Subclinical hepatitis E virus genotype 1 infection:The concept of“dynamic human reservoir”

Hepatitis E virus(HEV)is hyperendemic in South Asia and Africa accounting for half of total Global HEV burden.There are eight genotypes of HEV.Among them,the four common ones known to infect humans,genotypes 1 and 2 are prevalent in the developing world and genotypes 3 and 4 are causing challenge in the industrialized world.Asymptomatic HEV viremia in the general population,especially among blood donors,has been reported in the literature worldwide.The clinical implications related to this asymptomatic viremia are unclear and need further exploration.Detection of viremia due to HEV genotype 1 infection,apparently among healthy blood donors is also reported without much knowledge about its infection rate.Similarly,while HEV genotype 3 is known to be transmitted via blood transfusion in humans and has been subjected to screening in many European nations,instances of transmission have also been documented albeit without significant clinical consequences.Epidemiology of HEV genotype 1 in endemic areas often show waxing and waning pattern.Occasional sporadic occurrence of HEV infection interrupted by outbreaks have been frequently seen.In absence of known animal reservoir,where HEV exists in between outbreak is a mystery that needs further exploration.However,occurrence of asymptomatic HEV viremia due to HEV genotype 1 during epidemiologically quiescent period may explain that this phenomenon may act as a dynamic reservoir.Since HEV genotype 1 infection cannot cause chronicity,subclinical transient infection and transmission of virus might be the reason it sustains in interepidemic period.This might be the similar phenomenon with SARS COVID-19 corona virus infection which is circulating worldwide in distinct phases with peaks and plateaus despite vaccination against it.In view of existing evidence,we propose the concept of“Dynamic Human Reservoir.”Quiescent subclinical infection of HEV without any clinical consequences and subsequent transmission may contribute to the existence of the virus in a community.The potential for transmitting HEV infection by asymptomatic HEV infected individuals by fecal shedding of virus has not been reported in literature.This missing link may be a key to Pandora's box in understanding epidemiology of HEV infection in genotype 1 predominant region.

HIV-1整合酶基因序列分析方法验证

目的 验证实验室自建人类免疫缺陷病毒1型(HIV-1)整合酶基因序列分析方法。该方法可用于评估HIV-1整合酶区段基因型耐药水平。方法 根据世界卫生组织自建基因序列分析方法验证的建议,从20份HIV-1阳性样本中提取RNA,扩增HIV-1整合酶区基因片段,并测序。通过与病毒质量保证(VQA)共识进行比对,评估实验室自建的HIV-1整合酶基因序列分析方案的准确性,通过扩增成功率评估其灵敏度,通过同一样本的重复检测结果评估其精密度和重现性。结果 20份样本与VQA共识的核苷酸一致率均>98%;10个高病毒载量(>10 000拷贝·mL^(-1))样本和5个低病毒载量(1 000~5 000拷贝·mL^(-1))样本的扩增成功率均为100%;4个样本的同批次5复孔和5个样本5次检测的结果均符合90%的样本配对比较核苷酸一致率>98%的要求。结论 该HIV-1整合酶基因序列分析方法的准确性、灵敏度、精密度和重现性均符合要求,适用于HIV-1整合酶基因序列分析。

PAI-1和FV基因多态性与静脉血栓的临床意义

目的 一种新技术检测静脉血栓相关基因纤溶酶原激活物抑制剂-1(PAI-1)和凝血因子V(FV)基因多态性,分析清远地区人群基因频率分布情况,指导静脉血栓临床药物治疗。方法 提取2020年4月至2021年8月在清远市人民医院行静脉血栓基因检测的2 281例患者DNA,应用数字荧光分子杂交法检测PAI-1和FV基因多态性,并进行Sanger测序加以验证,大数据分析清远市人民医院就诊患者基因型分布频率,评估男、女性和心、脑血管疾病、肿瘤患者PAI-1和FV基因是否突变与发生静脉血栓的风险,指导抗血栓药物使用。结果 数字荧光分子杂交与Sanger测序结果完全符合(100%);大数据发现本地区人群PAI-1基因呈多态性分布(19.33%、50.33%、30.34%),而FV基因型突变极少,多为野生纯合型(99.91%);PAI-1和FV基因型频率和等位基因频率在男、女性和心、脑血管疾病、肿瘤患者人群中差异无统计学意义(P均>0.05);PAI-1基因多态性与疾病进程无明显相关性。结论 PAI-1基因检测对静脉血栓药物应用极具临床意义,可实现精准化个体治疗,但PAI-1基因多态性与其他疾病和性别无关。

