Hepatic pathological characteristics and factors influencing alanine transaminase value below twice the upper limit of normal in patients with chronic hepatitis B / 中华肝脏病杂志

Objective: To analyze the hepatic pathological characteristics and factors influencing an alanine transaminase value below twice the upper limit of normal in patients with chronic hepatitis B (CHB) and further explore the optimal ALT threshold strategy for initiating antiviral therapy. Methods: Clinical data of treatment-naïve CHB patients who underwent liver biopsies from January 2010 to December 2019 were retrospectively collected. Multiple regression models were used to explore the ALT levels and significant risk of hepatic histological changes (≥G2/S2). Receiver operating characteristic curve was used to evaluate the value of different models in diagnosing liver tissue inflammation≥G2 or fibrosis ≥ S2. Results: A total of 447 eligible CHB patients, with a median age of 38.0 years and 72.9% males, were included. During ALT normalization, there was significant liver inflammation (≥G2) and fibrosis (≥S2) in 66.9% and 53.0% of patients, respectively. With an ALT rise of 1-2×ULN, the proportions of liver inflammation≥G2 and fibrosis≥S2 were 81.2% and 60.0%, respectively. After adjusting for confounding factors, higher ALT levels (> 29 U/L) were found to be associated with significant liver inflammation (OR: 2.30, 95% CI: 1.11 ~ 4.77) and fibrosis (OR: 1.84, 95% CI: 1.10 ~ 3.09). After the measurement of glutamyltransferase-platelet ratio (GPR), the proportion of CHB patients with≥G2/S2 was significantly reduced under different treatment thresholds of ALT standards, and in particular, the erroneous evaluation of liver fibrosis≥S2 was significantly improved (33.5% to 57.5%). Conclusion: More than half of CHB patients have a normal ALT or one within 2 × ULN, regardless of whether or not there is apparent inflammation and fibrosis. GPR can significantly improve the precise assessment of different conditions of treatment thresholds for the ALT value in CHB patients.

Real-world study evaluating the incidence of liver damage conditions in patients with primary liver cancer using immune checkpoint inhibitor-based combination therapy / 中华肝脏病杂志

Objective: To evaluate the incidence of immune checkpoint inhibitor-based combination therapy-induced liver damage in patients with primary liver cancer. Methods: Clinical data of 65 hospitalized cases of primary liver cancer treated with programmed cell death-1 its ligand programmed death-ligand 1 (PD-1/PD-L1) antibody in the Department of Infectious Diseases of the Second Affiliated Hospital of Chongqing Medical University from January 1, 2018 to March 31, 2021 were retrospectively analyzed. The degree of liver injury before and after treatment was assessed according to CTCAE v5.0. Patients were grouped according to gender, age, presence or absence of cirrhosis, baseline Child-Pugh score, BCLC stage, and treatment regimen to compare the incidence of liver injury under different conditions. The χ (2) test or rank-sum test was used for comparison among multiple groups. Results: 46 cases (70.77%) had liver damage of any grade according to the CTCAE V5.0 criteria during the treatment and observation period. All 6 cases who received standardized anti-hepatitis B virus (HBV) treatment developed liver damage. 10 (15.38%), 15 (23.08%), 19 (29.23%), and 2 (3.08%) cases had grade 1, 2, 3, and 4 liver damage respectively. There was no statistically significant difference in the incidence of liver damage between male and female patients (68.33% and 100%, P = 0.180). There was no statistically significant difference in the incidence of liver damage among different age groups (P = 0.245). The incidence of liver damage in cirrhotic and non-cirrhotic group was 72.22%, and 63.64% (P = 0.370), respectively. The incidence of liver damage in patients with baseline Child-Pugh class A, B, and C were 71.43%, 61.11% and 100%, respectively, and the difference was not statistically significant (P = 0.878). The incidence of liver damage was not statistically significantly different under different BCLC stages (P = 1.000). The incidence of liver damage in the PD-1/PD-L1 antibody monotherapy, PD-1/PD-L1 antibody combined with targeted drug therapy, and PD-1/PD-L1 antibody combined with TACE/radiofrequency ablation treatment group were 60.00%, 67.85%, and 86.67%, respectively. There was no statistically significant difference in the incidence of liver damage between the treatment regimen (P = 0.480). Conclusion: Immune checkpoint inhibitor therapy-induced liver damage is common in patients with primary liver cancer; however, it rarely severely endangers the patient's life. Additionally, patient's gender, age, presence or absence of cirrhosis, baseline liver function, BCLC stage and the immunotherapy regimen has no effect on the incidence of immune-related liver damage.

