HBsAg Group Research Articles

HBV infection effects prognosis and activates the immune response in intrahepatic cholangiocarcinoma.

The impact of HBV infection on the prognosis of patients with intrahepatic cholangiocarcinoma (ICC) remains uncertain, and the underlying mechanism has not been elucidated. This study aims to explore the potential mechanism via clinical perspectives and immune features. We retrospectively reviewed 1308 patients with ICC treated surgically from January 2007 to January 2015. Then, we compared immune-related markers using immunohistochemistry staining to obtain the gene expression profile GSE107943 and related literature for preliminary bioinformatics analysis. Subsequently, we conducted a drug sensitivity assay to validate the role of TNFSF9 in the ICC organoid-autologous immune cell coculture system and in the patient-derived organoids-based xenograft platform. The analysis revealed that tumors in patients without HBV infection exhibited greater size and a higher likelihood of lymphatic metastasis, tumor invasion, and relapse. After resection, HBV-infected patients had longer survival time than uninfected patients (p<0.01). Interestingly, the expression of immune-related markers in HBV-positive patients with ICC was higher than that in uninfected patients (p<0.01). The percentage of CD8+ T cells in HBV-positive tissue was higher than that without HBV infection (p<0.05). We screened 21 differentially expressed genes and investigated the function of TNFSF9 through bioinformatics analyses. The expression of TNFSF9 in ICC organoids with HBV infection was lower than that in organoids without HBV infection. The growth of HBV-negative ICC organoids was significantly inhibited by inhibiting the expression of TNFSF9 with a neutralizing antibody. Additionally, the growth rate was faster in HbsAg (-) ICC patient-derived organoids-based xenograft model than in HbsAg (+) group. The activation of the immune response induced by HBV infection makes the prognosis of HBV-positive patients with ICC differ from that of uninfected patients.

A retrospective case-series of influence of chronic hepatitis B on synchronous liver metastasis of colorectal cancer.

Our retrospective analysis of a large number of cases found in patients with primary colorectal cancer (CRC) carrying positive HBsAg inhibited the occurrence of synchronous liver metastases (SLM). However, liver cirrhosis caused by non-HBV factors promoted the occurrence of SLM. This study aimed to investigate the effect of HBV on the occurrence of synchronous liver metastases (SLM) of colorectal cancer (CRC). Univariate and multivariate analyses were used to analyze the influence of clinical parameters on the occurrence of SLM. A total of 6, 020 patients with primary CRC were included in our study, of which 449 patients carrying HBsAg(+) accounted for 7.46%. 44 cases of SLM occurred in the HBsAg(+) group, accounting for 9.80%, which was much lower than 13.6% (758/5571) in the HBsAg(-) group (X=5.214, P=0.022). Among CRC patients with HBsAg(-), the incidence of SLM was 24.9% and 14.9% in the group with high APRI and FIB-4 levels, respectively, which were significantly higher than that in the compared groups (12.3% and 12.5%, all P<0.05). Compared with the control group, female patients, late-onset patients, and HBV-infective patients had lower risks of SLM (HR=0.737, 95%CI: 0.614-0.883, P<0.001; HR=0.752, 95%CI: 0.603-0.943, P=0.013; HR=0.682, 95%CI: 0.473-0.961, P=0.034). The carriage of HBsAg(+) status inhibited the occurrence of SLM from CRC. HBV-causing liver cirrhosis did not further influence the occurrence of SLM, whereas non-HBV-factor cirrhosis promoted the occurrence of SLM. Nevertheless, this still required prospective data validation.

The Coexistence of Hepatitis B Surface Antigen and Anti-HBs in Patients With Chronic HBV Infection: Prevalence and Related Factors.

The prevalence of coexistence of HBsAg and anti-HBs in chronic hepatitis B virus (HBV)-infected patients is different between studies. The mutations on the S gene were proved as the cause of this coexistence. This study determined the frequency and factors associated with coexistence of HBsAg and anti-HBs in chronic HBV-infected patients. This cross-sectional study was conducted at University Medical Center at Ho Chi Minh City, Vietnam, from April 2014 to December 2020. HBeAg, HBsAg, and anti-HBs were measured by chemiluminescent immunoassay. Mutations on the HBV small S gene from amino acids 1-227 were detected using Sanger sequencing on 177 patients. A total of 521 chronic HBV-infected patients were enrolled, including 350 males (62.7%), 17.1% with hepatic fibrosis of ≥ F3 and 9.8% with hepatocellular carcinoma (HCC). The coexistence of HBsAg and anti-HBs was detected in 9.8%, with 17.9% among genotype C compared to 7.4% in genotype B, P= .001. The coexistence group had lower levels of HBsAg titers (P= .052). There were significantly higher rates of coexistence in the group with HCC (19.6% vs 8.7%, P= .013). The existence of point mutations on the major hydrophilic region and the "a" determinant region of HBV was more frequently detected in the HBsAg and anti-HBs coexistence group (P= .043 and P= .008, respectively). The coexistence of HBsAg and anti-HBs was detected more frequently in the HBV genotype C group. The coexistence status was related to lower HBsAg titers, mutations on the major hydrophilic region, and/or the "a" determinant and exposed significant relation with HCC.