2021年苏州市新报告HIV-1感染者抗病毒治疗前耐药及亚型分析

目的了解苏州市新报告HIV-1感染者抗病毒治疗前耐药以及耐药位点突变情况。方法选取苏州市2021年新报告的HIV-1感染者780例,治疗前采集全血样本,提取血浆中的HIV-1病毒RNA,经反转录、巢式PCR扩增HIV-1 pol区基因后,进行sanger测序和基因型鉴定,并上传至斯坦福耐药数据库进行耐药分析。结果780例样本中成功扩增691例,基因型以CRF07_BC(占38.4%)及CRF01_AE亚型(占35.6%)为主,发生不同程度耐药突变53例,治疗前总耐药率为7.7%,对核苷类逆转录酶抑制剂(NRTIs)、非核苷类逆转录酶抑制剂(NNRTIs)、蛋白酶抑制剂(PIs)耐药率分别为0.4%、5.1%、2.7%。不同婚姻状况(χ^(2)=10.55,P<0.05)、不同HIV-1亚型(Fisher's精确检验,P<0.05)患者耐药率差异均有统计学意义。691例成功扩增样本中检测到耐药突变位点19种,对PIs、NRTIs、NNRTIs区耐药基因突变占比分别为3.5%、0.7%、18.4%;PIs突变频率最高位点为Q58E(60.0%),NNRTIs为V179D/E/T(64.9%),NRTIs区少数出现M41L、L210W以及T215S等耐药位点突变。结论2021年苏州市新报告HIV-1感染者治疗前耐药率较高,应加强耐药监测,及时调整抗病毒治疗方案,减少耐药病毒株的产生及传播。

基因1型鹅星状病毒VP27蛋白的原核表达及其多克隆抗体的制备与鉴定

【目的】制备可特异性识别基因1型鹅星状病毒(Goose astrovirus genotype 1,GAstV-1)且与GAstV-2不发生交叉反应的多克隆抗体,以期为后续GAstV-1免疫检测技术的建立提供材料。【方法】通过比对GAstV-1与GAstV-2衣壳蛋白的氨基酸序列以寻找其差异较大的区域作为靶基因。对GAstV-1 GDYJ-21-01株VP27基因密码子进行偏嗜性优化合成,构建原核表达质粒pCZN1-GAstV-1 VP27,转化大肠杆菌Top10感受态细胞以诱导表达VP27蛋白;将纯化后的VP27蛋白免疫新西兰白兔后收获抗血清以制备GAstV-1 VP27多克隆抗体,通过间接ELISA和SDS-PAGE分析该纯化抗体的效价和纯度,并利用间接免疫荧光试验(IFA)检测多克隆抗体的特异性。【结果】试验成功构建重组质粒pCZN1-GAstV-1 VP27;SDS-PAGE显示其表达的重组蛋白分子质量约为35 ku,主要以包涵体形式存在。间接ELISA试验结果显示,纯化后的GAstV-1 VP27多克隆抗体效价高达1∶9 841 500,纯度高于85%。IFA结果显示,GAstV-1 VP27多克隆抗体可特异性识别GAstV-1,且与GAstV-2无交叉反应。临床病料组织检测结果显示,GAstV-1核酸阳性的病料组织均可出现特异性荧光,而GAstV-2核酸阳性且GAstV-1核酸阴性的病料组织未出现荧光。【结论】本研究获得了高效价且可特异性识别GAstV-1(与GAstV-2无交叉反应)的VP27多克隆抗体,为建立鉴别诊断GAstV-1的抗原免疫检测技术奠定了基础。

高迁移率族蛋白B1巨噬细胞转移抑制因子联合CXC亚家族趋化因子16对高危型HPV感染患者诊断价值

目的:探究高迁移率族蛋白B1(HMGB1)、巨噬细胞转移抑制因子(MIF)联合CXC亚家族趋化因子16(CXCL16)在高危型人乳头状瘤病毒(HPV)感染患者中的表达意义及诊断价值。方法:纳入本院2020年10月至2023年10月期间接诊的150例HPV感染患者作为研究组,根据患者核酸检测结果分为高危型HPV感染组(n=40)和低危型HPV感染(n=110)。另选取同期于本院接受经阴道镜活检检查的健康女性作为对照组(n=100)。对研究组患者均采用HPV-DNA分型试剂盒检测;对研究组和对照组人员采用酶联免疫吸附法检测HMGB1和CXCL16水平,免疫组化检测MIF染色强度。对比对照组和研究组HMGB1、MIF和CXCL16差异;对比低危型和高危型HPV感染组HMGB1、MIF和CXCL16差异;采用受试者特征曲线(ROC)分析HMGB1、MIF和CXCL16联合检测对高危型HPV感染诊断价值;Spearman相关性分析HMGB1、MIF和CXCL16与不同HPV感染分型相关性。结果:与对照组相比,研究组血清HMGB1、CXCL16水平和MIF阳性细胞占比得分显著更高(均P<0.05);与低危型HPV感染组相比,高危型HPV感染组血清HMGB1、CXCL16水平和MIF阳性细胞占比得分显著更高(均P<0.05);ROC工作曲线分析结果显示HMGB1、MIF和CXCL16单独及联合诊断高危型HPV感染的AUC分别为0.748、0.684、0.791和0.934,联合检测诊断价值显著高于单独检测(Z=2.577、3.152、2.096,均P<0.05);Spearman相关性结果显示HMGB1、MIF和CXCL16与不同HPV感染分型存在显著正相关(r=0.615、0.633、0.649均P<0.05)。结论:高危型HPV感染患者血清HMGB1、CXCL16水平和MIF阳性细胞占比得分显著高于低危型和对照组,临床检查中应用HMGB1、MIF和CXCL16联合检测可提升高危型HPV感染临床诊断率,为临床提供一种新型检测方法和治疗依据。

