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Identification of a new hepatitis B virus recombinant D2/D3 in the city of São Paulo, Brazil. Arch Virol 2016; 162:457-467. [PMID: 27787680 DOI: 10.1007/s00705-016-3122-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/13/2016] [Indexed: 02/07/2023]
Abstract
Two hundred forty million people are chronically infected with hepatitis B virus (HBV) worldwide. The rise of globalization has facilitated the emergence of novel HBV recombinants and genotypes. We evaluated HBV genotypes and recombinants, mutations associated with resistance to antivirals (AVs), progression of hepatic illness, and inefficient hepatitis B vaccination responses in chronically infected individuals in the city of São Paulo, Brazil. Forty-five full-length and 24 partial-length sequences were obtained. The genotype distribution was as follows: A (66.7%), D (15.9%), F (11.6%) and C (4.3%). We describe a new recombinant (D2/D3), confirmed through next-generation sequencing (NGS) and reconstruction of the quasispecies sequences in silico. Primary resistance and major vaccine escape mutations were not found. We did, however, find mutations in the S region that might may be related to HBV antigenicity changes, as well as Pre-S deletions. The precore/core mutations A1762T + G1764A (40.9%) were found mostly in genotypes A and D, and G1896A (29.55%) was more frequent in genotype D than in genotype A. The genotypic distribution reflects the history of Brazilian immigration. This is the first description of recombination between genotypes D2 and D3 in Brazil. It is also the first confirmation through NGS and reconstruction of the quasispecies in silico. However, little is known about the response to treatment of recombinants. This demonstrates the need for molecular epidemiology studies involving the analysis of full-length HBV sequences.
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Zhand S, Karami C, Hosseinzadeh Adli A, Tabarraei A, Khodabakhshi B, Moradi A. Correlation Between Hepatitis B G1896A Precore Mutations and HBeAg in Chronic HBV Patients. Jundishapur J Microbiol 2015; 8:e17126. [PMID: 25825644 PMCID: PMC4376977 DOI: 10.5812/jjm.17126] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 07/14/2014] [Accepted: 09/27/2014] [Indexed: 02/06/2023] Open
Abstract
Background: Hepatitis B virus (HBV) infection is an important health concern worldwide, with critical outcomes. Hepatitis B e antigen (HBeAg) negative chronic hepatitis B is frequently caused by a mutation (G1896A) in the hepatitis B virus (HBV) precore (PC) reading frame, which creates a stop codon, causing premature termination of the HBe protein. Objectives: This study aimed to investigate the G1896A PC mutation and its effect on HBeAg detection in chronic HBV patients. Patients and Methods: In this study, 120 chronic HBV patients neither vaccinated or who had benefited from immunoglobulin therapy, were recruited. The HBV-DNA was extracted from plasma and polymerase chain reaction (PCR) was performed. Positive PCR products were subjected to automated sequencing. The HBV serological markers [hepatitis B s antigen (HBsAg), HBeAg] were tested. Results: One hundred out of 120 (83.3%) patients were HBeAg negative and 100% were HBsAg positive. The comparison of nucleotide sequences with the reference sequence (Accession number: AB033559) in HBeAg negative patients showed that there was a high rate of mutations in G1896A (93.18%). Conclusions: This study indicates that the rate of G1896A mutation at the PC region among HBeAg negative patients, in the Golestan province of Iran, was similar to the average rate encountered in other parts of Iran. The PC stop codon mutation was detected in 93.18% of HBeAg negative patients. Further studies with larger sample sizes are required to elucidate the exact role of these mutations in the clinical course of chronic HBV infection.
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Affiliation(s)
- Sareh Zhand
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Chiman Karami
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Ahmad Hosseinzadeh Adli
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Alijan Tabarraei
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Behnaz Khodabakhshi
- Infectious Diseases Research Centre, Golestan University of Medical Sciences, Gorgan, IR Iran
| | - Abdolvahab Moradi
- Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, IR Iran
- Corresponding author: Abdolvahab Moradi, Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, IR Iran. Tel: +98-9111772107, Fax: + 98-1714440225, E-mail:
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Bonvicino CR, Moreira MA, Soares MA. Hepatitis B virus lineages in mammalian hosts: Potential for bidirectional cross-species transmission. World J Gastroenterol 2014; 20:7665-7674. [PMID: 24976704 PMCID: PMC4069295 DOI: 10.3748/wjg.v20.i24.7665] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/30/2013] [Accepted: 03/13/2014] [Indexed: 02/06/2023] Open
Abstract
The hepatitis B virus (HBV) is a cosmopolitan infectious agent currently affecting over 350 million people worldwide, presently accounting for more than two billion infections. In addition to man, other hepatitis virus strains infect species of several mammalian families of the Primates, Rodentia and Chiroptera orders, in addition to birds. The mounting evidence of HBV infection in African, Asian and neotropical primates draws attention to the potential cross-species, zoonotic transmission of these viruses to man. Moreover, recent evidence also suggests the humans may also function as a source of viral infection to other mammals, particularly to domestic animals like poultry and swine. In this review, we list all evidence of HBV and HBV-like infection of nonhuman mammals and discuss their potential roles as donors or recipients of these viruses to humans and to other closely-related species.
