抗原抗体复合物型治疗性疫苗(乙克)临床研究中患者血清乙型肝炎病毒表面抗原下降的分析与启示

近年来全球慢性乙型肝炎(chronic hepatitis B,CHB)防治指南提出了“功能性治愈”(functional cure)的概念,即患者经过治疗达到血清乙型肝炎病毒表面抗原(hepatitis B virus surface antigen,HBsAg)消失,但现有抗病毒治疗很难实现这一目标。本研究对既往临床试验中经抗原抗体复合物型治疗性疫苗(乙克)治疗后的CHB患者HBsAg下降情况进行了归纳分析,结果显示,经乙克治疗随访后达到乙型肝炎e抗原(hepatitis B e antigen,HBeAg)血清学转换者的HBsAg下降高达0.95log₁₀IU/mL,显著高于未达到HBeAg血清学转换者的0.32log₁₀IU/mL(P<0.01),而经氢氧化铝佐剂治疗随访后发生HBeAg血清学转换(0.49log₁₀IU/mL)者与未发生HBeAg血清学转换者(0.36log₁₀IU/mL)之间HBsAg下降无统计学差异。乙克组治疗过程中,丙氨酸氨基转移酶(alanine aminotransferase,ALT)骤升(ALT flare)在HBsAg下降>1.0log₁₀IU/mL者中较多见,氢氧化铝组未观察到此现象。回归分析显示,乙克治疗后HBsAg下降的影响因素有患者出现HBeAg血清学转换、感染的HBV为B基因型、治疗过程中ALT出现10倍增高,以及基线血清HBsAg为高水平。结果提示,乙克诱导的特异性免疫对降低CHB患者血清HBsAg水平有一定效果,采用“抗病毒药物治疗＋针对HBsAg的中和性抗体被动免疫＋乙克主动免疫”的“三明治”治疗策略可能会提高“功能性治愈”率。     

Dynamic changes of hepatitis B virus polymerase gene including YMDD motif in lamivudine-treated patients with chronic hepatitis B

The mutation of YMDD motif of hepatitis B virus (HBV) polymerase gene is the most frequent cause in HBV resistant to lamivudine. The aim of the study was to investigate variation features of HBV polymerase gene in chronic hepatitis B (CHB) patients before and after lamivudine treatment. From the serum samples of five CHB patients before and after 12 months of lamivudine treatment, HBV polymerase gene was amplificated and positive DNA fragments were cloned into JM105 competent cell. Twenty positive clones of every sample were checked with mismatched polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and YMDD variants were sequenced. Among five patients after 12 months of lamivudine treatment, M552I mutations in two patients with HBV DNA rebounding and D553G mutation in one non-responder were detected except two patients with negative HBV DNA consecutively. In summary, D553G mutation is probably one of the reasons that caused non-responders during lamivudine treatment. The mutations of YMDD motif occurred after lamivudine treatment are caused by the induction of lamivudine.     

CD63在戊型肝炎病毒感染中的作用机制

本研究旨在寻找戊型肝炎病毒(hepatitis E virus,HEV)衣壳蛋白ORF2的相互作用蛋白,探讨其在HEV感染中的作用。采用酵母双杂交方法从人肝细胞文库中筛选与HEV ORF2相互作用的蛋白,结果显示CD63与HEV ORF2相互作用。Pull-down实验提示原核表达的ORF2与CD63结合较弱,而免疫共沉淀实验提示真核表达的ORF2能与CD63结合。流式细胞术检测结果显示,HEV易感细胞PLC/PRF/5细胞膜表面的CD63表达水平普遍低于HEV非易感细胞。过表达CD63抑制PLC/PRF/5细胞的HEV感染,而小干扰RNA(small interfering RNA,siRNA)干扰CD63表达则促进HEV感染。结果提示,CD63能与HEV ORF2相互作用,可能抑制HEV感染肝细胞。     