牛轮状病毒HSX-21内蒙株的分离鉴定与基因型分析

本研究采集内蒙古自治区呼和浩特市某牛场腹泻犊牛粪样,对其进行牛轮状病毒分离鉴定和遗传进化分析。将RT-PCR检测阳性的腹泻粪样接种于MA104细胞,盲传4代后分离得到一株出现明显细胞病变的毒株,命名为HSX-21;对分离的毒株进行VP7多重半套式PCR鉴定基因型,将分离毒株测序得到的VP6、VP7和VP4基因进行遗传进化分析。结果表明分离到的毒株基因型为A群G6P[1]型,VP6基因与美国分离株NCDV同源性高达99.7%,VP7基因与英国分离株RF同源性高达99.9%;VP4基因与中国分离株NMG17044同源性高达98.8%。通过对牛轮状病毒的分离和基因型的确定,可为有效的防控本地区牛轮状病毒感染提供前期基础和理论依据。

计算弥散加权成像联合瘤周DWI高信号征象评估胶质瘤IDH-1基因分型的临床应用

目的:探讨计算弥散加权成像(cDWI)拟合得到的高b值DWI图像及瘤周DWI高信号(NePDH)征象在区分不同IDH-1基因型胶质瘤中的临床价值。方法:回顾性纳入60例Ⅱ~Ⅳ级胶质瘤患者(IDH-1突变型25例,野生型35例),均行常规MRI平扫、增强及DWI(b=0、1000、3000 s/mm^(2))扫描。使用cDWI技术将DWI_(0,1000)拟合得到cDWI_(0,3000)图像。比较DWI_(0,3000)、cDWI_(0,3000)图像的信噪比(SNR)、对比噪声比(CNR),及医师判读NePDH征象的一致性。评价NePDH征象阳性、肿瘤实质区域表观弥散系数(ADC)_(0,1000)与IDH-1基因型的相关性。绘制受试者工作特征(ROC)曲线并评价各参数的诊断效能。结果:cDWI_(0,3000)图像SNR、CNR优于DWI_(0,3000)(P<0.05)。医师在DWI_(0,3000)、cDWI_(0,3000)上判读NePDH征象的一致性极高(κ=0.958)。不同IDH-1基因型组间,cDWI_(0,3000)上NePDH征象阳性例数差异具有统计学意义(P<0.05),且诊断效能与DWI_(0,3000)相仿(P>0.05)。NePDH征象结合肿瘤实质区ADC值诊断的灵敏度为96.00%,特异度为71.4%,ROC曲线下面积达0.834。结论:高b值cDWI及NePDH征象为术前诊断胶质瘤IDH-1基因型提供了一种无创、可靠的方法。

表观弥散系数与胶质瘤IDH-1/1p19q基因型的相关性研究

目的探讨ADC值与胶质瘤IDH-1/1p19q基因型间的相关性。方法回顾性分析2013年3月—2020年12月经病理证实的69例WHOⅡ/Ⅲ级神经胶质瘤患者的MRI和分子病理学检测结果,采用ROC曲线评估ADC值对胶质瘤基因型(IDH-1、1p19q)的诊断性能。结果IDH-1突变组ADC_(mean)、ADC_(min)、rADC_(mean)、rADC_(min)均分别显著高于IDH-1野生组(P<0.05、P<0.01、P<0.05、P<0.01),以rADC_(min) 0.979×10^(3) mm^(2)/s为阈值诊断IDH-1突变型与IDH-1野生型胶质瘤的效能最高(AUC=0.770),其敏感度、特异性分别为84.61%和59.09%。结论ADC可以作为无创性预测IDH-1突变型与野生型Ⅱ/Ⅲ级胶质瘤的影像学生物标志物。

