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Wedemeyer H, Leus M, Battersby TR, Glenn J, Gordien E, Kamili S, Kapoor H, Kessler HH, Lenz O, Lütgehetmann M, Mixson-Hayden T, Simon CO, Thomson M, Westman G, Miller V, Terrault N, Lampertico P. HDV RNA assays: Performance characteristics, clinical utility, and challenges. Hepatology 2023:01515467-990000000-00551. [PMID: 37640384 DOI: 10.1097/hep.0000000000000584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 08/31/2023]
Abstract
Coinfection with HBV and HDV results in hepatitis D, the most severe form of chronic viral hepatitis, frequently leading to liver decompensation and HCC. Pegylated interferon alpha, the only treatment option for chronic hepatitis D for many years, has limited efficacy. New treatments are in advanced clinical development, with one recent approval. Diagnosis and antiviral treatment response monitoring are based on detection and quantification of HDV RNA. However, the development of reliable HDV RNA assays is challenged by viral heterogeneity (at least 8 different genotypes and several subgenotypes), intrahost viral diversity, rapid viral evolution, and distinct secondary structure features of HDV RNA. Different RNA extraction methodologies, primer/probe design for nucleic acid tests, lack of automation, and overall dearth of standardization across testing laboratories contribute to substantial variability in performance characteristics of research-based and commercial HDV RNA assays. A World Health Organization (WHO) standard for HDV RNA, available for about 10 years, has been used by many laboratories to determine the limit of detection of their assays and facilitates comparisons of RNA levels across study centers. Here we review challenges for robust pan genotype HDV RNA quantification, discuss particular clinical needs and the importance of reliable HDV RNA quantification in the context of drug development and patient monitoring. We summarize distinct technical features and performance characteristics of available HDV RNA assays. Finally, we provide considerations for the use of HDV RNA assays in the context of drug development and patient monitoring.
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Affiliation(s)
- Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- Excellence Cluster RESIST, Hannover Medical School, Hannover, Germany
- D-SOLVE: EU-funded Network on Individualized Management of Hepatitis D
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Braunschweig, Germany
| | - Mitchell Leus
- Forum for Collaborative Research, School of Public Health, University of California, Berkeley, Washington DC Campus, Washington, District of Columbia, USA
| | | | - Jeffrey Glenn
- Departments of Medicine (Division of Gastroenterology and Hepatology) and Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Emmanuel Gordien
- Laboratoire de microbiologie clinique, Centre National de Référence pour les virus des hépatites B, C et Delta, Hôpital Avicenne Assistance Publique - Hôpitaux de Paris, Bobigny, France
| | - Saleem Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hema Kapoor
- Ex Quest Diagnostics, HK Healthcare Consultant LLC, Secaucus, New Jersey, USA
| | - Harald H Kessler
- Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz, Graz, Austria
| | - Oliver Lenz
- Clinical Microbiology and Immunology, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Marc Lütgehetmann
- Institute for Microbiology, Virology and Hygiene, University Medical Center Hamburg Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg, Lübeck, Kiel, Germany
| | - Tonya Mixson-Hayden
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christian O Simon
- Clinical Development and Medical Affairs, Roche Diagnostics Solutions, Rotkreuz, Switzerland
| | - Michael Thomson
- Division of Antivirals, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Gabriel Westman
- Swedish Medical Products Agency, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Veronica Miller
- Forum for Collaborative Research, School of Public Health, University of California, Berkeley, Washington DC Campus, Washington, District of Columbia, USA
| | - Norah Terrault
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan, Milan, Italy
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Roca Suarez AA, Batbold E, Bartosch B, Dashdorj N, Testoni B, Zoulim F. Emerging anti-HDV drugs and HBV cure strategies with anti-HDV activity. Liver Int 2023; 43 Suppl 1:87-95. [PMID: 37017060 DOI: 10.1111/liv.15417] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/25/2022] [Accepted: 09/05/2022] [Indexed: 04/06/2023]
Abstract
Hepatitis delta virus (HDV) is a satellite RNA virus that requires the presence of hepatitis B virus (HBV) for its replication. HDV/HBV co-infection is often associated with a faster disease progression of chronic hepatitis in comparison to HBV mono-infection. Therefore, the development of novel antiviral therapies targeting HDV represents a high priority and an urgent medical need. In this review, we summarize the ongoing efforts to evaluate promising HDV-specific drugs, such as lonafarnib (LNF), pegylated interferon lambda (PEG-IFN-λ) and their use as a combination therapy. Furthermore, we review the most recent developments in the area of anti-HBV drugs with potential effects against HDV, including therapeutic agents targeting hepatitis B surface antigen (HBsAg) expression, secretion and function. Finally, we consider the important insights that have emerged from the development of these potential antiviral strategies, as well as the intriguing questions that remain to be elucidated in this rapidly changing field.
