丙型肝炎病毒准种及其临床意义研究进展

丙型肝炎病毒（HCV）易发生变异,在宿主体内主要以准种形式存在。HCV准种能够参与病毒逃避宿主的免疫监控及抗病毒治疗的耐药性,导致病毒在宿主体内持续存在,形成慢性感染。该文就HCV准种的产生、研究方法、基因组各区段内准种的研究及其临床意义作一综述。     

免疫活性细胞回输造成丙型肝炎病毒准种构成-过性改变

观察持续性感染者外周血HCV准种构成及其在增强的免疫压力下的变化规律。应用基因扩增、分子克隆和测序的方法,对4例接受自体免疫活性细胞回输的丙型肝炎患者系列血清中的HCV V区基因片段,进行了序列分析及遗传进化关系比较。HCV病毒池中均以遗传密切相关的优势准种群为主,当机体免疫状态发生变化时,4例中有3名患者血清HCV准种构成发生了一过性改变。优势准群被弱势准群替代。随后其中两例的准种构成又回复到细胞回输前的状态,另一例则形成了新的优势毒株群。第四例患者在全部随访期内准种构成没有明显规律性变化。持续性感染的HCV准种构成是处于与机体免疫压力平衡的较稳定状态,且多以一个遗传密切相关的准种群为优势群体,在受到增强的免疫压力时,这种构成的平衡被打破,HCV的准种构成变化有不同的表现形式,主导毒株的规律性变化是主要的形式之一;但随时间推移,初始状态的准种构成还可回复。     

免疫活性细胞回输造成丙型肝炎病毒准种构成一过性改变

观察持续性感染者外周血HCV准种构成及其在增强的免疫压力下的变化规律。应用基因扩增、分子克隆和测序的方法,对4例接受自体免疫活性细胞回输的丙型肝炎患者系列血清中的HCVC区基因片段,进行了序列分析及遗传进化关系比较。HCV病毒池中均以遗传密切相关的优势准种群为主,当机体免疫状态发生变化时,4例中有3名患者血清HCV准种构成发生了一过性改变,优势准群被弱势准群替代。随后其中两例的准种构成又回复到细胞回输前的状态,另一例则形成了新的优势毒株群,第四例患者在全部随访期内准种构成没有明显规律性变化。持续性感染的HCV准种构成是处于与机体免疫压力平衡的较稳定状态,且多以一个遗传密切相关的准种群为优势群体,在受到增强的免疫压力时,这种构成的平衡被打破,HCV的准种构成变化有不同的表现形式,主导毒株的规律性变化是主要的形式之一;但随时间推移,初始状态的准种构成还可回复。     

丙型肝炎病毒准种血清学检测技术的建立

目的:建立一种以血清学为基础的丙型肝炎病毒(HCV)准种检测技术。方法:自20份HCV血清中各挑选30个克隆进行测序比较,分析HCV准种的复杂程度;以HCV准种代表性抗原组合制备免疫芯片,用血清学检测技术分析上述20份HCV血清中的准种变异程度;比较两种方法之间的检出灵敏度和相关性。结果:测序法检出灵敏度为70.0%,血清学检测法检出灵敏度为95.0%,后者显著高于前者(P0.05);两种方法检测结果的相关性为74.7%(P0.01)。结论:血清学检测技术操作简单,且能够反映丙型肝炎患者的HCV准种变异程度,适于临床推广。     

丙型肝炎病毒准种在NS2区的变异状况初探

探讨HCV准种在NS2区的基因结构特征及变异状况。利用逆转录－巢式PCR从1份HCV慢性携带者的阳性血清及1份丙肝患者的血清中获得HCV NS2全长cDNA,将其克隆于T载体,各随机挑取5个阳性克隆进行序列测定,结果显示克隆到HCV NS2全长基因,所测克隆在核苷酸水平和氨基酸水平互不相同。该慢性携带者HCV NS2区序列以完整读码框架（ORF）为主,一个于HCV多聚蛋白第835位氨基酸的位置出现终止信号,而该丙型肝炎患者以NS2N端发现终止信号的序列为主,其中三个于第835位氨基酸的位置出现终止信号,一个于第887位氨基酸的位置出现终止信号,仅一个克隆的序列为完整ORF。对ORF完整的序列进行比较,发现丙型肝炎患者氨基酸变异主要集中于N端,蛋白二级结构模拟显示丙肝患者NS2与慢性携带者的优势二级结构类似,研究表明从我们选择的两种感染者的HCV NS2序列看,不同临床类型的HCV病人体内的HCV准种在NS2区存在差异,这种差异可能与病毒存在于机体的状态一定的一致性。     

