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Assefa A, Getie M, Getie B, Yazie T, Enkobahry A. Molecular epidemiology of hepatitis B virus (HBV) in Ethiopia: A review article. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2024; 122:105618. [PMID: 38857639 DOI: 10.1016/j.meegid.2024.105618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/12/2024]
Abstract
Hepatitis B virus (HBV) belongs to the family Hepadnaviridae and is the smallest human DNA virus, with a genome that is only 3200 nucleotides long. The absence of proofreading function in HBV reverse transcriptase provides a wide range of genetic variants for targeted outgrowth at different stages of infection. A number of sub genotypes and ten HBV genotypes (A through J) have been identified through analyses of the divergence of HBV genomic sequences. Numerous clinical outcomes, including the emergence of chronicity, the course of the disease, the effectiveness of treatment, and the response to vaccination, have been related to differences in genotype between HBV isolates. There are just seven studies that have been done in Ethiopia that examine the molecular epidemiology of HBV. Moreover, these studies haven't been compiled and reviewed yet. In this review, we looked at the genetic diversity and molecular epidemiology of HBV, the relationship between HBV genotypes and clinical outcomes, the immunopathogenesis of HBV, and finally the molecular epidemiology of HBV in Ethiopia. PubMed, Embase, and Google Scholar search engines were used to find relevant articles for the review. By using HBV genotyping, clinicians can better tailor vaccination decisions and antiviral therapy for patients with chronic hepatitis B who are more likely to experience the disease's progression.
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Affiliation(s)
- Ayenew Assefa
- Unit of Immunology, Department of Medical Laboratory Science, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Molla Getie
- College of Medicine and Health Science, Medical Laboratory Science Department, Injibara University, Injibara, Ethiopia
| | - Birhanu Getie
- Unit of Medical Microbiology, Department of Medical Laboratory Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Takilosimeneh Yazie
- College of Health Science, Department of Pharmacy, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aklesya Enkobahry
- College of Medicine and Health Science, Department of Biomedical Science, Injibara University, Injibara, Ethiopia
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Prayitno SP, Natasha A, Lee S, Kim CM, Lee YM, Park K, Kim J, Kim SG, Park J, Rajoriya S, Palacios G, Oh Y, Song JW, Kim DM, Kim WK. Etiological agent and clinical characteristics of haemorrhagic fever with renal syndrome in the southern Republic of Korea: a genomic surveillance study. Clin Microbiol Infect 2024; 30:795-802. [PMID: 38402954 DOI: 10.1016/j.cmi.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES High incidences of haemorrhagic fever with renal syndrome (HFRS) have been reported in the southern Republic of Korea (ROK). A distinct southern genotype of Orthohantavirus hantanense (HTNV) was identified in Apodemus agrarius chejuensis on Jeju Island. However, its association with HFRS cases in southern ROK remains elusive. We investigated the potential of the southern HTNV genotype as an etiological agent of HFRS. METHODS Samples from 22 patients with HFRS and 193 small mammals were collected in the southern ROK. The clinical characteristics of patients infected with the southern HTNV genotype were analysed. Amplicon-based MinION sequencing was employed for southern HTNV from patients and rodents, facilitating subsequent analyses involving phylogenetics and genetic reassortment. RESULTS High-throughput sequencing of HTNV exhibited higher coverage with a cycle of threshold value below 32, acquiring nearly whole-genome sequences from six patients with HFRS and seven A. agrarius samples. The phylogenetic pattern of patient-derived HTNV demonstrated genetic clustering with HTNV from Apodemus species on Jeju Island and the southern Korean peninsula, revealing genetic reassortment in a single clinical sample between the M and S segments. DISCUSSION These findings imply that the southern HTNV genotype has the potential to induce HFRS in humans. The phylogenetic inference demonstrates the diverse and dynamic characteristics of the southern HTNV tripartite genomes. Therefore, this study highlights the significance of active surveillance and amplicon sequencing for detecting orthohantavirus infections. It also raises awareness and caution for physicians regarding the emergence of a southern HTNV genotype as a cause of HFRS in the ROK.
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Affiliation(s)
- Sara P Prayitno
- Department of Microbiology, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Augustine Natasha
- Department of Microbiology, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Seonghyeon Lee
- Department of Microbiology, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Choon-Mee Kim
- Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - You Mi Lee
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Kyungmin Park
- Department of Microbiology, College of Medicine, Korea University, Seoul, Republic of Korea; BK21 Graduate Program, Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jongwoo Kim
- Department of Microbiology, College of Medicine, Korea University, Seoul, Republic of Korea; BK21 Graduate Program, Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seong-Gyu Kim
- Department of Microbiology, College of Medicine, Korea University, Seoul, Republic of Korea; BK21 Graduate Program, Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jieun Park
- Department of Microbiology, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Shivani Rajoriya
- Department of Microbiology, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Gustavo Palacios
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Yeonsu Oh
- College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon, Republic of Korea
| | - Jin-Won Song
- Department of Microbiology, College of Medicine, Korea University, Seoul, Republic of Korea; BK21 Graduate Program, Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dong-Min Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Won-Keun Kim
- Department of Microbiology, College of Medicine, Hallym University, Chuncheon, Republic of Korea; Institute of Medical Science, College of Medicine, Hallym University, Chuncheon, Republic of Korea.
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Hossain MG, Islam M, Araf Y, Paul SK, Akter S, Khan MK, Ahmed MU, Khan S, Akbar SMF, Debnath CR. Comprehensive analysis of antigenic variations and genomic properties of hepatitis B virus in clinical samples in the mid-north east region of Bangladesh. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2024; 119:105572. [PMID: 38367678 DOI: 10.1016/j.meegid.2024.105572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
This investigation delineates an exhaustive analysis of the clinical, immunological, and genomic landscapes of hepatitis B virus (HBV) infection across a cohort of 22 verified patients. The demographic analysis unveiled a pronounced male bias (77.27%), with patient ages spanning 20 to 85 years and durations of illness ranging from 10 days to 4 years. Predominant clinical manifestations included fever, fatigue, anorexia, abdominal discomfort, and arthralgia, alongside observed co-morbidities such as chronic renal disorders and hepatocellular carcinoma. Antigenic profiling of the HBV envelope proteins elucidated significant heterogeneity among the infected subjects, particularly highlighted by discordances in the detection capabilities of small and large HBsAg assays, suggesting antigenic diversity. Quantitative assessment of viral loads unveiled a broad spectrum, accompanied by atypical HBeAg reactivity patterns, challenging the reliability of existing serological markers. Correlative studies between viral burden and antigenicity of the envelope proteins unearthed phenomena indicative of diagnostic evasion. Notably, samples demonstrating robust viral replication were paradoxically undetectable by the large HBsAg ELISA kit, advocating for more sophisticated diagnostic methodologies. Genotypic examination of three HBV isolates classified them as genotype D (D2), with phylogenetic alignment to strains from various global origins. Mutational profiling identified pivotal mutations within the basic core promoter and preS2/S1 regions, associated with an augmented risk of hepatocellular carcinoma. Further, mutations discerned in the small HBsAg and RT/overlap regions were recognized as contributors to vaccine and/or diagnostic escape mechanisms. In summation, this scholarly discourse elucidates the intricate interplay of clinical presentations, antigenic diversity, and genomic attributes in HBV infection, accentuating the imperative for ongoing investigative endeavors to refine diagnostic and therapeutic modalities.
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Affiliation(s)
- Md Golzar Hossain
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh.
| | - Mahfuz Islam
- Department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh
| | - Yusha Araf
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Shyamal Kumar Paul
- Department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh
| | - Sharmin Akter
- Department of Physiology, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | | | - Muzahed Uddin Ahmed
- Department of Medicine, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Sakirul Khan
- Research Center for Global and Local Infectious Diseases, Oita University, Oita, Japan; Department of Microbiology, Faculty of Medicine, Oita University, Oita, Japan
| | - Sheikh Mohammad Fazle Akbar
- Research Center for Global and Local Infectious Diseases, Oita University, Oita, Japan; Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan; Miyakawa Memorial Research Foundation, Tokyo, Japan
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Potter BI, Thijssen M, Trovão NS, Pineda-Peña A, Reynders M, Mina T, Alvarez C, Amini-Bavil-Olyaee S, Nevens F, Maes P, Lemey P, Van Ranst M, Baele G, Pourkarim MR. Contemporary and historical human migration patterns shape hepatitis B virus diversity. Virus Evol 2024; 10:veae009. [PMID: 38361827 PMCID: PMC10868554 DOI: 10.1093/ve/veae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/16/2023] [Accepted: 01/26/2024] [Indexed: 02/17/2024] Open
Abstract
Infection by hepatitis B virus (HBV) is responsible for approximately 296 million chronic cases of hepatitis B, and roughly 880,000 deaths annually. The global burden of HBV is distributed unevenly, largely owing to the heterogeneous geographic distribution of its subtypes, each of which demonstrates different severity and responsiveness to antiviral therapy. It is therefore crucial to the global public health response to HBV that the spatiotemporal spread of each genotype is well characterized. In this study, we describe a collection of 133 newly sequenced HBV strains from recent African immigrants upon their arrival in Belgium. We incorporate these sequences-all of which we determine to come from genotypes A, D, and E-into a large-scale phylogeographic study with genomes sampled across the globe. We focus on investigating the spatio-temporal processes shaping the evolutionary history of the three genotypes we observe. We incorporate several recently published ancient HBV genomes for genotypes A and D to aid our analysis. We show that different spatio-temporal processes underlie the A, D, and E genotypes with the former two having originated in southeastern Asia, after which they spread across the world. The HBV E genotype is estimated to have originated in Africa, after which it spread to Europe and the Americas. Our results highlight the use of phylogeographic reconstruction as a tool to understand the recent spatiotemporal dynamics of HBV, and highlight the importance of supporting vulnerable populations in accordance with the needs presented by specific HBV genotypes.
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Affiliation(s)
- Barney I Potter
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Leuven BE-3000, Belgium
| | - Marijn Thijssen
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Leuven BE-3000, Belgium
| | - Nídia Sequeira Trovão
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, United States
| | - Andrea Pineda-Peña
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT; Universidade Nova de Lisboa, UNL, Portugal Rua da Junqueira No 100, Lisbon 1349-008, Portugal
- Molecular Biology and Immunology Department, Fundacion Instituto de Inmunología de Colombia (FIDIC); Faculty of Animal Science, Universidad de Ciencias Aplicadas y Ambientales (U.D.C.A.), Avenida 50 No. 26-20, Bogota 0609, Colombia
| | - Marijke Reynders
- Department of Laboratory Medicine, Medical Microbiology, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, Bruges B-8000, Belgium
| | - Thomas Mina
- Nonis Lab Microbiology—Virology Unit, Gregori Afxentiou 5, Limassol 4003, Cyprus
| | - Carolina Alvarez
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Leuven BE-3000, Belgium
| | - Samad Amini-Bavil-Olyaee
- Cellular Sciences Department, Process Virology, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320, USA
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospital Leuven, KU Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Piet Maes
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Leuven BE-3000, Belgium
| | - Philippe Lemey
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Leuven BE-3000, Belgium
| | - Marc Van Ranst
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Leuven BE-3000, Belgium
| | - Guy Baele
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Leuven BE-3000, Belgium
| | - Mahmoud Reza Pourkarim
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Leuven BE-3000, Belgium
- Health Policy Research Centre, Institute of Health, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran
- Blood Transfusion Research Centre, High Institute for Research and Education in Transfusion, Hemmat Exp.Way, Tehran 14665-1157, Iran
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Abdelwahed AH, Heineman BD, Wu GY. Novel Approaches to Inhibition of HBsAg Expression from cccDNA and Chromosomal Integrants: A Review. J Clin Transl Hepatol 2023; 11:1485-1497. [PMID: 38161502 PMCID: PMC10752814 DOI: 10.14218/jcth.2023.00067] [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: 02/15/2023] [Revised: 07/19/2023] [Accepted: 08/16/2023] [Indexed: 01/03/2024] Open
Abstract
Hepatitis B virus (HBV) is a widely prevalent liver infection that can cause acute or chronic hepatitis. Although current treatment modalities are highly effective in the suppression of viral levels, they cannot eliminate the virus or achieve definitive cure. This is a consequence of the complex nature of HBV-host interactions. Major challenges to achieving sustained viral suppression include the presence of a high viral burden from the HBV DNA and hepatitis B surface antigen (HBsAg), the presence of reservoirs for HBV replication and antigen production, and the HBV-impaired innate and adaptive immune response of the host. Those therapeutic methods include cell entry inhibitors, HBsAg inhibitors, gene editing approaches, immune-targeting therapies and direct inhibitors of covalently closed circular DNA (cccDNA). Novel approaches that target these key mechanisms are now being studied in preclinical and clinical phases. In this review article, we provide a comprehensive review on mechanisms by which HBV escapes elimination from current treatments, and highlight new agents to achieve a definitive HBV cure.
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Affiliation(s)
- Ahmed H. Abdelwahed
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
| | - Brent D. Heineman
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
| | - George Y. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
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Langat BK, Ochwedo KO, Borlang J, Osiowy C, Mutai A, Okoth F, Muge E, Andonov A, Maritim ES. Genetic diversity, haplotype analysis, and prevalence of Hepatitis B virus MHR mutations among isolates from Kenyan blood donors. PLoS One 2023; 18:e0291378. [PMID: 37963165 PMCID: PMC10645356 DOI: 10.1371/journal.pone.0291378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/28/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The rapid spread of HBV has resulted in the emergence of new variants. These viral genotypes and variants, in addition to carcinogenic risk, can be key predictors of therapy response and outcomes. As a result, a better knowledge of these emerging HBV traits will aid in the development of a treatment for HBV infection. However, many Sub-Saharan African nations, including Kenya, have insufficient molecular data on HBV strains circulating locally. This study conducted a population-genetics analysis to evaluate the genetic diversity of HBV among Kenyan blood donors. In addition, within the same cohort, the incidence and features of immune-associated escape mutations and stop-codons in Hepatitis B surface antigen (HBsAg) were determined. METHODS In September 2015 to October 2016, 194 serum samples were obtained from HBsAg-positive blood donors residing in eleven different Kenyan counties: Kisumu, Machakos, Uasin Gishu, Nairobi, Nakuru, Embu, Garissa, Kisii, Mombasa, Nyeri, and Turkana. For the HBV surface (S) gene, HBV DNA was isolated, amplified, and sequenced. The sequences obtained were utilized to investigate the genetic and haplotype diversity within the S genes. RESULTS Among the blood donors, 74.74% were male, and the overall mean age was 25.36 years. HBV genotype A1 (88.14%) was the most common, followed by genotype D (10.82%), genotype C (0.52%), and HBV genotype E (0.52%). The phylogenetic analysis revealed twelve major clades, with cluster III comprising solely of 68 blood donor isolates (68/194-35.05%). A high haplotype diversity (Hd = 0.94) and low nucleotide diversity (π = 0.02) were observed. Kisumu county had high number of haplotypes (22), but low haplotype (gene) diversity (Hd = 0.90). Generally, a total of 90 haplotypes with some consisting of more than one sequence were observed. The gene exhibited negative values for Tajima's D (-2.04, p<0.05) and Fu's Fs (-88.84). Several mutations were found in 139 isolates, either within or outside the Major Hydrophilic Area (MHR). There were 29 mutations found, with 37.9% of them situated inside the "a" determinant. The most common mutations in this research were T143M and K122R. Escape mutations linked to diagnostic failure, vaccination and immunoglobulin treatment evasion were also discovered. Also, one stop-codon, W163STP, inside the MHR, was found in one sample from genotype A. CONCLUSION In Kenya, HBV/A1 is still the most common genotype. Despite limited genetic and nucleotide diversity, haplotype network analysis revealed haplotype variance among HBV genotypes from Kenyan blood donors. The virological properties of immune escape, which may be the source of viral replication endurance, were discovered in the viral strains studied and included immune-escape mutations and stop-codon. The discovery of HBsAg mutations in MHR in all isolates highlighted the need of monitoring MHR mutations in Kenya.