Analysis of S gene characteristic sequences and changes in properties of protein expression in HBV ASCs with low-level HBsAg.

ObjectiveWe detected the serum HBsAg immune complex (HBsAg-CIC) and sequenced the HBV S gene in these patients to reveal the association between sustained low-level expression of HBsAg and mutated S gene sequence characteristics, protein function changes, and HBsAg immune complex formation.MethodsA total of 204 samples were collected and divided into high-level (n = 60, HBsAg level >10 IU/ml) and low-level (n = 144, HBsAg level ≤ 10 IU/ml) HBsAg groups. The clinical and epidemiological data of the two groups were statistically compared. According to different serological patterns and genotypes, the HBsAg-CIC results of the high-level and low-level HBsAg groups were divided into different subgroups, and then the HBsAg-CIC positive rates among different subgroups were compared. We sequenced the S gene of HBV from the two groups and identified the relevant mutations in the MHR of the S gene. In addition, we compared the changes in HBsAg protein properties and functions after hot spot mutation in the MHR of the S gene.ResultsComparing the positive rates of HBsAg-CIC under different serological patterns and genotypes in the two groups, the HBsAg-CIC positive rate was higher in the low-level HBsAg group. Moreover, there was weak correlation between HBsAg-CIC and HBsAg or HBV DNA in both groups (r = 0.32, 0.27, 0.41, 0.48; P < 0.05). Sequencing of S gene in the two groups, showed that the hot-spot mutations were T126A, M133L/T/S, and F134L/T/I in MHR of S gene of genotype B, and hot-spot mutations were Q101R and I126S/T in MHR of S gene of genotype C. Additionally, the positive rate of MHR mutation in the S gene from HBsAg-CIC positive patients was higher in the low-level HBsAg group.ConclusionThe host immune process of clearing HBV seems to have multiple site mutations in MHR, which changes the physicochemical properties and functions of HBsAg and intensifies the formation of HBsAg-CIC, thus avoiding the effective recognition of HBsAg by the host and resulting in immune tolerance between the host and HBV, which may be one of the formation mechanisms of sustained low-level expression of HBsAg in the serum of HBV-infected persons.

Abnormal expression of CD44 aggravates liver disease progression in patients with non-alcoholic fatty liver disease accompanied with hepatitis B virus replication

Objective: To analyze the expression of CD44 in non-alcoholic fatty liver disease (NAFLD) accompanied with hepatitis B virus (HBV) infection and its clinical significance. Methods: Blood sample of hospitalized patients with NAFLD, chronic hepatitis B, cirrhosis, and healthy population (control) was collected. The study was approved by the hospital ethics committee. Serum CD44 level and clinopathological characteristics were analyzed quantitatively by enzyme-linked immunosorbent-assay. Flow cytometry was used to analyze the proportion of CD44(+)T lymphocytes in patients with NAFLD and chronic hepatitis B. NAFLD model was prepared with high-fat diet to verify the abnormal expression of CD44. Results: Compared with the healthy control group, the expression of serum CD44 in the cirrhosis group, chronic hepatitis B group and NAFLD group was increased, and the difference between the groups were statistically significant (P < 0.01). NAFLD patients graded as mild or severe group were equally accompanied by hepatocyte injury, abnormal blood glucose, lipid or CD44. In NAFLD patients accompanied with HBV infection, serum CD44 concentrations were significantly higher in HBsAg, HBeAg and HBV DNA positive group than HBsAg, HBeAg and HBV DNA negative group (P < 0.01). The proportion of CD44(+)T lymphocytes in peripheral blood of NAFLD and chronic hepatitis B group were 78.2% ± 16.3% and 68.5% ± 20.9%, respectively, and both groups (NAFLD and chronic hepatitis B) were significantly higher than the healthy control group (46.5% ± 20.5%) (P < 0.05). The high-fat diet model confirmed that in rat liver tissues the CD44 was overexpressed with fat deposition accompanied with liver cell damage, especially remarkable in liver tissues containing carcinogens. Conclusion: The abnormal expression of CD44 in patients with NAFLD may be related to the malignant transformation of HBV-related liver disease.

