Global burden of hepatitis B virus: current status, missed opportunities and a call for action

Factors influencing hepatitis B vaccination intention and behavior among college students in Tibet: Insights from the expanded theory of planned behavior

Hepatitis B (Hep B) remains a critical public health issue globally, particularly in Tibet, where vaccination rates and influencing factors among college students are yet understudied. This study applies a cross-sectional design to investigate the Hep B vaccination rate among 1,126 college students in Tibet and utilizes the expanded theory of planned behavior (ETPB) to identify vaccination behavior intention (BI) and vaccination behavior (VB). Stratified cluster sampling across three universities was used to assess behavioral attitudes (BA), subjective norms (SN), perceived behavioral control (PBC), past vaccination history (PVH) and vaccination knowledge (VK), and used structural equation modeling (SEM) for model validation and multi-group comparison. Results indicated that 16.3% of students had received the Hep B vaccine. VK notably improved BA toward vaccination (β = 0.518, p < .001). BA (β = 0.232, p < .001), PBC (β = 0.239, p < .001), SN (β = 0.385, p < .001) positively influenced BI. However, PVH failed to predict BI. BI (β = 0.448, p < .001) and PVH (β = 0.127, p < .001) were significant predictors of VB. Significant ethnic variations were noted. The positive effect of PVH on VB (β = 0.151, p < .001) and the mediating role of PBC in VB (β = 0.076, p < .05) were significant among Tibetan students. The effect of VK on BA was stronger among Tibetans (β = 0.503, p < .05),while the impact of attitude on BI was more pronounced among Han students (β = 0.366, p < .05). The vaccination rate for Hep B among college students in Tibet is relatively low, and the ETPB model effectively explains their vaccination intentions and behaviors. Tailored intervention strategies for Tibetan and Han students are recommended to boost vaccination rates effectively.

Mission 2030: Toward universal hepatitis B immunization

Despite the availability of efficacious and safe vaccines for more than 40 years, the rate of new hepatitis B virus (HBV) infections remains high, leaving large populations at risk of developing chronic hepatitis B, liver cirrhosis and cancer. The WHO aims at reducing the number of cases by 90% as part of its Immunization Agenda 2030. While legacy vaccines and established immunization protocols will play a significant role in achieving this goal, challenges such as an inconvenient multi-dose regimen and a reduced efficacy in adults persist. Novel vaccines with improved adjuvants, alternative antigens, and innovative administration routes show promise in overcoming these hurdles. However, achieving universal immunization requires increased vaccine coverage, likely by development and validation of two-dose vaccines for children, and the endorsement and implementation of such new approaches in future immunization policies. By addressing these challenges, the goal of controlling HBV globally through immunization becomes attainable.

Innate immune recognition in hepatitis B virus infection

Hepatitis B virus (HBV) remains a major global public health challenge, with approximately 254 million individuals chronically infected worldwide. The interaction between HBV and the innate immune system has garnered significant attention within the scientific community, with numerous studies exploring this relationship over the past several decades. While some research suggests that HBV infection activates the host's innate immune response, other studies indicate that HBV suppresses innate immune signaling pathways. These conflicting findings underscore the complexity of the HBV-innate immunity interaction, which remains inadequately understood. This review aims to clarify this interplay by examining it from three perspectives: (a) studies showing HBV activation of innate immunity; (b) evidence suggesting HBV suppression of innate immunity; and (c) findings that support HBV's role as a stealth virus. By synthesizing these perspectives, we aim to deepen the understanding of virus-host interactions that are crucial to HBV persistence and immune evasion, with potential implications for developing new therapeutic strategies for chronic HBV infection.

The significance of antibody to hepatitis B surface antigen in infection and clearance of hepatitis B virus

One of the key features of chronic hepatitis B virus (HBV) infection is the inability to mount sufficient and coordinated adaptive immune responses against HBV. Recent studies on HBV-specific B cells and antibody to hepatitis B surface antigen (anti-HBs) have shed light on their role in the pathogenesis of chronic hepatitis B (CHB). Anti-HBs is recognized as a protective immune marker, both for HBV infection clearance and following vaccination, and it is also considered an important indicator of functional cure for CHB. Notably, functional impairment of HBV-specific B cells may be reversible. The restoration of HBV-specific B cell function, along with the induction of an anti-HBs antibody response, is regarded as pivotal for terminating chronic HBV infection and achieving functional cure. This article reviews the significance of anti-HBs in both the infection and clearance of HBV, and discusses the potential of neutralizing antibodies and therapeutic vaccines as promising future strategies.

Development of a sandwich-type electrochemical DNA sensor based on CeO2/AuPt nanoprobes for highly sensitive detection of hepatitis B virus DNA

To provide accurate diagnostic evidence for early hepatitis B virus (HBV) infection-related diseases, this study targeted HBV DNA as an analyte, where a sandwich-type electrochemical DNA sensor based on gold nanoparticles/reduced graphene oxide (Au NPs/ERGO) and cerium oxide/gold-platinum nanoparticles (CeO2/AuPt NPs) was constructed. Au NPs/ERGO composite nanomaterials were first synthesized on the surface of a glass carbon electrode using electrochemical co-reduction, which significantly improved the specific surface area and electrical conductivity of the electrode. Further specific hybridization of target HBV-DNA was performed by combining capture probe DNA (S1-DNA) bound to AuNPs/ERGO with CeO2/AuPt modified signal probe DNA (S2-DNA). Leveraging the excellent H2O2 catalytic activity of the CeO2/AuPt nanocomposite, the constructed sandwich-type electrochemical DNA sensor was used to detect HBV DNA. By optimizing the detection conditions, the sensor showed a good linear response in the range of 1 fmol/L to 1 nmol/L, with a detection limit as low as 0.36 fmol/L. The sensor had good specificity, repeatability, and stability. Further, spiked recovery experiments of actual serum samples showed recoveries ranging from 98.7 % to 102.7 %, and the relative standard deviations were all lower than 4.77 %. This study provides a new method for the detection of HBV DNA with potential clinical applications.

Real-world clinical data-driven modelling on the initiation time of antiviral prophylaxis among pregnant women with chronic hepatitis B infection

BACKGROUND & AIMS

The risk of mother-to-child transmission for pregnant women with chronic hepatitis B (CHB) still exists, especially for those with high HBV DNA levels. The guidelines for initiating prophylaxis for pregnant women with CHB vary across countries. We aimed to explore the latest prophylaxis initiation time for these women.

METHODS

We collected the real-world clinical data of 328 pregnant women aged 20-49 with CHB, who were treated with telbivudine or tenofovir disoproxil fumarate, from July 2010 to December 2020 in China. A mathematical model was developed to describe the viral kinetics of HBV after prophylaxis. We calculated the time required to reduce viral load below the threshold value of 5.3 log10 IU/ml. We derived the prophylaxis initiation time by subtracting the required time to threshold from the childbirth gestational week.

RESULTS

The median time for 328 women to reduce HBV DNA levels below the threshold of 5.3 log10 IU/ml was 4.2 (range: 0.2-12.8) weeks, corresponding to a prophylaxis initiation time of no later than 35.1 (25.2-41.4) weeks. Specifically, for women with viral loads >8.0 log10 IU/ml, prophylaxis should be initiated before 33.9 (25.2-39.5) weeks, and even before the lower bound of 25.2 weeks, to maximize clinical safety. For women with viral load >7.0 to ≤8.0 log10 IU/ml, prophylaxis should be initiated before 35.5 (28.6-39.8) weeks, and for women with viral load >5.3 to ≤7.0 log10 IU/ml, prophylaxis should be initiated before 36.2 (28.3-41.4) weeks.

CONCLUSION

Pregnant women with HBV DNA levels >5.3 to ≤8.0 log10 IU/ml can initiate prophylaxis before 28 gestational weeks. However, women with HBV DNA >8.0 log10 IU/ml could consider initiating prophylaxis before 25 weeks.

IMPACT AND IMPLICATIONS

This study investigates how long it takes to decrease maternal viral load below a threshold (5.3 log10 IU/ml) after receiving antiviral prophylaxis in pregnant women with different HBV DNA levels based on real-world clinical data and mathematical modelling, which provides quantitative evidence on the initiation time of antiviral prophylaxis. The results show that pregnant women with CHB infection at high HBV DNA levels (>8 log10 IU/ml) should initiate antiviral prophylaxis earlier to decrease the risk of mother-to-child transmission of HBV. Physicians can determine when to begin antiviral prophylaxis for those women according to their maternal HBV DNA levels. Our findings justify the initiation time of antiviral prophylaxis recommended by the Chinese guidelines and will offer new insights for other international guidelines.