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Moradi A, Zhand S, Ghaemi A, Javid N, Bazouri M, Tabarraei A. Mutations in pre-core and basal-core promoter regions of hepatitis B virus in chronic HBV patients from Golestan, Iran. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2014; 17:370-7. [PMID: 24967066 PMCID: PMC4069846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 10/05/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES It has been reported that the mutation of the pre-core (PC) and basal-core promoter (BCP) may play an important role in the development of HBV-related hepatocellular carcinoma (HCC). In this study the PC and BCP mutations were investigated in chronic HBV patients. MATERIALS AND METHODS In this study, 120 chronic HBV patients from Golestan, Northeast of Iran who were not vaccinated against HBV, were recruited from the year 2008 to 2012. HBV-DNA extraction from plasma and PCR were performed and positive PCR products were subjected to automated sequencing. RESULTS One hundred out of 120 (83.3%) patients were HBeAg negative. Comparison of our nucleotide sequences with reference sequence showed high rate mutation in BCP and PC region (96.66%). Frame shift mutation was found in 78 (65%) of patients in BCP region, among them 8 (6.6%) patients showed mutation in PC region. CONCLUSION Our results demonstrated high rate of mutations in BCP and PC regions among HBV chronic patients in Northeast of Iran.
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Affiliation(s)
- Abdolvahab Moradi
- Infectious Diseases Research Center, Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Sareh Zhand
- Infectious Diseases Research Center, Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Amir Ghaemi
- Infectious Diseases Research Center, Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Naeme Javid
- Infectious Diseases Research Center, Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Masoud Bazouri
- Infectious Diseases Research Center, Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Alijan Tabarraei
- Infectious Diseases Research Center, Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran,Corresponding author: AlijanTabarraei. Infectious Diseases Research Centre, Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran. Tel: +98-9112733321; +98-171-4421289; Fax: +98-171-4440225; ;
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Eloy AMX, Moreira RC, Lemos MF, de Almeida Silva JL, Coêlho MRCD. Hepatitis B virus in the State of Alagoas, Brazil: genotypes characterization and mutations of the precore and basal core promoter regions. Braz J Infect Dis 2013; 17:704-6. [PMID: 24021712 PMCID: PMC9427428 DOI: 10.1016/j.bjid.2013.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/19/2013] [Accepted: 03/21/2013] [Indexed: 12/18/2022] Open
Abstract
The aims of this study were to investigate the genotypes of hepatitis B virus and to identify the precore G1896A and basal core promoter A1762T/G1764A mutations in HBsAg and anti-HBc-positive patients. Eighty-three asymptomatic individuals, three with acute hepatitis B and 33 with chronic hepatitis B referred to viral hepatitis centers in the State of Alagoas, Brazil were analyzed according to their viral load, HBeAg/anti-HBe profile and alanine aminotransferase serum level. The genotypes identified were: A (92.5%), C (5%), D (1.25%) and F (1.25%). The precore mutation was detected in 3.8% of sequences and basal core promoter mutation in 52.4%. These were identified in 45.45% of the asymptomatic individuals and 54.55% of the patients with chronic hepatitis, irrespective of viral load and alanine aminotransferase serum level. In genotype C, only the basal core promoter mutation was identified and no mutations were identified in genotypes D and F.
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Affiliation(s)
- Alba Maria Xavier Eloy
- Institute of Biological and Health Sciences (ICBS), Universidade Federal de Alagoas (UFAL), Maceió, AL, Brazil
- Clinical Analysis Laboratory, Prof. Alberto Antunes University Hospital, UFAL, Maceió, AL, Brazil
| | | | | | - Jéfferson Luis de Almeida Silva
- Virology Sector, Keizo Asami Immunopathology Laboratory (LIKA), Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Maria Rosângela Cunha Duarte Coêlho
- Virology Sector, Keizo Asami Immunopathology Laboratory (LIKA), Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
- Department of Physiology and Pharmacology, UFPE, Recife, PE, Brazil
- Corresponding author at: Rua Manuel Lubambo, 118, Afogados, Recife, PE 50850-040, Brazil.
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Compri AP, Miura I, Porta G, Lemos MF, Saraceni CP, Moreira RC. Hepatitis B virus infection in children, adolescents, and their relatives: genotype distribution and precore and core gene mutations. Rev Soc Bras Med Trop 2012; 45:301-4. [PMID: 22760125 DOI: 10.1590/s0037-86822012000300004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 09/08/2011] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The objectives of this study were evaluate hepatitis B virus (HBV) serological markers in children and adolescents followed up at the Child Institute of the Hospital das Clínicas, Faculdade de Medicina de São Paulo, Universidade de São Paulo; identify chronic HBV carriers and susceptible individuals in the intrafamilial environment; characterize HBV genotypes; and identify mutations in the patients and household contacts. METHODS Ninety-five hepatitis B surface antigen-positive children aged <19 years and 118 household contacts were enrolled in this study. Commercial kits were used for the detection of serological markers, and PCR was used for genotyping. RESULTS Hepatitis B e antigen (HBeAg) was detected in 66.3% (63/95) of cases. Three of the 30 HBeAg-negative and anti-HBeAg-positive patients presented with precore mutations and 11 presented with mutations in the basal core promoter (BCP). Genotype A was identified in 39 (43.8%) patients, genotype D in 45 (50.6%), and genotype C in 5 (5.6%). Of the 118 relatives, 40 were chronic HBV carriers, 52 presented with the anti-HBc marker, 19 were vaccinated, and 7 were susceptible. Among the relatives, genotypes A, D, and C were the most frequent. One parent presented with a precore mutation and 4 presented with BCP mutations. CONCLUSIONS Genotypes A and D were the most frequent among children, adolescents, and their relatives. The high prevalence of HBV in the families showed the possibility of its intrafamilial transmission.
