Algorithm of serologic screening and assessment of prevalence of serologically meaningful mutations of HBsAg in hepatitis B virus carriers

Algorithm of serologic screening for HBsAg-mutants in hepatitis B virus (HBV) carriers with high level of HBsAg was developed which is based on the detection of defects of interactions of serum HBsAg with monoclonal anti-HBs realizing as a decrease of ELISA sensitivity in 10 times or more during serial 10-fold dilutions. During 1st stage commercial test-systems based on monoclonal antibodies was used to select serum samples with discrepancy of test results. During 2nd stage HBsAg contained in selected sera was analyzed by the panel of monoclonal and polyclonal anti-HBs conjugates using decrease in ELISA sensitivity as a criterion. Serum samples from 2510 chronic carriers of HBV with high level of HBsAg were studied. 19 samples with discrepant results were found. Subsequent characterization of HBsAg with panel of 11 monoclonal and 1 polyclonal conjugates allowed to distinguish groups of sera with specific serologic "portraits". Atypical features of HBsAg were confirmed by genotyping 9 of 19 samples. Analysis of primary nucleotide sequence revealed serologically meaningful mutations in S-gene of HBV in all 9 isolates: 3 of them contained substitution mutation G145R, 5--S143L, and one--T143M. Distribution of mutations in HBsAg corresponded with specific serologic "portraits". Prevalence of HBsAg mutations in HBV carriers with high level of HBsAg was assessed for the first time: prevalence of G145R, S143L/T143M mutations, and all serologically atypical variants was 0.12%, 0.24%, and 0.76% respectively. Developed algorithm was proposed for epidemiologic monitoring of HBsAg-mutants of HBVand control of diagnostic test-systems.     

Viral Hepatitis and Rapid Diagnostic Test Based Screening for HBsAg in HIV-infected Patients in Rural Tanzania

Background

Co-infection with hepatitis B virus (HBV) is highly prevalent in people living with HIV in Sub-Saharan Africa. Screening for HBV surface antigen (HBsAg) before initiation of combination antiretroviral therapy (cART) is recommended. However, it is not part of diagnostic routines in HIV programs in many resource-limited countries although patients could benefit from optimized antiretroviral therapy covering both infections. Screening could be facilitated by rapid diagnostic tests for HBsAg. Operating experience with these point of care devices in HIV-positive patients in Sub-Saharan Africa is largely lacking. We determined the prevalence of HBV and Hepatitis C virus (HCV) infection as well as the diagnostic accuracy of the rapid test device Determine HBsAg in an HIV cohort in rural Tanzania.

Methods

Prospectively collected blood samples from adult, HIV-1 positive and antiretroviral treatment-naïve patients in the Kilombero and Ulanga antiretroviral cohort (KIULARCO) in rural Tanzania were analyzed at the point of care with Determine HBsAg, a reference HBsAg EIA and an anti-HCV EIA.

Results

Samples of 272 patients were included. Median age was 38 years (interquartile range [IQR] 32–47), 169/272 (63%) subjects were females and median CD4+ count was 250 cells/µL (IQR 97–439). HBsAg was detected in 25/272 (9.2%, 95% confidence interval [CI] 6.2–13.0%) subjects. Of these, 7/25 (28%) were positive for HBeAg. Sensitivity of Determine HBsAg was rated at 96% (95% CI 82.8–99.6%) and specificity at 100% (95% CI, 98.9–100%). Antibodies to HCV (anti-HCV) were found in 10/272 (3.7%, 95% CI 2.0–6.4%) of patients.

Conclusion

This study reports a high prevalence of HBV in HIV-positive patients in a rural Tanzanian setting. The rapid diagnostic test Determine HBsAg is an accurate assay for screening for HBsAg in HIV-1 infected patients at the point of care and may further help to guide cART in Sub-Saharan Africa.     

Negative Interference in Serum HBsAg ELISA from Rheumatoid Factors

Background

RF(Rheumatoid factor) is usually thought to cause positive interference in immunoassay. Recently, our study showed that high-concentration RFs caused negative interference as well as positive interference in serum HBsAg(Hepatitis B surface antigen) ELISA(Enzyme-linked immunosorbent assay), but it is unclear that RF causing negative interference is an anomaly produced by a certain ELISA kit or a common property of most of HBsAg ELISA kits.