Low-level viremia in nucleoside analog-treated chronic hepatitis B patients / 中华医学杂志(英文版)

Low-level viremia (LLV) was defined as persistent or intermittent episodes of detectable hepatitis B virus (HBV) DNA (<2000 IU/mL, detection limit of 10 IU/mL) after 48 weeks of antiviral treatment. Effective antiviral therapies for chronic hepatitis B (CHB) patients, such as entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF), have been shown to inhibit the replication of HBV DNA and prevent liver-related complications. However, even with long-term antiviral therapy, there are still a number of patients with persistent or intermittent LLV. At present, the research on LLV to address whether adversely affect the clinical outcome is limited, and the follow-up treatment for these patients is open to question. At the same time, the mechanism of LLV is not clear. In this review, we summarize the incidence of LLV, the association between LLV and long-term outcomes, possible mechanisms, and management strategies in these patient populations.

Analysis of spontaneous decline of HBV DNA in chronic hepatitis B patients in 12 weeks / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To analyze the spontaneous decline of HBV DNA in chronic hepatitis B patients in 12 weeks.</p><p><b>METHODS</b>Chronic hepatitis B patients not receiving antiviral treatment from 2003 to 2005 were divided into two groups according to the baseline value of ALT and TBil. Spontaneous decline of HBV DNA were retrospected, and the influence of the baseline value of ALT and TBil on spontaneous decline of HBV DNA was analyzed.</p><p><b>RESULTS</b>Total of 213 chronic hepatitis B patients (male 174, female 39, aged from 18 to 65) were recruited in this study, including 124 mild and moderate type of hepatitis B, 89 severe type of hepatitis B, and 19 patients (8.92%) were lost at the end of the 12th week. The mean baseline value of HBV DNA of all the patients was (6.66+/-1.03) log10 copies/ml, at 12 week the mean value of HBV DNA of all the patients was (5.98+/-1.53) log10 copies/ml (compared to baseline P<0.01), the decline value of HBV DNA was (0.68+/-1.46) log10 copies/ml. The mean baseline value of HBV DNA of patients with the severe type of hepatitis B was lower than that with the mild or moderate type of hepatitis B patients [(6.45+/-0.99) log10 copies/ml and (6.81+/-1.04) log10 copies/ml respectively] (P<0.05). However, there was no significant difference in the mean and the declined value of HBV DNA between these two groups at the 12th week (P<0.05). At the 12th week, the baseline values of ALT and TBil were higher in patients with HBV DNA<or=3 log10 copies/ml than those in patients with HBV DNA>3 log10 copies/ml (P>0.05); And there were no significant difference in the baseline values of ALT and TBil between patients with the declined value of HBV DNA>or=2 log10 copies/ml and patients with declined value of HBV DNA less than 2 log10 copies/ml. At the 12th week, the mean and the declined value of HBV DNA were similar between the patients with ALT<or=5xULN and the patients with ALT>5xULN at baseline. The mean baseline value of HBV DNA of patients in the group of patients whose baseline value of ALT<or=5xULN while TBil<or=5xULN was higher than that in the group of patients whose baseline value of ALT>5xULN while TBil>5xULN, ALT<or=5xULN while TBil>5xULN, ALT>5xULN while TBil<or=5xULN (P<0.05 respectively), there were no significant difference in the rate of the HBV DNA<or=3 log10 copies/ml and the rate of the declining value of HBV DNA<or=2 log10 copies/ml between the groups at 12 week (P>0.05 respectively).</p><p><b>CONCLUSIONS</b>There is spontaneous decline of HBV DNA in patients with chronic hepatitis B in 12 weeks, but the level of liver injury is not correlated with the level of spontaneous decline of HBV DNA in chronic hepatitis B patients in 12 weeks.</p>

