Comparison and significance of specific and non-specific cellular immunity in patients with chronic hepatitis B caused by infection with genotypes B or C of hepatitis B virus

The present study was designed to investigate possible relationships between the genotypes of hepa-titis B virus (HBV) and the HBV-specific cytotoxic T lymphocyte (CTL) responses. HBV genotypes, HBV specific CTL HBV DNA and other markers of HBV infection were determined in 138 patients with chronic hepatitis B. The results showed that the patients infected with genotype C (n=62) had a significantly lower HBV-specific CTL response than those who were infected with HBV genotype B (P<0.01). HBV DNA titer was higher in patients infected with HBV genotype C than in those infected with HBV geno-type B (P<0.01). Both alanine aminotransferase (ALT) and total bilirubin (TBIL) were higher in HBV genotype C infected patients than in those infected with genotype B (P<0.01 and <0.05, respectively). These results suggest that compared with CHB patients infected with HBV genotype B, the higher HBV DNA level and more severe liver damages in the patients infected with genotype C of HBV may be as-sociated with genotype C of the virus.     

Mechanism of inhibiting type I interferon induction by hepatitis B virus X protein

Hepatitis B virus (HBV) is regarded as a stealth virus, invading and replicating efficiently in human liver undetected by host innate antiviral immunity. Here, we show that type I interferon (IFN) induction but not its downstream signaling is blocked by HBV replication in HepG2.2.15 cells. This effect may be partially due to HBV X protein (HBx), which impairs IFNβ promoter activation by both Sendai virus (SeV) and components implicated in signaling by viral sensors. As a deubiquitinating enzyme (DUB), HBx cleaves Lys63-linked polyubiquitin chains from many proteins except TANK-binding kinase 1 (TBK1). It binds and deconjugates retinoic acid-inducible gene I (RIG I) and TNF receptor-associated factor 3 (TRAF3), causing their dissociation from the downstream adaptor CARDIF or TBK1 kinase. In addition to RIG I and TRAF3, HBx also interacts with CARDIF, TRIF, NEMO, TBK1, inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase epsilon (IKKi) and interferon regulatory factor 3 (IRF3). Our data indicate that multiple points of signaling pathways can be targeted by HBx to negatively regulate production of type I IFN.     

乙肝病毒表面抗原持续表达的新致病机制

乙型肝炎表面抗原(HBsAg)持续阳性是控制乙肝中难以解决的重大问题。本研究通过揭示HBsAg致病机制的基础研究,寻找抑制或清除HBsAg的新途径。通过建立有可比性的HBsAg转基因鼠和稳定表达细胞系及相应对照,进行比较转录组学和蛋白质组学研究,发现了HBsAg在HBV慢性感染中的一些新致病机制。其中包括:HBsAg促进肝细胞内CypA分泌,后者可趋化炎症细胞在HBsAg阳性灶周围浸润;在细胞模型中,HBsAg分泌可引起胞内GRP78蛋白下降,导致肝细胞抗凋亡能力减弱;发现HBsAg在细胞中可上调截短的LEF1基因的表达,缺乏活化全长LEF1促成瘤和增殖活性;而肝癌组织中LEF1则倾向于核内分布,并活化Wnt下游基因Cyclin D1与c-myc,有促肿瘤活性。在转基因鼠和细胞模型中都发现了物质和能量代谢相关的基因发生变化,并与临床慢性乙肝患者表现相符。研究中有关CypA的发现提供了抑制HBsAg的新途径;有关代谢的变化提出了改变饮食内容与习惯可能有利于HBsAg阳性感染者的预后。     

High prevalence of occult hepatitis B virus genotype H infection among children with clinical hepatitis in west Mexico