Vitamin D supplementation improves sustained virologic response in chronic hepatitis C (genotype 1)-nave patients

AIM: To determine whether adding vitamin D, a potent immunomodulator, improves the hepatitis C virus (HCV) response to antiviral therapy. METHODS: Seventy-two consecutive patients with chronic HCV genotype 1 were randomized into two groups: the treatment group (n = 36, 50% male, mean age 47 ± 11 years) received Peg-α-2b interferon (1.5 μg/kg per week) plus ribavirin (1000-1200 mg/d) together with vitamin D3 (2000 IU/d, target serum level > 32 ng/mL), and the control group (n = 36, 60% male, mean age 49 ± 7 years) received identical therapy without vitamin D. HCV-RNA was assessed by realtime polymerase chain reaction (sensitivity, 10 IU/mL). The sustained virologic response (SVR) was defined as undetectable HCV-RNA at 24 wk post-treatment. RESULTS: Clinical characteristics were similar in both groups. The treatment group had a higher mean bodymass index (27 ± 4 kg/m2 vs 24 ± 3 kg/m2, P < 0.01), viral load (50% vs 42%, P < 0.01), and fibrosis score (> F2: 42% vs 19%, P < 0.001) than the controls. At week 4, 16 (44%) treated patients and 6 (17%) controls were HCV-RNA negative (P < 0.001). At week 12, 34 (94%) treated patients and 17 (48%) controls were HCV-RNA negative (P < 0.001). At 24 wk post-treatment (SVR), 31 (86%) treated patients and 15 (42%) controls were HCV-RNA negative (P < 0.001). Viral load, advanced fibrosis and vitamin D supplementation were strongly and independently associated with SVR (multivariate analysis). Adverse events were mild and typical of Peg-α-2b/ribavirin. CONCLUSION: Adding vitamin D to conventional Peg-α-2b/ribavirin therapy for treatment-na■ve patients with chronic HCV genotype 1 infection significantly improves the viral response.

Susceptibility to hepatocellular carcinoma associated with null genotypes of GSTM] and GSTT1

AIM In order to study the association betweenthe null genotypes of GSTM1 and GSTT1 and thegenetic susceptibility to hepatocellularcarcinoma(HCC).METHODS The genotypes of GSTM1 and GSTT1of 63 cases of HCC and 88 controls were detectedwith the multiple PCR technique.RESULTS The frequency of GSTM1 nullgenotype was 57.1% among the cases,and42.0% among the controls,the difference beingstatistically significant(χ~2=3.35,P=0.067),but χ~2 value approaching the significance level.The odds ratio was 1.84(95% Cl= 0.91-3.37).The frequency of GSTT1 non-null genotype was87.3% among the cases and 52.5% among thecontrols,the difference being statisticallysignificant(χ~2=11.42,P=0.0007274).The oddsratio was 4.13(95% Cl=1.64-10.70).According to the cross analysis,the GSTT1 non-null genotype was more closely associated withHCC than GSTM1 null genotype,and these twofactors play an approximate additive interactionin the occurrence of HCC.CONCLUSION The persons with GSTM1 nullgenotype and GSTT1 non-null genotype have theincreased risk to HCC.

Influence of HLA-DRB1 alleles and HBV genotypes on interferon-α therapy for chronic hepatitis B

AIM. To investigate the influence of HLA-DRB1 alleles and HBV genotypes on inberferon-α therapy for chronic hepatitis B. METHODS： HLA-DRBI＊03, ＊07, ＊09,＊12, ＊15 alleles were determined using polymerase chain reaction/sequence specific primer （PCR/SSP） technique in 126 patients with chronic hepatitis B and 76 normal control subjects in Shandong Province, and HBV genotypes were determined by nested-PCR analysis using type-specific primers in 126 patients. RESULTS： The positivity of HLA-DRB1＊07 allele in chronic hepatitis B group was significantly higher than that in normal control group （X^2 = 6.33, P〈0.025, RR = 2.37）. Among the 126 patients, genotype B was found in 38 （30.2%）, genotype C in 69 （54.8%）, and mixed genotype （B＋C） in 19 （15.0%）, genotypes D-F were not found. Among the 46 DRB1＊07（＋） patients, 7 were responders and 39 were non-responders among them （X^2 = 6.71, P〈0.05）. The positivity of HLADRB1＊07 and prevalence of HBV genotype C were significantly higher in non-responders than in responders. CONCLUSION： High positivities of HLA-DRB1 ＊07 allele and HBV genotype C are closely associated with the lower response to interferon-α therapy for chronic hepatitis B.