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Affiliation(s)
| | - Kevin Omondi Ochwedo
- Department of Biology, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
| | | | - Carla Osiowy
- National Microbiology Laboratory, Winnipeg, Canada
| | - Alex Mutai
- Kenya National Blood Transfusion Services, Nairobi, Kenya
| | - Fredrick Okoth
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edward Muge
- Department of Medical Biochemistry, University of Nairobi, Nairobi, Kenya
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Ahmad AEF, Bakari AG, Musa BOP, Mustapha SK, Yusuf BJ, Abdullahi IN, Tahir MI, Afolaranmi TO, Hawkins C, Sagay AS, Muktar HM, Usman Y, Anka AU, Olayinka AT. INDOLEAMINE-2,3-DIOXYGENASE GENE EXPRESSION LEVELS IN RESPONSE TO CHRONIC HEPATITIS B VIRUS INFECTION IN ZARIA, NIGERIA. NIGERIAN JOURNAL OF IMMUNOLOGY 2023; 4:https://ojshostng.com/index.php/NJI/article/view/2721. [PMID: 37829172 PMCID: PMC10569226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Claudia Hawkins
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Haruna Mohammed Muktar
- Department of Haematology and Transfusion Science, Ahmadu Bello University, Zaria, Nigeria
| | - Yahaya Usman
- Department of Medical Laboratory Science, Ahmadu Bello University, Zaria, Nigeria
| | - Abubakar Umar Anka
- Department of Medical Laboratory Science, Ahmadu Bello University, Zaria, Nigeria
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Wedemeyer H, Aleman S, Brunetto MR, Blank A, Andreone P, Bogomolov P, Chulanov V, Mamonova N, Geyvandova N, Morozov V, Sagalova O, Stepanova T, Berger A, Manuilov D, Suri V, An Q, Da B, Flaherty J, Osinusi A, Liu Y, Merle U, Schulze Zur Wiesch J, Zeuzem S, Ciesek S, Cornberg M, Lampertico P. A Phase 3, Randomized Trial of Bulevirtide in Chronic Hepatitis D. N Engl J Med 2023; 389:22-32. [PMID: 37345876 DOI: 10.1056/nejmoa2213429] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Coinfection with hepatitis D virus (HDV) accelerates the progression of liver disease associated with chronic hepatitis B. Bulevirtide inhibits the entry of HDV into hepatocytes. METHODS In this ongoing phase 3 trial, patients with chronic hepatitis D, with or without compensated cirrhosis, were randomly assigned, in a 1:1:1 ratio, to receive bulevirtide subcutaneously at 2 mg per day (2-mg group) or 10 mg per day (10-mg group) for 144 weeks or to receive no treatment for 48 weeks followed by bulevirtide subcutaneously at 10 mg per day for 96 weeks (control group). Patients will complete 96 weeks of additional follow-up after the end of treatment. The primary end point was a combined response at week 48 of an undetectable HDV RNA level, or a level that decreased by at least 2 log10 IU per milliliter from baseline, and normalization of the alanine aminotransferase (ALT) level. The key secondary end point was an undetectable HDV RNA level at week 48, in a comparison between the 2-mg group and the 10-mg group. RESULTS A total of 49 patients were assigned to the 2-mg group, 50 to the 10-mg group, and 51 to the control group. A primary end-point response occurred in 45% of patients in the 2-mg group, 48% in the 10-mg group, and 2% in the control group (P<0.001 for the comparison of each dose group with the control group). The HDV RNA level at week 48 was undetectable in 12% of patients in the 2-mg group and in 20% in the 10-mg group (P = 0.41). The ALT level normalized in 12% of patients in the control group, 51% in the 2-mg group (difference from control, 39 percentage points [95% confidence interval {CI}, 20 to 56]), and 56% in the 10-mg group (difference from control, 44 percentage points [95% CI, 26 to 60]). Loss of hepatitis B virus surface antigen (HBsAg) or an HBsAg level that decreased by at least 1 log10 IU per milliliter did not occur in the bulevirtide groups by week 48. Headache, pruritus, fatigue, eosinophilia, injection-site reactions, upper abdominal pain, arthralgia, and asthenia were more common in the 2-mg and 10-mg groups combined than in the control group. No treatment-related serious adverse events occurred. Dose-dependent increases in bile acid levels were noted in the 2-mg and 10-mg groups. CONCLUSIONS After 48 weeks of bulevirtide treatment, HDV RNA and ALT levels were reduced in patients with chronic hepatitis D. (Funded by Gilead Sciences; MYR 301 ClinicalTrials.gov number, NCT03852719.).
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Affiliation(s)
- Heiner Wedemeyer
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Soo Aleman
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Maurizia Rossana Brunetto
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Antje Blank
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Pietro Andreone
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Pavel Bogomolov
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Vladimir Chulanov
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Nina Mamonova
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Natalia Geyvandova
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Viacheslav Morozov
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Olga Sagalova
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Tatyana Stepanova
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Annemarie Berger
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Dmitry Manuilov
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Vithika Suri
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Qi An
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Ben Da
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - John Flaherty
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Anu Osinusi
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Yang Liu
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Uta Merle
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Julian Schulze Zur Wiesch
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Stefan Zeuzem
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Sandra Ciesek
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Markus Cornberg
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
| | - Pietro Lampertico
- From Medizinische Hochschule Hannover, Excellence Cluster RESIST, and D-SOLVE Consortium (H.W., M.C.), Hannover, German Center for Infection Research (DZIF) Partner Site Hannover-Braunschweig, Braunschweig (H.W., M.C.), Clinical Pharmacology and Pharmacoepidemiology and DZIF Partner Site Heidelberg (A. Blank) and the Department of Internal Medicine IV (U.M.), Heidelberg University Hospital, Heidelberg, the Institute of Medical Virology (A. Berger, S.C.), the Department of Internal Medicine, University Hospital Frankfurt (S.Z.), DZIF (S.C.), and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP (S.C.), Frankfurt, and Universitätsklinikum Hamburg-Eppendorf, Medizinische Klinik, and DZIF, Hamburg-Lübeck-Borstel-Riems, Hamburg (J.S.W.) - all in Germany; the Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm (S.A.); the Department of Clinical and Experimental Medicine, University of Pisa, and the Hepatology Unit, Pisa University Hospital, Pisa (M.R.B.), the Division of Internal Medicine, University of Modena and Reggio Emilia, Modena (P.A.), and the Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, and the Department of Pathophysiology and Transplantation, University of Milan, Milan (P.L.) - all in Italy; M.F. Vladimirsky Moscow Regional Research and Clinical Institute (P.B.), National Medical Research Center of Tuberculosis and Infectious Diseases, Ministry of Health (V.C.), Sechenov University (V.C.), and the Clinic of Modern Medicine (T.S.), Moscow, the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg (N.M.), Stavropol Regional Clinical Hospital, Stavropol (N.G.), Hepatolog, Samara (V.M.), and Southern Ural State Medical University, Chelyabinsk (O.S.) - all in Russia; and Gilead Sciences, Foster City, CA (D.M., V.S., Q.A., B.D., J.F., A.O., Y.L.)
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Zhang J, Zhang Y, Khanal S, Cao D, Zhao J, Dang X, Nguyen LNT, Schank M, Wu XY, Jiang Y, Ning S, Wang L, El Gazzar M, Moorman JP, Guo H, Yao ZQ. Synthetic gRNA/Cas9 ribonucleoprotein targeting HBV DNA inhibits viral replication. J Med Virol 2023; 95:e28952. [PMID: 37455550 PMCID: PMC10977344 DOI: 10.1002/jmv.28952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
The presence of hepatitis B virus (HBV) covalently closed circular (ccc) DNA (cccDNA), which serves as a template for viral replication and integration of HBV DNA into the host cell genome, sustains liver pathogenesis and constitutes an intractable barrier to the eradication of chronic HBV infection. The current antiviral therapy for HBV infection, using nucleos(t)ide analogues (NAs), can suppress HBV replication but cannot eliminate integrated HBV DNA and episomal cccDNA. Clustered regularly interspaced short palindromic repeat (CRISPR)/Cas9 is a powerful genetic tool that can edit integrated HBV DNA and minichromosomal cccDNA for gene therapy, but its expression and delivery require a viral vector, which poses safety concerns for therapeutic applications in humans. In the present study, we used synthetic guide RNA (gRNA)/Cas9-ribonucleoprotein (RNP) as a nonviral formulation to develop a novel CRISPR/Cas9-mediated gene therapy for eradicating HBV infection. We designed a series of gRNAs targeting multiple specific HBV genes and tested their antiviral efficacy and cytotoxicity in different HBV cellular models. Transfection of stably HBV-infected human hepatoma cell line HepG2.2.15 with HBV-specific gRNA/Cas9 RNPs resulted in a substantial reduction in HBV transcripts. Specifically, gRNA5 and/or gRNA9 RNPs significantly reduced HBV cccDNA, total HBV DNA, pregenomic RNA, and HBV antigen (HBsAg, HBeAg) levels. T7 endonuclease 1 (T7E1) cleavage assay and DNA sequencing confirmed specific HBV gene cleavage and mutations at or around the gRNA target sites. Notably, this gene-editing system did not alter cellular viability or proliferation in the treated cells. Because of their rapid DNA cleavage capability, low off-target effects, low risk of insertional mutagenesis, and readiness for use in clinical application, these results suggest that synthetic gRNA/Cas9 RNP-based gene-editing can be utilized as a promising therapeutic drug for eradicating chronic HBV infection.
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Affiliation(s)
- Jinyu Zhang
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
- Department of Internal Medicine, Division of Infectious, Inflammatory and Immunologic Diseases, Quillen College of Medicine, ETSU, Johnson City, Tennessee 37614
| | - Yi Zhang
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
- Department of Internal Medicine, Division of Infectious, Inflammatory and Immunologic Diseases, Quillen College of Medicine, ETSU, Johnson City, Tennessee 37614
| | - Sushant Khanal
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
- Department of Internal Medicine, Division of Infectious, Inflammatory and Immunologic Diseases, Quillen College of Medicine, ETSU, Johnson City, Tennessee 37614
| | - Dechao Cao
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
- Department of Internal Medicine, Division of Infectious, Inflammatory and Immunologic Diseases, Quillen College of Medicine, ETSU, Johnson City, Tennessee 37614
| | - Juan Zhao
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
- Department of Internal Medicine, Division of Infectious, Inflammatory and Immunologic Diseases, Quillen College of Medicine, ETSU, Johnson City, Tennessee 37614
| | - Xindi Dang
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
- Department of Internal Medicine, Division of Infectious, Inflammatory and Immunologic Diseases, Quillen College of Medicine, ETSU, Johnson City, Tennessee 37614
| | - Lam Ngoc Thao Nguyen
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
- Department of Internal Medicine, Division of Infectious, Inflammatory and Immunologic Diseases, Quillen College of Medicine, ETSU, Johnson City, Tennessee 37614
| | - Madison Schank
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
- Department of Internal Medicine, Division of Infectious, Inflammatory and Immunologic Diseases, Quillen College of Medicine, ETSU, Johnson City, Tennessee 37614
| | - Xiao Y. Wu
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
- Department of Internal Medicine, Division of Infectious, Inflammatory and Immunologic Diseases, Quillen College of Medicine, ETSU, Johnson City, Tennessee 37614
| | - Yong Jiang
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
| | - Shunbin Ning
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
- Department of Internal Medicine, Division of Infectious, Inflammatory and Immunologic Diseases, Quillen College of Medicine, ETSU, Johnson City, Tennessee 37614
| | - Ling Wang
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
- Department of Internal Medicine, Division of Infectious, Inflammatory and Immunologic Diseases, Quillen College of Medicine, ETSU, Johnson City, Tennessee 37614
| | - Mohamed El Gazzar
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
- Department of Internal Medicine, Division of Infectious, Inflammatory and Immunologic Diseases, Quillen College of Medicine, ETSU, Johnson City, Tennessee 37614
| | - Jonathan P. Moorman
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
- Department of Internal Medicine, Division of Infectious, Inflammatory and Immunologic Diseases, Quillen College of Medicine, ETSU, Johnson City, Tennessee 37614
- HCV/HBV/HIV Program, James H. Quillen VA Medical Center, Department of Veterans Affairs, Johnson City, Tennessee 37614
| | - Haitao Guo
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA 15213
| | - Zhi Q. Yao
- Center of Excellence in Inflammation, Infectious Disease and Immunity, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee 37614
- Department of Internal Medicine, Division of Infectious, Inflammatory and Immunologic Diseases, Quillen College of Medicine, ETSU, Johnson City, Tennessee 37614
- HCV/HBV/HIV Program, James H. Quillen VA Medical Center, Department of Veterans Affairs, Johnson City, Tennessee 37614
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Diakite M, Shaw-Saliba K, Lau CY. Malignancy and viral infections in Sub-Saharan Africa: A review. FRONTIERS IN VIROLOGY (LAUSANNE, SWITZERLAND) 2023; 3:1103737. [PMID: 37476029 PMCID: PMC10358275 DOI: 10.3389/fviro.2023.1103737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
The burden of malignancy related to viral infection is increasing in Sub-Saharan Africa (SSA). In 2018, approximately 2 million new cancer cases worldwide were attributable to infection. Prevention or treatment of these infections could reduce cancer cases by 23% in less developed regions and about 7% in developed regions. Contemporaneous increases in longevity and changes in lifestyle have contributed to the cancer burden in SSA. African hospitals are reporting more cases of cancer related to infection (e.g., cervical cancer in women and stomach and liver cancer in men). SSA populations also have elevated underlying prevalence of viral infections compared to other regions. Of 10 infectious agents identified as carcinogenic by the International Agency for Research on Cancer, six are viruses: hepatitis B and C viruses (HBV and HCV, respectively), Epstein-Barr virus (EBV), high-risk types of human papillomavirus (HPV), Human T-cell lymphotropic virus type 1 (HTLV-1), and Kaposi's sarcoma herpesvirus (KSHV, also known as human herpesvirus type 8, HHV-8). Human immunodeficiency virus type 1 (HIV) also facilitates oncogenesis. EBV is associated with lymphomas and nasopharyngeal carcinoma; HBV and HCV are associated with hepatocellular carcinoma; KSHV causes Kaposi's sarcoma; HTLV-1 causes T-cell leukemia and lymphoma; HPV causes carcinoma of the oropharynx and anogenital squamous cell cancer. HIV-1, for which SSA has the greatest global burden, has been linked to increasing risk of malignancy through immunologic dysregulation and clonal hematopoiesis. Public health approaches to prevent infection, such as vaccination, safer injection techniques, screening of blood products, antimicrobial treatments and safer sexual practices could reduce the burden of cancer in Africa. In SSA, inequalities in access to cancer screening and treatment are exacerbated by the perception of cancer as taboo. National level cancer registries, new screening strategies for detection of viral infection and public health messaging should be prioritized in SSA's battle against malignancy. In this review, we discuss the impact of carcinogenic viruses in SSA with a focus on regional epidemiology.