A study on the anti-HBV effect of dendritic cell from human umbilical cord blood / 中华肝脏病杂志

<p><b>OBJECTIVE</b>Regarding the strong antigen-presenting abilities of dendritic cells (DC), this study was carried out based on the induction and proliferation of DC derived from human umbilical cord blood; the anti-HBV effect of cytotoxicity T lymphocytes (CTL) activated by those DC pulsed with HBsAg was also carried out to explore a new way to activate the HBsAg-specific CTL.</p><p><b>METHODS</b>Cord blood was collected from the cord veins of normal placentae after Cesarean sections, from which cord blood mononuclear cells (CBMC) were separated through density gradient centrifugation. The CBMC were cultured in RPMI 1640 with a cytokine cocktail. Pulsed with HBsAg, the DC were prepared to activate the HBsAg-specific CTL among the CBMC. The cytotoxic effect of CBMCs activated by the DC primed with HBsAg was assayed through the killing of those HepG2-S target cells.</p><p><b>RESULTS</b>Typical DC could be induced from CMBC cultured with a cytokine cocktail. DC pulsed by HBsAg activated HBsAg-specific CTL, which killed the target HepG2-S cells to some extent.</p><p><b>CONCLUSION</b>DC can be induced from CMBC with the cytokine cocktail and they show a strong antigen-presenting ability. DC produced in this way and pulsed by HBsAg can activate HBsAg-specific CTL in vitro. This might mean that it could be a new way to break the tolerance to HBV in chronic HBV-infected patients.</p>

A preliminary study using RNA interference technique against replication of HBV in vitro / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To identify the siRNA interference ability for the replication of HBV.</p><p><b>METHODS</b>Based on the sequence of HBV in HepG2 2.2.15 cells in GenBank, one sequence targeting the C antigen of HBV was cloned into the RNA polymerase III based expression vector pSuper. This recombinant was electroporated into HepG2 2.2.15 cells and the expression of HBsAg and HBeAg was assayed using ELISA.</p><p><b>RESULTS</b>The construction of the recombinant expression vector pSuper-C and its control vector pSuper was successfully confirmed by the results of enzyme digestion, electrophoresis and sequencing. However, there was no difference between the expression of HBsAg and HBeAg in the supernatant of HepG2 2.2.15 cell culture in the experimental and control groups.</p><p><b>CONCLUSIONS</b>The constructed pSuper-C did not show an interfering effect on the replication of HBV in HepG2 2.2.15 cells. In order to display this effect, further study is needed</p>

The role of dendritic cell and macrophage in hepatoma antigen-presenting / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the role of dendritic cells (DCs) and macrophages, differentiated from the same individual peripheral blood monocytes, in tumor antigen- presenting.</p><p><b>METHODS</b>DCs and macrophages were differentiated from human peripheral blood monocytes by adding both Granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4) or GM-CSF only. Then they were loaded with tumor antigen at different concentrations and cocultured with autologous T cells in 96-well flat-bottomed microtiter plates for five days at 37 degrees C, 5% CO(2). (3)H-thymine was added before the culture terminated, and twelve hours later, the cells were gathered to test the cpm value.</p><p><b>RESULTS</b>Both DCs and macrophages chased with tumor antigen could strongly stimulate the proliferation of autologous T cells, especially DCs. The stimulation effect with 20 microl/ml antigen was the most remarkable and the cmp values were 11,950.3 +/-1621.8, 8,708.5 +/-176.1, 402.5+/-43.1 in DCs group, Macrophages group, and lymphocytes group, respectively.</p><p><b>CONCLUSION</b>The antigen presenting role of DCs is stronger than that of macrophages from the same individual.</p>