Fast antibody responses by immuno-targeting and nanotechnology strategies versus HBsAg vaccine.

Objective(s):Though immunization with HBsAg has been routine since the 1980s, it has numerous limitations such as low or none humoral immune responses. Today, nanotechnology is used in vaccinology to achieve higher potency. The present study deals with the achievement of fast antibody response of humoral immune responses using immune-targeting through mannosylated nanocarriers of the vaccine.Materials and Methods:Mannose sugar and HBsAg were attached to the surface of iron oxide nanoparticles. Mannosylated iron oxide nanoparticles conjugated HBsAg (HBsAg +MLCMNP), iron oxide nanoparticles conjugated HBsAg (HBsAg +LCMNP), hepatitis B vaccine, and mere HBsAg were injected twice to BALB/c mice subcutaneously, while suitable control groups were considered. Specific total IgG antibodies were evaluated on the 7th and 14th days after the final immunization. The avidity maturation of the humoral immune response was assessed with an optimized ELISA. Graph pad prism software was used to analyze statistical data. Results:Results showed that on the seventh day of the final shooting, the mannosylated nano-vaccine caused higher antibody response induction than nano-vaccine without mannose and commercial vaccine groups. After 14 days of the second injection, a significant difference was seen versus the nano-vaccine without mannose but not the commercial vaccine group. In addition, the avidity index in mannosylated nano-vaccine showed a significant increase compared with the nano-vaccine without mannose and mere HBsAg group but not compared with the commercial vaccine.Conclusion:It seems that mannosylated nano-vaccine has more potency to achieve fast antibody responses and also higher quality of humoral immune response.

Cytosolic delivery of HBsAg and enhanced cellular immunity by pH-responsive liposome

It remains a major challenge to prime the cytotoxic T lymphocytes (CTLs) response for the treatment of Hepatitis B virus (HBV) infection. Inspired by an important natural biological behavior, membrane fusion, we constructed a pH-responsive nanocarrier (HBsAg&CpG@Lip) with a membrane fusion capacity for HBsAg intracellular delivery and subsequent process of CTLs. In the in vitro experiments, HBsAg&CpG@Lip greatly promoted the cellular uptake of HBsAg and the activation of BMDCs. It induced the cytosolic release of HBsAg in BMDCs, which was in conformity with the membrane fusion capacity of HBsAg&CpG@Lip. Such a capacity was improved by 4.4-fold in pH = 5.0 than that in pH = 7.4 at 60 min, which was calculated through fluorescence resonance energy transfer (FRET) efficiency. Furthermore, the cross-presentation activity induced by liposome at 1 μg/mL was equivalent to that by soluble antigen at 2000 μg/mL, which indicated an advantage for the liposome in cytosolic antigen delivery and potent CTLs activation. In respect of the transport of liposomes into draining lymph nodes (DLNs), the recruitment of liposome+migratory DCs at 24 h raised 11-fold than that at 3 h, suggesting that liposomes were mainly carried by migratory DCs. Meanwhile, HBsAg&CpG@Lip also elicited the activation of DCs and the generation of Tfh cells in DLNs. After immunization, HBsAg&CpG@Lip induced a higher anti-HBsAg IgG and ratio of IgG2c/IgG1 than that by HBsAg or Alum+HBsAg group. It also augmented a strong CTLs response as expected. Specifically, stimulation with HBsAg&CpG@Lip increased the number of IFN-γ-secreting splenocytes, the proportion of CD107α+CD8+and FasL+CD8+ T cells and the secretion of Granzyme B, which verified the design of membrane fusion in vivo. In summary, this design for HBsAg cytosolic delivery exhibits great benefits for triggering CTLs, opening an avenue for the development of a potent therapeutic HBV vaccine.

The combination of preoperative D-dimer and CA19-9 predicts lymph node metastasis and survival in intrahepatic cholangiocarcinoma patients after curative resection.