不同人类免疫缺陷病毒感染途径群体中戊型肝炎病毒的流行情况

本研究旨在了解不同人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染途径群体中戊型肝炎病毒(hepatitis E virus,HEV)抗体情况,探讨HEV疫苗接种的必要性。采集HIV感染者的血清或血浆,利用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测HEV IgG抗体、IgM抗体及抗原,荧光定量聚合酶链反应(polymerase chain reaction,PCR)检测HEV核酸,Roche高纯化HIV-1核酸定量检测试剂盒(PCR荧光法)检测HIV感染者的HIV载量。比较分析不同HIV感染途径群体中HEV流行率的差别。结果显示,HIV感染者中HEV IgG抗体的阳性率为37.4%,静脉吸毒、成分献血和传播途径不明HIV感染群体的HEV IgG抗体阳性率分别为49.3%、39.5%和30.4%。HEV核酸荧光PCR检测结果均为阴性。3种HIV感染群体之间HEV IgG抗体阳性率差异无统计学意义(χ~2=2.978,P0.05)。HEV IgG阳性与阴性感染者之间HIV载量差异无统计学意义(P0.05)。结果提示,为保护HIV感染者免受HEV感染,应考虑接种HEV疫苗。     

广西地区野鼠戊型肝炎病毒感染情况调查

从广西壮族自治区5个市采集256份野鼠肝脏和对应的血清211份,采用HEV抗体(HEV-Ab)酶联免疫试剂盒(双抗原夹心法)对血清样本进行抗-HEV检测,并对不同地区HEV抗体阳性率进行χ2检验。采用HEV核酸荧光PCR试剂盒对肝脏样本进行HEV核酸检测。结果显示,211份野鼠血清抗-HEV的抗体阳性率为6.6%,其中百色市的抗体阳性率最高,为14.1%,其他地区抗体阳性率均在10%以下。256份野鼠肝脏中未检测到HEV核酸。由此可见,广西壮族自治区5个市的野鼠中存在HEV感染,但其是否为HEV的自然宿主及在戊型肝炎传播中起何作用需进一步研究。     

中国西藏部分地区猪戊型肝炎病毒流行病学调查

戊型肝炎病毒(Hepatitis E Virus,HEV)感染是一个重要的全球公共卫生问题,而猪被认为是HEV的天然宿主。HEV可以跨种间传播,且已经证实生吃感染的猪肉会导致人感染。在中国西藏许多地区仍然有生吃猪肉、猪肝等的习惯,且不同种家畜混合饲养,极易造成HEV感染和传播。然而中国西藏地区猪HEV流行情况报道甚少。文中对中国西藏5个地区市(拉萨、日喀则、山南、那曲和昌都)猪血清进行HEV Immunoglobulin-M(Ig M)和Ig G抗体检测,并通过逆转录巢氏PCR(RT-n PCR)进行HEV RNA检测和定量RT-PCR(q RT-PCR)进行病毒拷贝计算,首次报道了藏猪血清HEV RNA阳性率。结果显示,在西藏猪中HEV有较高的流行趋势。猪血清HEV Ig M抗体阳性率高达7.6%(26/340),HEV Ig G抗体阳性率为1.8%(6/340),HEV RNA阳性率高达7.6%(26/340),血清中病毒拷贝高达1.7×107 copies/m L,而且5个地区有不同的流行趋势。结果表明西藏猪HEV感染情况严重。有关部门应加强管理,以避免人与动物之间的交叉感染和暴发。     

Silencing of UBP43 by shRNA enhances the antiviral activity of interferon against hepatitis B virus

Previous studies have shown that expression of the interferon-sensitive gene (ISG)I5 protease UBP43 is increased in the liver biopsy specimens of patients who do not respond to interferon (IFN)-α therapy. We hypothesized that UBP43 might hinder the ability of IFN to inhibit HBV replication. In this study, we investigated whether vector-based siRNA promoted by Hi (psiUBP43) could enhance IFN inhibiting HBV replication in cell culture. UBP43 was specifically silenced using shRNA. In HepG2.2.15 cells, the HBeAg and HBV DNA levels were significantly reduced by IFN after transfection of shRNA, imphicated that vector-based siRNA promoted by HI (psiUBP43) could enhance IFN inhibiting HBV replication in cell culture. These data suggest that UBP43 modulates the anti-HBV type I IFN response, and is a possible therapeutic target for the treatment of HBV infection.     