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Affiliation(s)
- Armando A Roca Suarez
- INSERM U1052, CNRS UMR-5286, Cancer Research Center of Lyon (CRCL), Lyon, France
- University of Lyon, Université Claude-Bernard (UCBL), Lyon, France
| | | | - Birke Bartosch
- INSERM U1052, CNRS UMR-5286, Cancer Research Center of Lyon (CRCL), Lyon, France
- University of Lyon, Université Claude-Bernard (UCBL), Lyon, France
| | | | - Barbara Testoni
- INSERM U1052, CNRS UMR-5286, Cancer Research Center of Lyon (CRCL), Lyon, France
- University of Lyon, Université Claude-Bernard (UCBL), Lyon, France
| | - Fabien Zoulim
- INSERM U1052, CNRS UMR-5286, Cancer Research Center of Lyon (CRCL), Lyon, France
- University of Lyon, Université Claude-Bernard (UCBL), Lyon, France
- Hospices Civils de Lyon (HCL), Lyon, France
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Brunetto MR, Ricco G, Negro F, Wedemeyer H, Yurdaydin C, Asselah T, Papatheodoridis G, Gheorghe L, Agarwal K, Farci P, Buti M. EASL Clinical Practice Guidelines on hepatitis delta virus. J Hepatol 2023; 79:433-460. [PMID: 37364791 DOI: 10.1016/j.jhep.2023.05.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 06/28/2023]
Abstract
Hepatitis D virus (HDV) is a defective virus that requires the hepatitis B virus to complete its life cycle and cause liver damage in humans. HDV is responsible for rare acute and chronic liver diseases and is considered the most aggressive hepatitis virus. Acute infection can cause acute liver failure, while persistent infection typically causes a severe form of chronic hepatitis which is associated with rapid and frequent progression to cirrhosis and its end-stage complications, hepatic decompensation and hepatocellular carcinoma. Major diagnostic and therapeutic innovations prompted the EASL Governing Board to commission specific Clinical Practice Guidelines on the identification, virologic and clinical characterisation, prognostic assessment, and appropriate clinical and therapeutic management of HDV-infected individuals.
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da Silva Queiroz JA, Roca TP, Souza RB, de Souza LFA, Passos-Silva AM, da Silva ALF, de Castro E Silva E, Borzacov LMP, de Cássia Pontello Rampazzo R, Dos Santos Pereira S, Dantas TO, Mazaro J, Villar LM, Salcedo JMV, da Matta DA, Vieira D. Development of quantitative multiplex RT-qPCR one step assay for detection of hepatitis delta virus. Sci Rep 2023; 13:12073. [PMID: 37495613 PMCID: PMC10372040 DOI: 10.1038/s41598-023-37756-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023] Open
Abstract
Hepatitis Delta is a disease caused by exposure to hepatitis B (HBV) and hepatitis D (HDV) viruses, usually with a more severe clinical outcome when compared to an HBV monoinfection. To date, the real prevalence of HDV infection is underestimated and detection methods are poorly available, especially in more endemic regions. Therefore, a one-step RT-qPCR method for quantification of HDV-RNA was developed. Biological samples were selected between 2017 and 2023 from patients at the Ambulatório Especializado em Hepatites Virais of the Centro de Pesquisa em Medicina Tropical de Rondônia and Serviço de Assistência Especializada and underwent the test developed by this study and a second quantitative RT-qPCR assay. The slope of the initial quantitative assay was - 3.321 with an efficiency of 100.04% and amplification factor equal to 2. Analysis of the repeatability data revealed a Limit of Quantification of 5 copies/reaction and Limit of Detection (95%) of 2.83 copies per reaction. In the diagnostic sensitivity tests, there was an accuracy of 97.37% when compared to the reference test. This assay proved to be highly efficient and reproducible, making it a valuable tool to monitor hepatitis Delta patients and assess the risk of disease progression, as well as the effectiveness of treatment.