BackgroundTo investigate the predictive role of D-dimer and its combination of preoperative CA19-9 for lymph node metastasis (LNM) and prognosis in intrahepatic cholangiocarcinoma (ICC) patients who underwent curative-intent resection.MethodsOne hundred and seventy-three patients admitted to our hospital between April 2012 and December 2018 were included. The combination of preoperative D-dimer and CA19-9 (CPDC) was scored as 0 (decreased D-dimer levels with decreased CA19-9 levels), 2 (elevated D-dimer levels with elevated CA19-9 levels), or 1 (all other combinations). Multivariate logistic regression analysis was performed to identify independent factors. Cox proportional hazard regression was adopted for the multivariate survival analysis.ResultsThe CPDC score was an independent predictor of LNM and overall survival (OS) in the multivariate analyses. For the prediction of LNM, the area under the curve (AUC) for the CPDC score was 0.722 (95% CI: 0.613–0.831, P<0.001), and for the prediction of survival, the AUC for the CPDC score was 0.756 (95% CI: 0.658–0.854, P<0.001). The predictive capacity of the CPDC score was higher than that of D-dimer or CA19-9. Kaplan-Meier curve analysis revealed that a CPDC =2 was significantly associated with a worse OS (P<0.001, median OS: 8.00 versus 19.00 months versus not reached) and shorter progression-free survival (PFS) (P<0.001, median PFS: 4.00 versus 11.00 versus 15.00 months) than a CPDC =1 or CPDC =0 in ICC patients. There were significant differences in the OS comparisons between any two groups. Decreased preoperative CPDC was associated with worse OS and PFS in all subgroups except in the HBsAg (+) group. In the cirrhosis, HBsAg (−) and tumour size ≥5 cm subgroups, there were significant differences in the OS and PFS comparisons between any two groups.ConclusionsThe preoperative CPDC score is a convenient and powerful prognostic biomarker to predict LNM and OS for ICC patients after curative resection. Especially for radiologically-negative metastatic lymph node in ICC patients, CPDC could be helpful to assess the extent of lymph node dissection and make follow-up plans.

Effects of hepatitis B virus infection and antiviral therapy on the clinical prognosis of nasopharyngeal carcinoma.

PurposeTo investigate the clinical characteristics of nasopharyngeal carcinoma (NPC) and a concomitant hepatitis B virus (HBV) infection, as well as the potential effects of HBV infection and antiviral therapy on prognosis.MethodsWe conducted a retrospective chart review of all NPC patients from December 2010 to December 2014. After collecting medical records and conducting follow‐ups on patients, a total of 876 eligible NPC patients were included. For each patient, medical records were reviewed. Factors predictive of outcome were compared using the log‐rank test and Cox regression analysis.ResultsAmong the 876 participants, 106 (12.1%) patients were HBV‐infected patients. The hepatitis B surface antigen‐positive [HBsAg(+)] group had a lower CD4+ T cell count than the HBsAg(−) group (P = .048). Among patients with stage I/II NPC, 5‐year overall survival (OS), disease‐free survival (DFS), relapse‐free survival, and distant metastasis‐free survival (DMFS) of the HBsAg(+) group were 82.5%, 70.7%, 87.7%, and 76.6%, respectively, whereas those of the HBsAg(−) group were 91.4%, 86.0%, 93.8%, and 92.1%, respectively. Statistically significant differences in OS, DFS, and DMFS existed between both groups (P = .017, .018, and .004, respectively). The multivariate analysis indicated that HBsAg status and N stage are independent risk factors affecting OS, DFS, and DMFS of NPC patients. A statistically significant difference in 5‐year DMFS existed between the antivirus (90.0%) and no‐antivirus groups (70.0%) (P = .043).ConclusionsHepatitis B virus infection is an independent risk factor for early stage NPC, which may be associated with its reduced immune functions compared to the HBsAg(−) group. Anti‐HBV treatment may improve the prognosis of HBV‐infected NPC patients.

An epidemiological survey of HBV infection and low-level HBsAg in military camps in eastern China.

This study aimed to investigate hepatitis B virus (HBV) infection in military personnel in eastern China, which will provide a basis for the prevention of HBV infection.A total of 15,508 soldiers and 2386 officers were recruited from military camps in eastern China. The markers, deoxyribonucleic acid, serotypes, and genotypes of HBV in serum were detected and analyzed.Hepatitis B surface antigen (HBsAg) positive rate was 0.44% in soldiers, in whom the low-level HBsAg accounted for 88.24%. The HBsAg positive rate was 1.72% in officers in whom the low-level HBsAg accounted for 12.20%. There were significant differences in the prevalence of high-level and low-level HBsAg, HBV serotypes, HBV DNA positive rate, and mean log HBV DNA between officers and soldiers (P < .05). Compared with the conventional method for HBV DNA extraction, the enrichment method for HBV DNA extraction could significantly improve the positive rate and quantification of HBV DNA by real-time fluorescence quantitative polymerase chain reaction (P < .05). Sequencing of S gene in HBV was used for the determination of serotype and genotype of HBV. The sequencing success rate was significantly different between soldiers and officers (P < .05) as well as between high-level HBsAg group and low-level HBsAg group (P < .05). Significant difference was also observed in the genotype distribution between soldiers and officers (P < .05).HBV infection displays a low prevalence and a low epidemic state, and the prevalence of low-level HBsAg is higher in soldiers. We should pay attention to improve the quality of conscription examination as well as emphasize the surveillance, prevention, and protection of HBV infection in military officers.