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Affiliation(s)
- Mahamadou Diakite
- University Clinical Research Center, University of Sciences, Techniques, and Technologies, Bamako, Mali
| | - Kathryn Shaw-Saliba
- Collaborative Clinical Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Chuen-Yen Lau
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
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11
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Mathew A, Ismael N, Meeds H, Vubil A, Zicai AF, Mabunda N, Blackard JT. Hepatitis B virus genotypes and drug resistance mutations circulating in blood donors in Beira, Mozambique. PLoS One 2023; 18:e0281855. [PMID: 36795797 PMCID: PMC9934330 DOI: 10.1371/journal.pone.0281855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
Hepatitis B virus (HBV) infects nearly 300 million people and is the leading cause of hepatitis and hepatocellular carcinoma worldwide. Despite the high burden of HBV in sub-Saharan Africa, countries such as Mozambique have limited data available on circulating HBV genotypes and the presence of drug resistance mutations. Blood donors from Beira, Mozambique were tested for HBV surface antigen (HBsAg) and HBV DNA at the Instituto Nacional de Saúde in Maputo, Mozambique. Regardless of HBsAg status, donors with detectable HBV DNA were evaluated for HBV genotype. PCR was performed with primers amplifying a 2.1-2.2 kilobase fragment of the HBV genome. PCR products were submitted for next generation sequencing (NGS), and consensus sequences were evaluated for HBV genotype, recombination, and the presence or absence of drug resistance mutations. Of the 1281 blood donors tested, 74 had quantifiable HBV DNA. The polymerase gene could be amplified from 45 of 58 (77.6%) individuals with chronic HBV infection and 12 of 16 (75%) with occult HBV infection. Among these 57, 51 (89.5%) sequences belonged to HBV genotype A1, while 6 (10.5%) were HBV genotype E. All genotype E sequences were E/A recombinants, and clustered separately from other genotype E references. Genotype A samples had a median viral load of 637 IU/mL, while genotype E samples had a median viral load of 476,084 IU/mL. No drug resistance mutations were observed in the consensus sequences. The current study demonstrates the genotypic diversity of HBV in blood donors in Mozambique, but the absence of dominant (consensus) drug resistance mutations. Studies in other at-risk populations are essential for understanding the epidemiology, risk of liver disease, and likelihood of treatment resistance in resource-limited settings.
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Affiliation(s)
- Ann Mathew
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Nalia Ismael
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Heidi Meeds
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Adolfo Vubil
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | | | - Jason T. Blackard
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
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12
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Campos-Valdez M, Feustel S, Monroy-Ramírez HC, Barrientos-Salcedo C, Ayón-Pérez MF, Ramos-Márquez ME, Fernández-Galindo DA, Silva-Gómez JA, Santos A, Armendáriz-Borunda J, Sánchez-Orozco LV. Influence of C107R mutation from hepatitis B virus genotype H on in vitro hepatitis B surface antigen detection and IFN-β-1a treatment. Future Virol 2022. [DOI: 10.2217/fvl-2021-0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Assess the in vitro effect of hepatitis B virus (HBV) genotype H (HBV/H) with the small surface HBV protein (HBs) C107R mutation on hepatitis B surface antigen (HBsAg) detection, TGFB1, CAT and IFNB1A expression, and the response to IFN-β-1a treatment. Methods: HBV/H wild-type and HBs C107R variant replicons were constructed and transfected into hepatic stellate cells and/or Huh7 that were later treated with IFN-β-1a. HBsAg, HBV-DNA, pgRNA, TGFB1, CAT and IFNB1A expression was analyzed. 3D HBs structure from wild-type and C107R were foreseen by AlphaFold protein predictor, and IFN-β-1a antiviral effect was evaluated. Results: C107R mutation did not impact viral replication, but HBsAg serologic detection was affected. Wild-type and C107R similarly modified gene expression and responded to IFN-β-1a. Conclusion: C107R disrupts the Cys107/Cys138 disulfide bond and impairs HBsAg detection. Independently of the mutation, there were changes in TGFB1, CAT and IFNB1A expression, and a medium response to IFN-β-1a treatment compared with genotype A and C.
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Affiliation(s)
- Marina Campos-Valdez
- Instituto de Biología Molecular en Medicina, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, 44340, México
| | - Sina Feustel
- Instituto de Biología Molecular en Medicina, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, 44340, México
| | - Hugo Christian Monroy-Ramírez
- Instituto de Biología Molecular en Medicina, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, 44340, México
| | - Carolina Barrientos-Salcedo
- Laboratorio de Química Médica y Quimiogenómica, Facultad de Bioanálisis, Universidad Veracruzana, Veracruz, México
| | | | - Martha Eloísa Ramos-Márquez
- Instituto de Enfermedades Crónico Degenerativas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, 44340, México
| | - David A Fernández-Galindo
- Instituto de Biología Molecular en Medicina, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, 44340, México
| | - Jorge Antonio Silva-Gómez
- Instituto de Biología Molecular en Medicina, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, 44340, México
| | - Arturo Santos
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Campus Guadalajara, Zapopan, Jalisco, 45201, México
| | - Juan Armendáriz-Borunda
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Campus Guadalajara, Zapopan, Jalisco, 45201, México
| | - Laura Verónica Sánchez-Orozco
- Instituto de Biología Molecular en Medicina, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, 44340, México
- Instituto de Enfermedades Crónico Degenerativas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, 44340, México
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13
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Anejo-Okopi J, Okeke E, Davwar PM, Onwuamah C, Onywera H, Omaiye P, Duguru M, Okojokwu OJ, Ujah OI, Jonathan B, George CA, Crown RS, Yakubu FB, Sokei JO, Okoli LC, Audu O, Inzaule SC, Abah IO, Agaba P, Agbaji OO, Sagay AS, Hawkins C. Molecular detection of hepatitis B virus genotype E with immune escape mutations in chronic hepatitis B patients on long-term antiviral therapy in Jos, Nigeria. Afr J Lab Med 2022; 11:1677. [PMID: 36337771 PMCID: PMC9634812 DOI: 10.4102/ajlm.v11i1.1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 04/28/2022] [Indexed: 12/26/2022] Open
Abstract
Background Previous studies in Nigeria have reported the presence of hepatitis B virus (HBV) genotype E and the availability of immune escape mutants. There is a paucity of data on chronic patients on long-term antiviral therapy for HBV infection. Objective This study assessed HBV genotypes and drug resistance variants among patients with chronic HBV infection receiving tenofovir in Jos, Nigeria. Methods This cross-sectional study consecutively enrolled 101 patients (51 with HIV/HBV co-infection and 50 with HBV infection only) on antiviral therapy from February 2018 to May 2019 at four hospitals in Jos, Nigeria. DNA quantification of HBV was performed on all samples; 30 samples with detectable viral load were selected for genotyping using Sanger sequencing by targeting the full-length sequences of reverse transcriptase gene of the HBV genome. Phylogenetic analysis was performed with reference sequences from GenBank. Escape mutant and drug resistance analysis were performed using HBV drug resistance interpretation and Geno2pheno. Results Only 30 (29.7%) of the 101 study participants had detectable HBV DNA. Of these, six (20.0%) isolates were successfully amplified and sequenced. The identified genotype was E, including escape mutations L127R (16.7%) and G145A (16.7%). Conclusion This study revealed exclusive dominance of genotype E in Nigeria. The S gene mutations G145A and L271R are known to be associated with modified antigenicity and impaired serologic assays, which may cause false negatives in the detection of anti-HBV surface antigen. The presence of mutants that are associated with vaccine immune escape may also have diagnostic and vaccine immune response implications.
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Affiliation(s)
- Joseph Anejo-Okopi
- Department of Microbiology, University of Jos, Jos, Nigeria
- AIDS Prevention Initiative in Nigeria, Jos University Teaching Hospital, Jos, Nigeria
| | - Edith Okeke
- Department of Internal Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Pantong M. Davwar
- Department of Internal Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Chika Onwuamah
- Center for Human Virology and Genomics Nigeria Institute of Medical Research, Lagos, Nigeria
| | - Harris Onywera
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- Research, Innovations, and Academics Unit, Tunacare Services Health Providers Limited, Nairobi, Kenya
| | - Patience Omaiye
- Department of Internal Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Mary Duguru
- Department of Internal Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | | | - Otobo I. Ujah
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, United States
| | - Bulus Jonathan
- Department of Family Medicine, Plateau State Specialist Hospital, Jos, Nigeria
| | - Chima A. George
- Department of Family Medicine, Bingham University Teaching Hospital, Jos, Nigeria
| | - Ramyil S. Crown
- Department of Medical Microbiology and Parasitology, Bingham University Teaching Hospital, Jos, Nigeria
| | - Fiyaktu B. Yakubu
- Department of Chemical Pathology, Jos University Teaching Hospital, Jos, Nigeria
| | - Judith O. Sokei
- Center for Human Virology and Genomics Nigeria Institute of Medical Research, Lagos, Nigeria
| | - Leona C. Okoli
- Center for Human Virology and Genomics Nigeria Institute of Medical Research, Lagos, Nigeria
| | - Onyemocho Audu
- Department of Epidemiology and Community Health, Benue State University, Makurdi, Nigeria
| | - Seth C. Inzaule
- Department of HIV and Global Hepatitis Program, World Health Organization, Geneva, Switzerland
| | - Isaac O. Abah
- Department of Pharmacology, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Patricia Agaba
- AIDS Prevention Initiative in Nigeria, Jos University Teaching Hospital, Jos, Nigeria
- Department of Family Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Oche O. Agbaji
- Department of Internal Medicine, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Atiene S. Sagay
- Department of Obstetrics and Gynaecology, University of Jos, Jos University Teaching Hospital, Jos, Nigeria
| | - Claudia Hawkins
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
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HBeAg-Negative/Anti-HBe-Positive Chronic Hepatitis B: A 40-Year-Old History. Viruses 2022; 14:v14081691. [PMID: 36016312 PMCID: PMC9416321 DOI: 10.3390/v14081691] [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] [Received: 07/12/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 12/03/2022] Open
Abstract
Hepatitis B “e” antigen (HBeAg) negative chronic hepatitis B (CHB), 40 years since discovery in the Mediterranean area, has become the most prevalent form of HBV-induced liver disease worldwide and a major health care burden caused by HBV infection. A great deal of knowledge accumulated over the last decades provides consistent evidence on the bimodal dynamics of the expression of structural and non-structural forms of the viral core proteins which associate with different virologic and clinic–pathologic outcomes of HBV infection. In absence of serum HBeAg, the presence and persistence of HBV replication causes and maintains virus-related liver injury. Thus, in clinical practice it is mandatory to screen HBV carriers with HBeAg-negative infection for the early diagnosis of HBeAg-negative CHB since antiviral therapy can cure HBV-induced liver disease when started at early stages.
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Bezerra CS, Portilho MM, Barbosa JR, de Azevedo CP, Mendonça ACDF, da Cruz JNM, Frota CC, do Lago BV, Villar LM. Dried blood spot sampling for hepatitis B virus quantification, sequencing and mutation detection. Sci Rep 2022; 12:1651. [PMID: 35102169 PMCID: PMC8803841 DOI: 10.1038/s41598-022-05264-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) diagnosis is performed on serum samples, but the access to this diagnosis is difficult in low-income regions. The use of dried blood spot (DBS) samples does not require special structure for collection, storage or transport. This study evaluates the use of DBS for detection, quantification and sequencing of HBV DNA using in-house techniques. Two study groups were included: 92 HBsAg + individuals and 49 negative controls. Serum and DBS samples were submitted to quantitative and qualitative in-house PCR for S/pol genes, sequencing and phylogenetic analyses. Total of 84 serum samples were successfully amplified. Of them, 63 paired DBS were also positive in qualitative PCR. Qualitative PCR in DBS presented a sensitivity of 75% and specificity of 100% (Kappa = 0.689). Quantitative PCR in DBS presented a detection limit of 852.5 copies/mL (250 IU/mL), sensitivity of 77.63% and specificity of 100% (Kappa = 0.731). A total of 63 serum samples and 36 DBS samples were submitted to sequencing, revealing the circulation of genotypes A (65.08%), D (4.8%), E (3.2%) and F (27%) with 100% of correspondence between serum and DBS. All sequenced samples displayed polymorphisms in HBsAg gene. An HIV-coinfected patient presented the rtM204V/I-rtL180M double resistance mutation in serum and DBS. In conclusion, DBS is an alternative to detect, quantify and characterize HBV DNA, being a possibility of increasing diagnosis in low-income settings, closing gaps in HBV control.
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16
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Wolf JM, Mazeto TK, Pereira VRZB, Simon D, Lunge VR. Recent molecular evolution of hepatitis B virus genotype F in Latin America. Arch Virol 2022; 167:597-602. [DOI: 10.1007/s00705-022-05376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/17/2021] [Indexed: 11/24/2022]
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17
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Xie Y, Ma H, Feng B, Song G. Combining the HBcrAg decline and HBV mutations predicts spontaneous HBeAg seroconversion in chronic hepatitis B patients during the immune clearance phase. J Med Virol 2021; 94:2694-2701. [PMID: 34951036 DOI: 10.1002/jmv.27545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess predictive ability of hepatitis B virus (HBV) markers and genome mutations for spontaneous hepatitis B e antigen (HBeAg) seroconversion. METHODS A total of 113 chronic hepatitis B (CHB) patients were followed up for 76 weeks without antiviral treatment. Baseline basal core promoter (BCP) and precore mutations were detected and serum hepatitis B surface antigen (HBsAg), HBeAg, hepatitis B core-related antigen (HBcrAg) and HBV DNA levels were serially quantified. RESULTS Eighteen patients experienced spontaneous HBeAg seroconversion (Group A), and the left 95 patients did not experience spontaneous HBeAg seroconversion (Group B). At week 28, HBsAg (P=0.03) and HBcrAg (P=0.01) levels were significantly different between Group A and B. Reduced HBsAg (P=0.02) and HBcrAg (P<0.01) levels from baseline to week 28 were significantly different between two groups. Multivariate logistic regression showed that lower HBcrAg (OR=1.02, P=0.03) levels at week 28, and HBcrAg levels with sharp decrease at week 28 (OR=0.19, P=0.02) were related with spontaneous HBeAg seroconversion. The areas under the receiver operating characteristic curve (AUROC) showed that reduction in HBcrAg levels from baseline to week 28 (0.93, P=0.001, 95% CI: 0.74-1.08) have excellent prediction value. The mutation frequencies of A1574T (51.11% vs 18.18%, P=0.001), G1862A (30.00% vs 13.03%, P=0.001), G1896A (27.22% vs 5.45%, P=0.001) and C1913G (32.78% vs 12.73%, P=0.001) in Group A were significantly higher than Group B. CONCLUSIONS Baseline A1574T, G1862A, G1896A and C1913G mutations and HBcrAg levels with sharp decrease at week 28 were associated with spontaneous HBeAg seroconversion. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yandi Xie
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing, China
| | - Hui Ma
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing, China
| | - Bo Feng
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing, China
| | - Guangjun Song
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing, China
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18
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Analysis of the Physicochemical Properties, Replication and Pathophysiology of a Massively Glycosylated Hepatitis B Virus HBsAg Escape Mutant. Viruses 2021; 13:v13112328. [PMID: 34835134 PMCID: PMC8622389 DOI: 10.3390/v13112328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 02/07/2023] Open
Abstract
Mutations in HBsAg, the surface antigen of the hepatitis B virus (HBV), might affect the serum HBV DNA level of HBV-infected patients, since the reverse transcriptase (RT) domain of HBV polymerase overlaps with the HBsAg-coding region. We previously identified a diagnostic escape mutant (W3S) HBV that produces massively glycosylated HBsAg. In this study, we constructed an HBV-producing vector that expresses W3S HBs (pHB-W3S) along with a wild-type HBV-producing plasmid (pHB-WT) in order to analyze the physicochemical properties, replication, and antiviral drug response of the mutant. Transfection of either pHB-WT or W3S into HepG2 cells yielded similar CsCl density profiles and eAg expression, as did transfection of a glycosylation defective mutant, pHB-W3S (N146G), in which a glycosylation site at the 146aa asparagine (N) site of HBs was mutated to glycine (G). Virion secretion, however, seemed to be severely impaired in cases of pHB-W3S and pHB-W3S (N146G), compared with pHB-WT, as determined by qPCR and Southern blot analysis. Furthermore, inhibition of glycosylation using tunicamycinTM on wild-type HBV production also reduced the virion secretion. These results suggested that the HBV core and Dane particle could be formed either by massively glycosylated or glycosylation-defective HBsAg, but reduced and/or almost completely blocked the virion secretion efficiency, indicating that balanced glycosylation of HBsAg is required for efficient release of HBV, and mutations inducing an imbalanced glycosylation of HBs would cause the virion to become stuck in the cells, which might be associated with various pathogeneses due to HBV infection.