Daclatasvir plus asunaprevir in treatment-na?ve patients with hepatitis C virus genotype 1b infection

AIM To assess daclatasvir plus asunaprevir(d UAL) in treatment-na?ve patients from China's Mainland, Russia and South Korea with hepatitis C virus(HCV) genotype 1 b infection. METHODS Patients were randomly assigned(3:1) to receive 24 wk of treatment with d UAL(daclatasvir 60 mg once daily and asunaprevir 100 mg twice daily) beginning on day 1 of the treatment period(immediate treatment arm) or following 12 wk of matching placebo(placebodeferred treatment arm). The primary endpoint was a comparison of sustained virologic response at posttreatment week 12(SVR12) compared with the historical SVR rate for peg-interferon plus ribavirin(70%) among patients in the immediate treatment arm. The first 12 wk of the study were blinded. Safety was assessed in d UAL-treated patients compared with placebo patients during the first 12 wk(doubleblind phase), and during 24 wk of d UAL in both arms combined.RESULTS In total, 207 patients were randomly assigned to immediate(n = 155) or placebo-deferred(n = 52) treatment. Most patients were Asian(86%), female(59%) and aged < 65 years(90%). Among them, 13% had cirrhosis, 32% had IL28 B non-CC genotypes and 53% had baseline HCV RNA levels of ≥ 6 million IU/m L. Among patients in the immediate treatment arm, SVR12 was achieved by 92%(95% confidence interval: 87.2-96.0), which was significantly higher than the historical comparator rate(70%). SVR12 was largely unaffected by cirrhosis(89%), age ≥ 65 years(92%), male sex(90%), baseline HCV RNA ≥ 6 million(89%) or IL28 B non-CC genotypes(96%), although SVR12 was higher among patients without(96%) than among those with(53%) baseline NS5 A resistanceassociated polymorphisms(at L31 or Y93 H). during the double-blind phase, aminotransferase elevations were more common among placebo recipients than among patients receiving d UAL. during 24 wk of d UAL therapy(combined arms), the most common adverse events(≥ 10%) were elevated alanine aminotransferase and upper respiratory tract infection; emergent grade 3-4 laboratory abnormalities were infrequently observed, and all grade 3-4 aminotransferase abnormalities(alanine aminotransferase, n = 9; aspartate transaminase, n = 6) reversed within 8-11 d. Two patients discontinued d UAL treatment; one due to aminotransferase elevations, nausea, and jaundice and the other due to a fatal adverse event unrelated to treatment. There were no treatment-related deaths.CONCLUSION d UAL was well-tolerated during this phase 3 study, and SVR12 with d UAL treatment(92%) exceeded thehistorical SVR rate for peg-interferon plus ribavirin of 70%.

复合性状转cry2A^(*)/bar基因水稻T2A-1与杂草稻F_(1)、F_(2)、F_(3)的适合度

[目的]本文旨在评价复合性状转cry2A^(*)/bar基因水稻T2A-1向杂草稻基因漂移的生态风险。[方法]在农田非竞争环境下,以T2A-1、受体水稻‘明恢63’及其分别与江苏泰州(WRTZ)、广东茂名(WRMM)、湖南益阳(WRYY)杂草稻的杂交后代(以T2A-1为父本的抗性后代F_(1)+、F_(2)+、F_(3)+,以MH63为父本的非抗性后代F_(1)-、F_(2)-、F_(3)-)为材料,评价T2A-1与杂草稻杂交后代的适合度。[结果]抗性基因在杂交后代中的传递符合孟德尔遗传规律;外源抗虫基因的导入显著降低抗性杂交后代的靶标虫压。虽然抗性杂交后代与相应非抗性杂交后代的部分适合度指标存在差异,但总相对适合度均无显著差异;抗性杂交后代总相对适合度显著高于或相当于相应杂草稻,且随杂交代数的增加无显著变化。抗性杂交后代与相应非抗性杂交后代的落粒率均无显著差异,除F 1TZ+、F 2TZ+与WRTZ相当外,其他杂交后代的落粒率均显著低于相应杂草稻。F 2和F 3在3和20 cm埋藏120 d后,只有27.75%~41.75%的F 2TZ+和F 3TZ+种子具有活力。[结论]在低虫压下,WRMM、WRYY的抗性杂交后代与杂草稻相比尽管具有相似或较高的营养和生殖能力,但落粒性和种子越冬能力较低,而WRTZ的抗性杂交后代种子虽然具有越冬能力,但落粒率较低,且从三代抗性杂交后代适合度变化来看,并无适合度提高的风险。因此在无除草剂选择压下T2A-1向杂草稻基因漂移可能引起的生态风险较低。

