Changes in hepatitis B virus DNA-polymerase activity in patients with chronic infection

Levels of serum hepatitis B virus DNA-polymerase (HBV-DNAP) were studied longitudinally over variable periods of time in 16 HBV chronic carriers using a modified assay procedure developed to increase reproducibility. Ten patients were tested on a short-term basis at 3- to 6-hr intervals for 48 hr or at 24- to 48-hr intervals for 15 consecutive days, and all showed marked vacillations in enzyme levels although hospitalized and untreated. Patients with chronic active hepatitis on liver biopsy had larger fluctuations compared to cases of chronic persistent hepatitis. Six patients were longitudinally tested over a period of 12–32 months and those three receiving immunosuppressive drugs showed a progressive increase in DNAP levels during therapy, but two returned to pretreatment levels after therapy was withdrawn and one even cleared permanently the complete virus with seroconversion to anti-HBe. Such outcome was also observed in one patient with chronic active hepatitis who remained untreated.     

IL-21与慢性乙型病毒性肝炎的关系研究

白细胞介素21是一类具有潜在的免疫调节作用、含有4个α螺旋结构的Ⅰ型细胞因子,主要由CD4+T和NKT细胞分泌产生。其受体分布极其广泛,通过与IL-21R结合后,IL-21参与子机体的多重免疫调节。如:促进Tfh、Th17等淋巴细胞增殖,增强CD8+T和NK细胞的细胞毒性,诱导B分化为浆细胞;同时又可抑制DC细胞的效应,促进B细胞和NK细胞调亡,以及负性调节Teg细胞的免疫抑制作用。免疫耐受是HBV病毒持续感染的根本原因,而IL-21在慢性乙肝病毒感染的清除及病毒抗原的血清学转换中可能发挥一定的调控作用。     

乙型肝炎病毒感染者癌基因蛋白的表达及与HBeAg的关系

目的为了阐明癌基因蛋白异常表达与乙型肝炎病毒（ＨＢＶ）复制的关系。方法用链霉菌素－生物素（ＳＬＡＢ）免疫组织化学染色和酶联免疫吸附试验（ＥＬＩＳＡ）方法，检测了６４例慢性ＨＢＶ感染者肝细胞中Ｃ－ｅｒｂＢ－２Ｐ１８５、ｒａｓＰ２１和Ｐ５３等癌基因蛋白和血清乙型肝炎病毒ｅ抗原（ＨＢｅＡｇ）。结果Ｃ－ｅｒｂＢ－２Ｐ１８５和ｒａｓＰ２１阳性组中，血清ＨＢｅＡｇ的阳性检出率分别为８９４％和８４６％，而阴性组ＨＢｅＡｇ的检出率分别为２０％和４８％，两组差异显著。结论表明癌基因蛋白Ｃ－ｅｒｂＢ－２Ｐ１８５和ｒａｓＰ２１的异常表达与ＨＢＶ复制密切相关。     

Transmission routes of hepatitis B virus infection in chronic hepatitis B patients in The Netherlands

The Netherlands is a low endemic country for hepatitis B virus (HBV). Rotterdam, a city in The Netherlands harbors a large group of chronic hepatitis B (CHB) patients of which most are born abroad. The study included 464 consecutive CHB patients who were reported to the Municipal Public Health Service in Rotterdam from January 1, 2002 to September 15, 2005. The HBV genotypes, possible transmission routes of infection and travel history of CHB patients born in The Netherlands, were compared with those CHB patients living in The Netherlands but who were foreign-born, taking into account the ethnicity of the mother. Of the 464 patients with CHB infection, 14% were Dutch-born and 86% were foreign-born. The CHB patients in the Dutch-born group had genotypes A (35%), B (15%), C (11%), D (37%), and G (2%). In the foreign-born group, the distribution of genotypes was A (20%), B (15%), C (11%), D (40%), and E (15%). In the Dutch-born group, sexual transmission accounted for a larger proportion of infections (P < 0.0001) compared to the foreign-born group, whereas perinatal transmission is reported to be higher in the foreign-born group and in the Dutch-born group with a foreign mother. The genotypes of the chronic HBV strains determined corresponded well with the HBV genotypes expected from the countries of origin of the patients or their mothers. Genotypes A and D are predominant in CHB patients in The Netherlands.     