The Forefront of Maintenance Therapy for Newly Diagnosed Advanced Ovarian Cancer in China: A Review of Updated Evidence With PARP Inhibitors

BACKGROUND

In the first-line (1L) maintenance treatment of newly diagnosed advanced ovarian cancer (OC), poly (ADP-ribose) polymerase inhibitors (PARPi) have demonstrated significant benefits in progression-free survival (PFS) and an encouraging trend in overall survival (OS).

OBJECTIVES

To provide a summary of advances and evidence regarding the use of PARPi in the maintenance treatment of newly diagnosed advanced OC in the Chinese population.

SEARCH STRATEGY

Systematic search of PubMed from January 2016 to June 2024.

SELECTION CRITERIA

Phase III randomized trials and real-world studies conducted in China were included.

MAIN RESULTS

PARPi 1L maintenance studies conducted in China have shown that PARPi can prolong PFS in OC patients with manageable safety. Chinese patients differ from foreign patients in baseline characteristics and safety data. Given the current situation of 1L maintenance therapy in China, recommendations are made for maintenance strategies based on different biomarker status.

CONCLUSIONS

PARPi 1L maintenance therapy offers survival benefit to Chinese patients with newly diagnosed advanced OC. OC has become a chronic disease that requires the selection of appropriate maintenance regimens based on multiple factors.

Predictive value of soluble PD-1 for HBsAg loss in HbeAg-negative patients with chronic hepatitis B: results from a prospective study

BACKGROUND

Soluble PD-1 (sPD-1) has emerged as a potential biomarker in chronic hepatitis B (CHB), but its predictive value for treatment response remains unclear.

OBJECTIVE

To examine the relationship between sPD-1 dynamics and HBsAg loss in HBeAg-negative CHB patients undergoing IFN-based therapy and assess the potential of sPD-1 as a biomarker for treatment response.

METHODS

We enrolled 222 HBeAg-negative CHB patients from a prospective study. Patients received at least 48 weeks of PEG-IFNα-2b therapy and were grouped based on HBsAg status at week 48 (loss vs. persistence). Peripheral blood sPD-1 levels were measured by ELISA, and PD-1 expression on CD4+ and CD8+ T cells was analyzed by flow cytometry. Propensity score matching (PSM) and Cox regression were applied to identify predictors of HBsAg loss.

RESULTS

Among the patients, 38.7% (86/222) achieved HBsAg loss. After PSM, both the HBsAg loss and HBsAg persistence groups included 74 patients, respectively. A reduction in HBsAg of more than 70% at week 12 (p = 0.012) and baseline sPD-1 level lower than 100 pg/mL (p = 0.016) were identified as independent predictors of HBsAg loss. sPD-1 levels showed a positive correlation with HBsAg levels, whereas PD-1 expression on peripheral CD4+ and CD8+ T cells demonstrated no significant association with HBsAg levels, suggesting that sPD-1 may better reflect systemic immune status.

CONCLUSIONS

sPD-1 may serve as a potential biomarker for predicting HBsAg loss in HBeAg-negative CHB patients undergoing IFN-based therapy.

Circulating citrate as a mediator in the relationship between HMGCR inhibitors and chronic hepatitis B: a Mendelian randomization study

Observational studies have found that HMGCR inhibitors can be used to treat chronic viral hepatitis. In this study, to explore the potential mechanism of HMGCR inhibitors in treating Chronic hepatitis B (CHB), two-sample and two-step Mendelian randomization (MR) were used to investigate the causal relationship between HMGCR inhibitors and the mediating role of circulating metabolites. GWAS data of expression quantitative trait loci eQTLs of HMGCR inhibitors, 168 circulating metabolites, CHB, and myocardial infarction were obtained from the IEUOpenGWAS project. Random effects inverse-variance weighted (IVW) was the main causal analysis method, and the MR-Egger regression method was used as a supplementary analysis method. Cochran's Q test and I2 statistic were used to determine the heterogeneity of SNPs. The intercept terms of the MR-Egger method and MR-PRESSO were used for pleiotropy analysis, and leave-one-out was used for sensitivity analysis. Mediation effect analysis was used to evaluate the mediating role of the circulating metabolites. Genetic variations in the drug target genes of HMGCR inhibitors were associated with a reduced risk of chronic hepatitis B and myocardial infarction (P < 0.05). Eight circulating metabolites had a significant causal relationship with HMGCR inhibitors and CHB. After further calculation of the mediation effect, citrate was used as a mediating variable between HMGCR inhibitors and CHB, with a mediation effect of - 0.015 and a mediation ratio of 9.769%. HMGCR inhibitors can significantly reduce the risk of CHB, and the circulating metabolite citrate may mediate this association. However, this study has certain limitations. The short-term effects of HMGCR inhibitors on CHB could not be assessed, and partial overlap between the GWAS data for HMGCR inhibitors and circulating metabolites may introduce bias in estimating causal effects.

Bifunctional chemokine-nanobody fusion protein enhances neutrophil recruitment to impede Acanthamoeba immune evasion

BACKGROUND

Acanthamoeba keratitis (AK) is a severe infectious disease that causes serious visual impairment and low quality of life. This study aims to investigate the immune landscape in AK, with the goal of improving treatment outcomes through immunotherapy.

METHODS

We conducted single-cell transcriptome sequencing on corneal tissues from nine patients (3 AK patients, 3 patients with fungal keratitis and 3 patients with bacterial keratitis). Bioinformatic analysis calculated the cell subsets and their proportions within different infectious keratitis. CellChat analysis elucidated the differential expression of chemokines in keratitis. After that, screening amebic nano-antibodies, synthesizing antibody-chemokine fusion proteins, and validated their affinity and chemotactic abilities in vitro and in vivo. And assessing of the therapeutic efficacy of antibody-chemokine fusion proteins.

FINDINGS

The UMAP plot demonstrated the 13 major cell clusters in infectious keratitis. Compared with non-AK group, the neutrophil proportion of AK group is markedly reduced. Cell communication indicated a diminished CXCL pathway in AK. Acanthamoeba-specific antibodies were obtained by screening a natural antibody library derived from alpacas. The amoeba-specific antibodies were conjugated with the CXCL1 chemokine, and this fusion protein exhibited robust binding affinity to Acanthamoeba and chemotactic capacity both in vitro and in vivo. Furthermore, in vivo animal investigations indicated that the fusion protein presented excellent therapeutic effect and could effectively eliminate the Acanthamoeba burden.

INTERPRETATION

This study revealed an immune evasion mechanism employed by Acanthamoeba and offered a therapeutic approach. It presents promising potential for enhancing the treatment of infectious diseases by targeting and overcoming challenges posed by immune evasion.

FUNDING

This work was funded by National Natural Science Foundation of China (grant number 82171017 and 82471041) and the Beijing Municipal Public Welfare Development and Reform Pilot Project for Medical Research Institutes (PWD&RPP-MRI, JYY2023-6).

Hepatitis B virus infection after immunization: How serious it is? An updated review

Infection with hepatitis B virus (HBV) is one of the significant challenges worldwide. Despite the availability of antiviral drugs against this virus, the most critical strategy to prevent HBV infection is HB vaccination. Basically, despite widespread conventional HB vaccination, due to various reasons, including waning of hepatitis B surface antibody (HBsAb) titer after vaccination, the emergence of vaccine-escape mutants, failure to respond to the vaccine due to viral and host factors, levels of response in high-risk individuals and non-responders to conventional HB vaccination remains a major, unsolved and severe concern. This review focuses on the underlying reasons for conventional hepatitis B vaccination failures. It also suggests solutions to overcome these failures by highlighting significant advances in vaccination, including hepatitis B third-generation vaccines and adjuvanted hepatitis B vaccines as efficient alternatives to second-generation vaccines. Potentially, these new strategies will compensate for the shortcomings caused by second-generation vaccines. Adherence to these denouements has a significant role in preventing the circulation of HBV among individuals and reducing the global burden of HBV-related diseases.

Changes in the prevalence of hepatitis B virus and its related factors in Inner Mongolia between 2006 and 2020

Objective

This study aimed to compare the prevalence of serum hepatitis B virus (HBV) markers in Inner Mongolia between 2006 and 2020.