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Cortes-Mancera F, Loureiro CL, Hoyos S, Restrepo JC, Correa G, Jaramillo S, Norder H, Pujol FH, Navas MC. Etiology and Viral Genotype in Patients with End-Stage Liver Diseases admitted to a Hepatology Unit in Colombia. HEPATITIS RESEARCH AND TREATMENT 2011; 2011:363205. [PMID: 21941645 PMCID: PMC3177233 DOI: 10.1155/2011/363205] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 07/21/2011] [Indexed: 12/11/2022]
Abstract
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the principal risk factor associated to end-stage liver diseases in the world. A study was carried out on end-stage liver disease cases admitted to an important hepatology unit in Medellin, the second largest city in Colombia. From 131 patients recruited in this prospective study, 71% of cases were diagnosed as cirrhosis, 12.2% as HCC, and 16.8% as cirrhosis and HCC. Regarding the risk factors of these patients, alcohol consumption was the most frequent (37.4%), followed by viral etiology (17.6%). Blood and/or hepatic tissue samples from patients with serological markers for HCV or HBV infection were characterized; on the basis of the phylogenetic analysis of HCV 5' UTR and HBV S gene, isolates belonged to HCV/1 and HBV/F3, respectively. These results confirm the presence of strains associated with poor clinical outcome, in patients with liver disease in Colombia; additionally, HBV basal core promoter double mutant was identified in HCC cases. Here we show the first study of cirrhosis and/or HCC in Colombian and HBV and HCV molecular characterization of these patients. Viral aetiology was not the main risk factor in this cohort but alcohol consumption.
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Affiliation(s)
- Fabian Cortes-Mancera
- Grupo de Gastrohepatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Instituto Tecnológico Metropolitano (ITM), Institución Universitaria Adscrita a la Alcaldía de Medellín, Medellín 549 59, Colombia
| | - Carmen Luisa Loureiro
- Laboratorio de Virología Molecular, CMBC, Instituto Venezolano de Investigaciones Científicas, Apdo. 20632, Caracas 1020A, Venezuela, Caracas, Venezuela
| | - Sergio Hoyos
- Grupo de Gastrohepatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Unidad de Hepatología y Trasplante Hepático, Hospital Pablo Tobón Uribe (HPTU), Calle 78B 69-240, Medellín, Colombia
| | - Juan-Carlos Restrepo
- Grupo de Gastrohepatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Unidad de Hepatología y Trasplante Hepático, Hospital Pablo Tobón Uribe (HPTU), Calle 78B 69-240, Medellín, Colombia
| | - Gonzalo Correa
- Grupo de Gastrohepatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Unidad de Hepatología y Trasplante Hepático, Hospital Pablo Tobón Uribe (HPTU), Calle 78B 69-240, Medellín, Colombia
| | - Sergio Jaramillo
- Grupo de Gastrohepatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Unidad de Hepatología y Trasplante Hepático, Hospital Pablo Tobón Uribe (HPTU), Calle 78B 69-240, Medellín, Colombia
| | - Helene Norder
- Department of Virology, Swedish Institute for Infectious Disease Control, 171 82 Solna, Sweden
| | - Flor Helene Pujol
- Laboratorio de Virología Molecular, CMBC, Instituto Venezolano de Investigaciones Científicas, Apdo. 20632, Caracas 1020A, Venezuela, Caracas, Venezuela
| | - Maria-Cristina Navas
- Grupo de Gastrohepatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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Becker CE, Mattos AAD, Bogo MR, Branco F, Sitnik R, Kretzmann NA. Genotyping of hepatitis B virus in a cohort of patients evaluated in a hospital of Porto Alegre, South of Brazil. ARQUIVOS DE GASTROENTEROLOGIA 2010; 47:13-7. [PMID: 20520969 DOI: 10.1590/s0004-28032010000100003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 06/23/2009] [Indexed: 01/05/2023]
Abstract
CONTEXT In recent years the hepatitis B virus (HBV) genotyping has been considered a relevant factor in the natural history of the disease. OBJECTIVE To determine hepatitis B virus genotypes and its epidemiological and clinical implications, in a cohort of patients in a hospital in Porto Alegre, South of Brazil. METHODS Sixty seven patients with HBV chronic infection markers who were being treated at ''Complexo Hospitalar Santa Casa'', in Porto Alegre, RS, Brazil, were evaluated. Demographic and epidemiological data were collected from these group of patients by following a standard protocol and ALT and HBeAg were determined. The genotypes and subtypes were determined by in-house PCR and, finally, the samples were sequenced. The level of significance used was 5%. RESULTS The qualitative analysis for HBV-DNA by PCR was positive in 79.1% of the samples (53/67). The genotype was determined in all positive VHB-DNA samples and the genotypes A (34%), D (60.4%) and F (5.4%) as well as the subtypes adw, ayw and adw4 were found. No significant correlation was found between the hepatitis B virus genotypes and demographic variables considered as risk factors for hepatitis B virus infection. There was also no correlation between the genotypes and the serological and laboratory variables related to liver disease. CONCLUSION We concluded that the most prevalent genotype found was D. However, further studies are needed to allow us to evaluate the implications of genetic variability in the clinical evolution of HBV carriers.