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19
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Athamneh RY, Arıkan A, Sayan M, Mahafzah A, Sallam M. Variable Proportions of Phylogenetic Clustering and Low Levels of Antiviral Drug Resistance among the Major HBV Sub-Genotypes in the Middle East and North Africa. Pathogens 2021; 10:1333. [PMID: 34684283 PMCID: PMC8540944 DOI: 10.3390/pathogens10101333] [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] [Received: 09/22/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/21/2022] Open
Abstract
Hepatitis B virus (HBV) infection remains a major public health threat in the Middle East and North Africa (MENA). Phylogenetic analysis of HBV can be helpful to study the putative transmission links and patterns of inter-country spread of the virus. The objectives of the current study were to analyze the HBV genotype/sub-genotype (SGT) distribution, reverse transcriptase (RT), and surface (S) gene mutations and to investigate the domestic transmission of HBV in the MENA. All HBV molecular sequences collected in the MENA were retrieved from GenBank as of 30 April 2021. Determination of genotypes/SGT, RT, and S mutations were based on the Geno2pheno (hbv) 2.0 online tool. For the most prevalent HBV SGTs, maximum likelihood phylogenetic analysis was conducted to identify the putative phylogenetic clusters, with approximate Shimodaira-Hasegawa-like likelihood ratio test values ≥ 0.90, and genetic distance cut-off values ≤ 0.025 substitutions/site as implemented in Cluster Picker. The total number of HBV sequences used for genotype/SGT determination was 4352 that represented a total of 20 MENA countries, with a majority from Iran (n = 2103, 48.3%), Saudi Arabia (n = 503, 11.6%), Tunisia (n = 395, 9.1%), and Turkey (n = 267, 6.1%). Genotype D dominated infections in the MENA (86.6%), followed by genotype A (4.1%), with SGT D1 as the most common in 14 MENA countries and SGT D7 dominance in the Maghreb. The highest prevalence of antiviral drug resistance was observed against lamivudine (4.5%) and telbivudine (4.3%). The proportion of domestic phylogenetic clustering was the highest for SGT D7 (61.9%), followed by SGT D2 (28.2%) and genotype E (25.7%). The largest fraction of domestic clusters with evidence of inter-country spread within the MENA was seen in SGT D7 (81.3%). Small networks (containing 3-14 sequences) dominated among domestic phylogenetic clusters. Specific patterns of HBV genetic diversity were seen in the MENA with SGT D1 dominance in the Levant, Iran, and Turkey; SGT D7 dominance in the Maghreb; and extensive diversity in Saudi Arabia and Egypt. A low prevalence of lamivudine, telbivudine, and entecavir drug resistance was observed in the region, with almost an absence of resistance to tenofovir and adefovir. Variable proportions of phylogenetic clustering indicated prominent domestic transmission of SGT D7 (particularly in the Maghreb) and relatively high levels of virus mobility in SGT D1.
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Affiliation(s)
- Rabaa Y. Athamneh
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia 99138, Cyprus; (R.Y.A.); (A.A.)
| | - Ayşe Arıkan
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia 99138, Cyprus; (R.Y.A.); (A.A.)
- DESAM, Near East University, Nicosia 99138, Cyprus;
| | - Murat Sayan
- DESAM, Near East University, Nicosia 99138, Cyprus;
- Clinical Laboratory, PCR Unit, Faculty of Medicine, Kocaeli University, İzmit 41380, Turkey
| | - Azmi Mahafzah
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, the University of Jordan, Amman 11942, Jordan;
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, the University of Jordan, Amman 11942, Jordan;
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, 22184 Malmö, Sweden
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20
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Fong TL, Lee BT, Chang M, Nasanbayar K, Tsogtoo E, Boldbaatar D, Dashdorj ED, Clifford NE, Dashdorj AN, Bang BR, Chida T, Lim C, Sugiyama M, Mizokami M, Dashdorj NJ, Liu P, Glenn JS, Dashdorj ND, Saito T. High Prevalence of Chronic Viral Hepatitis and Liver Fibrosis Among Mongols in Southern California. Dig Dis Sci 2021; 66:2833-2839. [PMID: 32770488 PMCID: PMC7868472 DOI: 10.1007/s10620-020-06499-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mongolia is a highly endemic region for chronic hepatitis B (HBV), hepatitis delta (HDV), and hepatitis C (HCV) infections. Aim of this study was to comprehensively characterize chronic viral hepatitis among Mongols living in Southern California. METHODS Three screening events were conducted between August and November 2018, with 528 adult Mongols tested for HBV and HCV. HBsAg (+) individuals (CHB) underwent additional testing for HDV RNA and anti-HDV. Liver tests, platelet count, and FibroScan™ were performed on CHB and chronic HCV (CHC) individuals. RESULTS Fifty-one out of 534 were HBsAg reactive (9.7%), and all were foreign-born. Mean age of CHB individuals was 37.8 (range 18-69) years. Forty-six out of 51 were HBeAg (-). HBV genotypes were exclusively D2 or A1. Twenty-one out of 51 (41.2%) were anti-HDV (+) and 17/51 (33.3%) were HDV RNA (+). HDV RNA (+) individuals had significantly higher ALT, fibrosis-4 score, and liver stiffness compared to HDV RNA (-) individuals. Incidence of advanced fibrosis was higher in HDV RNA (+) individuals (57% vs. 13%, p = 0.013). Forty-eight (9.1%) individuals were anti-HCV (+) and 19 (3.6%) were HCV RNA (+). Mean age of CHC individuals was 40.2 (range 28-71) years. Prevalence of anti-HCV (+) was higher among those born between 1945 and 1965 versus those born after 1965 (18.8% vs. 7.9%, p = 0.025). Genotype 1b was predominant. Incidence of cirrhosis was 7% among all participants. CONCLUSIONS Mongols living in the USA are at high risk for CHB and CHC infections. One-third of CHB individuals had CHD superinfection with advanced fibrosis. Universal screening for viral hepatitis in Mongols in the USA is mandatory.
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Affiliation(s)
- Tse-Ling Fong
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles California, USA,Asian Pacific Liver Center, St. Vincent Medical Center, Los Angeles, California, USA,Address correspondence to: Tse-Ling Fong, M.D., Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, 2nd floor, Los Angeles CA 90033 USA, Tel: +1-323-442-6171, Fax: +1-323-442-6169, , Naranbaatar D. Dashdorj, PhD, Co-Founder and Chairman of the Board, Onom Foundation, 3 Governance Academy Street, 15th Khoroo, Khan-Uul District, Ulaanbaatar 17013-0017, Mongolia, Phone: +976.7012.2006, Fax: +976.7013.2006, , Takeshi Saito, M.D., Ph.D., Associate Professor of Medicine, Molecular Microbiology & Immunology, and Pathology USC Research Center for Liver Diseases, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California2011 Zonal Avenue, HMR 801A, Los Angeles, CA 90033-9141, Phone: +1-323-442-2260, Fax:+1-323-442-5425,
| | - Brian T. Lee
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles California, USA
| | - Mimi Chang
- Asian Pacific Liver Center, St. Vincent Medical Center, Los Angeles, California, USA
| | | | | | | | | | | | | | - Bo Ram Bang
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles California, USA
| | - Takeshi Chida
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles California, USA
| | - Carolina Lim
- Asian Pacific Liver Center, St. Vincent Medical Center, Los Angeles, California, USA
| | - Masaya Sugiyama
- Genome Medical Sciences Project, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | - Masashi Mizokami
- Genome Medical Sciences Project, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | | | - Ping Liu
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeffrey S. Glenn
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Naranbaatar D. Dashdorj
- Onom Foundation, Ulaanbaatar, Mongolia,The Liver Center, Ulaanbaatar, Mongolia,Address correspondence to: Tse-Ling Fong, M.D., Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, 2nd floor, Los Angeles CA 90033 USA, Tel: +1-323-442-6171, Fax: +1-323-442-6169, , Naranbaatar D. Dashdorj, PhD, Co-Founder and Chairman of the Board, Onom Foundation, 3 Governance Academy Street, 15th Khoroo, Khan-Uul District, Ulaanbaatar 17013-0017, Mongolia, Phone: +976.7012.2006, Fax: +976.7013.2006, , Takeshi Saito, M.D., Ph.D., Associate Professor of Medicine, Molecular Microbiology & Immunology, and Pathology USC Research Center for Liver Diseases, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California2011 Zonal Avenue, HMR 801A, Los Angeles, CA 90033-9141, Phone: +1-323-442-2260, Fax:+1-323-442-5425,
| | - Takeshi Saito
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles California, USA,Address correspondence to: Tse-Ling Fong, M.D., Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, 2nd floor, Los Angeles CA 90033 USA, Tel: +1-323-442-6171, Fax: +1-323-442-6169, , Naranbaatar D. Dashdorj, PhD, Co-Founder and Chairman of the Board, Onom Foundation, 3 Governance Academy Street, 15th Khoroo, Khan-Uul District, Ulaanbaatar 17013-0017, Mongolia, Phone: +976.7012.2006, Fax: +976.7013.2006, , Takeshi Saito, M.D., Ph.D., Associate Professor of Medicine, Molecular Microbiology & Immunology, and Pathology USC Research Center for Liver Diseases, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California2011 Zonal Avenue, HMR 801A, Los Angeles, CA 90033-9141, Phone: +1-323-442-2260, Fax:+1-323-442-5425,
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21
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Elpek GO. Molecular pathways in viral hepatitis-associated liver carcinogenesis: An update. World J Clin Cases 2021; 9:4890-4917. [PMID: 34307543 PMCID: PMC8283590 DOI: 10.12998/wjcc.v9.i19.4890] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/14/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common type of cancer among primary malignant tumors of the liver and is a consequential cause of cancer-related deaths worldwide. In recent years, uncovering the molecular mechanisms involved in the development and behavior of this tumor has led to the identification of multiple potential treatment targets. Despite the vast amount of data on this topic, HCC remains a challenging tumor to treat due to its aggressive behavior and complex molecular profile. Therefore, the number of studies aiming to elucidate the mechanisms involved in both carcinogenesis and tumor progression in HCC continues to increase. In this context, the close association of HCC with viral hepatitis has led to numerous studies focusing on the direct or indirect involvement of viruses in the mechanisms contributing to tumor development and behavior. In line with these efforts, this review was undertaken to highlight the current understanding of the molecular mechanisms by which hepatitis B virus (HBV) and hepatitis C virus (HCV) participate in oncogenesis and tumor progression in HCC and summarize new findings. Cumulative evidence indicates that HBV DNA integration promotes genomic instability, resulting in the overexpression of genes related to cancer development, metastasis, and angiogenesis or inactivation of tumor suppressor genes. In addition, genetic variations in HBV itself, especially preS2 deletions, may play a role in malignant transformation. Epigenetic dysregulation caused by both viruses might also contribute to tumor formation and metastasis by modifying the methylation of DNA and histones or altering the expression of microRNAs. Similarly, viral proteins of both HBV and HCV can affect pathways that are important anticancer targets. The effects of these two viruses on the Hippo-Yap-Taz pathway in HCC development and behavior need to be investigated. Additional, comprehensive studies are also needed to determine these viruses' interaction with integrins, farnesoid X, and the apelin system in malignant transformation and tumor progression. Although the relationship of persistent inflammation caused by HBV and HCV hepatitis with carcinogenesis is well defined, further studies are warranted to decipher the relationship among inflammasomes and viruses in carcinogenesis and elucidate the role of virus-microbiota interactions in HCC development and progression.
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Affiliation(s)
- Gulsum Ozlem Elpek
- Department of Pathology, Akdeniz University Medical School, Antalya 07070, Turkey
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22
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Campos-Valdez M, Monroy-Ramírez HC, Armendáriz-Borunda J, Sánchez-Orozco LV. Molecular Mechanisms during Hepatitis B Infection and the Effects of the Virus Variability. Viruses 2021; 13:v13061167. [PMID: 34207116 PMCID: PMC8235420 DOI: 10.3390/v13061167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/16/2022] Open
Abstract
The immunopathogenesis and molecular mechanisms involved during a hepatitis B virus (HBV) infection have made the approaches for research complex, especially concerning the patients’ responses in the course of the early acute stage. The study of molecular bases involved in the viral clearance or persistence of the infection is complicated due to the difficulty to detect patients at the most adequate points of the disease, especially in the time lapse between the onset of the infection and the viral emergence. Despite this, there is valuable data obtained from animal and in vitro models, which have helped to clarify some aspects of the early immune response against HBV infection. The diversity of the HBV (genotypes and variants) has been proven to be associated not only with the development and outcome of the disease but also with the response to treatments. That is why factors involved in the virus evolution need to be considered while studying hepatitis B infection. This review brings together some of the published data to try to explain the immunological and molecular mechanisms involved in the different stages of the infection, clinical outcomes, viral persistence, and the impact of the variants of HBV in these processes.
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Affiliation(s)
- Marina Campos-Valdez
- Centro Universitario de Ciencias de la Salud, Departamento de Biología Molecular y Genómica, Instituto de Biología Molecular en Medicina, Universidad de Guadalajara, Guadalajara 44340, Jalisco, México; (M.C.-V.); (H.C.M.-R.); (J.A.-B.)
| | - Hugo C. Monroy-Ramírez
- Centro Universitario de Ciencias de la Salud, Departamento de Biología Molecular y Genómica, Instituto de Biología Molecular en Medicina, Universidad de Guadalajara, Guadalajara 44340, Jalisco, México; (M.C.-V.); (H.C.M.-R.); (J.A.-B.)
| | - Juan Armendáriz-Borunda
- Centro Universitario de Ciencias de la Salud, Departamento de Biología Molecular y Genómica, Instituto de Biología Molecular en Medicina, Universidad de Guadalajara, Guadalajara 44340, Jalisco, México; (M.C.-V.); (H.C.M.-R.); (J.A.-B.)
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Campus Guadalajara, Zapopan 45201, Jalisco, México
| | - Laura V. Sánchez-Orozco
- Centro Universitario de Ciencias de la Salud, Departamento de Biología Molecular y Genómica, Instituto de Biología Molecular en Medicina, Universidad de Guadalajara, Guadalajara 44340, Jalisco, México; (M.C.-V.); (H.C.M.-R.); (J.A.-B.)