Methods

The same sampling process was used in investigations conducted in 2006 and 2020. A multi-stage stratified random sampling method was used to select subjects aged 1-60 years old from 12 cities in Inner Mongolia. Blood samples were collected to detect serological HBV markers including hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), and hepatitis B core antibody (HBcAb). The prevalence of serum biomarkers of hepatitis B, standardized by age and sex, was analyzed and compared between 2006 and 2020.

Results

There were 6,304 subjects in 2006 and 6,500 in 2020. The prevalence of HBsAg was higher in 2006 than in 2020 (standardized 4.11% vs. 2.75%, p < 0.001). The results were observed for the serum biomarkers of HBsAb (standardized 41.40% vs. 42.14%, p = 0.39) between 2006 and 2020, as well as HBcAb (standardized 22.91% vs. 20.15%, p < 0.001). The hepatitis B vaccine (Hep B vaccine) provides protection against HBV infection. In 2006, the proportions of timely birth dose (TBD) and 3-dose Hep B vaccine coverage for individuals aged 1-14 years were 80.57 and 89.35%, respectively. By 2020, these proportions increased to 97.43 and 96.97%, respectively.

Conclusion

The prevalence of HBsAg decreased significantly from 2006 to 2020 in Inner Mongolia, suggesting that the Hep B vaccine has made remarkable progress in safeguarding the population against hepatitis B infection.

Noninvasive prediction of esophagogastric varices in hepatitis B: An extreme gradient boosting model based on ultrasound and serology

BACKGROUND

Severe esophagogastric varices (EGVs) significantly affect prognosis of patients with hepatitis B because of the risk of life-threatening hemorrhage. Endoscopy is the gold standard for EGV detection but it is invasive, costly and carries risks. Noninvasive predictive models using ultrasound and serological markers are essential for identifying high-risk patients and optimizing endoscopy utilization. Machine learning (ML) offers a powerful approach to analyze complex clinical data and improve predictive accuracy. This study hypothesized that ML models, utilizing noninvasive ultrasound and serological markers, can accurately predict the risk of EGVs in hepatitis B patients, thereby improving clinical decision-making.

AIM

To construct and validate a noninvasive predictive model using ML for EGVs in hepatitis B patients.

METHODS

We retrospectively collected ultrasound and serological data from 310 eligible cases, randomly dividing them into training (80%) and validation (20%) groups. Eleven ML algorithms were used to build predictive models. The performance of the models was evaluated using the area under the curve and decision curve analysis. The best-performing model was further analyzed using SHapley Additive exPlanation to interpret feature importance.

RESULTS

Among the 310 patients, 124 were identified as high-risk for EGVs. The extreme gradient boosting model demonstrated the best performance, achieving an area under the curve of 0.96 in the validation set. The model also exhibited high sensitivity (78%), specificity (94%), positive predictive value (84%), negative predictive value (88%), F1 score (83%), and overall accuracy (86%). The top four predictive variables were albumin, prothrombin time, portal vein flow velocity and spleen stiffness. A web-based version of the model was developed for clinical use, providing real-time predictions for high-risk patients.

CONCLUSION

We identified an efficient noninvasive predictive model using extreme gradient boosting for EGVs among hepatitis B patients. The model, presented as a web application, has potential for screening high-risk EGV patients and can aid clinicians in optimizing the use of endoscopy.

Prevalence and burden of HBV-HIV co-morbidity: a global systematic review and meta-analysis

Introduction

Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). Because of the shared modes of transmission, co-infections of HBV are common among people living with Human Immunodeficiency Virus (HIV) infection. While the use of antiretroviral therapy (ART) has significantly improved the life expectancy of HIV patients, hepatitis viral co-infections have become increasingly important. Particularly, HBV infection remains under-diagnosed and under-reported, despite its highly infectious nature. Therefore, this review was aimed at understanding the burden of hepatitis B disease among adults living with HIV receiving ART.

Methods

Using pertinent search terms, all research found in Google Scholar, HINARI, EMBAS, Scopus, and PubMed was located. Data were extracted following the evaluation of the evidence using the Joanna Briggs Institute's cross-sectional and cohort study methodologies.

Result

A total of 18 groups involving 71,411 adults with HBV-HIV were selected for the study. Of those, 10.21% with 95% CI (5.06, 15.36) and 11.05% with 95% CI (2.78, 19.32) of HBV-HIV adults worldwide had an overall prevalence of HBV, with an I2 value of 0.0% (p-value = 0.729) and an I2 value of 0.0% (p-value = 0.818) from cross-sectional and cohort studies, respectively.

Conclusion

The global prevalence of people living with HBV-HIV is high, which poses a serious risk to public health. The review can clearly show the current pooled prevalence of HIV-HBV in the world, which may be helpful for policymakers because a large number of recent studies were included in it. Thus, it is strongly advised to broaden the current preventive and control program's purview and implement new, sensitive screening, testing, and treatment techniques. To raise community awareness, it would also be preferable to revamp the current prevention and control program and establish target-specific task forces at various health facility levels.

Association Between Elevation of Serum Alanine Aminotransferase and HBsAg Seroclearance After Nucleos(t)ide Analog Withdrawal

BACKGROUND

Alanine aminotransferase (ALT) frequently elevates in chronic hepatitis B patients stopping nucleos(t)ide analogs (NAs).

AIMS

To clarify the association between ALT elevation and HBsAg seroclearance after NA withdrawal.

METHODS

This multicenter cohort study reviewed consecutive patients discontinuing NA between 2004/04/01 and 2022/05/24. Treatment initiation and discontinuation generally followed the Asian-Pacific guidelines. Eligible patients had negative HBeAg and undetectable HBV DNA before treatment cessation, without malignancy, organ transplant or autoimmune disorders. We used competing risk analysis to estimate HBsAg seroclearance incidence and a time-dependent model to investigate post-cessation ALT elevation.

RESULTS

Among 841 patients (74.7% male; median age, 53.2 years; median treatment duration, 34.7 months), 38 patients cleared HBsAg over a median follow-up of 3.7 years, with a 10-year cumulative incidence of 12.4%. The median peak ALT level was significantly lower in patients achieving HBsAg seroclearance versus not (93 vs. 127 U/L; p < 0.001). Hepatitis flare after NA cessation (> 5 times upper limit) was inversely associated with HBsAg seroclearance in the univariable analysis (sub-distribution hazard ratio [SHR], 0.31; 95% confidence interval [CI], 0.13-0.73; p = 0.007), and the association was not significant (adjusted SHR, 0.42; 95% CI, 0.09-2.01; p = 0.28) in the multivariable analysis adjusted for pretreatment HBV DNA. Consistent results were observed in the sensitivity analyses with different ALT cutoffs and subgroup analysis adjusted for HBsAg levels at treatment cessation.

CONCLUSION

ALT elevation after NA cessation is not associated with HBsAg seroclearance following NA withdrawal, suggesting cytolytic pathways are not essential for a functional cure.

Global Burden of Major Chronic Liver Diseases in 2021

BACKGROUND

This study utilised the Global Burden of Disease data (2010-2021) to analyse the rates and trends in point prevalence, annual incidence and years lived with disability (YLDs) for major chronic liver diseases, such as hepatitis B, hepatitis C, metabolic dysfunction-associated liver disease, cirrhosis and other chronic liver diseases.

METHODS

Age-standardised rates per 100,000 population for prevalence, annual incidence and YLDs were compared across regions and countries, as well as the socio-demographic index (SDI). Trends were expressed as percentage changes (PC) and estimates were reported with uncertainty intervals (UI).

RESULTS

Globally, in 2021, the age-standardised rates per 100,000 population for the prevalence of hepatitis B, hepatitis C, MASLD and cirrhosis and other chronic liver diseases were 3583.6 (95%UI 3293.6-3887.7), 1717.8 (1385.5-2075.3), 15018.1 (13756.5-16361.4) and 20302.6 (18845.2-21791.9) respectively. From 2010 to 2021, the PC in age-standardised prevalence rates were-20.4% for hepatitis B, -5.1% for hepatitis C, +11.2% for MASLD and + 2.6% for cirrhosis and other chronic liver diseases. Over the same period, the PC in age-standardized incidence rates were -24.7%, -6.8%, +3.2%, and +3.0%, respectively. Generally, negative associations, but with fluctuations, were found between age-standardised prevalence rates for hepatitis B, hepatitis C, cirrhosis and other chronic liver diseases and the SDI at a global level. However, MASLD prevalence peaked at moderate SDI levels.

