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      Genome-Wide Association Study Confirming Association of HLA-DP with Protection against Chronic Hepatitis B and Viral Clearance in Japanese and Korean

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          Abstract

          Hepatitis B virus (HBV) infection can lead to serious liver diseases, including liver cirrhosis (LC) and hepatocellular carcinoma (HCC); however, about 85–90% of infected individuals become inactive carriers with sustained biochemical remission and very low risk of LC or HCC. To identify host genetic factors contributing to HBV clearance, we conducted genome-wide association studies (GWAS) and replication analysis using samples from HBV carriers and spontaneously HBV-resolved Japanese and Korean individuals. Association analysis in the Japanese and Korean data identified the HLA-DPA1 and HLA-DPB1 genes with P meta  = 1.89×10 −12 for rs3077 and P meta  = 9.69×10 −10 for rs9277542. We also found that the HLA-DPA1 and HLA-DPB1 genes were significantly associated with protective effects against chronic hepatitis B (CHB) in Japanese, Korean and other Asian populations, including Chinese and Thai individuals ( P meta  = 4.40×10 −19 for rs3077 and P meta  = 1.28×10 −15 for rs9277542). These results suggest that the associations between the HLA-DP locus and the protective effects against persistent HBV infection and with clearance of HBV were replicated widely in East Asian populations; however, there are no reports of GWAS in Caucasian or African populations. Based on the GWAS in this study, there were no significant SNPs associated with HCC development. To clarify the pathogenesis of CHB and the mechanisms of HBV clearance, further studies are necessary, including functional analyses of the HLA-DP molecule.

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          Most cited references18

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          Genotype H: a new Amerindian genotype of hepatitis B virus revealed in Central America.

          The complete genomes were sequenced for ten hepatitis B virus (HBV) strains. Two of them, from Spain and Sweden, were most similar to genotype D, although encoding d specificity. Five of them were from Central America and belonged to genotype F. Two strains from Nicaragua and one from Los Angeles, USA, showed divergences of 3.1-4.1% within the small S gene from genotype F strains and were recognized previously as a divergent clade within genotype F. The complete genomes of the two genotype D strains were found to differ from published genotype D strains by 2.8-4.6%. Their S genes encoded Lys(122), Thr(127) and Lys(160), corresponding to the putative new subtype adw3 within this genotype, previously known to specify ayw2, ayw3 or, rarely, ayw4. The complete genomes of the three divergent strains diverged by 0.8-2.5% from each other, 7.2-10.2% from genotype F strains and 13.2-15.7% from other HBV strains. Since pairwise comparisons of 82 complete HBV genomes of intratypic and intertypic divergences ranged from 0.1 to 7.4% and 6.8 to 17.1%, respectively, the three sequenced strains should represent a new HBV genotype, for which the designation H is proposed. In the polymerase region, the three strains had 16 unique conserved amino acid residues not present in genotype F strains. So far, genotype H has been encountered in Nicaragua, Mexico and California. Phylogenetic analysis of the complete genomes and subgenomes of the three strains showed them clustering with genotype F but forming a separate branch supported by 100% bootstrap. Being most similar to genotype F, known to be an Amerindian genotype, genotype H has most likely split off from genotype F within the New World.
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            Hepatitis B therapy.

            The goal of hepatitis B treatment is to prevent cirrhosis, liver decompensation and hepatocellular carcinoma. In clinical practice, treatment response is determined by suppression of serum HBV DNA levels, hepatitis B e antigen seroconversion to hepatitis B e antibody, hepatitis B surface antigen loss, normalization of alanine aminotransferase levels and improvement in liver histology. Patients with life-threatening liver disease, and those with high levels of HBV replication and active or advanced liver disease, should be treated. Other patients should be monitored so that treatment can be initiated when indicated. Currently, seven medications are approved for the treatment of hepatitis B: two formulations of interferon and five nucleos(t)ide analogues. Interferon is administered for a finite duration while nucleos(t)ide analogues are usually administered for many years. Antiviral drug resistance is a major limiting factor to the success of nucleos(t)ide analogue treatment; therefore, treatment should be initiated with drugs that have a high genetic barrier to resistance (that is, a low potential for drug resistance). In addition, treatment response should be closely monitored to detect virologic breakthroughs, and the importance of medication adherence should be emphasized. Management of patients with treatment failure should be tailored according to the type of treatment failure (lack of initial response versus virologic breakthrough), the treatment that the patient is receiving, history of prior treatment, and the pretreatment characteristics of both the patient and the disease.
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              Association between an MHC class II allele and clearance of hepatitis B virus in the Gambia.

