PMID: 18801591 DOI: 10.1016/j.jhep.2008.06.026] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 06/04/2008] [Accepted: 06/10/2008] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIMS To investigate the mutations in hepatitis B virus (HBV) that might be related to hepatocellular carcinoma (HCC) in the high-risk area Qidong, China. METHODS DNA sequences of HBV basal core promoter (BCP) and the overlapping X gene were determined in 58 HCC and 71 chronic hepatitis (CH) patients. In addition, a consecutive series of plasma samples from 15 HCC cases were employed to compare the CP/X sequences before and after the occurrence of HCC. RESULTS T1762/A1764 double mutation was frequently found in Qidong patients, regardless of clinical status (65.5% in HCC and 73.2% in CH, P>0.05). Unexpectedly, the adjacent T1766/A1768 mutation significantly increased the risk of HCC (P<0.05). Moreover, the prevalence of triple mutations in BCP was significantly higher in patients with HCC than those with CH (P<0.05). The longitudinal study demonstrated that the mutations in BCP were gradually accumulated during the development of HCC. Colony formation assay showed while A1764 mutation alone did not alter the colony-inhibitory activity of HBx, double or triple mutations largely abrogated this effect. CONCLUSIONS The complex mutation involving T1766/A1768 was closely related to HCC. The enhanced risk of HCC caused by BCP variants could be attributable partially to the aberrant activity of HBx.
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Affiliation(s)
- Xia Guo
- National Laboratory of Oncogene and Related Genes, Cancer Institute of Shanghai Jiao-Tong University, School of Medicine, Shanghai 200032, China
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High prevalence of hepatitis B virus pre-S mutation and its association with hepatocellular carcinoma in Qidong, China. Arch Virol 2008; 153:1807-12. [DOI: 10.1007/s00705-008-0176-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 07/14/2008] [Indexed: 02/07/2023]
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