CONCLUSIONS

The global burden of chronic liver diseases remains substantial. Hepatitis B and C have decreased in prevalence and incidence in the last decade, while MASLD, cirrhosis and other chronic liver diseases have increased, necessitating targeted public health strategies and resource allocation.

Analysis of the Functional Role of TIMM29 in the Hepatitis B Virus Life Cycle

Hepatitis B virus (HBV) causes chronic hepatitis B, which can progress to liver cirrhosis and hepatocellular carcinoma. HBV has complex interactions with various cell organelles and proteins that ensure effective progeny virus production. We previously reported that a mitochondrial protein, TIMM29, should regulate the HBV life cycle through interactions with the HBV preS1 protein. Here, we established Halo-TIMM29wt-, Halo-TIMM29:∆99-192-, and Halo-TIMM29:92-194-expressing cells using TIMM29-knockout HB611 (TIMM29KO/HB611) cells, a stably HBV-producing cell line based on Huh6 cells. We found that HBV antigen expression and replication were downregulated in cells stably expressing full-length TIMM29, but not in those expressing TIMM29 deletion mutants. On the other hand, in the case of TIMM29-knockout C4 (TIMM29KO/C4), which is a human NTCP-expressing HepG2 cell line that is competent for HBV infection and amplification, these phenomena were not reproduced, except in full-length TIMM29 (Halo-TIMM29wt)-expressing cells. Using gene expression microarrays, we identified downregulation of ARRDC3 and BASP1 in TIMM29KO/HB611 and TIMM29KO/C4. It was suggested that TIMM29 localized at the mitochondrial inner membrane served as a signaling hub, orchestrating the activation of ARRDC3 and BASP1 expression to restrict HBV transcription. The expression of TIMM29 mutants in TIMM29KO/HB611 and TIMM29KO/C4 cells suggested that ARRDC3 was dependent on the HBV preS1-binding region of TIMM29 (amino acids 99-189). In contrast, BASP1 expression varied according to cell type, indicating additional regulatory mechanisms. Thus, this study should significantly advance our understanding of TIMM29-mediated inhibition of HBV amplification and lead to improvements in antiviral strategies and therapeutic interventions against HBV.

The Role of Killer Ig-like Receptors in Diseases from A to Z

Killer Ig-like Receptors (KIRs) regulate immune responses, maintaining the balance between activation and inhibition of the immune system. KIRs are expressed on natural killer cells and some CD8 T cells and interact with HLA class I molecules, influencing various physiological and pathological processes. KIRs' polymorphism creates a variability in immune responses among individuals. KIRs are involved in autoimmune disorders, cancer, infections, neurological diseases, and other diseases. Specific combinations of KIRs and HLA are linked to several diseases' susceptibility, progression, and outcomes. In particular, the balance between inhibitory and activating KIRs can determine how the immune system responds to pathogens and tumors. An imbalance can lead to an excessive response, contributing to autoimmune diseases, or an inadequate response, allowing immune evasion by pathogens or cancer cells. The increasing number of studies on KIRs highlights their essential role as diagnostic and prognostic biomarkers and potential therapeutic targets. This review provides a comprehensive overview of the role of KIRs in all clinical conditions and diseases, listed alphabetically, where they are analyzed.

Association between vaccination, viral antibodies, and asthma prevalence in the U.S.: insights from NHANES (1999-2020)

Objective

This investigation aimed to explore the differences in asthma prevalence among various demographic groups in the U.S., focusing on factors related to vaccination and viral antibodies.

Methods

The study analyzed data from 37,445 individuals collected through the National Health and Nutrition Examination Survey between 1998 and 2020. Employing weighted sampling methods, the analysis considered the stratification and clustering typical of the survey's design. It particularly examined how age, race, income, smoke, education, and gender factors influence both the prevalence and severity of asthma.

Results

This study aims to elucidate disparities in asthma prevalence across the U.S. population by examining the roles of demographic characteristics and factors related to vaccination and viral antibodies. It revealed a significant correlation between asthma prevalence and patient demographics, including age, gender, income, smoke, education, and race. We found that asthma patients were mostly found in participants with lower economic level (2.7 vs. 2.87). Non-Hispanic black women age exhibited a higher likelihood of asthma, at 17.7%, compared to non-Hispanic whites and Mexican Americans. Asthma prevalence peaks between the ages of 20 and 30 and has shown a rising trend over the years. Regarding vaccinations, hepatitis A, hepatitis B, pneumococcal, and HPV vaccines were associated with an increased risk of asthma. Conversely, patients testing positive for hepatitis A virus and core hepatitis B virus antibodies demonstrated a lower prevalence of asthma. Additionally, asthmatic patients showed lower average measles virus and rubella antibodies levels, at 0.53 and 3.32, respectively, compared to non-asthmatic individuals. Notably, asthma incidence was lower in herpesvirus I-positive patients (OR: 0.895, CI, 0.809%-0.991%), while herpesvirus II-positive patients displayed a higher incidence of asthma (OR: 1.102, CI, 0.974%-1.246%).

Conclusion

The study findings underscore the significant prevalence of asthma and its correlation with population demographics, vaccination rates, and serum viral antibodies. These results highlight the importance of implementing tailored public health interventions.

Enhancing diagnostic accuracy for HBV-related cirrhosis progression: predictive modeling using combined Golgi protein 73 and α1-microglobulin for the transition from nondecompensated to decompensated cirrhosis

BACKGROUND AND AIMS

Chronic hepatitis B poses a major health risk, especially its progression to decompensated cirrhosis. Early prediction is crucial for better outcomes. This study evaluated the predictive power of Golgi protein 73 (GP73), α1-microglobulin (α1M), age, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count (PLT) using machine learning models.

METHODS

A total of 179 patients (69 healthy controls, 59 with decompensated cirrhosis, and 51 with nondecompensated liver disease) were analyzed. Five random forest models incorporating different combinations of variables, including GP73, α1M, age, AST, ALT, PLT, aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) index were assessed using area under the curve (AUC) and accuracy. Logistic regression and a decision tree were also employed.

RESULTS

Random forest model 3 (age + GP73 + α1M + AST + ALT + PLT) achieved the highest AUC (0.96) and accuracy (0.90), outperforming model 4 (age + APRI + FIB-4 + GP73 + α1M, AUC: 0.96, accuracy: 0.76), and logistic regression (AUC: 0.91, accuracy: 0.86). GP73 and PLT were the most significant predictors of cirrhosis progression. There were nonlinear interactions between GP73 and α1M. When PLT levels were ≤143 × 109/L, patients with GP73 > 0.168 ng/L or ≤ 0.117 ng/L indicated an increased risk of decompensated cirrhosis.

CONCLUSION

The combination of GP73, α1M, age, AST, ALT, and PLT enhances prediction accuracy for the progression from nondecompensated to decompensated hepatitis B virus-related cirrhosis, with GP73 and α1M showing nonlinear interactions influenced by PLT levels.

Antiviral Therapy-Induced Changes in Long Non-Coding RNA Expression Profiles in Umbilical Cord Blood and Placental Tissues of Hepatitis B Virus-Infected Pregnant Women

Background

Hepatitis B virus (HBV) is a major global health concern, with maternal-fetal transmission being the primary route of transmission, which can lead to chronic HBV infection in newborns. Long non-coding RNAs (lncRNAs) play crucial roles in gene regulation and immune responses, but their involvement in HBV transmission during pregnancy remains unclear. This study aimed to assess the impact of tenofovir disoproxil fumarate (TDF)-based antiviral therapy on lncRNA expression profiles and immune signaling pathways in umbilical cord blood and placental tissues and to identify potential therapeutic targets for preventing intrauterine HBV infection.

Materials and Methods

Umbilical cord serum and placental tissues were collected from six HBV carriers. Three carriers received TDF-based antiviral therapy, and the remaining carriers who did not receive antiviral therapy served as controls. LncRNA microarray analysis and bioinformatics were used to evaluate the effects of antiviral therapy on lncRNA expression profiles and signaling pathways.

Results

Antiviral therapy exerted minimal effects on lncRNA expression profiles in umbilical cord blood. In placental tissues, significant alterations in lncRNA expression profiles were observed, including 249 upregulated and 381 downregulated lncRNAs. Antiviral therapy activated innate immune pathways, such as intracellular DNA sensing, chemokine signaling, type I interferon, Jak-Stat, and interferon-γ-mediated adaptive immunity. Through intersection analysis, CPED1 was found differentially expressed in both cord blood and placental tissues. KEGG pathway analysis suggested that low CPED1 expression may inhibit virus transmission via the JAK-STAT pathway.