Studies on the prevalence of infection with hepatitis B virus (HBV) among childrenare scarce in Latin American countries, especially in Mexico. This study was aimed toinvestigate the prevalence of HBV infection, occult hepatitis B infection (OBI) andHBV genotypes among children with clinical hepatitis. In total, 215 children withclinical hepatitis were evaluated for HBV infection. HBV serological markers and HBVDNA were analysed. OBI diagnosis and HBV genotyping was performed. HBV infection wasfound in 11.2% of children with clinical hepatitis. Among these HBV DNApositive-infected children, OBI was identified in 87.5% (n = 21/24) of the cases and12.5% (n = 3/24) were positive for both HBV DNA and hepatitis B surface antigen. OBIwas more frequent among children who had not been vaccinated against hepatitis B (p< 0.05) than in those who had been vaccinated. HBV genotype H was prevalent in 71%of the children followed by genotype G (8%) and genotype A (4%). In conclusion, OBIis common among Mexican children with clinical hepatitis and is associated with HBVgenotype H. The results show the importance of the molecular diagnosis of HBVinfection in Mexican paediatric patients with clinical hepatitis and emphasise thenecessity of reinforcing hepatitis B vaccination in children.     

Management of individuals with chronic hepatitis B virus infection and persistent normal or mildly elevated aminotransferase levels

No consensus exists with respect to positive hepatitis B virus (HBV) DNA results and persistent normal or mildly elevated alanine aminotransferase (ALT). The aim of this study is to investigate the appropriate management and prognosis of these populations with chronic hepatitis B (CHB). A total of 235 subjects with positive HBV DNA results and persistent normal or mildly elevated ALT were enrolled in this study. Liver biopsy and liver stiffness measurements (LSM) were performed in all participants at baseline. Antiviral therapy was initiated in patients with significant hepatic inflammation (G ≥ 2) and/or fibrosis (S ≥ 2). The patients were divided into entecavir and adefovir groups based on HBV DNA load (>2000 IU/mL vs <2000 IU/mL). The liver biopsies were repeated at 72 weeks for the patients received antiviral therapy. We found that 112 subjects were hepatitis B e antigen (HBeAg) positive, and 123 subjects were negative. The corresponding median ALTs were 46 (39.5-52.5) and 48 (41.5-57.0) U/mL, respectively. G ≥ 2 and/or S ≥ 2 diseases were present in 48.8% (82/168) of the HBeAg-positive and 51.2% (86/168) of HBeAg-negative patients, respectively. In addition, 96 HBeAg-positive and 72 HBeAg-negative patients were divided into entecavir and adefovir groups. Meanwhile, liver biopsies had greater diagnostic accuracy for determining cirrhosis than LSM (0.711 vs 1.0, P < 0.0001). At the end of the study period, undetectable HBV DNA levels and normal ALT levels were observed in CHB-infected patients. Furthermore, the patients showed histologic improvement at 72 weeks compared with baseline measurements (G, 1.72 ± 1.00 vs 0.73 ± 0.88, P = 0.0002; S, 1.484 ± 0.90 vs 0.99 ± 1.13, P < 0.0001). Collectively, liver biopsy enhanced diagnostic accuracy for CHB-infected individuals with persistent normal or mildly elevated aminotransferase levels. Moreover, antiviral therapy can improve or regress the hepatic fibrosis and cirrhosis.     

乙型肝炎病毒变异株功能基因组研究及其临床意义

综述了近年对乙型肝炎病毒（HBV）变异株的复制、免疫学特性、致病性、耐药性等功能基因组研究及其临床意义的研究进展,阐述基因组水平研究HBV变异株功能的重要性及有关结果,展望今后HBV变异株生物学特性研究的方向。     

硫普罗宁治疗慢性乙型肝炎的临床疗效对照研究

目的：评价硫普罗宁治疗慢性乙型肝炎的效果及安全性。方法：慢性乙型肝炎80例,随机分为两组。治疗组40例,以硫普罗宁0.2g加入5%葡萄糖溶液250ml中静滴,1次/日,连续治疗4周,对照组40例,以甘草酸二铵150mg加入5%葡萄糖溶液250ml中静滴,1次/日,连续治疗4周;同时分别监测肝功能指标：丙氨酸氨基转移酶（ALT）,天冬氨酸转移酶（AST）、总蛋白（TP）、总胆红素（TBi）、肝纤维化指标（HA、PCⅢ）及凝血酶原活动度（PTA）等,并进行比较分析。结果：硫普罗宁治疗组较对照组在肝功能复常方面显示良好的治疗效应,可使转氨酶及HA明显下降,两组显效率分别为50%（20/40）和25%（10/40）,总有效率为85%（34/40）和47.5%（19/40）,两组比较差异有显著性（p〈0.01）。结论：短期临床研究提示硫普罗宁治疗慢性乙型肝炎,可明显改善肝脏功能,有抗纤维化作用,且副作用少,疗效显著。     