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Affiliation(s)
- Carlos Eduardo Becker
- Pos-Graduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
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Alfaresi M, Elkoush A, Alshehhi H, Alzaabi A, Islam A. Hepatitis B virus genotypes and precore and core mutants in UAE patients. Virol J 2010; 7:160. [PMID: 20633273 PMCID: PMC2913959 DOI: 10.1186/1743-422x-7-160] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 07/15/2010] [Indexed: 01/04/2023] Open
Abstract
Background Knowledge of the HBV genotype with which a patient is infected is crucial information for a physician to have when planning clinical treatment for that patient. Previous studies have suggested that there are possible differences in the pathogenicity and therapeutic response of different HBV genotypes. However, the prevalence of the various HBV genotypes and Precore and Core mutations is unknown in the UAE. Therefore, we sought to determine the prevalence of the different HBV genotypes in the UAE population. Methodology/Principal Findings A total of 88 HBsAg-positive patients were included in the study. A method for genotyping and subtyping HBV by partial HBsAg gene sequencing using primers that are complementary to all known genotypes was used. Precore and core region of these viruses were also sequenced in 88 patients. HBV genotype D was the most prevalent (79.5%) genotype identified in our study population, followed by genotypes A (18.2%) and C (2.3%). The following subtypes were isolated: ayw2 (80.7%), adw2 (14.8%), and adw (2.3%). The HBV-DNA viral load was higher in HBeAg-positive patients than it was in patients who were HBeAg-negative. Precore mutants were found in 51 (58.0%) of 88 patients. Mutations in the basal core promotor were found in 22 (25.3%) of 88 patients. Conclusion/Significance HBV infection is a major health problem in the UAE, and while genotypes B and C are the most prevalent HBV genotypes in the Asian population, our study reveals that genotype D is the predominant genotype that is present in the UAE. More patients were HBeAg-negative than were HBeAg-positive in our study sample, which could be due to the duration of infection of the included patients. Additionally, the viral loads of the HBeAg-positive patients were higher those of the HBeAg-negative patients. Analysis of nucleotide 1858 showed presence of thymine in all patients with genotypes C, and D and in a few patients with genotypes A. This nucleotide was closely related to the presence of precore mutants. Mutations in the basal core promoter were found in 22 of 88 (25.3%) samples. These mutations were more frequent in patients infected with genotype A (37.5%) and not found in patients infected with genotype C.
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Affiliation(s)
- Mubarak Alfaresi
- Department of Pathology &Laboratory Medicine, Zayed Military Hospital, Abu Dhabi, UAE.
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Bagaglio S, Albarello L, Biswas P, Uberti-Foppa C, Fortis C, Morsica G. Virological pattern of hepatitis B infection in an HIV-positive man with fatal fulminant hepatitis B: a case report. J Med Case Rep 2009; 3:110. [PMID: 19946588 PMCID: PMC2783051 DOI: 10.1186/1752-1947-3-110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 11/09/2009] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION There seem to be no published data concerning the clinical impact of populations of hepatitis B virus (HBV) in the hepatic and extrahepatic compartments of HIV-infected people with severe acute hepatitis. CASE PRESENTATION A 26-year-old Caucasian man presenting to our hospital with clinical symptoms suggesting acute hepatitis was found to have an acute hepatitis B profile upon admission. He developed fatal fulminant hepatitis and was found to be heavily immunocompromised due to HIV-1 infection. He had a high plasma HBV and HIV load, and analysis of the partial pre-S1/pre-S2 domain showed the presence of mixed infection with D and F genotypes. Analysis of the point mutations within this region revealed the presence of HBV strains with amino acid substitutions at the immunodominant epitopes involved in B or T cell recognition. A homogeneous population of a pre-core mutant strain harbouring the A1896G and A1899G affecting HBeAg expression was invariably found in the liver tissue, plasma and peripheral blood mononuclear cells despite active HBeAg secretion; it was the dominant strain in the liver only, and was characterised by the presence of two point mutations in the direct repeat 1 domain involved in HBV replication activity. Taken together, these mutations are indicative of a highly replicative virus capable of evading immune responses. CONCLUSION This case report provides clinical evidence of a possible association between the rapid spread of highly replicative escape mutants and the development of fulminant hepatitis in a heavily immunocompromised patient. Virological surveillance of severe acute hepatitis B may be important in establishing an early treatment strategy involving antiviral drugs capable of preventing liver failure, especially in individuals for whom liver transplantation is not accepted as a standard indication.
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Affiliation(s)
- Sabrina Bagaglio
- Infectious Diseases Department, San Raffaele, Scientific Institute, Via Stamira d'Ancona, Milano 20127, Italy
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Andernach IE, Hübschen JM, Muller CP. Hepatitis B virus: the genotype E puzzle. Rev Med Virol 2009; 19:231-40. [PMID: 19475565 DOI: 10.1002/rmv.618] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hepatitis B virus (HBV) is highly endemic throughout sub-Saharan Africa. One of the two genotypes A and E dominates in most countries. With several subgenotypes and variants, genotype A is more diverse in Africa (4.00%) than in the rest of the world (2.96%), suggesting an African origin and a long history on the continent. Despite the African slave trade, genotype E has only sporadically been found within the Americas, indicating that this genotype was introduced only during the past 200 years into the general African population. A short history for this genotype in Africa is also supported by its conspicuously low genetic diversity (1.75%), which contrasts, however, with its excessively high HBsAg prevalence and its extensive spread throughout the vast West-African genotype E crescent. We discuss the spread and routes of transmission of genotype E and suggest that the distribution and current high prevalence levels of HBV (genotype E) in Africa are the result of the extensive use of unsafe needles, potentially solving the current African genotype E puzzle and shedding new light on the high HBV prevalence in Africa.