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Affiliation(s)
- Jackson Alves da Silva Queiroz
- Fundação Oswaldo Cruz Rondônia FIOCRUZ/RO, Rua da Beira, 7176, Porto Velho, 76812-245, Brazil
- Programa de Pós-Graduação em Biologia Experimental, Universidade Federal de Rondônia e Fundação Oswaldo Cruz Rondônia - UNIR/FIOCRUZ/RO, 76801-974, Porto Velho, Brazil
| | - Tárcio Peixoto Roca
- Fundação Oswaldo Cruz Rondônia FIOCRUZ/RO, Rua da Beira, 7176, Porto Velho, 76812-245, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Instituto Oswaldo Cruz/IOC, FIOCRUZ, 21041-250, Rio de Janeiro, Brazil
| | - Rutilene Barbosa Souza
- Centro de Infectologia Charles Merieux & Laboratório Rodolphe Merieux (FUNDHACRE), Rio Branco, 69918-340, Brazil
- Universidade Federal da Bahia - UFBA, Salvador, 40110-909, Brazil
| | - Luiz Fellype Alves de Souza
- Programa de Pós-Graduação em Medicina Tropical, Instituto Oswaldo Cruz/IOC, FIOCRUZ, 21041-250, Rio de Janeiro, Brazil
- Centro de Infectologia Charles Merieux & Laboratório Rodolphe Merieux (FUNDHACRE), Rio Branco, 69918-340, Brazil
| | - Ana Maísa Passos-Silva
- Fundação Oswaldo Cruz Rondônia FIOCRUZ/RO, Rua da Beira, 7176, Porto Velho, 76812-245, Brazil
- Programa de Pós-Graduação em Biologia Experimental, Universidade Federal de Rondônia e Fundação Oswaldo Cruz Rondônia - UNIR/FIOCRUZ/RO, 76801-974, Porto Velho, Brazil
| | - André Luiz Ferreira da Silva
- Fundação Oswaldo Cruz Rondônia FIOCRUZ/RO, Rua da Beira, 7176, Porto Velho, 76812-245, Brazil
- Programa de Pós-Graduação em Biologia Experimental, Universidade Federal de Rondônia e Fundação Oswaldo Cruz Rondônia - UNIR/FIOCRUZ/RO, 76801-974, Porto Velho, Brazil
| | - Eugênia de Castro E Silva
- Programa de Pós-Graduação em Medicina Tropical, Instituto Oswaldo Cruz/IOC, FIOCRUZ, 21041-250, Rio de Janeiro, Brazil
- Centro de Pesquisa em Medicina Tropical - CEPEM, Porto Velho, 76812-329, Brazil
| | | | | | - Soraya Dos Santos Pereira
- Fundação Oswaldo Cruz Rondônia FIOCRUZ/RO, Rua da Beira, 7176, Porto Velho, 76812-245, Brazil
- Programa de Pós-Graduação em Biologia Experimental, Universidade Federal de Rondônia e Fundação Oswaldo Cruz Rondônia - UNIR/FIOCRUZ/RO, 76801-974, Porto Velho, Brazil
| | | | - Janaína Mazaro
- Laboratório Central de Saúde Pública do Acre - LACEN/AC, Rio Branco, 69900-614, Brazil
| | - Lívia Melo Villar
- Programa de Pós-Graduação em Medicina Tropical, Instituto Oswaldo Cruz/IOC, FIOCRUZ, 21041-250, Rio de Janeiro, Brazil
| | | | - Daniel Archimedes da Matta
- Centro de Infectologia Charles Merieux & Laboratório Rodolphe Merieux (FUNDHACRE), Rio Branco, 69918-340, Brazil
| | - Deusilene Vieira
- Fundação Oswaldo Cruz Rondônia FIOCRUZ/RO, Rua da Beira, 7176, Porto Velho, 76812-245, Brazil.
- Programa de Pós-Graduação em Biologia Experimental, Universidade Federal de Rondônia e Fundação Oswaldo Cruz Rondônia - UNIR/FIOCRUZ/RO, 76801-974, Porto Velho, Brazil.
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