Twenty four-week peginterferon plus ribavirin after interferon-β induction for genotype 1b chronic hepatitis C

AIM:To investigate the possibility of shortening the duration of peginterferon(Peg-IFN)plus ribavirin(RBV) combination therapy by incorporating interferon-β (IFN-β)induction therapy. METHODS:A one treatment arm,cohort prospective study was conducted on seventy one patients.The patients were Japanese adults with genotype 1b chronic hepatitis C,HCV-RNA levels of≥5.0 Log IU/mL or 100 KIU/mL,and platelet counts of≥90 000/μL.The treatment regimen consisted of a 2 wk course of twicedaily administration of IFN-βfollowed by 24 wk PegIFN plus RBV combination therapy.We prolonged the duration of the Peg-IFN plus RBV therapy to 48 wk if the patient requested it. RESULTS:The patients,including 44%males,were characterized by an median age of 63 years(range: 32-78 years),an median platelet count of 13.9(range: 9.1-30.6)×10 4 /μL,62%IFN-na?ve,and median HCV- RNA of 6.1(range:5.1-7.2)Log IU/mL.The sustained virologic response(SVR)rates were 34%(Peg-IFN:1-24 wk,n=61,95%confidence interval(CI): 24%-47%)and 55%(Peg-IFN:20-24 wk,n=31,95% CI:38%-71%,P<0.001;vs Peg-IFN:1-19 wk).TheSVR rate when the administration was discontinued early was 13%(Peg-IFN:1-19 wk,n=30,95%CI: 5%-30%),and that when the administration was prolonged was 50%(Peg-IFN:25-48 wk,n=10,95% CI:24%-76%,P<0.05;vs Peg-IFN:1-19 wk).In the patients who received 20-24 wk of Peg-IFN plus RBV,only the higher platelet count(≥130 000/μL) was significantly correlated with the SVR(odds ratio: 11.680,95%CI:2.3064-79.474,P=0.0024).In 45% (14/31)of the patients with a higher platelet count (≥130000/μL)before therapy,the HCV-RNA level decreased to below 3.3 Log IU/mL at the completion of IFN-β,and their SVR rate was 93%(13/14)after 20-24 wk administration of Peg-IFN plus RBV. CONCLUSION:These results suggest the possibilities of shortening the duration of Peg-IFN plus RBV combination therapy by actively reducing HCV-RNA levels using the IFN-βinduction regimen.

Genotype-dependent activation or repression of HBV enhancer Ⅱ by transcription factor COUP-TF1

AIM: To study the expression of HBV enhancer Ⅱ by transcription factor COUP-TF1. METHODS: In order to study the regulation of HBV variants in the vicinity of the NRRE we cloned luciferase constructs containing the HBV enhancer Ⅱ from variants and from HBV genotypes A and D and cotransfected them together with expression vectors for COUP-TF1 into HepG2 cells. RESULTS: Our fi ndings show that enhancer Ⅱ of HBV genotype A is also repressed by COUP-TF1. In contrast, two different enhancer Ⅱ constructs of HBV genotype D were activated by COUP-TF1. The activation was independent of the NRRE because a natural variant with a deletion of nt 1763-1770 was still activated by COUP- TF1. CONCLUSION: Regulation of transcription of the HBV genome seems to differ among HBV genomes derived from different genotypes. These differences in transcriptional control among HBV genotypes may be the molecular basis for differences in the clinical course among HBV genotypes.

Daclatasvir vs telaprevir plus peginterferon alfa/ribavirin for hepatitis C virus genotype 1