Conclusion

This study demonstrated that TDF-based antiviral therapy altered lncRNA expression and activated immune signaling pathways in placental tissues, offering insights into the molecular mechanisms of maternal-fetal HBV transmission.

Potential Benefits of In Silico Methods: A Promising Alternative in Natural Compound's Drug Discovery and Repurposing for HBV Therapy

Hepatitis B virus (HBV) is an important global public health issue. The World Health Organization (WHO) 2024 Global Hepatitis Report estimated that the global prevalence of people living with HBV infection is 254 million, with an estimated prevalence incidence of 1.2 million new HBV infections yearly. Previous studies have shown that natural compounds have antiviral inhibition potentials. In silico methods such as molecular docking, virtual screening, pharmacophore modeling, quantitative structure-activity relationship (QSAR), and molecular dynamic simulations have been successfully applied in identifying bioactive compounds with strong binding energies in HBV treatment targets. The COVID-19 pandemic necessitated the importance of repurposing already approved drugs using in silico methods. This study is aimed at unveiling the benefits of in silico techniques as a potential alternative in natural compounds' drug discovery and repurposing for HBV therapy. Relevant articles from PubMed, Google Scholar, and Web of Science were retrieved and analyzed. Furthermore, this study comprehensively reviewed the literature containing identified bioactive compounds with strong inhibition of essential HBV proteins. Notably, hesperidin, quercetin, kaempferol, myricetin, and flavonoids have shown strong binding energies for hepatitis B surface antigen (HBsAg). The investigation reveals that in silico drug discovery methods offer an understanding of the mechanisms of action, reveal previously overlooked viral targets (including PreS1 Domain of HBsAg and cccDNA (Covalently Closed Circular DNA) regulators, and facilitate the creation of specific inhibitors. The integration of in silico, in vitro, and in vivo techniques is essential for the discovery of new drugs for HBV therapy. The insights further highlight the importance of natural compounds and in silico methods as targets in drug discovery for HBV therapy. Moreover, the combination of natural compounds, an in silico approach, and drug repurposing improves the chances of personalized and precision medicine in HBV treatment. Therefore, we recommend drug repurposing strategies that combine in vitro, in vivo, and in silico approaches to facilitate the discovery of effective HBV drugs.

Altered LY6E and TRIM6 expression in PBMCs correlated with HBsAg clearance and response to Peg-IFN-α treatment in HBeAg-negative chronic hepatitis B patients

BACKGROUND

Pegylated interferon alpha (Peg-IFN-α) has the potential to eradicate hepatitis B surface antigen (HBsAg). This study aimed to investigate whether the expression levels of lymphocyte antigen 6 family member E (LY6E) and tripartite motif-containing protein 6 (TRIM6) mRNAs in peripheral blood mononuclear cells (PBMCs) of hepatitis B e antigen (HBeAg)-negative chronic hepatitis B virus (HBV) patients is associated with the response to Peg-IFN-α treatment and HBsAg clearance.

METHODS

In this prospective study, HBeAg-negative chronic HBV patients treated with Peg-IFN-α were followed for 48 weeks. The participants were classified into two groups, the virological response (VR) group and nonvirological response (NVR) group, according to the changes in HBV DNA and HBsAg levels observed at week 48 of treatment. Furthermore, these patients were divided into a serological response (SR) group and a nonserological response (NSR) group, depending on whether they exhibited a loss of serum HBsAg or evidence of seroconversion. The expression levels of LY6E and TRIM6 mRNAs in PBMCs were evaluated using real-time quantitative PCR with fluorescence detection. The diagnostic performance of LY6E and TRIM6 was assessed by analyzing the receiver operating characteristic (ROC) curve and calculating the area under the ROC curve (AUC).

RESULTS

After the treatment period, the observed VR and SR rates were 44.64% and 28.57%, respectively. Dynamic changes in LY6E and TRIM6 mRNA levels were significantly different between the VR and NVR groups and between the SR and NSR groups. Multivariate analysis revealed that TRIM6 was independently associated with VR at weeks 12 and 24 of Peg-IFN-α therapy and with SR at week 12; in addition, LY6E was independently associated with VR at week 12 and SR at week 24. At week 24, the area under the curve (AUC) for LY6E in the prediction of VR was 0.6942, and the AUC for the prediction of SR was 0.7766; at week 12, TRIM6 had AUCs of 0.7600 for the prediction of VR and 0.8469 for the prediction of SR.

CONCLUSIONS

LY6E and TRIM6 are important biomarkers for early therapeutic responses to Peg-IFN-α and HBsAg clearance.

TRIAL REGISTRATION

Registration number: 2023 - 311. Date of registration: 1 October 2023.

CAR-NK cell therapy: a potential antiviral platform

Viral infections persist as a significant cause of morbidity and mortality worldwide. Conventional therapeutic approaches often fall short in fully eliminating viral infections, primarily due to the emergence of drug resistance. Natural killer (NK) cells, one of the important members of the innate immune system, possess potent immunosurveillance and cytotoxic functions, thereby playing a crucial role in the host's defense against viral infections. Chimeric antigen receptor (CAR)-NK cell therapy has been developed to redirect the cytotoxic function of NK cells specifically towards virus-infected cells, further enhancing their cytotoxic efficacy. In this manuscript, we review the role of NK cells in antiviral infections and explore the mechanisms by which viruses evade immune detection. Subsequently, we focus on the optimization strategies for CAR-NK cell therapy to address existing limitations. Furthermore, we discuss significant advancements in CAR-NK cell therapy targeting viral infections, including those caused by severe acute respiratory syndrome coronavirus 2, human immunodeficiency virus, hepatitis B virus, human cytomegalovirus, and Epstein-Barr virus.

MiR-451a attenuates hepatic steatosis and hepatitis C virus replication by targeting glycerol kinase

BACKGROUND

Lipotoxicity is one of the causes for the progression of fatty liver in chronic hepatitis (CH) towards end-stage liver diseases. The role of miRNAs in the signalling pathways of lipid metabolism has been studied, but their direct targets in this pathway have not been identified yet. Here, we have characterized a downregulated miRNA in CH namely miR-451a, which has a direct impact on the lipid metabolism pathway.

METHODS

Liver tissue samples and blood were collected from CHC/CHB patients and normal individuals. Huh7 and SNU449 cell lines were used for in vitro assays. Expressions of miRNA/mRNAs and proteins were confirmed by qRT-PCR and immuno-blot analysis. Oil Red O staining, Colorimetric, and Fluorometric assay kit were used to quantify triglyceride (TG) and cholesterol from tissue and serum, respectively. Target prediction and pathway analysis were performed using Targetscan, miRWalk, and DAVID respectively. 3'UTR-Luciferase assay and Co-immuno-precipitation were conducted to determine direct interaction between miRNA-mRNA and protein-protein, respectively. Unpaired two-tailed Student's t-test and Mann-Whitney test were employed as required using GraphPad prism. P < 0.05 was considered as significant.

RESULTS

The miRNA, miR-451a was selected as one of the downregulated miRNAs in progressive liver disease stages of CHC and CHB. Target identification and pathway analysis of this miRNA revealed that lipid metabolism pathway gene, glycerol kinase (GK), could be the target of this miRNA. Subsequent 3'UTR Luciferase assay and immuno-blot analysis confirmed the binding of miR-451a to GK. Though both hepatitis viruses, HCV and HBV, could alter the lipid metabolism pathways, intracellular TG and cholesterol content were observed to be significantly higher upon HCV infection only. It also suppressed the expression of miR-451a, resulting in overshooting of GK expression. GK interacted positively with the transcription factor SREBP1, which led to overexpression of Fatty acid synthase, Acetyl- CoA Carboxylase, and Stearoyl-CoA desaturase. As a result, intracellular fatty acids, TG, and cholesterol synthesis and accumulation heightened but trafficking dropped, resulting in hypo-cholesterolemia in blood. While, restoration of miR-451a impeded lipid accumulation, reduced steatohepatitis and suppressed HCV replication as well.

CONCLUSION

These findings suggest that the alteration in the hepatic lipid profile upon HCV/HBV infection is attributed to the downregulation of miR-451a, which has the potential to restrict the expression of GK and SREBP1 in the TG biosynthesis pathway, implying that supplementation of miR-451a may be a potential therapeutic strategy for impeding CHC.