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Affiliation(s)
- Iris E Andernach
- Institute of Immunology, Laboratoire National de Santé/CRP Santé, 20A rue Auguste Lumière, L-1950 Luxembourg, Luxembourg
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Mello FCA, Souto FJD, Nabuco LC, Villela-Nogueira CA, Coelho HSM, Franz HCF, Saraiva JCP, Virgolino HA, Motta-Castro ARC, Melo MMM, Martins RMB, Gomes SA. Hepatitis B virus genotypes circulating in Brazil: molecular characterization of genotype F isolates. BMC Microbiol 2007; 7:103. [PMID: 18036224 PMCID: PMC2231365 DOI: 10.1186/1471-2180-7-103] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 11/23/2007] [Indexed: 12/13/2022] Open
Abstract
Background Hepatitis B virus (HBV) isolates have been classified in eight genotypes, A to H, which exhibit distinct geographical distributions. Genotypes A, D and F are predominant in Brazil, a country formed by a miscegenated population, where the proportion of individuals from Caucasian, Amerindian and African origins varies by region. Genotype F, which is the most divergent, is considered indigenous to the Americas. A systematic molecular characterization of HBV isolates from different parts of the world would be invaluable in establishing HBV evolutionary origins and dispersion patterns. A large-scale study is needed to map the region-by-region distribution of the HBV genotypes in Brazil. Results Genotyping by PCR-RFLP of 303 HBV isolates from HBsAg-positive blood donors showed that at least two of the three genotypes, A, D, and F, co-circulate in each of the five geographic regions of Brazil. No other genotypes were identified. Overall, genotype A was most prevalent (48.5%), and most of these isolates were classified as subgenotype A1 (138/153; 90.2%). Genotype D was the most common genotype in the South (84.2%) and Central (47.6%) regions. The prevalence of genotype F was low (13%) countrywide. Nucleotide sequencing of the S gene and a phylogenetic analysis of 32 HBV genotype F isolates showed that a great majority (28/32; 87.5%) belonged to subgenotype F2, cluster II. The deduced serotype of 31 of 32 F isolates was adw4. The remaining isolate showed a leucine-to-isoleucine substitution at position 127. Conclusion The presence of genotypes A, D and F, and the absence of other genotypes in a large cohort of HBV infected individuals may reflect the ethnic origins of the Brazilian population. The high prevalence of isolates from subgenotype A1 (of African origin) indicates that the African influx during the colonial slavery period had a major impact on the circulation of HBV genotype A currently found in Brazil. Although most genotype F isolates belonged to cluster II, the presence of some isolates belonging to clusters I (subgroup Ib) and IV suggests the existence of two or more founder viral populations of genotype F in Brazil.
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Affiliation(s)
- Francisco C A Mello
- Laboratório de Virologia Molecular, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
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Bahri O, Cheikh I, Hajji N, Djebbi A, Maamouri N, Sadraoui A, Mami NB, Triki H. Hepatitis B genotypes, precore and core promoter mutants circulating in Tunisia. J Med Virol 2006; 78:353-7. [PMID: 16419125 DOI: 10.1002/jmv.20554] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hepatitis B virus (HBV) is characterized by genetic heterogeneity, including genotypes and mutations. Eight genotypes (A-H) have been identified throughout the world with a characteristic geographical distribution. Previous studies also suggest that the viral genotypes may correlate with differences in clinical features of the infection. Two types of mutations were particularly described, precore and basal promoter mutations; they may play an important role in the clinical outcome of HBV infection. The aim of this study was to investigate the prevalence of HBV genotypes and HBV variants in Tunisia, and their eventual association with severity of liver disease. Using a molecular method, HBV genotypes, precore and basal core promoter mutations were determined in 56 asymptomatic carriers and in 82 patients with histologically verified chronic liver disease and hepatocellular carcinoma (HCC). Three genotypes (D, A, and E) were detected; the prevalence was 80%, 8%, and 9%, respectively. No significant difference was observed for genotype D with clinical status. HBV mutants were detected in 93% of cases, precore mutants were the most prevalent. Basal core promoter mutants were observed in 61% of cases, they were frequently characterized by a double mutation in 1762 and 1764. Co-infection by these two types of mutants was detected in 50% of cases. Genotype D was the most prevalent HBV genotype in Tunisia. High circulation of precore and basal core promoter mutants are common in chronic hepatitis B infection in Tunisia.
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Affiliation(s)
- O Bahri
- Laboratory of Clinical Virology, Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia.
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14
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Thakeb F, El-Serafy M, Zakaria S, Monir B, Lashin S, Marzaban R, El-Awady M. Evaluation of liver tissue by polymerase chain reaction for hepatitis B virus in patients with negative viremia. World J Gastroenterol 2005; 11:6853-7. [PMID: 16425396 PMCID: PMC4725047 DOI: 10.3748/wjg.v11.i43.6853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinical significance of Hepatitis B virus (HBV) DNA localization in the liver tissue of patients with positive HBsAg and negative viremia.