AIM: To evaluate daclatasvir vs telaprevir, each combined with peginterferon alfa-2a/ribavirin(peg IFN/RBV), in treatment-naive hepatitis C virus(HCV) genotype(GT) 1-infected patients.METHODS: In this phase 3, randomized, open-label, noninferiority study, 602 patients were randomly assigned(2:1) to daclatasvir vs telaprevir, stratified by IL28 B rs12979860 host genotype(CC vs non-CC), cirrhosis status(compensated cirrhosis vs no cirrhosis), and HCV GT1 subtype(GT1a vs GT1b). Patients were selected by study inclusion criteria from a total of 793 enrolled patients. Patients received daclatasvir 60 mg once daily or telaprevir 750 mg 3 times daily plus peg IFN/RBV. Daclatasvir recipients received 24 wk of daclatasvir plus peg IFN/RBV; those without an extended rapid virologic response(e RVR; undetectable HCV-RNA at weeks 4 and 12) received an additional 24 wk of peg IFN/RBV. Telaprevir-treated patients received 12 wk of telaprevir plus peg IFN/RBV followed by 12(with e RVR) or 36(no e RVR) wk of peg IFN/RBV. The primary objective was to compare for noninferiority of sustained virologic response rates at posttreatment week 12(SVR12) in GT1b-infected patients. Key secondary objectives were to demonstrate that the rates of anemia(hemoglobin < 10 g/d L) and rashrelated events, through week 12, were lower with daclatasvir + peg IFN/RBV than with telaprevir + peg IFN/RBV among GT1b-infected patients. Resistance testing was performed using population-based sequencing of the NS5 A region for all patients at baseline, and for patients with virologic failure or relapse and HCV-RNA ≥ 1000 IU/m L, to investigate any link between NS5 A polymorphisms associated with daclatasvir resistance and virologic outcome. RESULTS: Patient demographics and disease characteristics were generally balanced across treatment arms; however, there was a higher proportion of black/African Americans in the daclatasvir groups(6.0% and 8.2% in the GT1 b and GT1 a groups, respectively) than in the telaprevir groups(2.2% and 3.0%). Among GT1 binfected patients, daclatasvir plus peg IFN/RBV was noninferior to telaprevir plus peg IFN/RBV for SVR12 [85%(228/268) vs 81%(109/134); difference, 4.3%(95%CI:-3.3% to 11.9%)]. Anemia(hemoglobin < 10 g/d L) was significantly less frequent with daclatasvir than with telaprevir [difference,-29.1%(95%CI:-38.8% to-19.4%)]. Rash-related events were also less common with daclatasvir than with telaprevir, but the difference was not statistically significant. In GT1 ainfected patients, SVR12 was 64.9% with daclatasvir and 69.7% with telaprevir. Among both daclatasvir and telaprevir treatment groups, across GT1b- or GT1a-infected patients, lower response rates were observed in patients with IL28 B non-CC and cirrhosis- factors known to affect response to peg IFN/RBV. Consistent with these observations, a multivariate logistic regression analysis in GT1b-infected patients d e m o n s t ra t e d t h a t S V R 1 2 wa s a s s o c i a t e d w i t h IL28 B host genotype(CC vs non-CC, P = 0.011) and cirrhosis status(absent vs present, P = 0.031). NS5 A polymorphisms associated with daclatasvir resistance(at L28, R30, L31, or Y93) were observed in 17.3% of GT1b-infected patients at baseline; such variants did not appear to be absolute predictors of failure since 72.1% of these patients achieved SVR12 compared with 86.9% without these polymorphisms. Among GT1b-infected patients, treatment was completed by 85.4%(229/268) in the daclatasvir group, and by 85.1%(114/134) in the telaprevir group, and among GT1a-infected patients, by 67.2%(90/134) and 69.7%(46/66), respectively. Discontinuations(of all 3 agents) due to an AE were more frequent with telaprevir than with daclatasvir, whereas discontinuations due to lack of efficacy were more frequent with daclatasvir, due, in part, to differences in futility criteria. CONCLUSION: Daclatasvir plus peg IFN/RBV demonstrated noninferiority to telaprevir plus peg IFN/RBV for SVR12 and was well-tolerated in treatment-naive GT1 binfected patients, supporting the use of daclatasvir with other direct-acting antivirals.

新生儿筛查发现的氨甲酰磷酸合成酶1缺乏症患儿长期随访研究

目的:研究浙江省新生儿筛查发现的氨甲酰磷酸合成酶1(CPS1)缺乏症患儿的基因型和表型特点及长期预后。方法:回顾性分析2013年9月至2023年8月浙江省新生儿疾病筛查中心采用干血斑串联质谱法筛查并联合基因检测诊断的CPS1缺乏症患者的所有筛查及临床随访资料。结果:共筛查新生儿4 056 755名,联合表型及基因检测诊断CPS1缺乏症6例;基因检测结果发现CPS1 10种变异,包括2种已知致病性变异(c.2359C>T、c.1549+1G>T)及8种未报道变异(c.3405-1G>T、c.2372C>T、c.1436C>T、c.2228T>C、c.2441G>A、c.3031G>A、c.3075T>C、c.390-403del)。患儿初筛血瓜氨酸值均有下降(2.72~6.21μmol/L),伴有血氨不同程度升高;诊断后给予限制天然蛋白摄入(特殊奶粉)、精氨酸及支持治疗,分别随访至9个月~10岁,有高氨血症发作3例,注意力缺陷多动、一过性口角抽动、肌张力增高各1例;除1例死亡,5例存活患儿的年龄与发育进程问卷及格里菲斯发育评估量表评分均正常,但合并身高或体重发育落后4例。结论:浙江省CPS1缺乏症患儿表现为典型血瓜氨酸低、高氨血症生化改变;基因变异多数为家族特有,未发现热点突变。新生儿筛查早期诊断规范治疗患儿预后较好。