Global, regional, and national burden of liver cancer in adolescents and young adults from 1990 to 2021: an analysis of the global burden of disease study 2021 and forecast to 2040

Background

The global burden of liver cancer among adolescents and young adults (AYAs) has often been underestimated, despite significant shifts in its etiology. This study analyzes the disease burden of liver cancer in AYAs from 1990 to 2021 and forecasts trends up to 2040 using data from the Global Burden of Disease Study 2021. Our goal is to provide insights that can inform resource allocation and policy planning.

Methods

Incidence, mortality, and disability-adjusted life years (DALYs) data were extracted and estimated annual percentage changes calculated to assess trends. Correlation between age-standardized rates and sociodemographic index (SDI) was analyzed using Spearman correlation, and future trends were predicted using the Bayesian age-period-cohort model.

Findings

Globally, there were 24,348 new liver cancer cases and 19,270 deaths among AYAs in 2021, with decreases in age-standardized rates for incidence, mortality, and DALYs from 1990 to 2021. East Asia bears the highest burden, with males experiencing significantly higher rates than females. The burden increases with age, peaking at 35-39 years. Higher SDI is associated with lower incidence, mortality, and DALYs. While HBV remains the leading cause, NASH is the fastest-growing contributor to liver cancer incidence and mortality. Projections indicate a continued decline in liver cancer burden among AYAs, though female cases are expected to rise.

Interpretation

Despite a gradual decline in liver cancer burden among AYAs, NASH is emerging as a significant and rising cause of incidence and mortality. Regional and gender disparities persist, highlighting the need for tailored prevention and healthcare strategies to alleviate the liver cancer AYA's burden globally.

Effects of tenofovir disoproxil fumarate on intrahepatic viral burden and liver immune microenvironment in patients with chronic hepatitis B

BACKGROUND

The impact of nucleos(t)ide analogues on intrahepatic viral burden and immune microenvironment in patients with chronic hepatitis B (CHB) is not clear.

OBJECTIVE

We aimed to characterise the effects of tenofovir disoproxil fumarate (TDF) on intrahepatic viral burden and the liver immune microenvironment in patients with CHB.

DESIGN

Core liver biopsies were collected at baseline and year 3 from patients with CHB with minimally raised serum alanine aminotransferase in a double-blind placebo-controlled trial (NCT01522625). Paired biopsies were analysed by RNA-sequencing (n=119 pairs), a custom multiplex immunofluorescence assay (n=30 pairs), and HBV-targeted long-read DNA sequencing (n=49 pairs).

RESULTS

Both non-integrated and integrated HBV DNA were present in all patients at baseline, with >65% having interchromosomal translocations. Treatment significantly reduced the frequency of HBV core+ hepatocytes and intrahepatic (integrated and non-integrated) HBV DNA, but had no effect on HBsAg+ hepatocytes. Clonally expanded integrations were enriched for HBsAg coding regions and showed dysregulation of nearby genes. At baseline, there was significant enrichment of intrahepatic CD8+ T cell proximity to HBV core+ hepatocytes, but not to HBsAg+ cells. The densities of T cells and B cells were significantly reduced by TDF. Transcriptomic analyses found TDF induced widespread downregulation of immune-related genes including inhibitory and regulatory genes.

CONCLUSION

TDF significantly reduced intrahepatic integrated and non-integrated HBV DNA, exerting disparate effects on HBV core+ and HBsAg+ cells and on different immune cell subsets. Our data suggest there may be differential cytotoxic T cell-mediated killing of HBV core+ versus HBsAg+ hepatocytes, providing insights for HBV cure strategies.

CRIPSR-Cas for hepatitis virus: a systematic review and meta-analysis of diagnostic test accuracy studies

Background and aims

Hepatitis viruses pose a significant global health challenge, necessitating accurate and efficient diagnostic methods. The CRISPR-Cas system, renowned for gene editing, shows potential tool in virus detection. This systematic review and meta-analysis aims to evaluate the diagnostic accuracy of CRISPR-Cas-based tests for hepatitis viruses, aiming to provide evidence for their effectiveness in clinical settings.

Methods

Studies from Web of Science, PubMed, and CNKI were analyzed. A bivariate random-effects model was employed to compute pooled estimates for sensitivity, specificity, and the area under the summary receiver operating characteristic (SROC) curve. Additionally, the methodological quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool.

Results

Following a rigorous screening process, 14 studies meeting our inclusion criteria were selected from an initial pool of 657 studies. The pooled sensitivity and specificity of the CRISPR-Cas system in hepatitis virus detection showed high sensitivity (0.99, 95% CI: 0.95-1.00) and specificity (0.99, 95% CI: 0.93-1.00) with SROC area 1.00 (95% CI: 0.99-1.00). However, considering the notable heterogeneity among the included studies, subgroup analyses and meta-regression were conducted. These analyses revealed that the type of hepatitis virus detected and the format of the final result presentation could be potential sources of this heterogeneity.

Conclusion

This systematic review and meta-analysis demonstrates the high diagnostic accuracy of CRISPR-Cas system in detecting hepatitis viruses. However, conclusions are limited by study number and quality. Therefore, more high-quality data are still needed to support this conclusion.

Hepatitis B vaccine and juvenile idiopathic arthritis: comparison of the seropositivity rates with healthy children at the time of diagnosis and booster dose response under treatment

INTRODUCTION/OBJECTIVES

The study aimed to determine whether in children with newly diagnosed juvenile idiopathic arthritis (JIA) hepatitis B surface antibody (anti-HBs) differs from healthy children and to see whether the revaccination is safe and effective under JIA treatment.

METHODS

Patients who were followed up with a diagnosis of JIA between January 2020 and February 2024 were included. The control group consisted of healthy children matched for age and gender. Patients with JIA who were seronegative and revaccinated against hepatitis B virus (HBV) at follow-up visits were evaluated in terms of antibody responses and side effects after vaccination.

RESULTS

The study included 187 patients with JIA, 104 (55.6%) girls. In the JIA group, the mean anti-HBs levels were 120.8 ± 228.3 IU/L, and 64.7% of patients had anti-HBs levels ≥ 10 mIU/ml, while in the control group, the mean anti-HBs levels were 184.9 ± 304.4 IU/L, and 68.7% of children had protective antibody level against HBV. Sixty-six patients with JIA in whom anti-HBs level < 10 IU/L received an additional three doses of HBV vaccine. After booster vaccination, only one patient had anti-HBs level < 10 IU/L; in the other 65 JIA patients, the mean anti-HBs levels were 530.4 ± 320.8 IU/L. None of the patients observed serious side effects or JIA exacerbation after vaccination.

CONCLUSIONS

Although the mean anti-HBs levels in newly diagnosed JIA patients were lower than in healthy children, no difference was found in the seropositivity rates. Vaccination against HBV during JIA treatment is safe and effective and should be encouraged. Key Points • Hepatitis B virus infection remains a public health problem and publications are indicating that vaccine responses may be lower in autoimmune diseases such as juvenile idiopathic disease. • The mean antibody levels against the HBV vaccine in newly diagnosed JIA patients were lower than in healthy children. • The fact that patients diagnosed with JIA were revaccinated under treatment and no side effects were observed will support the vaccination of these patients.

Identification of Biomarkers for Response to Interferon in Chronic Hepatitis B Based on Bioinformatics Analysis and Machine Learning

Interferon (IFN) is a pivotal agent against hepatitis B virus (HBV) in clinic, but there is a lack of accurate biomarkers to predict the response to IFN therapy in patients with chronic hepatitis B (CHB). Our study aimed to investigate potential targets for IFN therapy and to explore the network of interactions associated with IFN response. MicroRNA (miRNA) (GSE29911) and messenger RNA (GSE27555) datasets were used to screen the differentially expressed miRNAs (DEmiRNAs) and differentially expressed genes (DEGs). The random forest and k-nearest neighbors algorithm were used to further screen the core DEmiRNAs and build a prediction model. A Protein-Protein Interaction (PPI) network based on the STRING database was constructed and visualized by the Cytoscape software. Then, we collected transcription factors (TFs) from the TransmiR database to construct the TF-miRNA-hub gene regulatory network. Finally, real-time quantitative polymerase chain reaction was used to verify the expression of four miRNAs in HepG2-NTCP and Huh-7, and the effect of IFN treatment on four miRNAs' expression was preliminarily explored. Eighteen DEmiRNAs in GSE29911 and 700 DEGs in GSE27555 were identified. Boruta feature selection identified four miRNAs (miR-873, miR-200a, miR-30b, and let-7g) from 18 DEmiRNAs. We identified 48 TFs, 4 miRNAs, and 10 hub genes and constructed a TF-miRNA-hub gene network to suggest the mechanism of IFN response. According to the experimental results, miR-873 was upregulated and IFN treatment could inhibit it in HBV-transfected cells (p < 0.05). We constructed a TF-miRNA-hub gene regulatory network, and our results demonstrate that miR-873 was identified as a potential biomarker of IFN response in patients with CHB. This information provides an initial basis for understanding the complex IFN response regulatory mechanisms.