- Correspondence: ; Tel.: +52-33-3954-5677
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Hepatitis B virus genotypes in Brazil: Introduction and dissemination. INFECTION GENETICS AND EVOLUTION 2021; 93:104936. [PMID: 34023512 DOI: 10.1016/j.meegid.2021.104936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022]
Abstract
Hepatitis B is a viral infectious disease highly spread worldwide with a long evolutionary history associated with human migrations through the continents and countries. Hepatitis B virus (HBV) was disseminated probably from Africa and diverged into ten genotypes (HBV-A to HBV-J) distributed around the world. In Brazil, almost all HBV genotypes were already reported, with a predominance of three ones: A (52.1%), D (36.8%), and F (7.7%). This review aimed to evaluate the introduction and dissemination of the main HBV genotypes and subgenotypes in Brazil over the last centuries to explain the current epidemic scenario. The highest frequency of HBV-A is a consequence of the introduction and spreading of HBV-A1 in the 16th to 19th centuries due to the African slave trade, but the more recent introduction of HBV-A2 from Europe also contributed to the current situation. HBV-D is the second most frequent genotype because it was consecutively introduced by migrations from Europe (mainly subgenotype D3, but also D2) and the Middle East (D1) in the 19th to 20th centuries. On contrary, HBV-F (F1a, F1b, F2a, F2b, F3, and F4) was disseminated by the Amerindians in all South American countries, including Brazil, by migrations inside the continent for more than three centuries ago. Other HBV genotypes are rare and eventually frequent in some human groups because of the dissemination by very specific epidemiological routes. In conclusion, the current scenario of the HBV epidemics is a consequence of the introduction and dissemination of some subgenotypes from the three main genotypes A, D, and F over the last five centuries.
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rt269I Type of Hepatitis B Virus (HBV) Polymerase versus rt269L Is More Prone to Mutations within HBV Genome in Chronic Patients Infected with Genotype C2: Evidence from Analysis of Full HBV Genotype C2 Genome. Microorganisms 2021; 9:microorganisms9030601. [PMID: 33803998 PMCID: PMC7999911 DOI: 10.3390/microorganisms9030601] [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] [Received: 02/17/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 12/03/2022] Open
Abstract
Recently, it has been reported that the rt269I type of hepatitis B virus (HBV) polymerase (Pol) versus the rt269L type is more significantly related to lower viral replication and HBeAg negative infections in chronic hepatitis B (CHB) patients of genotype C2. In this study, we compared mutation rates within HBV genomes between rt269L and rt269I using a total of 234 HBV genotype C2 full genome sequences randomly selected from the HBV database (115 of rt269L and 119 of rt269I type). When we applied the Benjamini and Hochberg procedure for multiple comparisons, two parameters, dN and d, at the amino acids level in the Pol region were significantly higher in the rt269I type than in the rt269L type. Although it could not reach statistical significance from the Benjamini and Hochberg procedure, nonsynonymous (NS) mutations in the major hydrophilic region (MHR) or “a” determinant in the surface antigens (HBsAg ORF) related to host immune escape or vaccine escape are more frequently generated in rt269I strains than in rt269L. We also found that there are a total of 19 signature single nucleotide polymorphisms (SNPs), of which 2 and 17 nonsynonymous mutation types were specific to rt269L and rt269I, respectively: Of these, most are HBeAg negative infections (preC-W28*, X-V5M and V131I), lowered HBV DNA or virion production (C-I97F/L, rtM204I/V) or preexisting nucleot(s)ide analog resistance (NAr) (rtN139K/H, rtM204I/V and rtI224V) or disease severity (preC-W28*, C-I97F/L, C-Q182K/*, preS2-F141L, S-L213I/S, V/L5M, T36P/S/A, V131I, rtN139K/H, rtM204I/V and rtI224V). In conclusion, our data showed that rt269I types versus rt269L types are more prone to overall genome mutations, particularly in the Pol region and in the MHR or “a” determinant in genotype C2 infections and are more prevalent in signature NS mutations related to lowered HBV DNA replication, HBsAg and HBeAg secretion and potential NAr variants and hepatocellular carcinoma (HCC), possibly via type I interferon (IFN-I)-mediated enhanced inflammation. Our data suggest that rt269L types could contribute to liver disease progression via the generation of immune escape or enhanced persistent infection in chronic patients of genotype C2.
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Abstract
Hepatitis B virus (HBV) is a major cause of hepatocellular carcinoma (HCC). There are approximately 250 million people in the world that are chronically infected by this virus, resulting in nearly 1 million deaths every year. Many of these patients die from severe liver diseases, including HCC. HBV may induce HCC through the induction of chronic liver inflammation, which can cause oxidative stress and DNA damage. However, many studies also indicated that HBV could induce HCC via the alteration of hepatocellular physiology that may involve genetic and epigenetic changes of the host DNA, the alteration of cellular signaling pathways, and the inhibition of DNA repair mechanisms. This alteration of cellular physiology can lead to the accumulation of DNA damages and the promotion of cell cycles and predispose hepatocytes to oncogenic transformation.
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Affiliation(s)
- Jiyoung Lee
- Department of Molecular Microbiology and Immunology, University of Southern California Keck School of Medicine, 2011 Zonal Avenue, HMR-401, Los Angeles, CA, 90033, USA
| | - Kuen-Nan Tsai
- Department of Molecular Microbiology and Immunology, University of Southern California Keck School of Medicine, 2011 Zonal Avenue, HMR-401, Los Angeles, CA, 90033, USA
| | - Jing-Hsiung James Ou
- Department of Molecular Microbiology and Immunology, University of Southern California Keck School of Medicine, 2011 Zonal Avenue, HMR-401, Los Angeles, CA, 90033, USA.
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26
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Mbamalu C, Ekejindu I, Enweani I, Kalu S, Igwe D, Akaeze G. Hepatitis B virus precore/core region mutations and genotypes among hepatitis B virus chronic carriers in South-Eastern, Nigeria. Int J Health Sci (Qassim) 2021; 15:26-38. [PMID: 33708042 PMCID: PMC7934135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES The study aimed at detecting the prevailing hepatitis B virus (HBV) genotypes and the presence of clinically relevant mutations in the precore/core gene of the HBV DNA, among patients with chronic infection in South-eastern, Nigeria. METHODS A total of 72 participants with chronic HBV infection were enrolled into the study. Plasma samples from those with detectable HBV DNA were subjected to nested Polymerase Chain Reaction amplification using the precore/core specific primers. This resulted to the successful amplification and sequencing of the HBV precore/core region DNA from 16 participants. Mutation analysis on the precore/core region detected the presence of certain HBV precore/core gene mutations. Genotyping was carried out by phylogenetic analysis. RESULTS The precore region mutation at nucleotide position 1896, which is a G to A change resulting to a nonsense mutation, was detected in 6.25% of the participants. Other HBV precore region mutations that were detected include: G1899A, T1846A, G1862C, G1888A, T1821C, C1826T, A1827C, A1850T, C1858T, precore start codon Kozak sequence mutations and some novel core region mutations such as G/A1951T and G1957A. Genotyping revealed the existence of HBV genotype/subgenotype A1 (87.5%) and D (12.5%) among the participants. There was no significant difference in the occurrence of specific precore/core mutations among the HBV/hepatitis C virus dually infected and HBV mono-infected participants. CONCLUSION The data suggest the likelihood of a more severe outcome of hepatitis caused by HBV in South-eastern Nigeria due to the occurrence of a variety of precore/core mutation, which resulted to HBeAg-negative chronic HBV infection among the participants.
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Affiliation(s)
- Chinenye Mbamalu
- Medical Laboratory Services, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria,Address for correspondence: Chinenye Mbamalu, Medical Laboratory Services, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. Telephone: +2348068993161. E-mail:
| | - Ifeoma Ekejindu
- Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | - Ifeoma Enweani
- Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | - Stephen Kalu
- Department of HIV Care, PCR Laboratory Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - David Igwe
- Department of Biotechnology, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria,Department of Plant Pathology and Plant-Microbe Biology/Boyce Thompson Institute for Plant Research, Cornell University, Ithaca, New York, USA
| | - Gloria Akaeze
- Department of HIV Care, PCR Laboratory Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
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Ely A, Singh P, Smith TS, Arbuthnot P. In vitro transcribed mRNA for expression of designer nucleases: Advantages as a novel therapeutic for the management of chronic HBV infection. Adv Drug Deliv Rev 2021; 168:134-146. [PMID: 32485207 DOI: 10.1016/j.addr.2020.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
Chronic infection with the hepatitis B virus (HBV) remains a significant worldwide medical problem. While diseases caused by HIV infection, tuberculosis and malaria are on the decline, new cases of chronic hepatitis B are on the rise. Because often fatal complications of cirrhosis and hepatocellular carcinoma are associated with chronic hepatitis B, the need for a cure is as urgent as ever. Currently licensed therapeutics fail to eradicate the virus and this is attributable to persistence of the viral replication intermediate comprising covalently closed circular DNA (cccDNA). Elimination or inactivation of the viral cccDNA is thus a goal of research aimed at hepatitis B cure. The ability to engineer nucleases that are capable of specific cleavage of a DNA sequence now provides the means to disable cccDNA permanently. The scientific literature is replete with many examples of using designer zinc finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs) and RNA-guided endonucleases (RGENs) to inactivate HBV. However, important concerns about safety, dose control and efficient delivery need to be addressed before the technology is employed in a clinical setting. Use of in vitro transcribed mRNA to express therapeutic gene editors goes some way to overcoming these concerns. The labile nature of RNA limits off-target effects and enables dose control. Compatibility with hepatotropic non-viral vectors is convenient for the large scale preparation that will be required for advancing gene editing as a mode of curing chronic hepatitis B.
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Pujol F, Jaspe RC, Loureiro CL, Chemin I. Hepatitis B virus American genotypes: Pathogenic variants ? Clin Res Hepatol Gastroenterol 2020; 44:825-835. [PMID: 32553521 DOI: 10.1016/j.clinre.2020.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 02/06/2023]
Abstract
Hepatitis B virus (HBV) chronic infection is responsible for almost 900.000 deaths each year, due to cirrhosis or hepatocellular carcinoma (HCC). Ten HBV genotypes have been described (A-J). HBV genotype F and H circulate in America. HBV genotypes have been further classified in subgenotypes. There is a strong correlation between the genetic admixture of the American continent and the frequency of genotypes F or H: a high frequency of these genotypes is found in countries with a population with a higher ratio of Amerindian to African genetic admixture. The frequency of occult HBV infection in Amerindian communities from Latin America seems to be higher than the one found in other HBV-infected groups, but its association with American genotypes is unknown. There is growing evidence that some genotypes might be associated with a faster evolution to HCC. In particular, HBV genotype F has been implicated in a frequent and rapid progression to HCC. However, HBV genotype H has been associated to a less severe progression of disease. This study reviews the diversity and frequency of autochthonous HBV variants in the Americas and evaluates their association to severe progression of disease. Although no significant differences were found in the methylation pattern between different genotypes and subgenotypes of the American types, basal core promoter mutations might be more frequent in some subgenotypes, such as F1b and F2, than in other American subgenotypes or genotype H. F1b and probably F2 may be associated with a severe presentation of liver disease as opposed to a more benign course for subgenotype F4 and genotype H. Thus, preliminary evidence suggests that not all of the American variants are associated with a rapid progression to HCC.
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Affiliation(s)
- Flor Pujol
- Laboratorio de Virología Molecular, CMBC, IVIC, Apdo 20632, Caracas 1020A, Venezuela.
| | - Rossana C Jaspe
- Laboratorio de Virología Molecular, CMBC, IVIC, Apdo 20632, Caracas 1020A, Venezuela
| | - Carmen L Loureiro
- Laboratorio de Virología Molecular, CMBC, IVIC, Apdo 20632, Caracas 1020A, Venezuela
| | - Isabelle Chemin
- INSERM U1052, CNRS 5286, Université de Lyon, Université Claude Bernard Lyon 1, centre Léon Bérard, centre de recherche en cancérologie de Lyon, 69000, Lyon, France
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Husseini AA, Islam Saeed KM, Yurdcu E, Bozdayı AM. Molecular epidemiology of Hepatitis B virus, Hepatitis C virus, and Hepatitis D virus in general population of Afghanistan. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 31:658-666. [PMID: 33090103 DOI: 10.5152/tjg.2020.19169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS This study gives a clue about genotypes, subgenotypes and subtypes of HBV, HCV and HDV viruses in general population of Afghanistan. MATERIALS AND METHODS A total of 234 HBsAg, 44 anti-HCV and 5 Anti-Delta positive patients belong to 25-70 age group were obtained through a rapid screening test among 5898 residents of Afghanistan. After quantifying viral load, genotyping of 61 HBV, 29 HCV and 1 HDV samples were accomplished by sequencing of a segment of the HBV Pre S, HCV NS5B, and HDV Delta antigen regions respectively. Clinically important variants of the HBV polymerase gene, the "a" determinant of HBsAg, HCV NS5B and NS3 regions were assessed. RESULTS All HBV isolates were dispersed throughout the genotype D branch and ayw2 was the only subtypes found. The anti-HDV prevalence among HBsAg positive individuals was 2.2% and the single HDV sample, belonged to HDV genotype I. Analysis of HCV isolates revealed subtype HCV-1b in 75.86%, HCV-3a in 20.69% and HCV-3b in 3.44% patients. The observed mutant variants in the MHR of HBsAg were Y100 15%, Q101 5%, G102 15%, T115 45%, P120 5%, T131 5%. Likewise, S213T 10%, Q215P 5% and N248H 100% mutations were detected in the HBV polymerase region. C316N mutation was prevalent in 72.7% of HCV 1b participants. CONCLUSION Genotypic variation in Afghan patients is in line with the ones existing in neighboring countries and regions. HBV genotypes D1, subtype ayw2, HDV RNA type I, and HCV RNA genotype 1b are likely to be dominant in Afghan patients.
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Affiliation(s)
- Abbas Ali Husseini
- Institute of Hepatology, Ankara University School of Medicine, Ankara, Turkey
| | - Khwaja Mir Islam Saeed
- Grant and Service Contract Management Unit (GCMU), Ministry of Public Health, Kabul, Afghanistan
| | - Esra Yurdcu
- Institute of Hepatology, Ankara University School of Medicine, Ankara, Turkey
| | - A Mithat Bozdayı
- Institute of Hepatology, Ankara University Faculty of Medicine, Ankara, Turkey
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30
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Baclig MO, Reyes KG, Liles VR, Gopez-Cervantes J. Association of hepatitis B genotypes with clinical profile of patients with chronic hepatitis B. INTERNATIONAL JOURNAL OF MOLECULAR EPIDEMIOLOGY AND GENETICS 2020; 11:26-30. [PMID: 33240460 PMCID: PMC7677507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
Hepatitis B virus (HBV) infection is a common cause of chronic liver disease and is responsible for HBV-related deaths due to cirrhosis and HCC. It is well recognized that viral genotypes play an important role on the outcome of HBV infection. Ten HBV genotypes have been identified and the prevalence varies geographically. A hospital-based cross-sectional study was conducted to determine the association of HBV genotypes with the clinical profile of CHB patients. PCR-RFLP was performed to identify HBV genotypes. In this study, majority (70%) of patients were males; with ages between 22 to 67 years with a mean of 42.5 years. The ALT ranged from 23 to 111 U/L (mean 72.5 U/L). HBV DNA levels varied from less than 6 to more than 110,000,000 IU/ml. Forty-seven percent of the patients had chronic active hepatitis at the time of diagnosis. Of these, 36% were HBeAg positive while 64% were HBeAg negative. Inactive HBsAg carrier was found in 53% of cases. No significant association was established between HBV genotypes and fibrosis. PCR-RFLP analysis showed that 57%, 10%, and 13% of the samples belonged to HBV/A, HBV/B, and HBV/C, respectively and the remaining 20% had non-detectable HBV genotype. HBV/D to HBV/J were not observed in this study. Taken together, the patient's clinical profile such as sex, ALT levels, HBeAg status, HBV DNA levels and liver histology were not found to be significantly associated with HBV genotypes. A large-scale longitudinal study examining multiple HBV strains are needed to determine significant correlation of clinical profile.