Methods

Serum models were made by blending HBsAg-positive sera and high- or moderate-concentration RFs sera at the ratio of 1: 9, then one-step and two-step ELISA were adopted to determine HBsAg in serum models.

Results

No matter what kind of kit used, one-step ELISA showed that HBsAg S/CO( sample/cut off) values in serum models were significantly lower than original values. Bivariate correlations tests showed decline rates of HBsAg S/CO Values were not associated to serum RF concentrations ranging from 288 to 3560 IU/mL. HBsAg converted to be negative in 69.80% serum models with original-value ranging from 1.00 to 10.00, and in 2.68% serum models with higher original-value. RF causing decline of HBsAg S/CO value provided by one-step ELISA was more obvious than that provided by two-step ELISA.

Conclusions

It is concluded that susceptibility of all HBsAg ELISA assays to interference from RF, leading to predominantly lower and in some cases "false-negative" results, and moreover, the lower the original HBsAg S/CO Value, the higher the false-negative rate.     

Comparison of serum HBsAg quantitation by four immunoassays, and relationships of HBsAg level with HBV replication and HBV genotypes

Background

The decline in hepatitis B virus surface antigen (HBsAg) may be an early predictor of the viral efficacy of Hepatitis B virus (HBV) therapy. The HBsAg levels obtained by different immunoassays now need comparing and the relationships between levels of HBsAg and HBV DNA alongside HBsAg and genotype must be evaluated.

Methodology/Principal Findings

HBsAg levels were compared among 80 patients using the Abbott Architect assay, a commercial immunoassay approved for HBsAg detection and quantitation, and three other assays derived from immunoassays approved for HBsAg detection (manufactured by Diasorin, Bio-Rad and Roche). Good correlation was found between the Abbot vs. Diasorin, Bio-Rad and Roche assays with narrow 95% limits of agreement and small mean differences: −0.06 to 0.11, −0.09 log₁₀ IU/mL; −0.57 to 0.64, −0.04 log₁₀ IU/mL; −0.09 to 0.45, −0.27 log₁₀ IU/mL, respectively. These agreements were not affected by genotypes A or D. HBsAg was weakly correlated with HBV DNA, whatever the HBsAg assay used: Abbott, ρ = 0.36 p = 0.001, Diasorin ρ = 0.34, p = 0.002; Bio-Rad ρ = 0.37, p<0.001; or Roche ρ = 0.41, p<0.001. This relationship between levels of HBsAg and HBV DNA seemed to depend on genotypes. Whereas HBsAg (Abbott assay) tended to correlate with HBV DNA for genotype A (ρ = 0.44, p = 0.02), no such correlation was significant for genotypes D (ρ = 0.29, p = 0.15).

Conclusion/Significance

The quantitation of HBsAg in routine clinical samples is comparable between the reference assay and the adapted assays with acceptable accuracy limits, low levels of variability and minimum discrepancy. While HBsAg quantitation is not affected by HBV genotype, the observed association between levels of HBsAg and HBV DNA seems genotype dependent.     

Hepatitis B surface antigen (HBsAg) infection in a hemodialysis unit. II. Factors affecting host immune response to HBsAg.

Serum from 86 hemodialysis patients, 105 healthy hospital staff "at risk" and 160 regular hospital staff was screened for hepatitis B surface antigen (HBsAg) and antibody (anti-HBs). The combined prevalence of HBsAg and anti-HBs was higher in the staff of the artificial kidney unit (57.7%) than in the hemodialysis patients (33.7%). The healthy subjects with HBsAg infection responded significantly more often by producing anti-HBs compared with the hemodialysis patients. Twelve of 29 (41.4%) hemodialysis patients with HBsAg infection produced anti-HBs, while 17 (58.6%) remained positive for HBsAg. This differential response could not be attributed to age, sex, time spent undergoing hemodialysis, delayed cutaneous reactivity or response to phytohemagglutinin (PHA) or pokeweed mitogen (PWM). However, a much larger proportion of patients with HBsAg than with anti-HBs had previously received blood transfusions (88.2% v. 33.3%). Our results indicate that development of the chronic HBsAg carrier state or production of anti-HBs in uremic patients may be influenced by the route of immunization or the dose of antigen, or both. Although uremic patients maintain normal in vitro response to PHA and PWM, they may have depressed immunity in vivo because of a decreased total number of T-lymphocytes.     