HCV准种单链构象多态现象的检测

单链构象的多态现象(SSCP)是根据PCR技术广泛用于检测不同DNA序列的一门技术，由遗传学家开发的致突变检测，最近已采用于病毒基因组准种的分析，如丙型肝炎病毒(HCV)。由于该技术严格的标准化及其检测的局限性使之很难推广，HCV高变异区准种内的变异体被克隆到Puc　119，引起质粒定量，这种变种可用作SSCP最佳模板，所研究的变量有许多检测到的变异体，少数变异体检测的敏感性，电泳温度、单链DNA产生的方法、PCR循环次数的影响以及与校读能力有关的DNA多聚酶的应用。结果表明，它是能在准种内至少测出5种变异体的最佳方法，并能检出低至2％水平的准种内的变异体，电泳在室温18小时其重复性最好，使用Taq多聚酶单个引物作20次循环产生的单链DNA给准种构成一个精确的映象，Pfu多聚酶的应用减低了检测较小的带型的敏感性。SSCP法提供了评价HCV准种一个精确的工具。     

苏南地区1b型丙型肝炎病毒包膜区变异进化研究

本研究旨在了解本地区丙型肝炎病毒(Hepatitis C virus,HCV)基因型构成的前提下,分析1b型丙型肝炎病毒包膜2(second envelope glycoprotein E2)区的变异和种系进化,并研究其准种变异与临床肝病活动度的关系。对宜兴市人民医院收集的抗HCV抗体阳性患者166名,RT-PCR方法检测HCVRNA,HCVRNA阳性患者采用型特异性引物分型法确定病毒基因型;选择其中未经干扰素治疗的43例1b型慢性丙型肝炎患者的血清标本,扩增E2区,从中选取肝硬化患者4例,慢性非肝硬化患者6例的E2区PCR产物纯化测序,序列采用CLUSTALW与GENBANK上多株不同型别的HCV序列进行比对分析,结果采用Phylip软件构建遗传进化树;并观察E2区高变区1(HVR-1)的氨基酸(aminoacid,aa)残基序列的变异特征;采用单链构象多态性垂直电泳检测43例患者个体内HCVE2区准种的变异情况,比较不同肝病活动度患者准种变异情况。结果表明本地区HCV以1b型为主(84.3%),对E2区基因序列和氨基酸序列变异的分析显示其变异具有一定的规律性,种系进化树提示本地区HCV病毒序列与上海、湖南、日本等地的HCV株有较近的亲缘性。43例患者中ALT高于正常的丙型肝炎患者准种复杂程度明显高于ALT正常者(P<0.05)。故本地区HCV基因变异符合中国东南部的特点,基因变异与临床肝病活动度具有相关性。     

苏南地区1b型丙型肝炎病毒包膜区变异进化研究

本研究旨在了解本地区丙型肝炎病毒(Hepatitis Cvirus,HCV)基因型构成的前提下,分析1b型丙型肝炎病毒包膜2(second envelope glycoprotein E2)区的变异和种系进化,并研究其准种变异与临床肝病活动度的关系.对宜兴市人民医院收集的抗HCV抗体阳性患者166名,RT-PCR方法检测HCVRNA,HCVRNA阳性患者采用型特异性引物分型法确定病毒基因型;选择其中未经干扰素治疗的43例1b型慢性丙型肝炎患者的血清标本,扩增E2区,从中选取肝硬化患者4例,慢性非肝硬化患者6例的E2区PCR产物纯化测序,序列采用CLUSTALW与GENBANK上多株不同型别的HCV序列进行比对分析,结果采用Phylip软件构建遗传进化树;并观察E2区高变区1(HVR-1)的氨基酸(amino acid,aa)残基序列的变异特征;采用单链构象多态性垂直电泳检测43例患者个体内HCV E2区准种的变异情况,比较不同肝病活动度患者准种变异情况.结果表明本地区HCV以1b型为主(84.3%),对E2区基因序列和氨基酸序列变异的分析显示其变异具有一定的规律性,种系进化树提示本地区HCV病毒序列与上海、湖南、日本等地的HCV株有较近的亲缘性.43例患者中ALT高于正常的丙型肝炎患者准种复杂程度明显高于ALT正常者(P＜0.05).故本地区HCV基因变异符合中国东南部的特点,基因变异与临床肝病活动度具有相关性.     

丙型肝炎病毒准种在NS2区的变异状况初探

探讨HCV准种在NS2区的基因结构特征及变异状况.利用逆转录-巢式PCR从1份HCV慢性携带者的阳性血清及1份丙肝患者的血清中获得HCVNS2全长cDNA,将其克隆于T载体,各随机挑取5个阳性克隆进行序列测定.结果显示克隆到HCVNS2全长基因,所测克隆在核苷酸水平和氨基酸水平互不相同.该慢性携带者HCVNS2区序列以完整读码框架(ORF)为主,一个于HCV多聚蛋白第835位氨基酸的位置出现终止信号,而该丙型肝炎患者以NS2N端发现终止信号的序列为主,其中三个于第835位氨基酸的位置出现终止信号,一个于第887位氨基酸的位置出现终止信号,仅一个克隆的序列为完整ORF.对ORF完整的序列进行比较,发现丙型肝炎患者氨基酸变异主要集中于N端,蛋白二级结构模拟显示丙肝患者NS2与慢性携带者的优势二级结构类似.研究表明从我们选择的两例感染者的HCVNS2序列看,不同临床类型的HCV病人体内的HCV准种在NS2区存在差异,这种差异可能与病毒存在于机体的状态有一定的一致性.     