A mathematical model of the intracellular replication and within host evolution of hepatitis type B virus: Understanding the long time course of chronic hepatitis

Hepatitis B virus (HBV) causes acute and chronic liver disease. Especially, chronic hepatitis is a major risk factor of liver cirrhosis and hepatocellular carcinoma. Viral kinetics of HBV observed in peripheral blood is quite different depending on the clinical course of hepatitis. But the relationship between the intracellular replication dynamics and clinical course of HBV infection is unclear. Further it is very difficult to predict the long time course of hepatitis because the nature of HBV is changed by mutation within host with high mutation rate. We investigate the intracellular replication dynamics and within host evolution of HBV by using a mathematical model. Two different intracellular replication patterns of HBV, “explosive” and “arrested”, are switched depending on the viral gene expression pattern. In the explosive replication, prominent growth of HBV is observed. On the other hand, the virion production is restricted in the arrested replication. It is suggested that the arrested and explosive replication is associated with chronic hepatitis and exacerbation of hepatitis respectively. It is shown by our evolutionary simulation that the exacerbation of hepatitis is caused by the emergence of explosive genotype of HBV from arrested genotype by mutation during chronic hepatitis. It is also shown that chronic infection without exacerbation is maintained by short waiting time for virion release and superinfection with arrested genotype. It is suggested that extension of waiting time for virion release and existence of uninfected hepatocyte in the liver may become risk factors for the exacerbation of hepatitis.     

Causes of vertical transmission of hepatitis B virus under the at‐risk prevention strategy in Japan

The number of hepatitis B virus (HBV) carrier babies has decreased markedly since the introduction in Japan of an “at‐risk” strategy for preventing HBV infection. However, elimination of HBV infection from our country appears difficult. To clarify the limitations of the at‐risk strategy for preventing vertical transmission of HBV, causes of vertical transmission in a single hospital were retrospectively analyzed. The following causes were presumed in 17 carrier pediatric cases: five patients had prenatal HBV infection, HBV infection during/after the immunization program was confirmed in five cases, two patients had prenatal infection or infection during the immunization program and three cases were caused by human error (by the patients' guardians). Because their mothers were HBV‐negative at screening and only developed acute hepatitis B in the perinatal period, another two cases (Cases 3 and 10) did not undergo immunization because they were not subjects of the at‐risk strategy. Sequence analyses in ten patients revealed genotype C (subgenotype, C2/Ce) in nine cases and genotype A (subgenotype, A2/Ae) in one case (Case 3). In Japan, HBV subgenotype Ae has recently been found more frequently among sexually active men with acute hepatitis. There are concerns that horizontal transmission of HBV from these men to their pregnant partners could increase. These data suggest clear limitations to the at‐risk strategy in Japan and the possibility that the increase in genotype A may influence vertical transmission of HBV.     