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Affiliation(s)
- Michael O Baclig
- Research and Biotechnology, St. Luke’s Medical Center279 E. Rodriguez Sr. Blvd., Quezon 1112, Philippines
- St. Luke’s Medical Center College of Medicine-William H. Quasha Memorial, Cathedral Heights ComplexE. Rodriguez Sr. Blvd., Quezon 1112, Philippines
| | - Karen G Reyes
- Research and Biotechnology, St. Luke’s Medical Center279 E. Rodriguez Sr. Blvd., Quezon 1112, Philippines
| | - Veni R Liles
- Research and Biotechnology, St. Luke’s Medical Center279 E. Rodriguez Sr. Blvd., Quezon 1112, Philippines
| | - Juliet Gopez-Cervantes
- Center for Liver Disease, St. Luke’s Medical Center279 E. Rodriguez Sr. Blvd., Quezon 1112, Philippines
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31
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Aguilera A, Trastoy R, Rodríguez-Frias F, Muñoz-Bellido JL, Melón S, Suárez A, Orduña A, Viciana I, Bernal S, García-Bujalance S, Montiel N, Molina JM, Basaras M, Fernández-Cuenca F, García-Arata I, Reina G, Ocete MD, Fuentes A, Navarro-de la Cruz D, Nieto L, Blazquez de Castro A, Buti M, Álvarez M, García F. GEHEP 010 study: Prevalence and distribution of hepatitis B virus genotypes in Spain (2000-2016). J Infect 2020; 81:600-606. [PMID: 32711039 DOI: 10.1016/j.jinf.2020.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/29/2020] [Accepted: 07/17/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To study the prevalence and distribution of HBV genotypes in Spain for the period 2000-2016. METHODS Retrospective study recruiting 2559 patients from 17 hospitals. Distribution of HBV genotypes, as well as sex, age, geographical origin, mode of transmission, HDV-, HIV- and/or HCV-coinfection, and treatment were recorded. RESULTS 1924 chronically HBV native Spanish patients have been recruited. Median age was 54 years (IQR: 41-62), 69.6% male, 6.3% HIV-coinfected, 3.1% were HCV-coinfected, 1.7% HDV-co/superinfected. Genotype distribution was: 55.9% D, 33.5% A, 5.6% F, 0.8% G, and 1.9% other genotypes (E, B, H and C). HBV genotype A was closely associated with male sex, sexual transmission, and HIV-coinfection. In contrast, HBV genotype D was associated with female sex and vertical transmission. Different patterns of genotype distribution and diversity were found between different geographical regions. In addition, HBV epidemiological patterns are evolving in Spain, mainly because of immigration. Finally, similar overall rates of treatment success across all HBV genotypes were found. CONCLUSIONS We present here the most recent data on molecular epidemiology of HBV in Spain (GEHEP010 Study). This study confirms that the HBV genotype distribution in Spain varies based on age, sex, origin, HIV-coinfection, geographical regions and epidemiological groups.
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Affiliation(s)
- Antonio Aguilera
- Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago IDIS, Spain
| | - Rocío Trastoy
- Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | | | | | - Santiago Melón
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Avelina Suárez
- Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Antonio Orduña
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Isabel Viciana
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Samuel Bernal
- Hospital Universitario Virgen de Valme, Sevilla, Spain
| | | | | | | | | | | | | | | | | | - Ana Fuentes
- Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs, Av. de la Innovación S/N, 18016 Granada, Spain
| | | | | | | | - María Buti
- Hospital Universitario Vall d'Hebrón, Barcelona, Spain
| | - Marta Álvarez
- Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs, Av. de la Innovación S/N, 18016 Granada, Spain
| | - Federico García
- Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs, Av. de la Innovación S/N, 18016 Granada, Spain.
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32
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Cross-Protection of Hepatitis B Vaccination among Different Genotypes. Vaccines (Basel) 2020; 8:vaccines8030456. [PMID: 32824318 PMCID: PMC7563454 DOI: 10.3390/vaccines8030456] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B (HB) vaccination is the most effective method for preventing HB virus (HBV) infection. Universal HB vaccination containing recombinant HB surface antigens (HBsAg) is recommended. Our data revealed that human monoclonal HB surface antibody (anti-HBs) from individuals inoculated with genotype C-based HB vaccine induced cross-protection against HBV genotype A infection. An in vitro infection model demonstrated anti-HBs-positive sera from individuals inoculated with genotype A- or C-based HB vaccine harbored polyclonal anti-HBs that could bind to non-vaccinated genotype HBV. However, because there were low titers of anti-HBs specific for HBsAg of non-vaccinated genotype, high anti-HBs titers would be required to prevent non-vaccinated genotype HBV infection. Clinically, the 2015 Centers for Disease Control and Prevention guidelines state that periodic monitoring of anti-HBs levels after routine HB vaccination is not needed and that booster doses of HB vaccine are not recommended. However, the American Red Cross suggests that HB-vaccine-induced immune memory might be limited; although HB vaccination can prevent clinical liver injury (hepatitis), subclinical HBV infections of non-vaccinated genotypes resulting in detectable HB core antibody could not be completely prevented. Therefore, monitoring anti-HBs levels after routine vaccination might be necessary for certain subjects in high-risk groups.
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33
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Jeong GU, Ahn BY, Jung J, Kim H, Kim TH, Kim W, Lee A, Lee K, Kim JH. A recombinant human immunoglobulin with coherent avidity to hepatitis B virus surface antigens of various viral genotypes and clinical mutants. PLoS One 2020; 15:e0236704. [PMID: 32790777 PMCID: PMC7425877 DOI: 10.1371/journal.pone.0236704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/12/2020] [Indexed: 12/26/2022] Open
Abstract
The hepatitis B virus (HBV) envelope is composed of a lipid bilayer and three glycoproteins, referred to as the large (L), middle (M), and small (S) hepatitis B virus surface antigens (HBsAg). S protein constitutes the major portion of the viral envelope and an even greater proportion of subviral particles (SVP) that circulate in the blood. Recombinant S proteins are currently used as a preventive vaccine, while plasma fractions isolated from vaccinated people, referred to as hepatitis B immune globulin (HBIG), are used for short-term prophylaxis. Here, we characterized a recombinant human IgG1 type anti-S antibody named Lenvervimab regarding its binding property to a variety of cloned S antigens. Immunochemical data showed an overall consistent avidity of the antibody to S antigens of most viral genotypes distributed worldwide. Further, antibody binding was not affected by the mutations in the antigenic ‘a’ determinant found in many clinical variants, including the immune escape mutant G145R. In addition, mutations in the S gene sequence that confer drug resistance to the viral polymerase did not interfere with the antibody binding. These results support for a preventive use of the antibody against HBV infection.
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Affiliation(s)
- Gi Uk Jeong
- Department of Life Science, Korea University, Seoul, Korea
| | - Byung-Yoon Ahn
- Department of Life Science, Korea University, Seoul, Korea
- * E-mail: (BYA); (JHK)
| | - Jaesung Jung
- Mogam Institute for Biomedical Research, Youngin, Korea
| | - Hyunjin Kim
- Mogam Institute for Biomedical Research, Youngin, Korea
| | - Tae-Hee Kim
- Mogam Institute for Biomedical Research, Youngin, Korea
| | - Woohyun Kim
- Mogam Institute for Biomedical Research, Youngin, Korea
| | - Ara Lee
- Mogam Institute for Biomedical Research, Youngin, Korea
| | - Kyuhyun Lee
- Development Division PL Unit, GC Pharma Corp., Youngin, Korea
| | - Jung-Hwan Kim
- Mogam Institute for Biomedical Research, Youngin, Korea
- * E-mail: (BYA); (JHK)
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34
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Tracing back hepatitis B virus genotype D introduction and dissemination in South Brazil. INFECTION GENETICS AND EVOLUTION 2020; 82:104294. [DOI: 10.1016/j.meegid.2020.104294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/04/2020] [Accepted: 03/22/2020] [Indexed: 12/14/2022]
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35
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Abe H, Ushijima Y, Bikangui R, Loembe MM, Agnandji ST, de Vries SG, Grobusch MP, Lell B, Yasuda J. Ongoing evolution of hepatitis B virus during viremia in patients with febrile in Central Africa. J Med Virol 2019; 92:251-256. [PMID: 31538666 DOI: 10.1002/jmv.25598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/16/2019] [Indexed: 11/08/2022]
Abstract
Hepatitis B virus (HBV) infection remains to be a major public health issue worldwide, although there is currently a safe vaccine and effective antiviral treatments. In surveillance of infectious diseases in Gabon, HBV viremia was detected in patients with febrile. Whole-genome sequencing was conducted to characterize the HBV strains currently circulating in Gabon and to investigate HBV genome diversity during viremia. Phylogenetic analysis revealed the existence of former subgenotype A5, which exhibits a particular pattern of distribution from several West and Central African countries to Haiti. Furthermore, sequencing analysis identified two similar HBV strains mixed in one sample, and a very rare 1-base pair insertion in the viral precore region. This insertion caused a frameshift mutation, indicating the production of an aberrant fusion protein of the HBV x and e antigens. Our data showed that the detected HBV strain was possibly in an "evolving" state during viremia, a phase of active replication.
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Affiliation(s)
- Haruka Abe
- Department of Emerging Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Yuri Ushijima
- Department of Emerging Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Rodrigue Bikangui
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.,Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Marguerite M Loembe
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.,Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany.,Université des Sciences de la Santé de Libreville, Libreville, Gabon
| | - Selidji T Agnandji
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.,Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Sophia G de Vries
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Martin P Grobusch
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.,Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany.,Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.,Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany.,Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Jiro Yasuda
- Department of Emerging Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan.,National Research Center for the Control and Prevention of Infectious Diseases (CCPID), Nagasaki University, Nagasaki, Japan.,Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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36
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Ogawa M, Kamimura S, Kanda T, Takahashi H, Mizutani T, Matsumoto N, Yamamoto T, Nirei K, Matsuoka S, Takei M, Moriyama M. Long-term follow-up of a Japanese patient with hepatitis B virus genotype H and human immunodeficiency virus coinfection. Future Virol 2019. [DOI: 10.2217/fvl-2019-0089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Hepatitis B virus (HBV) genotypes affect the pathogenesis of disease progression during the course of HBV infection. In Japan, HBV genotype H is one of the rare HBV genotypes. We recovered HBV genotype H from a blood sample from a Japanese HIV-infected patient with acute exacerbation of chronic HBV infection. Due to the development of drugs for treating HBV and HIV, HBV genotype H and HIV coinfection has been well controlled by nucleos(t)ide analogs and highly active antiretroviral therapy, respectively, from 2002 to 2019. Further study is needed with regard to HBV genotype H and its pathogenesis.
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Affiliation(s)
- Masahiro Ogawa
- Division of Gastroenterology & Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Shinya Kamimura
- Division of Gastroenterology & Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Tatsuo Kanda
- Division of Gastroenterology & Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Hiroshi Takahashi
- Division of Gastroenterology & Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Taku Mizutani
- Division of Gastroenterology & Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Naoki Matsumoto
- Division of Gastroenterology & Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Toshiki Yamamoto
- Division of Gastroenterology & Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Kazushige Nirei
- Division of Gastroenterology & Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Shunichi Matsuoka
- Division of Gastroenterology & Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Masami Takei
- Division of Hematology & Rheumatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Mitsuhiko Moriyama
- Division of Gastroenterology & Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
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Sagnelli C, Sagnelli E. Towards the worldwide eradication of hepatitis B virus infection: A combination of prophylactic and therapeutic factors. World J Clin Infect Dis 2019; 9:11-22. [DOI: 10.5495/wjcid.v9.i2.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) is still a global health problem, mostly because of the intermediate/high rates of HBV chronic carriers living in most Asian, African and eastern European countries. The universal HBV vaccination of new-borns undertaken in most nations over the last 3 decades and effective HBV antiviral treatments (nucleos(t)ide analogue with high genetic barrier to viral resistance) introduced in the last decade have shown their beneficial effects in inducing a clear reduction of HBV endemicity in the countries where they have been extensively applied. Great hopes are now placed on new antiviral and immunotherapeutic drugs that are now at an advanced stage of study. It is in fact already conceivable that the synergistic use of new drugs targeting more than one HBV-lifecycle steps (covalent closed circular DNA destruction/silencing, HBV entry inhibitors, nucleocapsid assembly modulators targeting viral transcripts) and of some new immunotherapeutic agents might eliminate the intrahepatic covalent closed circular DNA and achieve the eradication of HBV infection. In spite of this, a strong effort should be given to extensive educational and screening programs for the at-risk population and to the implementation of HBV vaccination in developing countries.
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Affiliation(s)
- Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples 80131, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples 80131, Italy
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38
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Lee SY, Choi YM, Oh SJ, Yang SB, Lee J, Choe WH, Kook YH, Kim BJ. rt269I Type of Hepatitis B Virus (HBV) Leads to HBV e Antigen Negative Infections and Liver Disease Progression via Mitochondrial Stress Mediated Type I Interferon Production in Chronic Patients With Genotype C Infections. Front Immunol 2019; 10:1735. [PMID: 31402915 PMCID: PMC6677150 DOI: 10.3389/fimmu.2019.01735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/09/2019] [Indexed: 12/19/2022] Open
Abstract
Hepatitis B virus infection is a serious global health problem and causes life-threatening liver disease. In particular, genotype C shows high prevalence and severe liver disease compared with other genotypes. However, the underlying mechanisms regarding virological traits still remain unclear. This study investigated the clinical factors and capacity to modulate Type I interferon (IFN-I) between two HBV polymerase polymorphisms rt269L and rt269I in genotype C. This report compared clinical factors between rt269L and rt269I in 220 Korean chronic patients with genotype C infections. The prevalence of preC mutations between rt269L and rt269I was compared using this study's cohort and the GenBank database. For in vitro and in vivo experiments, transient transfection using HBV genome plasmid and HBV virion infection using HepG2-hNTCP-C4 and HepaRG systems and hydrodynamic injection of HBV genome into mice tails were conducted, respectively. This report's clinical data indicated that rt269I vs. rt269L was more significantly related to HBV e antigen (HBeAg) negative serostatus, lower levels of HBV DNA and HBsAg, and disease progression. Our epidemiological study showed HBeAg negative infections of rt269I infections were attributed to a higher frequency of preC mutations at 1896 (G to A). Our in vitro and in vivo studies also found that rt269I could lead to mitochondrial stress mediated STING dependent IFN-I production, resulting in decreasing HBV replication via the induction of heme-oxygenase-1. In addition, we also found that rt269I could lead to enhanced iNOS mediated NO production in an IFN-I dependent manner. These data demonstrated that rt269I can contribute to HBeAg negative infections and liver disease progression in chronic patients with genotype C infections via mitochondrial stress mediated IFN-I production.