静脉注射吸毒感染者体内HIV-1CRF07_BC的准种变异特征

为了研究静脉注射吸毒者(IDU)体内HIV-1CRF07_BC病毒准种变异和遗传多样性特征,本文采用单基因组扩增(SGA)技术分别从6份CRF07_BC感染者血浆获得HIV-1病毒准种env基因gp120片段序列11～28条,采用构建系统进化树的方法进行聚类分析,描述感染者血浆中CRF07_BC病毒准种的变异特征;运用Simplot软件、分段系统进化树和对平均两两比对基因距离进行遗传多样性作图(Diversity plot)的方法分析病毒准种间的重组。系统进化树分析结果显示仅1个病例具有较高的遗传同质性,而其他5个病例的遗传异质性较高,主要表现为系统进化树上形成2～4个次级进化簇。此外,有3个病例存在病毒准种间的重组。本研究表明SGA技术能有效地分析感染者体内病毒准种复杂的变异特征。     

Quasispecies in viral persistence and pathogenesis of hepatitis C virus.

Hepatitis C virus (HCV) is an important cause of chronic liver disease worldwide. This RNA virus circulates as a quasispecies and its genetic heterogeneity has been implicated in the lack of protective immunity against HCV and in its persistence following infection. HCV might escape from immune surveillance by developing mutations in proteins that are subject to immune pressure.     

The hepatitis C virus persistence: how to evade the immune system?

Hepatitis C virus (HCV) is an emerging virus of medical importance. A majority of HCV infections become chronic and lead to chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. HCV usually induces robust immune responses, but it frequently escapes the immune defense to establish persistent infection. The fact that HCV exists as an evolving quasispecies plays an important role in the selection of escape mutants. Furthermore, several viral proteins interfere with cellular functions, in particular, those involved in the immune response of the host. Several HCV proteins also modulate cell signalling through interaction with different effectors involved in cell proliferation and apoptosis, or in the interferon-signalling pathway. In addition, HCV infects immune cells such as B and T cells, and thus affects their normal functions. These various strategies used by HCV to counter the immune response of the host are reviewed here. A better understanding of these mechanisms would help design new therapeutic targets.     

Genomic variability of hepatitis G virus/GBV-C at the NS3 region: clinical implications

A new hepatitis virus, named GBV-C or hepatitis G virus (HGV), closely related to the hepatitis C virus (HCV), was identified in 1994. The existence of quasispecies in HCV is very important. In this work polymerase chain reaction amplification of the NS3 region of the genome of GBV-C/HGV and heteroduplex mobility assay (HMA) were combined to investigate the presence of quasispecies in patients with chronic infection by GBV-C/HGV. Patients with chronic infection by HCV were used to validate the method. The HMA was also used to investigate the similarity between the cited genomic region of GBV-C/HGV in different infected patients. A high degree of heterogeneity was found for HGV existing as quasispecies and as differences between samples. This is of extreme importance because of the intrinsic clinical and pathogenic implications of quasispecies of a virus capable of producing disease, and is in accord with other studies which report on the genomic variability of the NS3 region.     

Broadly neutralizing antibodies protect against hepatitis C virus quasispecies challenge

A major problem in hepatitis C virus (HCV) immunotherapy or vaccine design is the extreme variability of the virus. We identified human monoclonal antibodies (mAbs) that neutralize genetically diverse HCV isolates and protect against heterologous HCV quasispecies challenge in a human liver-chimeric mouse model. The results provide evidence that broadly neutralizing antibodies to HCV protect against heterologous viral infection and suggest that a prophylactic vaccine against HCV may be achievable.     