Negative effect of hepatitis in overall and progression-free survival among patients with diffuse large B-cell lymphoma

BackgroundHepatitis B virus (HBV) is one of the most prevalent and serious infections worldwide. HBV reactivation is a serious complication for lymphoma patients who are being treated with rituximab-containing regimen. Since the impact of HBV has not been fully evaluated on the prognosis of diffuse large B cell lymphoma (DLBCL), this study examined the effect of the hepatitis infection on the progression-free survival (PFS) and overall survival (OS) in patients with DLBCL who received rituximab-containing chemotherapy.MethodsThis retrospective cohort study was conducted at Princess Noorah Oncology Center, Jeddah by reviewing all medical records of 172 DLBCL diagnosed patients and recieved Rituximab-containing chemotherapy dated from January 2009 to February 2016.ResultsOut of 172 patients, 53 were found positive in hepatitis serology. The 12 of those were HBsAg-positive and 41 were HBcAb-positive. Hepatitis reactivation was observed in 1% of the patients (i.e., 2 out of 172) and both of them were HBsAg-positive. Thus, the risk of hepatitis reactivation among the HBsAg-positive patients was 17% (i.e., 2 out of 12). The predicted 3-year PFS for HBsAg-positive and HBcAb-positive were 52% (± 8%), while 76% (± 4) for HBsAg-negative and HBcAb-negative patients. On the other hand, the predicted 3-year OS for HBsAg and HBcAb-negative group is 93% (±3) while for HBsAg-positive and HBcAb-positive is 77% (±7), respectively.ConclusionThe present study demonstrated a low HBV reactivation rate of 1% exclusively in 2 patients with HBsAg-positive status diagnosed with DLBCL and receiving R-CHOP chemotherapy.

Prevalence of Hepatitis B Reactivation Among Chinese Individuals With Chronic Hepatitis C Treated With Pan-Oral Direct-Acting Antivirals.

BackgroundClearance of hepatitis C virus (HCV) has been reported to induce the reactivation of hepatitis B virus (HBV). The aim of this study was to investigate the rate of HBV reactivation in HCV-infected Chinese patients who received treatment with pan-oral direct-acting antivirals (DAAs).MethodsData from HCV subjects receiving oral DAA therapy were retrospectively collected from October 2015 to May 2017. Patients who were seropositive for HBsAg or anti-HBc were enrolled. The efficacy of DAAs, including end-of-treatment virologic response (ETVR) and sustained virologic response (SVR) 12, was recorded. HBV virologic reactivation was defined as a reappearance of HBsAg, or increased HBV DNA by at least one log10 IU/mL. HBV clinical reactivation was defined as virologic reactivation and serum alanine aminotransferase (ALT) over two-fold of the upper limit of normal.ResultsThere were 11 (7.2%) cases and 53 (34.6%) cases in the HBsAg group and the anti-HBc group among all 153 subjects. All individuals achieved ETVR and SVR12. There were no cases with reappearance of HBsAg during DAAs therapy. Among seven cases in the HBsAg group whose HBV DNA level was determined, HBV virological reactivation was detected in two subjects (28.6%). Among all 11 subjects in the HBsAg group, there was one (9.1%) case with HBV clinical reactivation, which was resolved following treatment with Entaclavir. The case with HBV clinical reactivation had a higher baseline HBV DNA viral load (1,380 IU/mL) compared with that of the other patients (20 - 296 IU/mL).ConclusionHBV virological and clinical reactivation occurred in 28.5% and 9.1% of subjects with HBsAg seropositivity. No HBV reactivation was observed in the cases with past HBV infection.