乙型肝炎病毒表面抗原-抗体复合物治疗慢性乙型肝炎患者病毒S基因变异研究

目的 研究应用乙型肝炎病毒表面抗原(HBsAg)-抗体复合物治疗性疫苗(YIC)治疗慢性乙型肝炎患者是否会诱生S基因免疫逃逸变异株的出现。方法 选取5例用30μg或60μgYIC治疗后血清乙型肝炎病毒(HBV)DNA水平下降>2log10、伴有乙型肝炎病毒e抗原(HBeAg)转阴应答,但在随访6个月后病毒DNA水平重复升高的患者作为研究对象,另选取1例对YIC治疗始终无应答患者和1例注射安慰剂患者作为对照,用聚合酶链反应(PCR)方法扩增治疗前(0周)及治疗后(44周)血清中HBV DNA的S基因、前-核心基因、核心基因启动子片段,并进行序列比对分析。结果 S基因“a”决定簇及前-核心基因均未发生变异,但YIC治疗后有3例HBV的核心基因启动子1762/1764位点序列有变异,另有2例在核心基因启动子的其他位点有核苷酸变异。结论 研究显示5例出现病毒重新复制的患者并非由于发生了病毒S基因逃逸变异所致。     

重访乙型肝炎病毒感染肾脏的意义

乙型肝炎病毒(hepatitis B virus,HBV)嗜肝性主要由病毒与受体作用的特异性、支持共价闭合环状DNA(covalently closed circular DNA,cccDNA)形成的宿主因子和促进病毒RNA转录的核因子3种因素决定。人的肾脏很可能也提供这些要素,且许多研究发现HBV感染标记存在于慢性乙型肝炎患者的肾脏细胞中。本文探讨了HBV感染肾脏的可能性。由于目前血清乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)消失是功能性治愈慢性乙型肝炎的关键指标,如果肾脏也是HBV感染、表达和复制的另一靶器官,则肾脏在功能性治愈慢性乙型肝炎中的作用不可忽视。     

IL28B基因在乙型肝炎病毒感染中的作用

乙型肝炎病毒(Hepatitis B virus,HBV)感染是引发乙型肝炎的病因,慢性化程度较高,后期可诱发肝硬化甚至肝癌。IL28B基因属于新型干扰素λ家族,已有研究报道其遗传多态性与HBV感染者的治疗效果和病毒自然清除率具有相关性。通过探讨IL28B基因遗传易感性与HBV感染、患者治疗应答和病毒清除的关系,可以进一步了解宿主基因多态性在HBV感染治疗和病毒自然清除中的作用机制,为乙肝患者个体化医疗提供一定的理论基础。     

不同干扰素应答慢性乙型肝炎患者的基因组DNA甲基化谱差异分析

α干扰素,包括长效干扰素——聚乙醇化α干扰素(PEG-IFNα),是临床用以治疗慢性乙型肝炎的首选药物。但干扰素治疗通常只能在有限的患者中获得完全应答。目前干扰素治疗应答相关指标预测的灵敏度与特异度远未令人满意,因此继续寻找潜在的与干扰素疗效预测相关的分子标记仍是一个十分有意义的工作。为探讨慢性乙型肝炎患者基因组DNA甲基化状态与干扰素治疗疗效的关系,本研究采用RocheNimbleGen人甲基化DNA免疫共沉淀-芯片(MeDIP-chip)技术,分析20例不同干扰素疗效慢性乙型肝炎患者的血浆基因组启动子甲基化谱差异,并利用MeDIP-定量聚合酶链反应(MeDIP-qPCR)检验部分基因启动子区域DNA甲基化的水平。结果显示,与快速应答组相比,无应答组中有588个基因启动子区甲基化水平存在显著差异(P0.05)。这些基因主要涉及多个信号通路,即钙离子信号通路、细胞周期调节通路、肝脏代谢相关通路等。MeDIP-qPCR验证与芯片结果的一致性超过80%。本研究为探讨差异甲基化基因在干扰素应答中的作用及发现潜在的预测干扰素疗效的血液分子标记奠定了基础。     