Evolutionary rate and genetic drift of hepatitis C virus are not correlated with the host immune response: studies of infected donor-recipient clusters

Six donor-recipient clusters of hepatitis C virus (HCV)-infected individuals were studied. For five clusters the period of infection of the donor could be estimated, and for all six clusters the time of infection of the recipients from the donor via blood transfusion was also precisely known. Detailed phylogenetic analyses were carried out to investigate the genomic evolution of the viral quasispecies within infected individuals in each cluster. The molecular clock analysis showed that HCV quasispecies within a patient are evolving at the same rate and that donors that have been infected for longer time tend to have a lower evolutionary rate. Phylogenetic analysis based on the split decomposition method revealed different evolutionary patterns in different donor-recipient clusters. Reactivity of antibody against the first hypervariable region (HVR1) of HCV in donor and recipient sera was evaluated and correlated to the calculated evolutionary rate. Results indicate that anti-HVR1 reactivity was related more to the overall level of humoral immune response of the host than to the HVR1 sequence itself, suggesting that the particular sequence of the HVR1 peptides is not the determinant of reactivity. Moreover, no correlation was found between the evolutionary rate or the heterogeneity of the viral quasispecies in the patients and the strength of the immune response to HVR1 epitopes. Rather, the results seem to imply that genetic drift is less dependent on immune pressure than on the rate of evolution and that the genetic drift of HCV is independent of the host immune pressure.     

Impact of highly active antiretroviral therapy and immunologic status on hepatitis C virus quasispecies diversity in human immunodeficiency virus/hepatitis C virus-coinfected patients

This study analyzes the effect of highly active antiretroviral therapy (HAART), and thus immunologic status, on hepatitis C virus (HCV) load and quasispecies diversity in patients coinfected with the human immunodeficiency virus (HIV) and HCV. Three cohorts of coinfected patients were analyzed retrospectively over a period of 7 to 10 months: group A was antiretroviral drug na?ve at baseline and then on HAART for the remainder of the study, group B did not receive antiretroviral therapy at any point, and group C was on HAART for the entire study. HCV quasispecies diversity was analyzed by sequencing hypervariable region 1. In a longitudinal analysis, there was no significant change from baseline in any immunologic, virologic, or quasispecies parameter in any of the three groups. However, in comparison to groups A and B, group C had significantly higher CD4+- and CD8+-cell counts, a trend toward a higher HCV load, and significantly increased number of HCV clones, entropy, genetic distance, and ratio of nonsynonymous substitutions per nonsynonymous site to synonymous substitutions per synonymous site (Ka/Ks). In addition, CD4+-cell count was positively correlated with HCV load, genetic distance, and Ka. Interestingly, patients infected with HCV genotype 2 or 3 had a significantly higher CD4+-cell count, HCV load, genetic distance, and Ka/Ks than those infected with genotype 1. These results suggest that there is no immediate effect of HAART on HCV but that, with prolonged HAART, immune restoration results in an increase in HCV load and quasispecies diversity.     

The Role of Viral Mutation in the Pathogenesis of Chronic Viral Hepatitis

The quasispecies nature of hepatitis B and C virus (HBV, HCV) plays an important role in the pathogenesis, immune escape and drug resistance during chronic infection. Although there is still a lack of effective treatment for hepatitis C, a series of nucleoside analogs (NA) have been developed for the treatment of hepatitis B. NA resistant HBV mutants can accumulate during prolonged therapy and lead to the failure of anti-HBV therapy. Switching to other sensitive NAs can inhibit the emerged resistant mutants. Therefore, understanding the evolution of viral quasispecies under drug pressure is crucial for the establishment of antiviral strategy and the monitoring of antiviral process. Immune response and escape are complicated process, during which both host and virus factors may play their roles. Further understanding of the interaction and interrelationship between host and these viruses may lead to optimized prevention, diagnosis and treatment for chronic hepatitis.     

Differential amplification of hypervariable region 1 of hepatitis C virus by partially mismatched primers

The quasispecies nature of hepatitis C virus (HCV) has been well documented over its whole genome and the most variable domain is located at the 5' end of the second envelope region, the so-called hypervariable region 1 (HVR1). HVR1 has therefore been extensively used as the target for characterizing HCV quasispecies profiles. In this study, we reported our finding that partially mismatched primers preferentially amplify different HVR1 sequences in a heterogeneous virus population. This finding suggests a possible mechanism of bias during the amplification of HVR1 sequences and may be responsible for some conflicting data regarding evolutionary or clinical implications of HCV quasispecies.     

Virus evolution within patients increases pathogenicity

Viruses like the human immunodeficiency virus (HIV), the hepatitis B virus (HBV), the hepatitis C virus (HCV) and many others undergo numerous rounds of inaccurate reproduction within an infected host. The resulting viral quasispecies is heterogeneous and sensitive to any selection pressure. Here we extend earlier work by showing that for a wide class of models describing the interaction between the virus population and the immune system, virus evolution has a well-defined direction toward increased pathogenicity. In particular, we study virus-induced impairment of the immune response and certain cross-reactive stimulation of specific immune responses. For eight different mathematical models, we show that virus evolution reduces the equilibrium abundance of uninfected cells and increases the rate at which uninfected cells are infected. Thus, in general, virus evolution makes things worse. An idea for combating HIV infection, however, is constructing a virus mutant that could outcompete the existing infection without being pathogenic itself.