HBsAg定量检测在慢性乙型肝炎自然病程中的意义

目的 研究慢性乙型肝炎病毒(HBV)感染自然病程中HBsAg水平变化情况以及和HBV DNA的关系.方法 将183名HBV感染者按感染的不同阶段分为免疫耐受期(IT)42例,免疫清除期(IC)46例,非/低水平复制期(LR)57例,和再活动期(HBeAg阴性肝炎组ENH)38例,回顾性分析每个阶段血清中HBsAg和HBV DNA水平以及两者之间的关系.结果 HBsAg含量分别为IT期最高[(3.81±0.46) Ig IU/mL],其次为IC期[(3.41±0.77) Ig IU/mL],最低是LR期[(2.87±0.61)Ig0.61IU/mL],每期之间HBsAg含量差异有统计学意义(P＜0.05),ENH组HBsAg含量又有所升高[(3.31 ±0.78)Ig IU/mL].IT期HBsAg与HBV DNA无相关(r=0.231,P＞0.05),IC期HBsAg与HBV DNA呈正相关(r=0.612,P＜0.05),ENH期两者无相关(r=0.189,P＞0.05);不同时期HBsAg含量与ALT均无相关性.结论 HBV感染的不同阶段HBsAg水平有差异,IT期最高,进入IC期后开始下降,在LR期降至最低,ENH期再度升高,HBsAg与HBV DNA仅在IC期有相关性,血清HBsAg的表达与不同的免疫背景有关.     

Increased frequency of micronuclei in the lymphocytes of patients chronically infected with hepatitis B or hepatitis C virus

In this study, we analysed the frequency of micronuclei (MN), nucleoplasmic bridges (NPBs) and nuclear buds (NBUDs) and evaluated mutagen-induced sensitivity in the lymphocytes of patients chronically infected with hepatitis B virus (HBV) or hepatitis C virus (HCV). In total, 49 patients with chronic viral hepatitis (28 HBV-infected and 21 HCV-infected patients) and 33 healthy, non-infected blood donor controls were investigated. The frequencies (‰) of MN, NPBs and NBUDs in the controls were 4.41 ± 2.15, 1.15 ± 0.97 and 2.98 ± 1.31, respectively. The frequencies of MN and NPBs were significantly increased (p < 0.0001) in the patient group (7.01 ± 3.23 and 2.76 ± 2.08, respectively) compared with the control group. When considered separately, the HBV-infected patients (7.18 ± 3.57) and HCV-infected patients (3.27 ± 2.40) each had greater numbers of MN than did the controls (p < 0.0001). The HCV-infected patients displayed high numbers of NPBs (2.09 ± 1.33) and NBUDs (4.38 ± 3.28), but only the HBV-infected patients exhibited a significant difference (NPBs = 3.27 ± 2.40, p < 0.0001 and NBUDs = 4.71 ± 2.79, p = 0.03) in comparison with the controls. Similar results were obtained for males, but not for females, when all patients or the HBV-infected group was compared with the controls. The lymphocytes of the infected patients did not exhibit sensitivity to mutagen in comparison with the lymphocytes of the controls (p = 0.06). These results showed that the lymphocytes of patients who were chronically infected with HBV or HCV presented greater chromosomal instability.     

构建表达Flag-GPI的重组乙型肝炎病毒载体

乙型肝炎病毒(hepatitis B virus,HBV)是小型的嗜肝DNA病毒,能够特异性地感染人肝实质细胞。HBV的易感性可以归于多个方面,包括细胞表面的受体以及细胞内的蛋白或其他因子,目前对HBV易感性的了解还有待深入。本课题利用课题组原有的HBV 5c3c载体和糖基磷脂酰肌醇(glycosylphosphatidylinositol,GPI)的特性,构建了重组HBV载体5c3c-CD59-Flag-GPI和5c3cT-Flag-GPI,转染Huh7细胞后可以将Flag标签锚定在细胞膜上,且可利用Flag抗体通过流式细胞术对其进行分选。在回补HBV包膜蛋白的情况下,5c3cT-Flag-GPI能包装形成完整的重组HBV颗粒。本研究为后续优化重组HBV的包装效率,进而为HBV易感性研究提供工具并奠定基础。     