Seroepidemiology of hepatitis C virus infection in Japan and HCV infection in haemodialysis patients

Abstract: Since January 1990, Japanese Red Cross Blood Centres have introduced hepatitis C virus screening with a first-generation ELISA. From April to December 1992, approximately 0.98% among 10905 489 blood donations screened by a second-generation assay were anti-HCV-positive in all Japan. Seropositivity of anti-HCV increased with the age and serum transminase value in both sexes. In blood donors having a history of transfusion, the anti-HCV reactive rate was 7.4%. The results of the study made by the Japanese Red Cross Non-A, Non-B Hepatitis Research Group show the effectiveness of implementation of HCV screening to prevent posttransfusion hepatitis. Consecutive haemodialysis patients with chronic renal failure are at risk for inflection by a variety of blood-borne agents transmitted within dialysis units. Because of their immunocompromised state, they frequently also have an unusual susceptibility to a variety of nosocomial infections, such as HBV, and HTLV-I. We tested the prevalence of anti-HCV in 1423 (848 males and 575 females) haemodialiysis patients from 18 hospitals in Kumamoto Prefecture, Japan using the Orhto first generation anti- HCV screening assay. There were 316 patients (22.2%) positive for HCV antibodies. The second-generation test was positive in most haemodialysis patients who were eractive to the firs-generation assay. The prevalence of HCV infection increased with the duration of haemodialysis, yet there was a high frequency of HCV seropositivity even wihtout blood transfusion. Acquisition of HCV in dialysis patients could be explained by HCV seropositivity even without blood (all haemodialysis are done with disposable kits, and needles), by secondary HCV infection after the immunodeficiency of haemodialysis, or by HCV infection of the kidney or glomerular deposition of immune HCV/anti-HCV complexes leading to chronic renal failure (as with HBV infection of the liver and kidney).     

Interleukin IL-1B gene polymorphism in Tunisian patients with chronic hepatitis B infection: Association with replication levels

Approaches based on association studies have proven useful in identifying genetic predictors for many diseases, including susceptibility to chronic hepatitis B. In this study we were interested by the IL-1B genetic variants that have been involved in the immune response and we analyzed their role in the susceptibility to develop chronic hepatitis B in the Tunisian population. IL - 1B is a potent proinflammatory cytokine that plays an important role in inflammation of the liver. Polymorphic gene IL-1 ( − 511, +3954) was analyzed in a total of 476 individuals: 236 patients with chronic hepatitis B from different cities of Tunisia recruited in Pasteur Institute between January 2017 and December 2018 and 240 controls. Genomic DNA was obtained using the standard salting-out method and genotyping was performed by polymerase chain reaction (PCR)-restriction fragment length polymorphism. For − 511C>T polymorphism a significant association was found between patients and controls when comparing the genotypic (P = 0.007; χ² = 9.74 and odds ratio [OR] = 0.60; confidence interval [CI] = 0.41–0.89) and allelic (P = 0.001; χ² = 10.60) frequencies. When the viral load was taken into account a highly significant difference was found (P = 9 × 10⁻⁴; χ² = 10.89). For +3954C>T polymorphism a significant association was found between patients and controls when comparing genotypic (P = 0.0058; χ² = 7.60 and OR = 1.67; CI = 1.14–2.46) and allelic (P = 0.0029; χ² = 8.81) frequencies. T allele can be used as a strong marker for hepatitis B virus disease for both polymorphisms.     