Association of PTPN22 gene polymorphisms with chronic hepatitis B virus infection in Chinese Han population

Lymphoid protein tyrosine phosphatase encoded by protein tyrosine phosphatase non-receptor 22 (PTPN22) gene plays an important regulatory role in T- and B-cell activation. This study investigated PTPN22 −1123G/C and intron 16 T/C polymorphisms in 372 patients with chronic hepatitis B virus (HBV) infection, 72 HBV infection resolvers and 273 healthy controls. Genotypic association tests between groups assuming codominant, dominant or log-additive genetic models were performed. In recessive model, PTPN22 −1123G/C genotype GG in healthy controls was more frequent than infection resolvers (P = 0.037, OR = 3.606, 95%CI = 1.079–12.053) and this genotype in HBV patients was more frequent than resolvers although the difference was not significant (P = 0.059). The PTPN22 intron 16 T/C genotype TC in cirrhosis patients was significantly higher than asymptomatic carriers (ASC) in codominant (P = 0.028, OR = 9.792, 95%CI = 1.281–74.832) and overdominant (P = 0.025, OR = 10.142, 95%CI = 1.332–77.214) models. This genotype in hepatocellular carcinoma (HCC) patients was significantly higher than ASC in codominant (P = 0.034, OR = 9.200, 95%CI = 1.176–71.990) and overdominant (P = 0.030, OR = 9.677, 95%CI = 1.241–75.442) models. These findings suggest that PTPN22 polymorphisms may predispose the chronicity or the development of cirrhosis and HCC in HBV infection.     

Association of interleukin-18 gene polymorphism (-607A/A genotype) with susceptibility to chronic hepatitis B virus infection

Polymorphisms in the gene promoter can lead to different levels of cytokine expression and let some individuals have unique immune responses. Therefore, the association of single nucleotide polymorphism of interleukin (IL)-18 promoter region in chronic hepatitis B virus (HBV) infection was examined. The results demonstrated the significant involvement of genotype A/A at position -607 in patients (n = 140) when compared with healthy individuals (n = 140) [OR (95% CI) = 2.62 (1.36-5.09), P(c)= 0.009]. The frequencies of -607A/A, C/A, C/C genotypes were 27.86%, 48.57% and 23.57% in chronic HBV patients and 12.80%, 59.30% and 27.90% in healthy controls, respectively. No significant association at the position -137 was found between the two groups. The frequencies of -607A/-137G haplotype homozygosity were higher in the chronic HBV patients (17.14%) than in the controls (8.57%) [OR (95% CI) = 2.21 (1-4.93), P = 0.05], although this was not statistically significant when corrected for multiple comparison (P(c)= 0.40). In conclusion, this study proposes that A/A genotype at position -607 in IL-18 gene can be used as a new genetic maker in Thai population for predicting chronic hepatitis B development.     

Concurrent hepatitis C virus and hepatitis delta virus superinfection in patients with chronic hepatitis B virus infection.

Since hepatitis C virus (HCV) and hepatitis delta virus (HDV) are transmitted by the same routes as hepatitis B virus (HBV), simultaneous or concurrent HCV and HDV infection in patients with chronic HBV infection may occur. To test this hypothesis and to examine the clinicohistological and immunopathological presentations of such multiple hepatitis virus infections, acute and/or convalescent serum specimens from 86 patients with acute HDV superinfection were tested by enzyme immunoassay for antibodies to HCV. Of the 86 patients, 18 (20.9%) were associated with HCV infection. Although patients with early mortality cannot be evaluated by the HCV markers used in this study, the results showed that the clinical and histologic features were similar except that patients with HCV infection were older than those without HCV infection (P less than 0.01). Immunopathological studies carried out within 2 months after the onset of acute HDV superinfection demonstrated that hepatitis B core antigen (HBcAg) was not detected in any patient and HDV antigen was detected in 18.2% of the patients with HCV infection whereas HBcAg and HDAg were found in 7% and 65.1%, respectively, of those without HCV coinfection (P less than 0.02). It is concluded that concurrent HCV and HDV superinfections can and do occur in patients with chronic HBV infection. In these triple viral infections, HCV may even transiently suppress HDV and HBV.     