Mechanism of Si Ni San Combined with Astragalus in Treating Hepatic Fibrosis: A Network Pharmacology and Molecular Docking Study

Si Ni San combined with Astragalus (SNSQ) has demonstrated significant efficacy in the treatment of hepatic fibrosis (HF), as confirmed by clinical practice. However, its pharmacological mechanism remains unclear. This study employs network pharmacology to identify key targets and proteins for molecular docking. Additionally, animal experiments were conducted to validate the network pharmacology results, providing further insights into the mechanism of SNSQ in treating HF. Effective compounds of SNSQ were screened from the Traditional Chinese Medicine Systems Pharmacology (TCMSP) and Encyclopedia of Traditional Chinese Medicine (ETCM) databases. Molecular formula structures of these effective compounds were obtained from the PubChem database. Partial target proteins with a probability greater than 0.6 were sourced from the SWISS database. Uniprot IDs corresponding to these target proteins were retrieved from the SUPERPRED database. The remaining target proteins of the compounds were obtained from the Uniprot database based on the Uniprot IDs. The drug target proteins were then summarized. Target points related to HF were selected from the GeneCards and OMIM databases. Common target points were identified in the Venn diagram and imported into Cytoscape 3.9.1 software to construct the "SNSQ-effective compound-target pathway-HF" network. AutoDock software was used for molecular docking of compounds and target proteins with high-degree values. The common target points underwent GO function enrichment and KEGG pathway enrichment analysis using the DAVID database. An HF rat model was established, and serum AST and ALT activities were measured. The Hyp assay kit was utilized to detect the Hyp content in liver tissue. To the transcription levels of pro-inflammatory factors (IL-1β, TNF-α, IL-6) and anti-inflammatory factors (IL-10, TGF-β1, IL-4) in rat serum and liver.IL-1β, TNF-α, IL-10, and TGF-β1 were chosen for validation through ELISA. Western blotting and qRT-PCR were used to assess the expression of related proteins, namely NFKB1, NF-κBp65, NF-κBp50, α-SMA, and Col-1 in liver tissue. qRT-PCR was also employed to study the expression of ECM synthesis and proliferation-related genes, including Cyclin D1, TIMP1, COL1A1 in HSC-T6 cells and rat liver tissue, as well as the inhibition of the ECM-related gene MMP13 in HSC-T6 cells and rat liver tissue. A total of 16 valid compounds were predicted, with kaempferol, sitosterol, and isorhamnetin exhibiting high-degree values. KEGG enrichment analysis revealed that the target genes of SNSQ were enriched in multiple pathological pathways, with the NF-Kappa B signaling pathway being predominant. Molecular docking simulations indicated strong affinities between SNSQ's primary components-kaempferol, sitosterol, isorhamnetin-and NFKB1. Experimental results demonstrated significant reductions in AST, ALT, and Hyp levels in the SNSQ group. Pro-inflammatory factors (IL-1β, TNF-ɑ) were markedly reduced, while anti-inflammatory factors (IL-10, TGF-β1) were substantially increased. The protein expression and transcription levels of α-SMA and Col-1 were significantly decreased, whereas those of NFKB1, NF-κBp65, and NF-κBp50 were notably elevated. mRNA expression levels of Cyclin D1, TIMP1, COL1A1 in HSC-T6 cells and rat liver tissue were significantly decreased, whereas MMP13 mRNA expression level was significantly increased. Treatment of HF with SNSQ involves multiple targets and pathways, with a close association with the overexpression of NFKB1 and activation of the NF-Kappa B signaling pathway. Its mechanism is closely linked to the activation of inflammatory responses, HSC activation, and proliferation.

Emerging biotechnologies for engineering liver organoids

The engineering construction of the liver has attracted enormous attention. Organoids, as emerging miniature three-dimensional cultivation units, hold significant potential in the biomimetic simulation of liver structure and function. Despite notable successes, organoids still face limitations such as high variability and low maturity. To overcome these challenges, engineering strategies have been established to maintain organoid stability and enhance their efficacy, laying the groundwork for the development of advanced liver organoids. The present review comprehensively summarizes the construction of engineered liver organoids and their prospective applications in biomedicine. Initially, we briefly present the latest research progress on matrix materials that maintain the three-dimensional morphology of organoids. Next, we discuss the manipulative role of engineering technologies in organoid assembly. Additionally, we outline the impact of gene-level regulation on organoid growth and development. Further, we introduce the applications of liver organoids in disease modeling, drug screening and regenerative medicine. Lastly, we overview the current obstacles and forward-looking perspectives on the future of engineered liver organoids. We anticipate that ongoing innovations in engineered liver organoids will lead to significant advancements in medical applications.

The use of virtual reality-assisted interventions on psychological well-being and treatment adherence among kidney transplant recipients: A randomized controlled study

This randomized controlled trial aims to investigate the effects of educational and psychological interventions on the health outcomes of patients suffering from chronic diseases. We recruited 372 patients and randomly assigned them to one of two intervention arms during the trial, which lasted for a year. Both groups participated in a 12-month intervention program, where the intervention group received health education and supportive psychological therapy utilizing virtual reality (VR) technology, while the control group received conventional health education guidance. Statistical analysis showed that compared to the control group, the intervention group demonstrated significant improvements (p < 0.05) in depression assessment scores, compliance scores, and Barthel functional scoring. However, the two groups had no significant difference in the incidence of complications and health knowledge mastery. Additionally, the intervention group had fewer hospitalization days than the control group, with statistically significant differences. The research results prove that targeted intervention effectively improves medication adherence, patient awareness, and reduces patient hospitalization days, which is particularly important for managing chronic diseases.

Hepatitis B Hospitalizations in Brazil: Temporal and Regional Patterns from 2008 to 2023

Hepatitis B remains a significant global public health concern, particularly in low- and middle-income countries, where prevention and control measures often face challenges. In Brazil, substantial efforts have been made over the years to combat the burden caused by hepatitis B through public health interventions, including vaccination programs, antenatal screening, and prevention of vertical transmission. However, despite these advancements, disparities in disease trends persist across regions and vulnerable populations, requiring ongoing analysis and intervention. This study aimed to analyze the trend in hospital admissions for hepatitis B in Brazil from 2008 to 2023. Data were collected from the SUS Hospital Information System. Statistical analyses were conducted using the Joinpoint Regression Program (version 5.0.2), applying a 5% significance level to identify significant trends over the study period. A total of 19,735 hospitalizations for hepatitis B were recorded during the study period. The overall trend showed a significant decline in hospital admissions, reflecting the effectiveness of public health interventions such as expanded vaccination coverage, screening programs, and prevention strategies. Despite this overall decline, notable regional disparities were observed. The midwest region exhibited an increasing trend in hospitalizations, contrasting with the national decline. Furthermore, a concerning rise in hospital admissions among infants under one year of age was identified, indicating potential shortcomings in the prevention of the vertical transmission of the virus. This study highlights both the successes and persistent challenges in controlling hepatitis B hospitalizations in Brazil. Maintaining high vaccination coverage and implementing targeted public health campaigns for vulnerable populations are crucial for sustaining progress. The regional disparities and failures in vertical transmission prevention require continued attention and intervention to advance toward the goal of eliminating hepatitis B as a public health threat in Brazil.

Evaluating the scope of human leukocyte antigen polymorphisms influencing hepatitis B virus-related liver cancer and cirrhosis through multi-clustering analysis

Hepatitis B virus remains a major cause of cirrhosis and hepatocellular carcinoma, with genetic polymorphisms and mutations influencing immune responses and disease progression. Nguyen et al present novel findings on specific human leukocyte antigen (HLA) alleles, including rs2856718 of HLA-DQ and rs3077 and rs9277535 of HLA-DP, which may predispose individuals to cirrhosis and liver cancer, based on multi-clustering analysis. Here, we discuss the feasibility of this approach and identify key areas for further investigation, aiming to offer insights for advancing clinical practice and research in liver disease and related cancers.