Saccharomyces cerevisiae can release hepatitis B virus surface antigen (HBsAg) particles into the medium by its secretory apparatus

We constructed a plasmid that directs the synthesis and secretion of hepatitis B virus (HBV) surface antigen (HBsAg) particles by Saccharomyces cerevisiae. This plasmid contains a proteinase-resistant HBsAg M (M-P31c) gene fused at its 5'-terminus with a chicken-lysozyme signal peptide (C-SIG) gene, which is placed under the yeast GLD (glyceraldehyde-3-phosphate dehydrogenese gene) promoter. The products encoded by the C-SIG + M-P31c (LM-P31c) gene were synthesized and assembled themselves into HBsAg particles in yeast cells, and the particles were released into the medium along with poly-HSA (polymerized human serum albumin) binding activity. The HBsAg particles purified from the medium were very similar in density (1.19 g cm^–3), size (19.2±0.8 nm in diameter) and shape (sphere) to human-plasma-derived HBsAg particles. When several sec (temperature-sensitive secretion-defective) mutants were used as host cells, the release of HBsAg particles into the medium was blocked at 37°C but not at 25°C, indicating that the HBsAg particles are exported through the normal yeast secretion pathway. To our knowledge, this is the first report that yeast cells are capable of secreting particles into the medium. Correspondence to: S. Kuroda     

Hepatitis B antigenemia among blood donors: the changing scene.

For the period May 1973 to August 1974 inclusive, the mean prevalence of hepatitis B antigenemia (HBsAg) in all Canadian provinces (per 100,000 population) was, for "first-time" donors, 242 and, for "repeat" donors, 77. A modification of counterimmunoelectrophoresis was used in all 16 regional transfusion centres. The findings confirm the previously noted high prevalence for the Province of Québec and the continuing relatively high prevalence for Canada. The prevalence of HBsAg among donors could be lessened by institution of the following measures: development of a more effective technique for the screening of hepatitis carriers, study of nonparenterally transmitted hepatitis, better reporting of post-transfusion hepatitis, and greater discrimination in prescribing blood and blood components.     

胸腺素α原作为乙型肝炎表面抗原佐剂的研究

目的：研究胸腺素α原（ProTα）作为佐剂对重组乙型肝炎表面抗原（HBsAg）诱导小鼠产生乙型肝炎表面抗体（抗-HBs）的影响。方法：以纯系BALB/c小鼠为免疫对象,分组情况为：①HBsAg组（1μgHBsAg）;②0.1μgProTα＋1μgHBsAg组;③0.5μgProTα＋1μgHBsAg组;④1μgProTα＋1μgHBsAg组;⑤铝佐剂组（1μgVacon疫苗）;⑥1μgPro-Tα＋1μgVacon疫苗组;每组10只小鼠,分别于0、2周各肌肉注射免疫1次。采用ELISA法检测血清抗-HBs滴度（即IgG亚类IgG1和IgG2a）。结果：与单独注射HBsAg组相比,1μgProTα＋1μgHBsAg组抗-HBs总抗体滴度明显增高（P〈0.05）,抗体持续时间更长,且ProTα可以平衡Th1和Th2免疫反应;2组间IgG1/IgG2a差异显著（P〈0.05）。与铝佐剂相比,ProTα增强了小鼠对HBsAg的反应性,提高抗-HBs阳转率。结论：ProTα在增强小鼠抗-HBs产生的同时,提高细胞免疫反应,提示ProTα是一种很有潜力的HBsAg佐剂。     