The best predictive model for hepatocellular carcinoma in patients with chronic hepatitis B infection

Chronic hepatitis B (CHB) seriously threatens human health. About 820,000 deaths annually are due to related complications such as hepatitis B and hepatocellular carcinoma (HCC). Recently, the use of oral antiviral agents has significantly improved the prognosis of patients with CHB infection and reduced the risk of HCC. However, hepatitis B virus still remains a major factor in the development of HCC, raising many concerns. Therefore, numerous studies have been conducted to assess the risk of HCC in patients with CHB infection and many models have been proposed to predict the risk of developing HCC. However, as each study has different models for predicting HCC development that can be applied depending on the use of antiviral agents or the type of antiviral agents, it is necessary to properly understand characteristics of each model when using it for the evaluation of HCC in patients with CHB infection. In addition, because different variables such as host factor, viral activity, and cirrhosis are used to evaluate the risk of HCC development, it is necessary to assess the risk by carefully verifying which variables are used. Recently, studies have also evaluated the risk of HCC using risk prediction models through transient elastography and artificial intelligence (AI) system. These HCC risk predication models are also noteworthy. In this review, we aimed to compare HCC risk prediction models in patients with CHB infection reported to date to confirm variables used and specificity between each model to determine an appropriate HCC risk prediction method.     

汉族人白细胞介素-18基因启动子多态性与慢性乙型肝炎的相关性研究

目的 探讨中国汉族人白细胞介素-18（interleukin-18,IL-18）基因启动子单核苷酸多态性及其与慢性乙型肝炎易感性之间的关系。方法 应用序列特异性引物一聚合酶链反应技术，检测231例慢性乙型肝炎患者和300名正常人儿．馏基因启动子-607C/A、-137G／C单核苷酸多态性位点基因型。结果 正常对照组和慢性乙型肝炎组中，IL-18基因启动子-607C/A位点3种基因型频率分别为CC型：0．22（66／300）和0．27（62／231），CA型：0．53（160／300）和0．50（116／231），AA型：0．25（74／300）和0．23（53／231）；IL-18基因启动子-137G／C位点3种基因型频率分别为GG型：0．67（202／300）和0．79（182／231），GC型：0．30（90／300）和0．19（45／231），CC型：0．03（8／300）和0．02（4／231）。经Y0检验，慢性乙型肝炎组IL-18基因启动子-137GG分布频率显著高于正常对照组（X^2=8．55，P=0．003），而-607C／-137C和-607A／-137C单倍型频率显著低于正常对照组。进一步比较慢性乙型肝炎患者儿．馏基因启动子多态性与乙型肝炎病毒（hepatitis Bvirus，HBV）DNA复制的关系，发现高水平HBV—DNA组-607位点AA基因型分布频率明显低于低水平HBV—DNA组（Y2=6．03，P=0．014）。结论 汉族人慢性乙型肝炎与IL-18基因启动子-607C/A、-137G／C单核苷酸多态性相关，其中IL-18基因启动子-137位点C等位基因可能对机体HBV感染有保护作用，而启动子-607位点AA型对感染后HBV—DNA的复制可能有抑制作用。     

慢性乙型肝炎PBMC凋亡及淋巴细胞亚群的检测

目的了解慢性/慢性重型乙型肝炎外周血淋巴细胞激活诱导细胞死亡(AICD)现象的存在情况、各免疫细胞的状况、AICD与淋巴细胞状况的关系,以探讨乙型肝炎慢性化和重型化的机制.方法利用慢性、慢性重型乙型肝炎病人和健康献血员外周血单个核细胞(PBMC)在PHA-P刺激下培养72h,通过流式细胞仪检测PBMC的凋亡情况;采用流式细胞仪结合全自动血液分析仪对慢性、慢性重型乙型肝炎病人及正常对照组外周血各淋巴细胞亚群进行检测.结果慢性乙型肝炎组PBMC凋亡率高于慢性重型乙型肝炎组(P＜0.01),高于正常对照组(P＜0.01).慢性乙型肝炎组总淋巴细胞百分率高于慢性重型乙型肝炎组(P＜0.01),慢性重型乙型肝炎组淋巴细胞数低于正常对照组(P＜0.01);CD3+、CD3+CD4+细胞数低于正常对照组(P＜0.01),低于慢性乙型肝炎组(P＜0.05);CD3+CD8+细胞数低于正常对照组(P＜0.05),低于慢性乙型肝炎组(P＜0.05).单核细胞百分率高于正常对照组(P＜0.01),高于慢性乙型肝炎组(P＜0.05).结论慢性乙型肝炎患者外周血淋巴细胞活化与凋亡共存,慢性重型乙型肝炎患者外周血淋巴细胞消耗严重,AICD参与乙型肝炎慢性化、重型化的发生机理.     