The primary study on the anti-HBV effect of whole recombinant yeast / 中华肝脏病杂志

<p><b>OBJECTIVES</b>Based on the immunologic character of Pichia pastoris yeast, a new therapeutic vaccine, whole recombinant yeast, was used to explore a new way to activate cell-mediated anti-viral immunity.</p><p><b>METHODS</b>The recombinant plasmids, pPIC9K/S and PIC9K/hsp(1-370)-S, were constructed by inserting the gene encoding HBsAg, HSP70 (1-370) -HBsAg into vector pPIC9K and then the recombinants were transfected into Pichia pastoris yeast,GS115, respectively. Then that recombinant yeast immunized BALB/C mice were detected for humoral and cellular immunity to HBsAg.</p><p><b>RESULTS</b>Recombinant yeast successfully activated the humoral immunity to HBsAg in mice, but failed to activate the cellular immunity.</p><p><b>CONCLUSION</b>The whole recombinant yeast can be used as vaccine, but need further study for optimal way of immunization.</p>

Transient expression of fusion protein with a chimeric HBsAg-HSP70 construct in HepG2 cells / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate transient expression of fusion protein with a chimeric HBsAg-HSP70 construct in HepG2 cells.</p><p><b>METHODS</b>Enkaryotic expression plasmids inserted HBsAg gene or chimeric HBsAg-HSP70 gene were prepared and transfected into HepG2 cells by means of cationic liposome. mRNA were detected by RT-PCR and proteins expressed in the cells were detected by immunocytochemistry 48 hours later. HBsAg in cultured supernatants and cell lysates were assayed by ELISA.</p><p><b>RESULTS</b>Fusion protein (HBsAg-HSP70) transient expression in HepG2 cells were confirmed by RT-PCR, immunocytochemistry or ELISA, but fusion protein was not assayed in cell cultured supernatants by ELISA.</p><p><b>CONCLUSIONS</b>Transfection of HepG2 cells with a chimeric HBsAg-HSP70 construct leads to express fusion protein, but it does not secrete into cell cultured supernatants.</p>

Study on induction of dendritic cells from myeloid leukemia cell lines and their antitumor immune function / 中国实验血液学杂志

Dendritic cell (DC) plays a key role in antitumor immune response. However, there is a deficiency of DC function in the majority of leukemia patients. It is a novel idea that expanding DC in vitro and enhancing their antitumor immune function and DC-based tumor vaccines may be used as an efficient immune therapy for leukemia. In the project, the condition to induce DC from myeloid leukemia cell lines and its anti-leukemia response were investigated. HL-60, K562 and THP-1 cells were cultured with various combinations of cytokines for inducing DC. The morphologic features were analyzed with optical and electron microscopy. The phenotype of DC was detected by FCM with CD1a, CD40, CD80, CD86, HLA-A, B, C and HLA-DR monoclonal antibodies. The ability of DC stimulating lymphocyte proliferation was observed by allo-mixed lymphocyte reaction using (3)H-TdR incorporation. Cytotoxicity assay was measured by (51)Cr-release method. The level of IL-12 and IFN-gamma in supernatant of DC culture was measured by ELISA. It was proved that the DCs derived from K562, HL-60 and THP-1 cells showed a typical morphology of dendritic cell. The induced cells expressed the surface differentiation antigens of DC. A high expression of phenotypes was found in HL-60-DC and THP-1-DC stimulated by GM-CSF + IL-4 + TNF-gamma and K562-DC with GM-CSF + IL-4 + IL-12. The DCs from the 3 leukemia cell lines stimulated allo-MLR and CTL reaction strongly. Different contents of IL-12 were detected in the supernatants of DC culture and IFN-gamma in the coculture of DC and blood mononuclear cells. It is concluded that the myeloid leukemia cells are able to be induced DCs by cytokines in vitro. The different leukemia cells need different cytokines and cultural conditions. DCs derived from leukemia cells express phenotype of antigen-presenting cells. They have the ability of stimulating T lymphocyte proliferation and inducing CTL reaction to clear leukemia cells, and the DCs secrete IL-12 and increase secretion of IFN-gamma by T cells.