p21~(HBsAg/HBsAg)转基因小鼠肝脏病理学研究

[目的]观察p21HBsAg/HBsAg转基因小鼠肝脏病理学改变。[方法]分别选取2,6,12,18,24月龄的SPF级p21HBsAg/HBsAg转基因小鼠和p21+/+野生型小鼠,剖检进行大体观察,取肝脏及肝脏肿瘤组织,进行组织学HE染色及电镜超微结构观察。[结果]p21HBsAg/HBsAg转基因小鼠肝脏大体、光镜和电镜下均有的明显病理改变。随着月龄的增加,肝脏色暗质硬,表面有结节和肿瘤形成;光镜下,肝细胞浊肿,炎症细胞浸润,脂肪变性,点状、灶状和碎屑状坏死,非典型增生,肝细胞癌。癌细胞分化良好,类似肝细胞,形成索状和腺泡状结构。癌细胞核深染,具核分裂像。电镜下,癌细胞核变形,核膜曲折凹陷,线粒体肿胀,数目增多,脊减少。4例18月龄转基因小鼠发生肝细胞癌(4/10),6例24月龄的转基因小鼠发生肝细胞癌(6/10),其中2例发现远处转移;[结论]p21HBsAg/HBsAg转基因小鼠肝脏出现明显病理损害,18月龄小鼠开始发展成高分化的肝细胞癌,高龄小鼠形成的肝细胞癌能够转移。     

Longitudinal Change of HBsAg in HBeAg-negative Patients with Genotype B or C Infection

Background & Aims

Quantitative HBsAg has been recognized to assist in the management of chronic hepatitis B virus (HBV) infection. However, its role in disease monitoring of HBeAg-negative patients remains unclear. We aimed to investigate the longitudinal HBsAg change in HBeAg-negative carriers with HBV genotype B or C infection.

Methods

This is a retrospective cohort study conducted in a university hospital. Treatment-naïve HBeAg-negative carriers followed for more than 3 years were recruited. Their hepatitis activities were categorized by longitudinal HBV-DNA levels into high viral-load (HVL: HBV-DNA >/ = 2000 IU/mL persistently), low viral-load (LVL: HBV-DNA <2000 IU/mL persistently) and fluctuated viral-load (FVL: HBV-DNA between HVL and LVL). The baseline and end-of-follow-up (EOF) HBsAg levels were quantified for analyses.

Results

We recruited 187 patients with a median follow-up of 8 years. LVL patients had a significantly lower HBsAg at baseline and EOF and a significantly greater annualized HBsAg decline compared with the FVL and HVL. The longitudinal HBsAg change was independent of genotype B or C. The lower baseline HBsAg level predicted the HBsAg decline and HBsAg loss, whereas the higher baseline HBV-DNA predicted the hepatitis flare. A baseline HBsAg <50 IU/mL predicted subsequent HBsAg loss with a sensitivity of 82% and specificity of 67%. The annualized HBsAg decline appeared non-linear, and accelerated as the HBsAg level lowered (0.054, 0.091, 0.126 log₁₀ IU/mL in patients with baseline HBsAg >1000, 100–999, <100 IU/mL, respectively, P for trend = .014).

Conclusions

In genotype B or C HBeAg-negative carriers, baseline HBsAg levels correlate with future disease activities and help to predict HBsAg decline or loss. Inactive carriers with lower baseline HBsAg levels have a greater and accelerating HBsAg decline over time, regardless of HBV genotypes.     

重组CHO细胞HBsAg 纯化工艺的优化

目的：优化重组CHO细胞HBsAg纯化工艺。方法：由乙肝病毒S基因转化的中国仓鼠卵巢(CHO)细胞培养收液,经初步提纯、密度梯度离心、凝胶过滤层析可得到HBsAg纯品。结果：通过凝胶过滤层析收取HBsAg活性峰,控制HBsAg活性峰的收量,并把HBsAg活性峰的下降段再收集起来重新层析,改进后可使HBsAg的总回收率达到60％以上,而且牛血清蛋白残余量达到10mg/ml以下,HBsAg纯度97％以上。结论：重组CHO细胞HBsAg纯化工艺改进后,使HBsAg在产量及质量上均有明显提高。     