METHODS: HBV virological parameters of 33 HBsAg positive chronic hepatitis patients, including seromarkers and HBV DNA amplification in both sera and liver biopsies, were evaluated.
RESULTS: Ten patients had negative viremia and positive HBV DNA in their liver biopsies. Most of them had HBeAg-negative/HBeAb-positive chronic hepatitis. Their liver biochemical and histopathological profiles were different from the viremic patients. Their disease pattern was designated as “hepatitis B in situ”.
CONCLUSION: Hepatitis B in situ is a consequential entity which can be missed in clinical practice. It is a new clinical pattern of chronic HBV infection that considers HBV in liver biopsy and adds a new indication for antiviral therapy.
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Affiliation(s)
- Fouad Thakeb
- Tropical Medicine Department, Cairo University, Cairo, Egypt
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15
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Abstract
Hepatitis B Virus (HBV) genotypes have come of age. The concept that HBV genotypes may influence the course of disease and relevant biological differences has now been recognised. However, there are still major gaps in our knowledge. Most clinical data come from Asia and describe findings in patients infected with genotypes B and C. Large scale studies with genotypes A and D as found in Europe or A, D and E from Africa are urgently needed to broaden our understanding. Experimental data which explain in vivo findings in terms of differences in molecular biology in vitro are still in the beginning. The succeeding years will see many interesting studies which will aid our understanding of how variants and genotypes of HBV influence the spectrum of disease in people infected with HBV.
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Affiliation(s)
- S Schaefer
- Abteilung Virologie, Institut für Mikrobiologie, Universität Rostock, Rostock, Germany.
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16
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Kramvis A, Kew M, François G. Hepatitis B virus genotypes. Vaccine 2005; 23:2409-23. [PMID: 15752827 DOI: 10.1016/j.vaccine.2004.10.045] [Citation(s) in RCA: 255] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Revised: 09/27/2004] [Accepted: 10/14/2004] [Indexed: 12/17/2022]
Abstract
Eight genotypes of hepatitis B virus (A-H) are currently recognized, and subgenotypes have recently been described in four of these genotypes (A, B, C and F). The genotypes show a distinct geographical distribution between and even within regions, and are proving to be an invaluable tool in tracing the molecular evolution and patterns and modes of spread of hepatitis B virus. Structural and functional differences between genotypes can influence the severity, course and likelihood of complications, and response to treatment of hepatitis B virus infection and possibly vaccination against the virus. Although the number of studies on these genotypes has increased dramatically during recent years, much remains to be learnt about their full implications.
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Affiliation(s)
- Anna Kramvis
- MRC/University Molecular Hepatology Research Unit, Department of Medicine, University of the Witwatersrand Medical School, 7 York Road, Parktown, 2193 Johannesburg, South Africa.
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17
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Song LH, Duy DN, Binh VQ, Luty AJF, Kremsner PG, Bock CT. Low frequency of mutations in the X gene, core promoter and precore region of hepatitis B virus infected Vietnamese. J Viral Hepat 2005; 12:160-7. [PMID: 15720531 DOI: 10.1111/j.1365-2893.2005.00560.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Numerous mutations in the hepatitis B virus (HBV) genome have been described, but in most cases their role in the pathogenesis of HBV infection is still unclear. Therefore, we analysed specific mutations in HBV-infected Vietnamese patients and assessed their potential relationship with their clinical outcome. A total of 153 HBV-infected Vietnamese patients with well-characterised clinical profiles were enrolled. None of the study participants had a history of alcohol or drug use and none received any antiviral or immunosuppressive therapy before or during the course of this study. The HBx- and core promoter regions were analysed by sequencing. The majority of isolates corresponded to genotype A. The presence of hepatitis B e antigen (HBeAg) was associated with significantly higher viral loads in the chronic HBV-infection group (P = 0.026). Double mutations in the core promoter (1762/1764) were more frequent in those with cancer than in noncancer patients (P < 0.01). Mutations at nucleotide (nt) 1766/1773 were found at low prevalence but with no obvious association to clinical presentation. Cytosine at nt 1858 was predominant but the stop codon mutation in the precore region was not detected. In the study, 4/48 hepatocellular carcinoma (HCC) patients revealed truncated HBx, whilst the serine to alanine mutation (codon 31) of HBx was more prevalent in cancer patients than in asymptomatic HBV carriers (P < 0.01). Thus, the low frequency of mutations indicates the relation of the absence of antiviral pressure in this population. The exclusively found prevalence of certain mutations detected in those with HBV-related carcinoma nevertheless indicates a degree of association with disease progression.