No response to hepatitis B vaccine in infants born to HBsAg(+) mothers is associated to the transplacental transfer of HBsAg

Background: No or low hepatitis B (HB) vaccine response is more frequent in infants from HBsAg(+) mothers than those from HBsAg(−). Our previous study found temporary positivity of HBsAg in infants from HBsAg(+) mothers. In this study, we hypothesized that HBsAg in infant blunt immune response to standard hepatitis B vaccination.Methods: A total of 328 consecutive HBsAg(+) mothers and their offspring were enrolled. Blood samples were taken from mothers and their infants and quantified for HBsAg, anti-HBs titer and HBV DNA load concentration; Placenta samples were collected to stain for HBsAg.Results: First, 6.7% infants (22/328) showed anti-HBs titer lower than 10 mIU/mL after HB vaccination (non-response to HB vaccine). HBsAg(+) newborns showed higher risk of non-response than HBsAg(−) infants (13.0% versus 5.0%, p = 0.016). Infants from high HBsAg titer mothers displayed higher risk of HBsAg positivity at birth than those from low titer mothers (45.3% versus 2.8%, p < 0.001). HBsAg titer in mothers of HBsAg(+) newborns was much higher than mothers of HBsAg(−) newborns (p < 0.001). All those data supported HBsAg can be transferred through placenta. Our hypothesis was further reinforced by immunostaining with specific antibody against HBsAg, a substantial higher prevalence (87.5% versus 30.8%, p = 0.024) and stronger immunostaining (p = 0.008) was demonstrated in HBsAg(+) group comparing with placenta of the HBsAg(−) group.Conclusion: No response to HB vaccine in infants of HBsAg(+) mothers was associated to the transplacental transfer of HBsAg.

The intracellular HBV DNAs as novel and sensitive biomarkers for the clinical diagnosis of occult HBV infection in HBeAg negative hepatocellular carcinoma in China.

This study aimed to investigate the virological status in liver (both tumor and adjacent non-tumor tissue), the clinical features and the contribution of occult HBV infection (OBI) to postoperative prognosis in HBeAg-negative(−) hepatocellular carcinoma (HCC) patients in China. Using quantitative TaqMan fluorescent real-time PCR assays, HBV covalently closed circular DNA (cccDNA) and total DNA (tDNA) were both quantified in 11 (HBsAg(−)) and 57 (HBsAg-positive(+)) pairs of tumor tissue (TT) and adjacent non-tumor tissue (ANTT) obtained from HBeAg(−) HCC patients who received no antiviral treatment and were negative for anti-HCV before surgical treatment. Of 11 HBsAg(−) patients, 36% were with HBsAb(+) HBeAb(+) HBcAb(+). However, only 9% of the HBsAg(−) patients were HBsAb(−) HBeAb(+) HBcAb(+), which accounted for the majority (93%) in the HBsAg(+) group. TT and ANTT HBV tDNAs in 11 HCC patients with HBsAg (−) and HBeAg (−) were all detectable. HBV cccDNA and tDNA were all lower in the HBsAg(−) group than those in the HBsAg(+) group. By Kaplan-Meier analysis, patients with OBI were associated with a lower risk of cirrhosis and better overall survival (OS). The intracellular HBV DNAs, such as HBV cccDNA and tDNA are valuable biological markers for the diagnosis of occult HBV infection in HCC patients. This would assist the clinical implementation of a more personalized therapy for viral re-activation control and improve the survival rate of OBI patients.

Angiogenic output in viral hepatitis, C and B, and HCV-associated hepatocellular carcinoma

IntroductionAngiogenesis is known to play a pivotal role in most of malignancy, including HCC, and in chronic inflammation. AimTo investigate the angiogenic output in HCV and HBV infection and its implication in the development of HCV associated HCC. Materials and methodsBlood samples were collected and grouped as; HS healthy subjects control group; HCC–HCV; chronic HCV infected patient group (HCV+ve) who are positive for serum anti-HCV antibodies and HCV–RNA; anti-HCV antibody positive and HCV–RNA negative patient group (HCV−ve); patients with positive HBsAg and HBV-DNA group (HBV+ve); and HBsAg positive and HBV-DNA negative patient group (HBV−ve). Serum levels of vascular endothelial growth factor, angiopoietin-2, endostatin and angiostatin were assessed in different studied groups. ResultsThe level of sVEGF was insignificantly elevated in both HCV+ve and HCV−ve groups when compared with controls, while Ang-2, sES and sAS were significantly elevated in both groups as compared with healthy controls. The studied parameters were significantly elevated in HBV-+ve patients when compared with the control. However, HBV−ve patients showed significantly elevated levels in sAng-2, sES and sAS when compared with the control while the level of sVEGF was equal to that of controls. In patients with HCC, the studied parameters showed a significant elevation when compared with healthy controls and patients either with HBV or HCV infection except for sAS in the case of HCV-+ve patients and VEGF for HBV-+ve patients who were also higher but not significant. ConclusionThe increased hepatic angiogenesis in chronic HCV and HBV could provide the molecular basis for liver carcinogenesis and contribute to the increased risk of HCC in patients with cirrhosis due to HCV and/or HBV.