Pegylated interferon alpha-2a (40 kDa) in the treatment of chronic hepatitis B

Chronic hepatitis B virus (HBV) is a serious and life-threatening disease afflicting 350 million of the world's population. So far, current monotherapy with conventional interferon-alpha, lamivudine, and adefovir dipivoxil remains unsatisfactory. In addition, the use of conventional interferon-alpha needs to be administered subcutaneously daily or thrice weekly and is associated with frequent adverse events. Although nucleoside-nucleotide analogs such as lamivudine and adefovir dipivoxil are well tolerated and can normalize serum alanine aminotransaminase rapidly, 1-year therapy with either lamivudine or adefovir dipivoxil results in low hepatitis B e antigen (HBeAg) seroconversion rates. In HBeAg negative patients, most of the patients would relapse after lamivudine has been discontinued. Pegylated interferon alpha-2a, an immunomodulatory agent, is a new drug that has just completed phase III clinical trials for the treatment of both HBeAg positive and HBeAg negative chronic HBV infection. The advantage of pegylated interferon alpha-2a in achieving sustained virological response over nucleoside-nucleotide analogs is particularly obvious in the HBeAg negative group. In both of these phase III studies, sustained off-treatment response is superior to the use of lamivudine. These recent data put pegylated interferon alpha-2a as the first choice of anti-HBV therapy, especially in young and motivated patients with chronic HBV infection.     

Conformational equilibria and rates of localized motion within hepatitis B virus capsids

Functional analysis of hepatitis B virus (HBV) core particles has associated a number of biological roles with the C terminus of the capsid protein. One set of functions require the C terminus to be on the exterior of the capsid, while others place this domain on the interior. According to the crystal structure of the capsid, this segment is strictly internal to the capsid shell and buried at a protein-protein interface. Using kinetic hydrolysis, a form of protease digestion assayed by SDS-PAGE and mass spectrometry, the structurally and biologically important C-terminal region of HBV capsid protein assembly domain (Cp149, residues 1-149) has been shown to be dynamic in both dimer and capsid forms. HBV is an enveloped virus with a T = 4 icosahedral core that is composed of 120 copies of a homodimer capsid protein. Free dimer and assembled capsid forms of the protein are readily hydrolyzed by trypsin and thermolysin, around residues 127-128, indicating that this region is dynamic and exposed to the capsid surface. The measured conformational equilibria have an opposite temperature dependence between free dimer and assembled capsid. This work helps to explain the previously described allosteric regulation of assembly and functional properties of a buried domain. These observations make a critical connection between structure, dynamics, and function: made possible by the first quantitative measurements of conformational equilibria and rates of conversion between protein conformers for a megaDalton complex.     

ISG15 modification of filamin B negatively regulates the type I interferon‐induced JNK signalling pathway

Interferon (IFN)‐induced signalling pathways have essential functions in innate immune responses. In response to type I IFNs, filamin B tethers RAC1 and a Jun N‐terminal kinase (JNK)‐specific mitogen‐activated protein kinase (MAPK) module—MEKK1, MKK4 and JNK—and thereby promotes the activation of JNK and JNK‐mediated apoptosis. Here, we show that type I IFNs induce the conjugation of filamin B by interferon‐stimulated gene 15 (ISG15). ISGylation of filamin B led to the release of RAC1, MEKK1 and MKK4 from the scaffold protein and thus to the prevention of sequential activation of the JNK cascade. By contrast, blockade of filamin B ISGylation by substitution of Lys 2467 with arginine or by knockdown of ubiquitin‐activating enzyme E1‐like (UBEL1) prevented the release of the signalling molecules from filamin B, resulting in persistent promotion of JNK activation and JNK‐mediated apoptosis. These results indicate that filamin B ISGylation acts as a negative feedback regulatory gate for the desensitization of type I IFN‐induced JNK signalling.     

Recent advances in the study of hepatitis B virus covalently closed circular DNA

Chronic hepatitis B infection is caused by hepatitis B virus (HBV) and a total cure is yet to be achieved. The viral covalently closed circular DNA (cccDNA) is the key to establish a persistent infection within hepatocytes. Current antiviral strategies have no effect on the pre-existing cccDNA reservoir. Therefore, the study of the molecular mechanism of cccDNA formation is becoming a major focus of HBV research. This review summarizes the current advances in cccDNA molecular biology and the latest studies on the elimination or inactivation of cccDNA, including three major areas: (1) epigenetic regulation of cccDNA by HBV X protein, (2) immune-mediated degradation, and (3) genome-editing nucleases. All these aspects provide clues on how to finally attain a cure for chronic hepatitis B infection.

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