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Affiliation(s)
- So-Young Lee
- Department of Biomedical Sciences, Microbiology and Immunology and Liver Research Institute, College of Medicine, Seoul National University, Seoul, South Korea
| | - Yu-Min Choi
- Department of Biomedical Sciences, Microbiology and Immunology and Liver Research Institute, College of Medicine, Seoul National University, Seoul, South Korea
| | - Song-Ji Oh
- Department of Biomedical Sciences, Microbiology and Immunology and Liver Research Institute, College of Medicine, Seoul National University, Seoul, South Korea
| | - Soo-Bin Yang
- Department of Biomedical Sciences, Microbiology and Immunology and Liver Research Institute, College of Medicine, Seoul National University, Seoul, South Korea
| | - JunHyeok Lee
- Department of Biomedical Sciences, Microbiology and Immunology and Liver Research Institute, College of Medicine, Seoul National University, Seoul, South Korea
| | - Won-Hyeok Choe
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Yoon-Hoh Kook
- Department of Biomedical Sciences, Microbiology and Immunology and Liver Research Institute, College of Medicine, Seoul National University, Seoul, South Korea
| | - Bum-Joon Kim
- Department of Biomedical Sciences, Microbiology and Immunology and Liver Research Institute, College of Medicine, Seoul National University, Seoul, South Korea
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39
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Limeres MJ, Gomez ER, Noseda DG, Cerrudo CS, Ghiringhelli PD, Nusblat AD, Cuestas ML. Impact of hepatitis B virus genotype F on in vitro diagnosis: detection efficiency of HBsAg from Amerindian subgenotypes F1b and F4. Arch Virol 2019; 164:2297-2307. [PMID: 31267215 DOI: 10.1007/s00705-019-04332-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/31/2019] [Indexed: 02/06/2023]
Abstract
The influence of the high genetic variability of hepatitis B virus (HBV) on the sensitivity of serological assays has received little attention so far. A major source of variability is related to viral genotypes and subgenotypes. Their possible influence on diagnosis and prophylaxis is poorly known and has mostly been evaluated for genotypes A, B, C and D. Robust data showing the detection efficiency of HBsAg from genotype F is lacking. This study examined the effect of virus-like particles containing HBsAg from genotypes A and F (particularly, F1b and F4) produced in Pichia pastoris in relation to the anti-HBs antibodies used in the immunoassays for in vitro diagnosis and compared it with that exerted by the G145R S-escape mutant. The results showed that HBsAg detection rates for subgenotypes F1b and F4 differed significantly from those obtained for genotype A and that subgenotype F1b had a major impact on the sensitivity of the immunoassays tested. Prediction of the tertiary structure of subgenotypes F1b and F4 revealed changes inside and outside the major hydrophilic region (aa 101-160) of the HBsAg compared to genotype A and the G145R variant. A phosphorylation site (target for protein kinase C) produced by the G145R substitution might prevent recognition by anti-HBs antibodies. In conclusion, the use of different genotypes or variants for diagnosis could improve the rate of detection of HBV infection. The incorporation of a genotype-F-derived HBsAg vaccine in areas where this genotype is endemic should be evaluated, since this might also affect vaccination efficacy.
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Affiliation(s)
- María J Limeres
- CONICET, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Evangelina R Gomez
- Instituto de Agrobiotecnología y Biología Molecular, INTA-CONICET, Buenos Aires, Argentina
| | - Diego G Noseda
- Instituto de Investigaciones Biotecnológicas-Instituto Tecnológico de Chascomús (IIB-INTECH), Universidad Nacional de San Martín (UNSAM)-Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Carolina S Cerrudo
- Departamento de Ciencia y Tecnología, Laboratorio de Ingeniería Genética y Biología Celular y Molecular, Área Virosis de Insectos (LIGBCM-AVI), Instituto de Microbiología Básica y Aplicada (IMBA), Universidad Nacional de Quilmes, Bernal, Provincia de Buenos Aires, Argentina
| | - Pablo D Ghiringhelli
- Departamento de Ciencia y Tecnología, Laboratorio de Ingeniería Genética y Biología Celular y Molecular, Área Virosis de Insectos (LIGBCM-AVI), Instituto de Microbiología Básica y Aplicada (IMBA), Universidad Nacional de Quilmes, Bernal, Provincia de Buenos Aires, Argentina
| | - Alejandro D Nusblat
- Facultad de Farmacia y Bioquímica, Instituto de Nanobiotecnología (NANOBIOTEC), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - María L Cuestas
- CONICET, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Universidad de Buenos Aires, Buenos Aires, Argentina.
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Ahmad AE, Bakari AG, Musa BOP, Mustapha SK, Jamoh BY, Abdullahi IN, Tahir MI, Olatunji AO, Maishanu SH, Suleiman AB, Tolulope A, Hawkins C, Sagay AS, Zoakah A, Olayinka AT. Pattern of prevalent Hepatitis B virus genotypes in Zaria, Nigeria. Niger Postgrad Med J 2019; 26:80-86. [PMID: 31187746 PMCID: PMC6626198 DOI: 10.4103/npmj.npmj_59_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Hepatitis B virus (HBV) is hyperendemic in Nigeria. Available literature reveal genotype E as being predominant in West Africa. This study aimed at identifying the current pattern and prevalent genotypes of HBV in Zaria, Nigeria. Materials and Methods: Four millilitre of blood was collected in ethylenediaminetetraacetic acid-container from each of 165 HBV surface antigen-positive participants recruited purposively from the gastroenterology clinic from May to August, 2017. Plasma was separated and frozen at −20°C till analysis. Multiplex-nested polymerase chain reaction using type-specific primers was used to identify the various HBV genotypes. Results: Median (and interquartile range ) age of the participants was 31.0 (25.5–39.0) years, with males constituting 107 (64.8%). Majority (83.6%) of the samples analysed were HBV-DNA-positive with 82.6% of the HBV-DNA-positive samples being mixed genotype infections. Irrespective of mode of occurrence, five HBV genotypes were identified with HBV/E (97.1%) being the most predominant, followed by HBV/B (82.6%), HBV/A (24.6%), then HBV/C (17.4%), while HBV/D (0.7%) was the least prevalent. Conclusion: In most (99.1%) of the mixed-infection were a combination of genotype E, the predominant genotype, with other genotypes predominantly genotype B. HBV genotypes E, B, A, C and D are the prevalent genotypes in Zaria, Nigeria, as they occur in single genotype and in mixed-genotypes pattern.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Claudia Hawkins
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Ayuba Zoakah
- Department of Community Medicine, University of Jos, Jos, Nigeria
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41
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Wong TCL, Fung JYY, Cui TYS, Lam AHK, Dai JWC, Chan ACY, Cheung TT, Chok KSH, Ng KKC, Lo CM. Liver transplantation using hepatitis B core positive grafts with antiviral monotherapy prophylaxis. J Hepatol 2019; 70:1114-1122. [PMID: 30871981 DOI: 10.1016/j.jhep.2019.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/20/2019] [Accepted: 03/04/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The impact of hepatitis B core antibody (anti-HBc) positive liver grafts on survival and the risk of de novo hepatitis B virus (HBV) infection after liver transplantation (LT) remain controversial. Therefore, we aimed to analyze this risk and the associated outcomes in a large cohort of patients. METHODS This was a retrospective study that included all adults who underwent LT at Queen Mary Hospital, Hong Kong, between 2000 and 2015. Data were retrieved from a prospectively collected database. Antiviral monotherapy prophylaxis was given for patients receiving grafts from anti-HBc positive donors. RESULTS A total of 964 LTs were performed during the study period, with 416 (43.2%) anti-HBc positive and 548 (56.8%) anti-HBc negative donors. The median follow-up time was 7.8 years. Perioperative outcomes (hospital mortality, complications, primary nonfunction and delayed graft function) were similar between the 2 groups. The 1-, 5- and 10-year graft survival rates were comparable in anti-HBc positive (93.3%, 85.3% and 76.8%) and anti-HBc negative groups (92.5%, 82.9% and 78.4%, p = 0.944). The 1-, 5- and 10-year patient survival rates in anti-HBc positive group were 94.2%, 87% and 79% and were similar to the anti-HBc negative group (93.5%, 84% and 79.7%, p = 0.712). One-hundred and eight HBsAg negative recipients received anti-HBc positive grafts, of whom 64 received lamivudine and 44 entecavir monotherapy prophylaxis. The risk of de novo HBV was 3/108 (2.8%) and all occurred in the lamivudine era. There were 659 HBsAg-positive patients and 308 (46.7%) received anti-HBc positive grafts. The risk of HBV recurrence was similar between the 2 groups. Donor anti-HBc status did not impact on long-term patient and graft survival, or the risk of hepatocellular carcinoma recurrence after LT. CONCLUSIONS De novo HBV was exceedingly rare especially with entecavir prophylaxis. Anti-HBc positive grafts did not impact on perioperative and long-term outcomes after transplant. LAY SUMMARY The risk of de novo hepatitis B infection after liver transplantation was rare when using hepatitis B core positive liver grafts with entecavir monotherapy prophylaxis. Hepatitis B core antibody status did not impact on perioperative and long-term outcomes after liver transplantation. This provides support for the clinical use of hepatitis B core positive liver grafts when required.
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Affiliation(s)
- Tiffany Cho-Lam Wong
- Department of Surgery, The University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong; Department of Surgery, The University of Hong Kong-Shenzhen Hospital, China
| | - James Yan-Yue Fung
- Department of Medicine, The University of Hong Kong, Hong Kong; Department of Medicine, Queen Mary Hospital, Hong Kong.
| | | | | | - Jeff Wing-Chiu Dai
- Department of Surgery, The University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong
| | - Albert Chi-Yan Chan
- Department of Surgery, The University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong; Department of Surgery, The University of Hong Kong-Shenzhen Hospital, China
| | - Tan-To Cheung
- Department of Surgery, The University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong; Department of Surgery, The University of Hong Kong-Shenzhen Hospital, China
| | - Kenneth Siu-Ho Chok
- Department of Surgery, The University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong; Department of Surgery, The University of Hong Kong-Shenzhen Hospital, China
| | | | - Chung-Mau Lo
- Department of Surgery, The University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong; Department of Surgery, The University of Hong Kong-Shenzhen Hospital, China
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42
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Kostyushev D, Brezgin S, Kostyusheva A, Zarifyan D, Goptar I, Chulanov V. Orthologous CRISPR/Cas9 systems for specific and efficient degradation of covalently closed circular DNA of hepatitis B virus. Cell Mol Life Sci 2019; 76:1779-1794. [PMID: 30673820 PMCID: PMC11105500 DOI: 10.1007/s00018-019-03021-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 12/11/2022]
Abstract
Covalently closed circular DNA (cccDNA) of hepatitis B virus (HBV) is the major cause of viral persistence and chronic hepatitis B. CRISPR/Cas9 nucleases can specifically target HBV cccDNA for decay, but off-target effects of nucleases in the human genome limit their clinical utility. CRISPR/Cas9 systems from four different species were co-expressed in cell lines with guide RNAs targeting conserved regions of the HBV genome. CRISPR/Cas9 systems from Streptococcus pyogenes (Sp) and Streptococcus thermophilus (St) targeting conserved regions of the HBV genome blocked HBV replication and, most importantly, resulted in degradation of over 90% of HBV cccDNA by 6 days post-transfection. Degradation of HBV cccDNA was impaired by inhibition of non-homologous end-joining pathway and resulted in an erroneous repair of HBV cccDNA. HBV cccDNA methylation also affected antiviral activity of CRISPR/Cas9. Single-nucleotide HBV genetic variants did not impact anti-HBV activity of St CRISPR/Cas9, suggesting its utility in targeting many HBV variants. However, two or more mismatches impaired or blocked CRISPR/Cas9 activity, indicating that host DNA will not likely be targeted. Deep sequencing revealed that Sp CRISPR/Cas9 induced off-target mutagenesis, whereas St CRISPR/Cas9 had no effect on the host genome. St CRISPR/Cas9 system represents the safest system with high anti-HBV activity.
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Affiliation(s)
- Dmitry Kostyushev
- Viral Hepatitis Laboratory, Central Research Institute of Epidemiology, 3A Novogireevskaya Street, Moscow, 111123, Russian Federation.
| | - Sergey Brezgin
- Viral Hepatitis Laboratory, Central Research Institute of Epidemiology, 3A Novogireevskaya Street, Moscow, 111123, Russian Federation
- Institute of Immunology, Federal Medical Biological Agency, Moscow, 115478, Russian Federation
| | - Anastasiya Kostyusheva
- Viral Hepatitis Laboratory, Central Research Institute of Epidemiology, 3A Novogireevskaya Street, Moscow, 111123, Russian Federation
| | - Dmitry Zarifyan
- Viral Hepatitis Laboratory, Central Research Institute of Epidemiology, 3A Novogireevskaya Street, Moscow, 111123, Russian Federation
| | - Irina Goptar
- Viral Hepatitis Laboratory, Central Research Institute of Epidemiology, 3A Novogireevskaya Street, Moscow, 111123, Russian Federation
- Izmerov Research Institute of Occupational Health, Moscow, 105275, Russian Federation
| | - Vladimir Chulanov
- Viral Hepatitis Laboratory, Central Research Institute of Epidemiology, 3A Novogireevskaya Street, Moscow, 111123, Russian Federation
- Sechenov University, Moscow, 119146, Russian Federation
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43
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Comparison of pre-S1/S2 variations of hepatitis B virus between asymptomatic carriers and cirrhotic/hepatocellular carcinoma-affected individuals. Clin Exp Hepatol 2019; 5:161-168. [PMID: 31501793 PMCID: PMC6728863 DOI: 10.5114/ceh.2019.84781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/15/2019] [Indexed: 12/13/2022] Open
Abstract
Aim of the study Host and viral factors can influence the clinical course of chronic hepatitis B virus (HBV) infection. Mutations in pre-S1/S2 gene regions are among the most important viral factors determining the HBV infection outcome. The aim of this study was to investigate the role of pre-S1/S2 mutations in HBV infection outcome. Material and methods A total of 52 samples from 26 asymptomatic carriers (ASCs) and 26 liver cirrhosis/hepatocellular carcinoma (LC/HCC) patients were enrolled. The HBV DNA genome was extracted from the sera, and pre-S1/S2 regions of the samples were amplified by nested-polymerase chain reaction, prior to being subjected to sequencing, sequence investigation and phylogenetic analysis. Results Certain deletions were detected mostly located at the boundary of the pre-S1 and pre-S2 regions. These deletions were detected more frequently in ASC cases than in LC/HCC patients (p < 0.007). The rate of critical point mutations, including L11Q, N37S and K38R, was significantly higher in the ASC group, whereas the A49V substitution rate was significantly higher in the LC/HCC group (p < 0.05). The phylogenetic analysis indicated that all the sequences belonged to genotype D. Conclusions According to the results, point mutations such as L11Q, N37S, K38R and A49V, as well as certain deletions, may be associated with HBV infection outcome, among an HBV genotype D pure population.
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44
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Ababneh NA, Sallam M, Kaddomi D, Attili AM, Bsisu I, Khamees N, Khatib A, Mahafzah A. Patterns of hepatitis B virus S gene escape mutants and reverse transcriptase mutations among genotype D isolates in Jordan. PeerJ 2019; 7:e6583. [PMID: 30867996 PMCID: PMC6410685 DOI: 10.7717/peerj.6583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/08/2019] [Indexed: 12/18/2022] Open
Abstract
Background Hepatitis B virus (HBV) is an important infectious cause of morbidity and mortality in Jordan. HBV genotype D is the most prevalent in the country. Virus escape mutants in the HBV S region is an important public health problem halting preventive efforts. The aim of the current study was to investigate patterns of HBV escape and resistance mutations and to assess domestic transmission of the virus. Methods Patients infected with HBV were recruited at Jordan University Hospital (n = 56) and were diagnosed during (1984-2012). A total of 37 partial HBV S sequences were generated using Sanger's method. Mutation analysis was done using the HIV grade HBV drug resistance interpretation online tool and Geno2pheno (HBV) online tools. Domestic transmission of HBV was assessed using maximum likelihood phylogenetic inference with similar GenBank sequences. Results Genotyping revealed an exclusive presence of sub-genotype D1. Typical HBV escape mutants were identified in seven patients. These mutations included: L109R, Q129R, M133L, S143L and D144E with overall prevalence of 18.9% (95% CI [9.5-34.2]). Reverse transcriptase (RT) sequence analysis showed mutations in three patients with overall prevalence of 8.1% (95% CI [2.8-21.3]). RT mutations included: V173L, S202I, L180M, M204V and T184A. Transmission cluster analysis revealed a relatively high proportion of infections taking place as a result of domestic spread (29.7%). Conclusions Based on our findings, RT mutation analysis appears to be of high value before the initiation of therapy in patients with chronic HBV infection in Jordan. Phylogenetic analyses revealed a considerable proportion of local spread in the country which should be considered in the preventive infection control efforts.