丙型肝炎病毒高水平复制细胞株的构建及其机制初步研究

旨在探讨丙型肝炎病毒(hepatitis C virus, HCV)cured细胞株的易感机制。本研究将体外转录的HCV RNA电转入肝癌细胞系Huh 7细胞,建立HCV复制子细胞株,用 γ-干扰素(interferon,IFN)处理复制子细胞株,获得HCV cured Huh 7A和Huh 7B细胞株。用插入报告基因的HCV毒株Jc1-G感染上述细胞株,分别进行荧光素酶活性测定、蛋白质印迹法和荧光定量聚合酶链反应(polymerase chain reaction,PCR)检测以验证其易感性。收集Huh 7、Huh 7.5、Huh 7A和Huh 7B细胞并利用IFN-α处理,之后用蛋白质印迹法及荧光定量PCR进行检测,验证细胞株中IFN诱生信号通路中关键因子内源性表达及抗病毒活性ISGs的激活水平。结果显示,在Huh 7A和Huh 7B细胞中检测不到病毒RNA,与Huh 7细胞一致。病毒感染实验中,与Huh 7细胞相比,Huh 7A和Huh 7B细胞株中荧光素酶活性增高百倍,病毒蛋白表达和RNA水平亦显著上调,与Huh 7.5细胞株中的表达水平接近。IFN信号通路实验中,与Huh 7细胞相比,Huh 7A和Huh 7B细胞株中RIG-I/MDA5/MAVS内源性蛋白表达和mRNA水平无明显差异;IFN-α处理细胞后IFN刺激基因isg56,mx1,mx2,oax1,oax2,viperin,cxcl10,ifitm1和ifitm3激活水平亦无显著变化。结果提示,本研究制备的Huh 7A和Huh 7B细胞株可支持HCV高水平复制,将为研究病毒复制机制提供有力的支持。     

乙肝病毒突变核心蛋白基因的克隆及序列分析

目的克隆发生长片段缺失的乙肝病毒核心蛋白基因（HBV-C）,并对其进行DNA序列和蛋白质结构分析。方法通过PCR从1株乙型肝炎病毒中扩增得到发生长片段缺失的HBV-C基因,利用TA克隆将PCR产物克隆人pUCm—T载体并进行测序、同源性比较和蛋白质结构分析。结果PCR扩增出的HBV-C基因经序列分析表明长度为454bp,其核苷酸序列缺失了220—317bp之间的98个碱基,造成从74个氨基酸起发生移码突变。结论成功克隆发生长片段缺失的HBV-C基因,为表达及功能研究奠定了基础。     

Vaccine- and hepatitis B immune globulin-induced escape mutations of hepatitis B virus surface antigen

Hepatitis B virus surface antigen (HBsAg) vaccination has been shown to be effective in preventing hepatitis B virus (HBV) infection. The protection is based on the induction of anti-HBs antibodies against a major cluster of antigenic epitopes of HBsAg, defined as the 'a' determinant region of small HBsAg. Prophylaxis of recurrent HBV infection in patients who have undergone liver transplantation for hepatitis B-related end-stage liver disease is achieved by the administration of hepatitis B immune globulins (HBIg) derived from HBsAg-vaccinated subjects. The anti-HBs-mediated immune pressure on HBV, however, seems to go along with the emergence and/or selection of immune escape HBV mutants that enable viral persistence in spite of adequate antibody titers. These HBsAg escape mutants harbor single or double point mutations that may significantly alter the immunological characteristics of HBsAg. Most escape mutations that influence HBsAg recognition by anti-HBs antibodies are located in the second 'a' determinant loop. Notably, HBsAg with an arginine replacement for glycine at amino acid 145 is considered the quintessential immune escape mutant because it has been isolated consistently in clinical samples of HBIg-treated individuals and vaccinated infants of chronically infected mothers. Direct binding studies with monoclonal antibodies demonstrated a more dramatic impact of this mutation on anti-HBs antibody recognition, compared with other point mutations in this antigenic domain. The clinical and epidemiological significance of these emerging HBsAg mutants will be a matter of research for years to come, especially as data available so far document that these mutants are viable and infectious strains. Strategies for vaccination programs and posttransplantation prophylaxis of recurrent hepatitis need to be developed that may prevent immune escape mutant HBV from spreading and to prevent these strains from becoming dominant during the next decennia.     

免疫因素及cccDNA 与HBV的持续感染

由于乙肝疫苗普遍接种,乙型肝炎的流行已经下降,但慢性乙型肝炎（CHB）仍是严重的全球性公共卫生问题。超螺旋共价闭合环状DNA（cccDNA）作为原始转录模板,逃避机体免疫及抗病毒药物清除,在HBV持续感染中发挥重要作用。基于调节患者对HBV的免疫功能研究新的治疗策略以清除细胞核内cccDNA可能成为根除HBV持续感染的途径。