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Affiliation(s)
- L H Song
- Department of Molecular Pathology, Institute of Pathology, University of Tuebingen, Tuebingen, Germany
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18
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França PHC, González JE, Munné MS, Brandão LH, Gouvea VS, Sablon E, Vanderborght BOM. Strong association between genotype F and hepatitis B virus (HBV) e antigen-negative variants among HBV-infected argentinean blood donors. J Clin Microbiol 2005; 42:5015-21. [PMID: 15528689 PMCID: PMC525202 DOI: 10.1128/jcm.42.11.5015-5021.2004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A number of reports have indicated an increased risk of cirrhosis and hepatocellular carcinoma in hepatitis B virus (HBV)-infected individuals carrying HBV e antigen (HBeAg)-negative variants. Although distinct core promoter and precore mutations distributed according to geographical locality and viral genotype have been reported, epidemiological data from South America are still scarce. The prevalences of HBV genotypes and core promoter and precore polymorphisms in 75 HBeAg-negative Argentinean blood donors were surveyed. The observed frequencies of HBV genotypes were 64.0% for genotype F, 17.3% each for genotypes A and D, and 1.3% for genotype C. Genotype F strains were widely distributed and significantly more prevalent in the northern region of the country (P < 0.001). An overall high proportion of a stop codon mutation (UAG) at precore codon 28 (66.7%) was observed. Wild-type codon 28 (UGG) was present in 29.3% of the samples, and the remaining 4.0% of samples had mixed variants. The combination of A at nucleotide (nt) 1762 and G at nt 1764 of the core promoter was found in 58.7% of the samples. The variant profiles--T at nt 1762 and A at nt 1764 or A at nt 1762 and A at nt 1764--were detected in 28.0 and 1.3% of the samples, respectively. The observed core promoter polymorphisms could not be related to the ratio of HBeAg to anti-HBeAg antibody, HBV genotype, or precore codon 28 status. Nevertheless, a clear association of genotype F and a precore stop codon mutation was found (P < 0.05). In conclusion, HBV genotype F and mutant codon 28 strains predominated and were strongly associated in a geographically broad Argentinean blood donor population.
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Affiliation(s)
- Paulo H C França
- Departmento de Virologia, Instituto de Microbiologia, Rio de Janeiro, Brazil
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19
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Sun X, Rokuhara A, Tanaka E, Gad A, Mutou H, Matsumoto A, Yoshizawa K, Kiyosawa K. Nucleotide mutations associated with hepatitis B e antigen negativity. J Med Virol 2005; 76:170-5. [PMID: 15834874 DOI: 10.1002/jmv.20340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
One hundred and forty four patients with chronic hepatitis B were tested to identify new mutations associated with hepatitis B e antigen (HBeAg) negativity, using a full genome sequence analysis. All the patients were Chinese and had hepatitis B virus infection of genotype C. Patients with none of the pre-core or core promoter mutations were significantly (P < 0.001) less common in the group with anti-HBe (13%) than in the group with HBeAg (56%). The complete nucleotide sequence was determined in four anti-HBe-positive patients who had neither pre-core nor core promoter mutations and in five HBeAg-positive patients who also had neither of these mutations (the groups were matched for age and sex). Six mutations were found to be significantly more common in the former group than in the latter: G529A (3/4 vs. 0/5), C934A (4/4 vs. 1/5), A1053G (4/4 vs. 1/5), G1915T/A (4/4 vs. 0/5), T2005C/A (4/4 vs. 0/5), and C3026T (3/4 vs. 0/5). Three of the six mutations were significantly more common in the four anti-HBe-positive patients who had neither pre-core nor core promoter mutations, compared to 11 HBeAg-positive patients who had pre-core and core promoter mutations, and also compared to 15 anti-HBe-positive patients who had pre-core and core promoter mutations, suggesting further the specificity of these mutations. Of the six mutations, two resulted in amino acid substitution in the polymerase protein, and one is located near the enhancer I region. The results suggest that the six newly discovered mutations are associated with HBeAg negativity.
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Affiliation(s)
- XiaoHong Sun
- Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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20
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Sitnik R, Pinho JRR, Bertolini DA, Bernardini AP, Da Silva LC, Carrilho FJ. Hepatitis B virus genotypes and precore and core mutants in Brazilian patients. J Clin Microbiol 2004; 42:2455-60. [PMID: 15184419 PMCID: PMC427827 DOI: 10.1128/jcm.42.6.2455-2460.2004] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2003] [Revised: 02/08/2004] [Accepted: 03/02/2004] [Indexed: 02/06/2023] Open
Abstract
A method for genotyping hepatitis B virus by partial HBsAg gene sequencing with primers common to all known genotypes was developed. Mutations related to anti-HBs resistance are also detected with this method. Samples from 103 Brazilian patients were analyzed. Precore and core region of these viruses were also sequenced in 101 patients. Genotypes A, B, C, D, and F were found with frequencies of 49.5, 2.9, 13.6, 24.3, and 9.7%, respectively. Genotypes B and C were found only in Asian patients, whereas genotypes A, D, and F were more common in patients without an Asian background. Precore mutants were found in 32 (31.7%) of 101 patients, with a higher frequency in those infected with genotype D (22 of 25 [88.0%]). Analysis of nucleotide 1858 showed presence of thymine in all patients with genotypes B, C, and D and in a few patients with genotypes A (10.0%) and F (30.0%), who showed more frequently the presence of cytosine. This nucleotide was closely related to the presence of precore mutants. Mutations in the basal core promoter were found in 64 of 101 (63.4%) samples. These mutations were more frequent in patients infected with genotype F (90.0%) and less frequent in patients infected with genotype B (33.3%). Deletions in this region were found in two genotype C-infected patients.
