慢性丙型肝炎患者丙型肝炎病毒NS5A区序列与干扰素疗效的关系

目的　探讨上海地区丙型肝炎病毒 (HCV) 1b亚型慢性感染者的血清HCV非结构基因5A(NS5A)与干扰素 (IFN)疗效的关系。方法　收集上海地区 2 4例HCV1b慢性感染者在干扰素治疗前后及随访过程中的血清标本 ,定量检测治疗前血清HCVRNA ,用逆转录 聚合酶链反应方法扩增NS5A的干扰素敏感决定区 (ISDR)基因并进行测序和分析。另扩增干扰素应答类型不同的 3例患者治疗前后共 5株HCV病毒的NS5A全长序列 ,测序后作种系发生树分析及蛋白二级结构预测。结果　治疗前血清HCVRNA的定量结果显示 ,持续应答组的病毒滴度 (平均滴度 4 50× 1 0 4copies ml)明显低于复发组和无应答组 (平均滴度 1 82× 1 0 7copies ml)。 2 4例慢性丙型肝炎患者干扰素治疗前血清HCV的ISDR氨基酸序列与抗干扰素的HCV J株比较 ,1 3例为野生型 ,1 1例为中间型 ,无突变型。 6例完全应答者 3例感染的是野生型株 ,另 3例感染的是中间型病毒株。 5株HCV病毒的NS5A全长序列种系发生树显示 ,3种不同应答类型株在种系发生上分属 3个组别 ,无应答株与抗干扰素的HCV J株关系相近被归为 1组。蛋白质二级结构预测显示 ,上述病毒株NS5A蛋白在二级结构方面基本相似 ,仅在 2 2 55～ 2 2 89范围内有明显不同 ,这一区域与PKR结合域部分重叠。结论　HCVNS5A基因

Association between NS5A gene sequence and response to interferon therapy in chronic hepatitis C patients in Shanghai

BACKGROUND: To elucidate relationship between amino acid sequence of non-structural protein 5A (NS5A) and outcome of HCV (1 b) patients after interferon (IFNa) therapy. METHODS: Sera of 24 patients were collected before, during and after IFNa therapy. Pretreatment RNA levels and the sequences of HCV NS5A interferon sensitivity determining region (ISDR) were determined. NS5A full-length sequences of 5 HCV isolates from 3 patients with different response types were also analyzed. Phylogenetic tree analysis and protein secondary structure prediction were undertaken. RESULTS: Pretreatment RNA levels of sustained response group were significantly lower than that of non-response group and relapse group (4.50X104 copies/ml versus 1.82X107 copies/ml, P < 0.01).ISDR sequences of NS5A from pretreatment sera were compared with HCV-J strain (prototype).Thirteen of 24 isolates were wild type,11 of 24 were intermediate type and none of them was mutant type. 3 of 6 sustained responders were infected with wild-type isolates, the rest with intermediate type isolates. Phylogenetic tree based on NS5A full-length sequences classified 5 isolates with 3 different response types into 3 groups. Non-response isolates belonged to the same group as HCV-J. Secondary structure prediction of 5 isolates revealed significant differences existing in 2 255- 2 289.This region was partly overlapped with PKR-binding domain. CONCLUSIONS: Low HCV RNA levels in serum are associated with favorable outcome of IFNa therapy. ISDR sequence alone could not predict outcome of IFN treatment. Combination of determination of HCV RNA levels in serum with sequence analysis of PKR-binding domain may be helpful in predicting the efficacy of IFN therapy.