A Bayesian Meta-Analysis on Prevalence of Hepatitis B Virus Infection among Chinese Volunteer Blood Donors

BackgroundAlthough transfusion-transmitted infection of hepatitis B virus (HBV) threatens the blood safety of China, the nationwide circumstance of HBV infection among blood donors is still unclear.ObjectivesTo comprehensively estimate the prevalence of HBsAg positive and HBV occult infection (OBI) among Chinese volunteer blood donors through bayesian meta-analysis.MethodsWe performed an electronic search in Pub-Med, Web of Knowledge, Medline, Wanfang Data and CNKI, complemented by a hand search of relevant reference lists. Two authors independently extracted data from the eligible studies. Then two bayesian random-effect meta-analyses were performed, followed by bayesian meta-regressions.Results5957412 and 571227 donors were identified in HBsAg group and OBI group, respectively. The pooled prevalence of HBsAg group and OBI group among donors is 1.085% (95% credible interval [CI] 0.859%∼1.398%) and 0.094% (95% CI 0.0578%∼0.1655%). For HBsAg group, subgroup analysis shows the more developed area has a lower prevalence than the less developed area; meta-regression indicates there is a significant decreasing trend in HBsAg positive prevalence with sampling year (beta = −0.1202, 95% −0.2081∼−0.0312).ConclusionBlood safety against HBV infection in China is suffering serious threats and the government should take effective measures to improve this situation.

Analysis on clinical features and immunity in chronic hepatitis B virus infected patients with low-level HBsAg

To understand clinical features and immunity of chronic HBV-infected patients with high or low level HBsAg, the differences of serum two-component-determined circulating immune complexes (TCIC) and peripheral blood lymphocyte subsets between these patients were analyzed. 126 patients with chronic hepatitis B virus infection were divided into two groups including 44 with low-level HBsAg and 82 with high-level HBsAg, and three phases including non-active phase, immune active phase and immune tolerant phase by level of HBsAg and natural history of chronic hepatitis B virus infection. Antibody capture-ELISA method and flow cytometry were used to assay serum TCIC and peripheral blood lymphocyte subsets in 44 patients with low-level HBsAg (Group A), 82 patients with high-level HBsAg (Group B) and 22 healthy volunteers (Group C), respectively, and the results were analyzed and compared. Among these 44 patients in Group A, 40 patients (90.9%) were stable in non-active phase and the positive rate of HBsAg/IgG-CIC was the highest, accounting for 15.9% (7/44), while the positive rate of HBsAg/C3-CIC was the highest in Group B, accounting for 46.3% (38/82). The positive rates of serum TCIC, A value and non-active CD3+CD8+ percentages in Group A were all lower than those in Group B with corresponding phases (P<0.01-0.05), however, the percentages of CD4+/CD8+were higher than those in the corresponding phases of Group B(P<0.01). Patients with low-level HBsAg were correlated to low capability of TCIC synthesis and elimination and there was a low dose-induced immunotolerance phenomenon. Key words: Immune complex, chronic HBV infection, HBsAg, lymphocyte subsets, immunotolerance.

Beta2-GPI: a novel factor in the development of hepatocellular carcinoma

This study investigated the effect and clinical significance of beta2-GPI in hepatocellular carcinoma (HCC). Double fluorescent immunostaining analysis was performed in paraffin wax-embedded histological sections of nine HCC parenchyma, seven adjacent non-cancerous tissues and seven control liver tissues from hepatitis B virus (HBV) infected patients using a beta2-GPI polyclonal antibody and a HBV surface antibody. NF-κB activation was assessed by a non-radioactive electrophoretic mobility shift assay (EMSA) and immunofluorescence assay in SMMC-7721 HCC cells exposed to various treatments. The cells were transiently transfected with vectors expressing beta2-GPI (group one), HBsAg (group two), both beta2-GPI and HBsAg (group three), or with a control vector (group four). Untransfected cells (group five) were also used as a control. Alpha fetoprotein (AFP) expressions were also detected by ELISA in all groups. The highest degree of co-localization of beta2-GPI and HBsAg proteins was seen in the endochylema and occurred at the nuclear border in the cancer tissues. Weak beta2-GPI protein staining was present in the endochylema, with a strong signal for HBsAg protein in HBV control samples. Adjacent non-tumorous liver tissue samples also showed HBsAg staining but stronger beta2-GPI signals in the endochylema. In experiments with SMMC-7721 HCC cells, groups one and two had induced activation of NF-κB with the relative NF-κB DNA-binding activities of 55.84 and 51.12, respectively. However, the highest relative NF-κB DNA-binding activity was observed in group three (80.5). The percentages of cells with NF-κB translocated from the cytoplasm to nucleus in groups one, two, three, four and five compared with total cells were 13.5, 8.7, 24.9, 5.7 and 0.95%, respectively. The mean AFP levels were significantly higher in group three (0.0640±0.0059) than in group five (P<0.001). It appeared higher in group three than in group one (0.0562±0.0060, P<0.05) and group four (0.0585±0.0040, P<0.05), while no significant differences were seen between groups three and two, and between groups four and five. Beta2-GPI may play a role in the development of HBV-related HCC by activating NF-κB via interaction of beta2-GPI and HBsAg.