抗乙型肝炎病毒表面抗原“y”亚型及“a”组抗原决定簇杂交瘤细胞株的建立与应用

用部分纯化的HBsAg/adr和ayw亚型免疫Balb/c小鼠的脾细胞,在PEG作用下与Sp2/o骨髓瘤细胞进行融合,经ELISA及RIA法筛选出了分泌抗HBsAg/a(SH 1 D9)、抗HBsAg/y(SG 3 B10)亚型决定簇的杂交瘤细胞系,在组织培养上清液中它们的滴度分别     

Transmission of HBsAg from mother to infant in four ethnic groups.

Antenatal screening in the West Midlands during a three-year period identified 297 mothers who were chronic carriers of hepatitis B surface antigen (HBsAg)--a prevalence of about 1 in 850. About half of their infants had HBsAg in the cord blood, but of 122 infants followed up for over three months (mean 8.5 months) only 17 (14%) were still positive for HBsAg. Cord-blood HBsAg-positivity was evenly distributed among different ethnic groups, but the transmission rate was highest among the Chinese, and no carriers were discovered among 39 European infants. Raised serum transaminase concentrations were found in some of the carrier infants who were otherwise healthy. The results suggest that adequate follow-up of HBsAg-positive infants may be achieved by tests at 4 months and 1 year of age, and that the role of breast-feeding in mother-to-infant transmission of HBsAg is unimportant. The Chinese community may be a suitable population in which to test the effectiveness of specific immunoglobulin administration at birth in preventing the development of the HBsAg carrier state.     

Assessment of sensitivity of commercial test-systems for HBsAg immunodetection according to their ability to detect HBsAg-mutants of hepatitis B virus

Comparative study of widely distributed on Russian market commercial test-systems for HBsAg detection by enzyme immunoassay was performed. Panel of serum samples containing mutant forms of HBsAg was developed for the study. It showed that only 2 out of 7 studied test-systems are able to detect mutant forms of HBsAg with the same sensitivity as "wild-type" forms of HBsAg. Test-systems based only on monoclonal antibodies did not detect HBsAg with G145R substitution in concentration 5 ng/ml. The study confirms the relevance of problem of HBsAg-mutants detection for hepatitis B immunodiagnostics.     

Anti-HBbrno: a new CIEP hepatitis B marker, more sensitive than HBsAg radioimmunoassay.

Evidence is presented for the new HBbrnoAg-Anti-HGbrno system association with the HBsAg. The association is displayed particularly in a prevalence of Ausria detectable HBsAg carriers among the anti-HBbrno carriers, suggesting the anti-HBbrno to be a marker of contact with hepatitis B or, possibly, an indicator of co-existing HBsAg antigenaemia, not detectable by radioimmunoassay. Identity of HBbrnoAg with HBsAg/a, d, y, w, is ruled out, the identity with the other HBV associated antigenic specificities remaining questionable.     

p21HBsAg/HBsAg转基因小鼠肝脏病理学研究

目的观察p21HBsAg/HBsAg转基因小鼠肝脏病理学改变.方法分别选取2、6、12、18、24月龄的SPF级p21HBsAg/HBsAg转基因小鼠和p21+/+野生型小鼠,剖检进行大体观察,取肝脏及肝脏肿瘤组织,进行组织学HE染色及电镜超微结构观察.结果 p21HBsAg/HBsAg转基因小鼠肝脏大体、光镜和电镜下均有明显病理改变.随着月龄的增加,肝脏色暗质硬,表面有结节和肿瘤形成;光镜下,肝细胞浊肿,炎症细胞浸润,脂肪变性,点状、灶状和碎屑状坏死,非典型增生,肝细胞癌.癌细胞分化良好,类似肝细胞,形成索状和腺泡状结构.癌细胞核深染,具核分裂像.电镜下,癌细胞核变形,核膜曲折凹陷,线粒体肿胀,数目增多,嵴减少.4例18月龄转基因小鼠发生肝细胞癌(4/10),6例24月龄的转基因小鼠发生肝细胞癌(6/10),其中2例发现远处转移.结论 p21HBsAg/HBsAg转基因小鼠肝脏出现明显病理损害,18月龄小鼠开始发展成高分化的肝细胞癌,高龄小鼠形成的肝细胞癌能够转移.     