Acute type A hepatitis during chronic hepatitis B virus infection: association of depressed hepatitis B virus replication with appearance of endogenous alpha interferon

Two patients with chronic type B hepatitis and intercurrent episodes of acute type A hepatitis are presented. Serological markers of hepatitis B virus replication decreased or became undetectable in both patients during the acute illness, while interferon activity was transiently detected in serum. The presence of serum leukocyte (alpha) interferon was confirmed by neutralization with specific antisera and tests of pH2 stability. These observations suggest a role for natural leukocyte (alpha) interferon in the modulation and control of hepatitis B virus infection and provide further evidence to support trials of exogenous leukocyte (alpha) interferon in the chronic infection.     

Occult hepatitis B virus infection in patients with leprosy

Leprosy patients may present with immune system impairment and have a higher hepatitis B virus (HBV) seroprevalence, justifying the investigation of occult HBV infection in these individuals. The aim of this study was to verify the frequency and the clinical factors associated with occult HBV infection in leprosy patients. Between 2015 and 2016, leprosy patients from a reference center in Brazil were interviewed to assess clinical data. Blood samples were collected for the screening of HBV serological markers using enzyme-linked immunosorbent assay. Patients with negative hepatitis B surface antigen (HBsAg) that had positive anti-HBc and/or anti-HBs were selected for HBV DNA detection using real-time polymerase chain reaction. SPSS was used for data analysis. Among 114 selected patients, six were identified with occult infection (5.3%) and five of them with multibacillary leprosy. Three patients with occult infection had a history of a type 2 reaction (P = 0.072; OR, 4.97; 95% CI, 0.87-28.52). Only two patients with occult infection had isolated anti-HBc, while three had isolated anti-HBs, including those with the highest HBV DNA titers. In conclusion, in leprosy patients with negative HBsAg and positive anti-HBc and/or anti-HBs, occult HBV infection occurs in 5.3% and can be found even in patients with isolated anti-HBs.     

The role of the hepatitis B virus infection in patients with chronic hepatitis in argentina

Over a seven-year period, we monitored 221 patients with chronic hepatitis from two medical centers. By using the counterelectrophoresis (CEP) test to detect the presence of HBsAg and anti-HBc, or both, we established that 87.7% of them had hepatitis B infection. Serum specimens originally found negative for HBsAg by CEP were further tested by reversed passive hemagglutination (RPH), and those originally found negative for anti-HBc by CEP were further tested by radioimmunoassay (RIA). Five patients were anti-HBc-positive and HBsAg-negative. No sex predominance was observed, but HBsAg incidence increased with increasing age. The HBeAg antigen was detected in 46.8% of the 161 cases tested for it; the most frequent subtype found was adw (63.7%). The present findings indicate that HBV infection largely contributes to the development of chronic hepatitis in Argentinian patients.     

Association of concurrent hepatitis B surface antigen and antibody to hepatitis B surface antigen with hepatocellular carcinoma in chronic hepatitis B virus infection

Antibody to hepatitis B surface antigen (HBsAg) (anti‐HBs) can exist in patients with chronic hepatitis B virus (HBV) infection. To date, little is known about the association of concurrent HBsAg and anti‐HBs (concurrent HBsAg/ anti‐HBs) with hepatocellular carcinoma (HCC). The aim of this study was to investigate the clinical relevance of concurrent HBsAg/anti‐HBs with preS deletion mutations and HCC in chronic HBV infection. A total of 755 patients with chronic HBV infection were included consecutively at a tertiary center. Logistic regression analysis was used to identify risk factors for HCC, and serum HBV DNA was amplified, followed by direct sequencing to detect preS deletions. The prevalence of concurrent HBsAg/anti‐HBs was 6.4% (48/755) and all HBVs tested were genotype C. HCC occurred more frequently in the concurrent HBsAg/anti‐HBs group than in the HBsAg only group [22.9% (11/48) vs. 7.9% (56/707), P = 0.002]. In multivariate analyses, age >40 years [odds ratio (OR), 14.712; 95% confidence interval (CI), 4.365–49.579; P < 0.001], male gender (OR 2.431; 95% CI, 1.226–4.820; P = 0.011), decompensated cirrhosis (OR, 3.642; 95% CI, 1.788–7.421; P < 0.001) and concurrent HBsAg/anti‐HBs (OR, 4.336; 95% CI, 1.956–9.613; P < 0.001) were associated independently with HCC. In molecular analysis, preS deletion mutations were more frequent in the concurrent HBsAg/anti‐HBs and HCC groups than in the HBsAg without HCC group (42.3% and 32.5% vs. 11.3%; P = 0.002 and 0.012, respectively). In conclusion, concurrent HBsAg/anti‐HBs is associated with preS deletion mutations and may be one of the risk factors for HCC in chronic HBV infection with genotype C. J. Med. Virol. 81:1531–1538, 2009. © 2009 Wiley‐Liss, Inc.     