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Affiliation(s)
- Roberta Sitnik
- Serviço de Virologia, Instituto Adolfo Lutz, Av. Brigadeiro Luiz Antonio, 4701, 01401-002 São Paulo, SP, Brazil
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21
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Gomes SA, de Castro L, Niel C, Santos EA. Uncommon mutation pattern of a hepatitis B virus isolate from genotype F infecting a patient with AIDS. J Infect 2004; 48:102-8. [PMID: 14667799 DOI: 10.1016/s0163-4453(03)00126-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To study the genomic variations of a hepatitis B virus (HBV) isolate in a patient coinfected with human immunodeficiency virus type 1 (HIV-1) who developed severe hepatitis and died of AIDS. METHODS Two blood samples were collected, the first one during the asymptomatic phase of HIV-1 infection, and the other, 3 years later, few months before the death of the patient. Both samples were HBsAg and anti-HBe positive. Pre-S/S and precore-core genome regions were PCR amplified and analyzed. RESULTS The HBV isolate belonged to genotype F, cluster IV. A number of unique amino acid substitutions were found in the surface antigen gene and the overlapping polymerase coding region of HBV genomes derived from both samples. However, these substitutions reflected natural variations rather than mutations of clinical significance. The precore stop codon mutation A(1896) was present in both genomes. Furthermore, the HBV genome derived from the second, but not first sample, showed two out-of-frame core interval deletions, one and 103 nucleotides in length, respectively. CONCLUSIONS This is the first report of an HBV isolate from genotype F with core internal deletions. Our results suggest an association between specific core mutations and the severe hepatitis developed by the patient.
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Affiliation(s)
- S A Gomes
- Department of Virology, Oswaldo Cruz Institute, Rio de Janeiro, Brazil.
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22
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Conde SRSDS, Móia LDJP, Barbosa MSB, Amaral IDSA, Miranda ECBDM, Soares MDCP, Brito EMDF, Souza ODSC, de Araújo MT, Demachki S, Rebello JRP, Mesquita MGS, Denis AB, Ishak R. Prevalência de genótipos e de mutantes pré-core A-1896 do vírus da hepatite B e suas implicações na hepatite crônica, em uma população da Amazônia oriental. Rev Soc Bras Med Trop 2004; 37 Suppl 2:33-9. [PMID: 15586894 DOI: 10.1590/s0037-86822004000700005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
A infecção pelo virus da hepatite B apresenta amplo espectro de manifestações clínicas. Objetivando conhecer os genótipos do HBV mais prevalentes e determinar a ocorrência da mutação pré-core A-1896, em uma população da Amazônia oriental, correlacionando com o diagnóstico clínico, foram selecionados 51 pacientes portadores crônicos de HBsAg e HBV-DNA positivos e divididos em três grupos: grupo A (n=14, pacientes assintomáticos); grupo B (n=20, sintomáticos HBeAg positivos) e grupo C (n=17, sintomáticos HBeAg negativos), sendo usado o sequenciador automático ABI modelo 377 para identificação de genótipos e mutantes pré-core. Os resultados evidenciaram o genótipo A como o mais prevalente, 81,8%, 89,5% e 93,7%, nos grupos A, B e C, respectivamente. A mutação pré-core A-1896 foi encontrada em 11,5% (3/26), sendo todos assintomáticos. Concluiu-se que na população estudada o genótipo A foi o mais prevalente e houve baixa ocorrência do mutante pré-core A-1896, ambos não se constituindo fatores agravantes da doença hepática.
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Norder H, Arauz-Ruiz P, Blitz L, Pujol FH, Echevarria JM, Magnius LO. The T(1858) variant predisposing to the precore stop mutation correlates with one of two major genotype F hepatitis B virus clades. J Gen Virol 2003; 84:2083-2087. [PMID: 12867638 DOI: 10.1099/vir.0.19034-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The precore mutation G(1896)-->A occurs frequently in anti-HBe-positive carriers of HBsAg with T(1858) in the stem of the encapsidation signal. Hepatitis B virus (HBV) genotype F, considered an Amerindian genotype, subdivides into two clades and the precore mutation occurs in Central American F strains. To investigate the relationship between substitutions at position 1858 and these clades, the precore and small S genes of 48 strains of HBV genotype F were subjected to phylogenetic analyses. Isolates of one clade, formed mainly of Central American strains, all had T(1858) and Thr(45) in the S gene, whereas in the other clade, formed mainly of South American strains and one strain from Polynesia, all had C(1858) and Leu(45). The latter strain was related to strains from Venezuela and Colombia, supporting an Amerindian contribution to the Polynesian population. The position of the Polynesian strain in the phylogenetic tree indicates that the two clades have resulted from an early split, showing a high degree of genetic stability of the stem of the HBsAg encapsidation signal.
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Affiliation(s)
- Heléne Norder
- Virological Department, Swedish Institute for Infectious Disease Control, S-171 82 Solna, Sweden
| | - Patricia Arauz-Ruiz
- Virological Department, Swedish Institute for Infectious Disease Control, S-171 82 Solna, Sweden
| | - Linda Blitz
- Laboratorio Regional de Referencia Virologica, Instituto de Investigaciones Clinicas, LUZ, Maracaibo, Venezuela
| | - Flor H Pujol
- Laboratorio de Virologia Molecular, CMBC, IVIC, Caracas, Venezuela
| | - José M Echevarria
- Centro Nacional de Microbiologia, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Lars O Magnius
- Virological Department, Swedish Institute for Infectious Disease Control, S-171 82 Solna, Sweden
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