Improved immunogenicity of HIV-1 epitopes in HBsAg chimeric DNA vaccine plasmids by structural mutations of HBsAg

To improve the immunogenicity of epitopes from the envelope protein of HIV-1, we have developed gene gun-delivered subunit DNA vaccines by inserting the sequences encoding the V3 region into the hepatitis B virus (HBV) envelope gene, often called the surface antigen (HBsAg). We have examined the possibility of modifying the immune response to V3 by introducing modifications into the carrier HBsAg in gene gun DNA immunization of mice. In some plasmid constructions, the V3 sequence was introduced into the preS2 region of the HBsAg. Although this region is not present in all protein subunits of the HBsAg particles produced, abolishing the internal translational initiation site for the S protein had no effect on the immune response to V3. Expression of V3 at the N-terminal or C-terminal part of the HBsAg protein resulted in equal anti-V3 antibody and cytotoxic T-lymphocyte (CTL) responses. However, elimination of secretion by single amino-acid mutations in the HBsAg decreased the anti-HBsAg antibody response but enhanced the anti-V3 antibody response. In contrast, the CTL response to V3 was independent of the structural mutations but could be improved by a total deletion of the HBsAg sequence part. Thus, the immune response to heterologous epitopes can be altered by modifications in the carrier HBsAg protein. Modifications of the HBsAg carrier might interfere with the dominant immune response to the HBsAg epitopes, allowing better antibody induction to less immunogenic foreign epitopes. However, for induction of CTL responses, the expression of minimal epitopes may be advantageous.     

Use of baculovector for the expression of HBsAg gene in insect cells

Based on the information of molecular biology of Autographa californica Nuclear Polyhedrosis virus (AcNPV), a recombinant transfer plasmid pAcMV was constructed by molecular procedures included using two synthetic localized probes, which provided an inserted position linked with BamHI sequences nearly at polyhedrin initiating ATG codon. Then an expression vector pAcMV-HBsAg was reconstructed, it contained HBsAg gene from subclone pYPSS-1 derived from adwserotype of HBV. The recombinant virus containing HBsAg gene was isolated and purified through 3 cycles plaques and hybridization experiment after cotransfection of Spodoptera frugiperda cells with DNA of pAcMV-HBsAg and AcNPV. The expression of HBsAg gene in S. frugiperda cells infected with recombinant virus AcRV-HBsAg was identified by ELISA as haemagglutination tests. The yield of HBsAg excreted from S. frugiperda cells (an appropriate density usually between 1-2 X 10(6) cells/ml) after 48-72 h infected with AcRV-HBsAg was 4-8 mg/L. HBsAg harvested from the infected culture medium was shown immunoelectromicroscopy to be composed of spherical particles of about 22 nm diameter. Using this purified HBsAg, Bal b/c mice was immunized, the titer of anti-HBsAg serum measured measured by RIA was similar to that of purified HBsAg from human blood. Stable recombinant virus was isolated and could be shown to replicate in corn borer (Ostrinia nubilalis) larvae. All of these results can be expected that this expression vector system will be commercially developed to its fullest potential for diagnosis and vaccine HBsAg.     

用单克隆抗体分析HBsAg的多肽及a决定簇的表位

通过Western-Blot发现,多克隆抗-HBs抗体及单克隆抗体B_(13),A_1均识别24kd及27kd两条多肽带,而单克隆抗体B_6,B_9及B_(12)只识别24kd,不识别27kd的多肽带。用这几株单克隆抗体对不同来源HBsAg a决定簇的表位密度进行了研究,结果表明血源、重组CHO细胞表达及重组痘苗病毒表达的HBsAg与重组酵母表达的HBsAg在结合单克隆抗体A_1、B_6及B_9的密度上有数量的差别,并且有统计学意义。