Leucocyte hepatitis B virus DNA in acute and chronic hepatitis B virus infection

In the present study we have investigated 53 patients with a spectrum of acute and chronic hepatitis B virus (HBV) infection for the presence of leucocyte HBV-DNA with the aid of molecular techniques. HBV-DNA was detected in peripheral blood mononuclear cells of 31 of 45 (69%) of chronic HBsAg carriers and 2 of 8 (25%) patients with acute hepatitis B. Although HBV-DNA was detected more frequently in leucocytes from those HBsAg carriers seropositive for HBeAg (79%), 50% of those with anti-HBe in serum had leucocytes positive for HBV-DNA independent of the presence of serum HBV-DNA. Examination of various leucocyte subpopulations showed the presence of HBV-DNA in polymorphonuclear leucocytes as well as T- and non-T-enriched mononuclear cell fractions. The HBV-DNA identified was predominantly 3.2-kilobase (kb), while higher molecular weight sequences were rarely detected, and lower molecular weight sequences indicative of active viral replication were not observed. These data indicate that although leucocytes do not actively support viral replication, they frequently harbour 3.2-kb HBV-DNA and may act as a reservoir for infection and, more importantly, since leucocytes contaminate several body secretions, may be involved in virus transmission.     

Association of paraoxonase activity and atherosclerosis in patients with chronic hepatitis B

Background

The hepatitis B virus is a significant pathogen that causes cirrhosis, and hepatocellular cancer as a result of the damage it causes to liver cells. Its infection affects more than 400 million people globally. Although there is an effective vaccine and treatment methods, almost 1, 000, 000 people die every year.

Objective

To investigate paraoxonase and arylesterase activities along with oxidative status parameters and serum lipid levels, and to find out if there is any increased susceptibility to atherogenesis.

Methods

Thirty-four subjects with chronic hepatitis B and 39 healthy subjects as control were enrolled in the study. Age, body mass index and gender, Serum Triglycerides (TG), High-density Lipoprotein (HDL) and Low-Density lipoprotein (LDL) levels, serum paraoxonase-1 and arylesterase activities were determined. Oxidative and antioxidative statuses were evaluated by measuring serum-free sulfhydryl groups, lipid hydroperoxide levels, total antioxidant capacity, total oxidant status, and oxidative stress index.

Results

Serum TG and LDL levels were higher while serum HDL levels were lower in patients with chronic hepatitis B than in controls but the differences did not reach statistical significance. Serum paraoxonase-1 and arylesterase activities, plasma free sulfhydryl groups, and total antioxidant capacity were significantly lower in patients than in controls (p=0.018, p=0.005, p<0.001, p=0.037 respectively), while lipid hydroperoxide, total oxidant status, and oxidative stress index were significantly higher (for all p<0.001).

Conclusion

The diminution in the paraoxonase-1 and arylesterase activities could contribute to the accelerated development of atherosclerosis in patients with chronic hepatitis B.     

Serum transferrin as a liver fibrosis biomarker in patients with chronic hepatitis B

Background/Aims

Transferrin and alpha-1 antitrypsin are reportedly associated with liver fibrosis. We evaluated the usefulness of serum transferrin and alpha-1 antitrypsin as new liver fibrosis markers in patients with chronic hepatitis B.

Methods

The study included 293 patients with chronic hepatitis B who underwent a liver biopsy between October 2005 and June 2009, and who had no history of hepatocellular carcinoma. Serum markers and liver fibrosis stages were compared.

Results

Univariate analysis revealed that age (P<0.001), serum platelet count (P<0.001), and serum alkaline phosphatase level (P=0.003) differed significantly between the patients with and without liver cirrhosis. Serum transferrin levels were significantly lower in advanced fibrosis than in mild fibrosis in both univariate analysis (P=0.002) and multivariate analysis (P=0.009). In addition, the serum transferrin level was significantly lower in cirrhotic patients than in noncirrhotic patients (P=0.020). However, the serum level of alpha-1 antitrypsin was not significantly associated with liver cirrhosis in patients with chronic hepatitis B.

Conclusions

Serum transferrin could be promising serum marker for predicting advanced liver fibrosis in patients with chronic hepatitis B.