              The course of hepatitis B virus (HBV) infection does not appear to be determined by variations in viral virulence and may be influenced by the host immune response. We studied the distribution of human leukocyte antigens in children and adult men in the Gambia who spontaneously recovered from HBV infection as compared with the distribution of these antigens in subjects with persistent infection. In a two-stage, case-control study, we analyzed the frequency of MHC class I antigens and class II haplotypes in people with either transient or persistent HBV infection. MHC class I typing was performed by microlymphocytotoxicity assays. MHC class II typing was performed with analysis of restriction-fragment-length polymorphisms (RFLPs), supplemented by other techniques. In the first stage (the study of children up to the age of 10 years), the RFLP pattern 25-1, which includes the class II allele HLA-DRB1*1302, was found in 58 of 218 subjects with transient HBV infection (26.6 percent) and 30 of 185 subjects with persistent infection (16.2 percent) (relative risk of carrying the 25-1 pattern in the persistently infected group as compared with the transiently infected group, 0.53; 95 percent confidence interval, 0.32 to 0.90; P = 0.012). In the second stage (the study of adults), HLA-DRB1*1302 was found in 50 of 195 subjects with transient HBV infection (25.6 percent) and in 3 of 40 subjects with persistent infection (7.5 percent) (relative risk, 0.24; 95 percent confidence interval, 0.04 to 0.80; P = 0.012). The RFLP pattern 13-2, which includes the class II allele DRB1*1301, was less frequent in children with persistent infection than in those with transient infection, an association that was neither confirmed nor excluded by the data on adults. Possible associations with HLA class I antigens found in children were not supported by the data on adults. The MHC class II allele DRB1*1302 was associated with protection against persistent HBV infection among both children and adults in the Gambia.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2012
                21 June 2012
                : 7
                : 6
                : e39175
                Affiliations
                [1 ]Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
                [2 ]Department of Human Genetics, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
                [3 ]Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
                [4 ]Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
                [5 ]Department of Internal Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
                [6 ]Department of Internal Medicine, Teine Keijinkai Hospital, Sapporo, Japan
                [7 ]Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Japan
                [8 ]Division of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
                [9 ]Division of Gastroenterology and Hepatology, Saitama Medical University, Saitama, Japan
                [10 ]Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
                [11 ]Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
                [12 ]Department of Gastroenterology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
                [13 ]Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
                [14 ]Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
                [15 ]Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka, Japan
                [16 ]Department of Hepatology, Osaka City University Graduate School of Medicine, Osaka, Japan
                [17 ]Second Department of Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
                [18 ]Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
                [19 ]Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
                [20 ]Division of Hepatology and Pancreatology, Kawasaki Medical College, Kurashiki, Japan
                [21 ]Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
                [22 ]Central Research Laboratory, Hitachi Ltd., Kokubunji, Tokyo, Japan
                Drexel University College of Medicine, United States of America
                Author notes

                Conceived and designed the experiments: NN HS YT. Performed the experiments: HS Y. Mawatari M. Sageshima YO. Analyzed the data: NN MK AK. Contributed reagents/materials/analysis tools: KM M. Sugiyama SHA JYP SH JHK KS M. Kurosaki YA SM MW ET MH SK EO YI EM AT Y. Murawaki YH IS M. Korenaga KH TI NI KHH YT MM. Wrote the paper: NN M. Kawashima YT KT MM.

                Article
                PONE-D-12-03950
                10.1371/journal.pone.0039175
                3380898
                22737229
                e5973e59-c0e6-4a7b-be13-56ca2cd04363
                Nishida et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                : 1 February 2012
                : 16 May 2012
                Page count
                Pages: 8
                Categories
                Research Article
                Biology
                Computational Biology
                Population Genetics
                Genetic Polymorphism
                Genetics
                Human Genetics
                Genome-Wide Association Studies
                Medicine
                Gastroenterology and Hepatology
                Liver Diseases
                Infectious Hepatitis
                Hepatitis B
                Infectious Diseases
                Viral Diseases
                Hepatitis
                Hepatitis B

                Uncategorized
                Uncategorized

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