Study on the relationship between HBV infection and polymorphism of CIITA G-944C gene among Jinuo, Dai and Aini minority populations in Yunnan province

To explore the relationship between HBV infection and the genotypes and allele frequencies of CIITA G-944C gene polymorphism in three minority populations (Jinuo, Dai and Aini population) in Xishuangbanna district, Yunnan province. Polymerase chain reaction and sequencing method were used to study the genotypes and allele frequencies distributions of CIITA G-944C gene polymorphism in those three populations. Relationship between the genotypes distribution and HBV infection results were also analyzed. The rates on HBV infection and HBsAg carrier status in Aini minority population were 89.2% and 16.3%, which were significantly higher than in Jinuo (27.9% and 3.9%, χ(2) = 135.196 and 10.361, P = 0.000 and 0.001) and Dai population (44.9% and 6.6%, χ(2) = 96.783 and 8.748, P = 0.000 and 0.003) while among Aini population it was significantly different with the other two minority populations. The CC genotype and C allele frequencies were more distributed in Aini population than in the other two minority populations. In contrast, the GG genotype and G allele frequencies were lower than the other two minority populations, with χ(2) rates between Aini and Jinuo population were 11.841 and 12.208 and the P as 0.003 and 0.000 respectively while the χ(2) rates between Aini and Dai population were 23.902 and 20.220 with P value as 0.000 and 0.000. The genotypes frequencies of CIITA G-944C was significantly different in the infected individuals (IF) group and health control (HC) group in Jinuo population (χ(2) = 6.150 and 4.911, P = 0.046 and 0.027). When compared with HBsAg(+) group and HBsAg(-) group, the genotypes and allele frequencies were different in Aini population and the total three minority populations (χ(2) rates in Jinuo minority were 8.650 and 5.034 with P values as 0.013 and 0.025). However, the χ(2) rates in the whole population were 13.047 and 9.416 with P values as 0.001 and 0.002, respectively. The distribution of CC genotype and C allele gene in HBsAg(+) group was increasing. Data from non-condition logistic regression analysis and adjusting for confounding factors, the HBsAg(+) group had a significantly increase of HBsAg(-) group under the C allele Recessive Model (P = 0.000; OR = 2.964; 95%CI: 1.609 - 5.460). The genotypes and allele frequencies distribution of CIITA G-944C were different in the three ethnic populations. Polymorphism of this gene was closely associated with HBsAg carrier. The CC genotype patients were more easily to become HBsAg carrier.

Effects of HBsAg pulsed dendritic vaccination on anti-HBs production in immunosuppressed rats after liver transplantation

To explore the effects of HBsAg pulsed dendritic vaccination on anti-HBs production in immunosuppressed rats after liver transplantation (LT). Brown-Norway liver allografts were transplanted into Lewis recipients. The transplanted Lewis rats were injected with EK506 (2 mg/kg) and randomly divided into two groups: rats in HBsAg-DCs group (n = 15) were intraperitoneally injected with HBsAg pulsed DCs at 14 d and 28 d after LT, and rats in the HBsAg group (n = 15) were injected with HBsAg (200 mul) once a week for 12 weeks. Rats without any immunosuppressive treatment after LT served as controls (n = 5). IL-2 and IFN-gamma mRNA expression in spleen were analyzed by RT-PCR, serum IL-2, IFN-gamma and anti-HBs were detected by ELISA. High dose of FK506 resulted in the immunosuppressed in LT rats, as evident by low production of IL-2 and IFN-gamma, and without liver rejection compared to rats in the control group. HBsAg-DCs induced high titer of anti-HBs antibody, however, titer of anti-HBs were seldom detectable in the HBsAg group at 1, 2 and 3 mouth after vaccination. The capacity of HBsAg-DCs to induce anti-HBs in immunosuppressed rats suggested that DC vaccine may prevent HBV recurrence in liver transplanted patients.