Interferon-free treatments in patients with hepatitis C genotype 1-4 infections in a real-world setting

AIM To investigated the real-world effectiveness and safety of various regimens of interferon-free treatments in patients infected with hepatitis C virus(HCV).METHODS We performed an observational study to analyze different antiviral treatments administered to 462 HCV-infected patients, of which 56.7% had liver cirrhosis. HCV RNA after 4 wk of treatment and at 12 wk after treatment sustained virologic response(SVR) as well as serious adverse events(SAEs) was analyzed first for the whole cohort and then separately in patients who met or did not meet the inclusion criteria of a clinical trial(CT-met and CT-unmet, respectively).RESULTS The most frequently prescribed treatment was simeprevir/sofosbuvir(36.4%), followed by sofosbuvir/ledipasvir(24.9%) and ombitasvir/paritaprevir/ritonavir(r)/dasabuvir(19.9%). Ribavirin(RBV) was administered in 198 patients(42.9%). SVRs occurred in 437/462 patients(94.6%). The SVRs ranged between 93.3% and 100% for genotypes 1-4. SVRs were achieved in 96.2% patients in the CTmet group vs 91.9% patients in the CT-unmet group(P = 0.049). Undetectable HCV RNA at week 4 occurred in 72.9% of the patients. In the univariate analysis, the factors associated with SVRs were lower liver stiffness, absence of cirrhosis, higher platelet count, higher albumin levels, no RBV dose reduction, undetectable HCV RNA at week 4 and CT-met group. In the multivariate analysis, only albumin was an independent predictor of treatment failure(P = 0.04). Eleven patients(2.4%) developed SAEs; 5.2% and 0.7% of the patients in the CT-unmet and CT-met groups, respectively(P = 0.003).CONCLUSION A high proportion of patients with HCV infection achieved SVRs. For patients who did not meet the CT criteria, treatment regimens must be optimized.

Boceprevir is highly effective in treatment-experienced hepatitis C virus-positive genotype-1 menopausal women

AIM: To investigate the safety/efficacy of Boceprevirbased triple therapy in hepatitis C virus(HCV)-G1 menopausal women who were historic relapsers, partial-responders and null-responders. METHODS: In this single-assignment, unblinded study, we treated fifty-six menopausal women with HCV-G1, 46% F3-F4, and previous PEG-α/RBV failure(7% null, 41% non-responder, and 52% relapser) with 4 wk lead-in with PEG-IFNα2b/RBV followed by PEGIFNα2b/RBV+Boceprevir for 32 wk, with an additional 12 wk of PEG-IFN-α-2b/RBV if patients were HCV-RNApositive by week 8. In previous null-responders, 44 wk of triple therapy was used. The primary objective of retreatment was to verify whether a sustained virological response(SVR)(HCV RNA undetectable at 24 wk of follow-up) rate of at least 20% could be obtained. The secondary objective was the evaluation of the percent of patients with negative HCV RNA at week 4(RVR), 8(RVR BOC), 12(EVR), or at the end-of-treatment(ETR) that reached SVR. To assess the relationship between SVR and clinical and biochemical parameters, multiple logistic regression analysis was used.RESULTS: After lead-in, only two patients had RVR; HCV-RNA was unchanged in all but 62% who had ≤1 log10 decrease. After Boceprevir, HCV RNA became undetectable at week 8 in 32/56(57.1%) and at week 12 in 41/56(73.2%). Of these, 53.8% and 52.0%, respectively, achieved SVR. Overall, SVR was obtained in 25/56(44.6%). SVR was achieved in 55% previous relapsers vs. 41% non-responders(P = 0.250), in 44% F0-F2 vs 54% F3-F4(P = 0.488), and in 11/19(57.9%) of patients with cirrhosis. At univariate analysis for baseline predictors of SVR, only previous response to antiviral therapy(OR = 2.662, 95%CI: 0.957-6.881, P = 0.043), was related with SVR. When considering "on treatment" factors, 1 log10 HCV RNA decline at week 4(3.733, 95%CI: 1.676-12.658, P = 0.034) and achievement of RVR BOC(7.347, 95%CI: 2.156-25.035, P = 0.001) were significantly related with the SVR, although RVR BOC only(6.794, 95%CI: 1.596-21.644, P = 0.010) maintained significance at multivariate logistic regression analysis. Anemia and neutropenia were managed with Erythropoietin and Filgrastim supplementation, respectively. Only six patients discontinued therapy. CONCLUSION: Boceprevir obtained high SVR response independent of previous response, RVR or baseline fibrosis or cirrhosis. RVR BOC was the only independent predictor of SVR.