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Affiliation(s)
- Nidaa A Ababneh
- Cell Therapy Center (CTC), University of Jordan, Amman, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan, Amman, Jordan.,Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman, Jordan.,Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Doaa Kaddomi
- Gastroenterology and Liver Division, Department of Internal Medicine, Jordan University Hospital, Amman, Jordan
| | | | - Isam Bsisu
- School of Medicine, University of Jordan, Amman, Jordan
| | - Nadia Khamees
- Gastroenterology and Liver Division, Department of Internal Medicine, Jordan University Hospital, Amman, Jordan
| | - Amer Khatib
- Gastroenterology and Liver Division, Department of Internal Medicine, Jordan University Hospital, Amman, Jordan
| | - Azmi Mahafzah
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan, Amman, Jordan.,Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman, Jordan
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45
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Pettersson JHO, Myking S, Elshaug H, Bygdås KIE, Stene-Johansen K. Molecular epidemiology of hepatitis B virus infection in Norway. BMC Infect Dis 2019; 19:236. [PMID: 30845915 PMCID: PMC6407267 DOI: 10.1186/s12879-019-3868-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Background Hepatitis B virus (HBV) infection remains a serious global health challenge. The widespread distribution of HBV is highlighted by multiple HBV genotypes associated with different geographical origin and transmission patterns, as well as, clinical outcomes. Investigating population HBV genotype composition and origin is therefore highly warranted. Methods In this molecular epidemiological study we analysed 1157 HBV S-gene sequences collected from patients in Norway, primarily in the period 2004–2011, and linked them to epidemiological data from the Norwegian surveillance system for communicable diseases. Results Of the patients with reported country of infection (n = 909), 10% (n = 93) were infected in Norway, but the majority (n = 816; 90%) stated that they became infected outside of Norway. Of the patients infected outside of Norway, most became infected in Southeast and East Asia (n = 465; 51%) and Central, West, and North Africa (n = 254; 28%). The distribution of HBV genotypes in Norway is dominated by genotype D (32%) followed by genotype A (22%), B and C (18 and 18%, respectively), and E (7%). Genotype B, C and E were phylogenetically categorized by a majority of sequences originating from distinct geographical regions, either Asia or Africa, whereas genotype A and D originated from multiple geographic regions. However, within genotype A and D, our molecular epidemiology analysis indicated a geographical clustering of sequences depending on their geographical origin. Conclusions The majority of HBV patients in Norway became infected outside of Norway and were represented by most common genotypes. Patients stated to have been infected in Norway were found primarily within genotype A and D, and were phylogenetically characterized by both small local clusters and interspersed sequences that clustered with non-Norwegian sequences, indicating that a proportion of the patients assumed to have been infected in Norway likely became infected outside of Norway although assumed the contrary. Electronic supplementary material The online version of this article (10.1186/s12879-019-3868-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John H-O Pettersson
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway. .,Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden. .,Marie Bashir Institute for Infectious Diseases and Biosecurity, Charles Perkins Centre, School of Life and Environmental Sciences and Sydney Medical School, the University of Sydney, Sydney, NSW, 2006, Australia. .,Public Health Agency of Sweden, Nobels väg 18, SE-171 82, Solna, Sweden.
| | - Solveig Myking
- Department of Infectious Disease Registries, Norwegian Institute of Public Health, Oslo, Norway
| | - Hilde Elshaug
- Department of Molecular Biology, Norwegian Institute of Public Health, Oslo, Norway
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46
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Groc S, Abbate JL, Le Gal F, Gerber A, Tuaillon E, Albert JL, Nkoghé D, Leroy EM, Roche B, Becquart P. High prevalence and diversity of hepatitis B and hepatitis delta virus in Gabon. J Viral Hepat 2019; 26:170-182. [PMID: 30141209 DOI: 10.1111/jvh.12991] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/28/2018] [Accepted: 07/23/2018] [Indexed: 12/15/2022]
Abstract
Although central Africa is classified as having a high endemicity of hepatitis B virus (HBV) and hepatitis D virus (HDV) infection, there is paucity of prevalence studies. For the first time on a country-wide level in Central Africa, we show in Gabon an overall 7.4% prevalence of Hepatitis B surface antigen (HBsAg) and that more than 25% of the HBsAg-positive population are infected by HDV. Although HBV prevalence did not differ significantly between provinces, there is a north-south split in the distribution of HDV seroprevalence, with the highest rates (>66.0%) correlating with the presence of specific ethnic groups in the northeastern provinces. Genotyping revealed high genetic diversity of the HBV and HDV strains circulating in Gabon, including many restricted to this region of the globe. This work confirmed that high exposure to HBV and HDV infection reported in selected regions of Gabon holds true across the whole country.
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Affiliation(s)
- Soraya Groc
- MIVEGEC, IRD/CNRS/Univ. Montpellier, Montpellier, France
| | - Jessica Lee Abbate
- MIVEGEC, IRD/CNRS/Univ. Montpellier, Montpellier, France.,UMR UMMISCO (UMI 209 IRD-UPMC), Bondy, France
| | - Frédéric Le Gal
- Laboratoire de Microbiologie Clinique, Hôpital Avicenne, Centre National de Référence des Virus des Hépatites B C et Delta, Bobigny, France.,Unité INSERM U955, Equipe 18, Créteil, France
| | - Athenaïs Gerber
- Laboratoire de Microbiologie Clinique, Hôpital Avicenne, Centre National de Référence des Virus des Hépatites B C et Delta, Bobigny, France
| | - Edouard Tuaillon
- Pathogenesis and Control of Chronic Infections, Inserm U1058, University of Montpellier, Montpellier, France.,CHU de Montpellier, Montpellier, France
| | - Jean-Louis Albert
- Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Dieudonné Nkoghé
- Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Eric M Leroy
- MIVEGEC, IRD/CNRS/Univ. Montpellier, Montpellier, France.,Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Benjamin Roche
- MIVEGEC, IRD/CNRS/Univ. Montpellier, Montpellier, France.,UMR UMMISCO (UMI 209 IRD-UPMC), Bondy, France
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47
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Makvandi M, Soleimani Jelodar R, Samarbafzadeh A, Neisi N, Sharifi Z, Gholampour A, Masjedizadeh A, Shayesteh A. Natural History of Chronic Hepatitis B Virus Infection in Ahvaz City, Iran. Asian Pac J Cancer Prev 2018; 19:2125-2129. [PMID: 30139211 PMCID: PMC6171397 DOI: 10.22034/apjcp.2018.19.8.2125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Objective: A long persistent of Chronic Hepatitis B (CHB) infection may develop liver cirrhosis or hepatocellular
carcinoma (HCC) and about one million people die due to HBV -related liver cancer and end-stage liver disease annually
worldwide. The natural history of CHB phases comprises four phases: immune tolerant (HBeAg detectable and ALT
(Alanine Transaminase) normal, HBeAg-positive immune active (HBeAg detectable, anti-HBe antibodies undetectable
and ALT persistently elevated), HBeAg-negative immune active (HBeAg undetectable, anti-HBe antibodies present
and ALT persistently elevated), inactive carrier (HBeAg undetectable, anti-HBe antibodies present and ALT normal).
The evaluation of chronic hepatitis B phases is a crucial to manage the burden of disease and limit the development
of associated complications, such as cirrhosis and hepatocellular carcinoma (HCC). Thus this study conducted to
evaluate the natural history of HBV infection in patients with chronic HBV infection in Ahvaz city, Iran. Methods: In
this study, 71 non-treated CHB individuals were recruited including 44 (62%) males and 27(38%) females. The sera
were tested for HBV markers, HBsAg, HBcIgG, HBeAg, and HBeAb. ALT assay and HBV viral load were carried out
for each CHB individual. Results: Based on the analysis of serological, ALT status and viral load, the results showed:
immune tolerance 5(7%), eAg+ Immune Clearance 14(19.7%), eAg- Immune Clearance 29 (40.84%) and Inactive
Carrier 23 (32.39%). The HBeAg seroconversion was observed in a male age 18 year. Conclusion: The results of
the natural history of individuals with chronic hepatitis B phases CHB shows immune tolerance (7%), eAg+ Immune
Clearance (19.7%), eAg- Immune Clearance (40.84%) and Inactive Carrier (32.39%). To prevent the consequence of
CHB infection, an individual in immune tolerance phase should be tested periodically for ALT level, HBV markers,
HBsAg, HBcIgG, HBeAg, HBeAb and HBV viral load. Then decision-making therapy can be applied for CHB patients
at early stage of immune clearance.
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Affiliation(s)
- Manoochehr Makvandi
- Infectious and Tropical Disease Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Virology Department, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Bannister EG, Yuen L, Littlejohn M, Edwards R, Sozzi V, Colledge D, Li X, Locarnini S, Hardikar W, Revill PA. Molecular characterization of hepatitis B virus (HBV) in African children living in Australia identifies genotypes and variants associated with poor clinical outcome. J Gen Virol 2018; 99:1103-1114. [PMID: 29932395 DOI: 10.1099/jgv.0.001086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Migration from sub-Saharan Africa is contributing to the rising incidence of chronic hepatitis B (CHB) infection and its complications in Australia. African CHB is associated with unique genotypes, such as E and A1, which are associated with reduced vaccine efficacy and early-onset hepatocellular carcinoma, respectively, although the prevalence of these genotypes outside Africa is poorly described. Treatment-naïve children of African origin with CHB were recruited at the Royal Children's Hospital Melbourne. Population-based sequencing of the complete HBV genome, or the clinically relevant basal core promoter (BCP)/precore (PC) region, was performed, and the HBV genotype/subgenotype assigned by phylogenetic analysis. HBV was characterized in serum from 67 children, median age 12.5 years. HBV genotype E was most frequent (70 %), with genotype D [25 %; subgenotypes D6 (formerly D7)/D3/D2)] and subgenotype A1 (5 %) also being identified. Despite their young age, over 50 % of the children were HBeAg-negative and had seroconverted to anti-HBe, with this being associated with canonical BCP/PC mutations in the majority of cases. The profile of HBV in African children living in Australia was characterized by early HBeAg seroconversion and infection with HBV variants associated with poor clinical outcome, as well as genotypes previously associated with reduced vaccine efficacy or rapid progression to liver cancer. These findings have important ramifications for patient monitoring and treatment guidelines in the Australian paediatric setting.
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Affiliation(s)
- Elizabeth G Bannister
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia.,2Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia.,3Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Lilly Yuen
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Margaret Littlejohn
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Rosalind Edwards
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Vitina Sozzi
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Danni Colledge
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Xin Li
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Stephen Locarnini
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Winita Hardikar
- 2Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia.,3Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Peter A Revill
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia.,4Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
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49
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Sagnelli C, Ciccozzi M, Alessio L, Cella E, Gualdieri L, Pisaturo M, Minichini C, Di Caprio G, Starace M, Onorato L, Capoprese M, Occhiello L, Angeletti S, Scotto G, Macera M, Sagnelli E, Coppola N. HBV molecular epidemiology and clinical condition of immigrants living in Italy. Infection 2018; 46:523-531. [PMID: 29796738 DOI: 10.1007/s15010-018-1153-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/17/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We investigated 170 HBsAg-positive immigrants living in Italy for 1-7 years to ascertain whether they may have become infected in the host country. METHODS Of 2032 adult immigrants interviewed, 1727 (85%) voluntarily adhered to a screening program for bloodborne or sexually transmitted infections. HBsAg was detected in 170 (9.8%) screened immigrants who completed the diagnostic, clinical and therapeutic process at the nearest clinic of infectious diseases. HBV molecular biology was performed applying a homemade technology. Phylogenetic signal of the datasets was obtained by a likelihood-mapping analysis using TreePuzzle. RESULTS Of the 170 HBsAg-positive immigrants, 133 were inactive carriers, 29 had chronic hepatitis and 8 compensated cirrhosis. HBV genotype was identified in 109 of the 113 HBV-DNA-positive immigrants and HBV-genotype-E predominated (68.9%). Of these 109, 6 (5.5%) subjects showed an HBV genotype absent or extremely rare in their native country: HBV-genotype-E in three from Eastern Europe and in one from Sri Lanka, possibly acquired from other immigrants from sub-Saharan countries, HBV-genotype-D1 in one from Burkina Faso and one from Senegal, possibly acquired in Italy. CONCLUSION The data suggest that immigrants may acquire HBV infection in Italy and, therefore, HBV vaccination programs should be extended to all immigrants living in Italy.
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Affiliation(s)
- Caterina Sagnelli
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy.,Medical Center, Centro Sociale ex Canapificio, Caserta, Italy.,Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy.,Medical Center, Centro Suore Missionarie della Carità, Naples, Italy
| | - Massimo Ciccozzi
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Loredana Alessio
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy.,Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
| | - Eleonora Cella
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Luciano Gualdieri
- Medical Center, Centro per la Tutela della Salute degli Immigrati, Naples, Italy
| | - Mariantonietta Pisaturo
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy.,Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy.,Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Carmine Minichini
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
| | - Giovanni Di Caprio
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy.,Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
| | - Mario Starace
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
| | - Lorenzo Onorato
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy.,Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
| | - Mara Capoprese
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy.,Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
| | - Laura Occhiello
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy.,Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Margherita Macera
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy.,Medical Center, Centro Sociale ex Canapificio, Caserta, Italy.,Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
| | - Evangelista Sagnelli
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy.
| | - Nicola Coppola
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
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50
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Bello-López JM, Delgado-Balbuena L, Rojas-Huidobro D, Rojo-Medina J. Treatment of platelet concentrates and plasma with riboflavin and UV light: Impact in bacterial reduction. Transfus Clin Biol 2018; 25:197-203. [PMID: 29656962 DOI: 10.1016/j.tracli.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/16/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Transfusion of hemocomponents is essential for clinical and surgical procedures and therefore their safety has increased. An option for pathogen reduction includes the combination of riboflavin and UV light. To our knowledge, there are no studies in Latin America that demonstrate the effectiveness of the pathogen reduction in hemocomponents. The objective of this work was to evaluate the efficiency of a pathogens reduction system in platelets concentrates (PC) and plasma. MATERIALS AND METHODS PC and plasma were contaminated with Escherichia coli, Klebsiella pneumoniae, Streptococcus pyogenes and Staphylococcus epidermidis at 104 to 106 CFU and subjected to bacterial reduction. After bacterial reduction, hemocomponents were subjected to cultivation of surviving bacteria by automated method and classical colonies quantification. Additionally, quality control testing was performed in order to confirm the integrity of platelets and coagulation laboratory values in plasma before and after bacterial reduction. RESULTS The bacterial death in PC/plasma was expressed by Logarithmic Reduction Value as follows: for both strains (E. coli and S. pyogenes) 4/4, 5/5 and 6/6; for K. pneumoniae 2.54/2.23, 2.94/2.22 and 3.44/2.98, for S. epidermidis 4/4, 3.11/5 and 3.23/4.19, for 104, 105 and 106 CFU, respectively. In PC and plasma, platelet count, pH (at 22°C), activated partial thromboplastin time (aPTT), prothrombin time (PT), fibrinogen, factor VIII and total proteins (TP) were slightly modified. CONCLUSIONS UV light with riboflavin is able to reduce an important number of pathogens in hemocomponents; however, the bacterial reduction is influenced by the nature and quantity of the pathogen.
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Affiliation(s)
- J M Bello-López
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico; Hospital Juárez de México, Av. Instituto Politécnico Nacional 5160, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico.
| | - L Delgado-Balbuena
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico
| | - D Rojas-Huidobro
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico
| | - J Rojo-Medina
- Centro Nacional de la Transfusión Sanguínea, Av. Othón de Mendizábal 195, Zacatenco, Gustavo A. Madero, 07360 México City, Mexico
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