Prevalence and Transfusion Risks of Occult Hepatitis B Infection Among HBcAb-Positive Blood Donors in a High-Endemic Region

Background: Hepatitis B virus (HBV) remains a significant global health concern, particularly in sub-Saharan Africa, where endemicity is high. Occult hepatitis B infection (OBI) presents a unique challenge to transfusion safety, as HBV DNA may persist in HBsAg-negative individuals. This study examines the prevalence of HBcAb positivity among blood donors at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, and assesses the risk of HBV transmission. Methods: A cross-sectional study was conducted among 200 blood donors. Samples were screened for HBsAg and HBV serological markers using a rapid assay and ELISA. HBcAb-positive samples were analyzed for HBV DNA using real-time polymerase chain reaction (qRT-PCR). Viral loads were quantified, and socio-demographic characteristics were recorded. Results: HBcAb was detected in 57 (28.5%) of the 200 donors. The most common serological pattern among donors was HBsAg-negative and HBcAb-negative (69%). Among these HBcAb-positive donors, HBV DNA was detected in three cases (1.5%), with viral loads of 753.1, 2.193 × 104, and 4.538 × 104 IU/mL. The presence of HBV DNA in these donors confirms the risk of OBI transmission through transfusion. Socio-demographic analysis revealed that 48.5% of donors were aged 26-35 years, 23.5% were aged 18-25 years, 23% were aged 36-42 years, and 2.5% were either 43-50 or above 50 years of age, of which 99.5% were male. These findings highlight a significant prevalence of HBcAb positivity and OBI, aligning with studies in similar high-endemic settings. Conclusions: HBcAb positivity and OBI represent significant transfusion risks in endemic regions. The presence of HBV DNA in 1.5% of HBcAb-positive donors in the study population highlights the limitations of HBsAg-based screening. Incorporating nucleic acid testing (NAT) into routine blood donor screening protocols is critical to enhancing transfusion safety. Further research is needed to evaluate the feasibility and cost-effectiveness of such interventions in resource-limited settings.

Long-term efficacy and anamnestic response of hepatitis B vaccine derived from Chinese hamster ovary cell after 18-20 years

To evaluate the long-term efficacy and anamnestic response of Chinese hamster ovary (CHO) cell-derived hepatitis B vaccine (CHO-HepB) after 18-20 years, a cross-sectional survey was conducted in seven communities in Zhengding County at the end of 2017. The birth cohort 1997-1999 vaccinated primarily with three doses of CHO-HepB were enrolled in the survey. The HBV serological markers were quantified using the Chemiluminescence method. The infection status of HBsAg-positive participants was determined by comparing their results with the previous data. For those with an anti-HBs antibody negative, the anamnestic response was evaluated by measuring anti-HBs antibody concentrations following a dose of HepB administration. A total of 1352 participants were enrolled, with the prevalence of HBsAg, anti-HBs, and anti-HBc being 0.4 %, 74.5 %, and 1.3 %, respectively. There was no significant difference in the HBV markers (HBsAg, anti-HBs and anti-HBc) between birth-year groups (P > 0.05). The geometric mean concentration (GMC) of anti-HBs antibodies among 1007 positive participants was 191 mIU/ml. No new infections or carriers were identified in the survey. Combined with the three previous surveys of the same birth cohort, the positive rates of HBsAg, anti-HBs, and anti-HBc remained largely unchanged over two decades following CHO-HepB vaccination. Of 248 participants who received a booster vaccination, 231 (93.1 %) showed an anti-HBs antibody positive with a GMC of 369 mIU/mL. Moreover, the positive rate and GMC of anti-HBs were higher in the CHO-HepB booster group compared to the Saccharomyces cerevisiae-HepB booster group. The long-term efficacy of the CHO-HepB remains stable for 18-20 years after primary vaccination, and a higher seroconversion rate of anti-HBs is observed following a booster vaccination of CHO-HepB. Given the absence of new infections or carriers over the past two decades, it appears unnecessary to administer a booster vaccination of HepB.

Increasing Prevalence of Occult HBV Infection in Adults Vaccinated Against Hepatitis B at Birth

BACKGROUND/OBJECTIVES

Immunization with the hepatitis B vaccine is the most effective means of preventing acute HBV infection. However, whether the primary vaccination of infants confers lifelong immunity remains controversial. Therefore, the ongoing surveillance of vaccine recipients is required.

METHODS

A longitudinal study was carried out based on LongAn county, one of the five clinical trial centers for hepatitis B immunization in China in the 1980s. Serum samples were collected and tested for HBV serological markers and DNA.

RESULTS

A total of 637 subjects born in 1987-1993 were recruited, including 503 males and 134 females. The total prevalence of HBsAg was 3.9%. The prevalence in females (8.2%) was significantly higher than that in males (2.8%) (p = 0.004). The prevalence of anti-HBc in females (52.2%) was also significantly higher than that in males (41.2%) (p = 0.021). The prevalence of anti-HBs was 42.7% and did not differ significantly between males (41.7%) and females (46.3%) (p = 0.347). Compared to data from surveillance over the last ten years, the positivity rate of HBsAg did not increase. The positivity rate of anti-HBs decreased significantly (p = 0.049) while that of anti-HBc increased significantly (p = 0.001). The prevalence of occult HBV infection (OBI) in 2024 (6.0%) was significantly higher than that in 2017 (1.6%) (p = 0.045). Subjects diagnosed with OBI in 2017 maintained occult infection in 2024.

CONCLUSIONS

Neonatal HBV vaccination maintained effective protection for at least 37 years. However, the prevalence of OBI increases with age in those vaccinated at birth, raising a new issue of how to prevent and control OBI in the post-universal infant vaccination era.

Domestic cat hepadnavirus genotype B is present in Southern Brazil

Domestic cat hepadnavirus (DCH) (Orthohepadnavirus felisdomestici) is an emerging virus related to the hepatitis B virus (HBV) already reported in many countries. The molecular prevalence of DCH varies widely in the regions investigated so far. In the present work, we reported the presence of DCH in Brazil. Sixty cat serum samples tested by DCH presence using PCR and 1.67% (1/60) were positive, similar to the low positive molecular rates reported in United States and Japan. The DCH full-length genome was classified in genotype B, which is uncommon since this genotype was only reported once in Japan. The DCH-positive sample was obtained in a stray cat female apparently healthy, presenting ALT, AST, and ALKP normal values, and negative for FIV and FeLV. Due the low positivity rate detected, some factors as alteration in hepatic enzymes and FIV/FeLV infection could not be evaluated. Other works are necessary to statistically validate these observations in Brazil.

Ginsenoside Rg1: A bioactive therapeutic agent for diverse liver diseases

Diverse liver diseases are characterised by late diagnosis and rapid progression and have become one of the major threats to human health. To delay the transition from benign tissue lesions to a substantial organ injury, scientists have gradually applied natural compounds derived from plants as a complementary therapy in the field of hepatology. Ginseng (Panax ginseng C. A. Meyer) is a tonic traditional Chinese herbal medicine, and natural products, including ginsenoside Rg1 (G-Rg1), which is a kind of 20(S)-protopanaxatriol saponin with a relatively high biological activity, can be isolated from the roots or stems of ginseng. Given these information, this review aimed to summarise and discuss the metabolic mechanisms of G-Rg1 in the regulation of diverse liver diseases and the measures to improve its bioavailability. As a kind of monomer in Chinese medicine with multitarget pharmacological effects, G-Rg1 can provide significant therapeutic benefits in the alleviation of alcoholic liver disease, nonalcoholic fatty liver disease, liver fibrosis, viral hepatitis, etc., which mainly rely on the inhibition of apoptosis, strengthening endogenous anti-inflammatory and antioxidant mechanisms, activation of immune responses and regulation of efflux transport signals, to improve pathological changes in the liver caused by lipid deposition, inflammation, oxidative stress, accumulation of hepatotoxic product, etc. However, the poor bioavailability of G-Rg1 must be overcome to improve its clinical application value. In summary, focusing on the hepatoprotective benefits of G-Rg1 will provide new insights into the development of natural Chinese medicine resources and their pharmaceutical products to target the treatment of liver diseases.

AFB1 consolidates HBV harm to induce liver injury and carcinogenic risk by inactivating FTCD-AS1-PXR-MASP1 axis

Aflatoxin B1 (AFB1) has been reported to synergize with hepatitis B virus (HBV) to induce development of hepatocellular carcinoma (HCC). Precise daily exposure to AFB1 and its contribution to liver injury have not been quantified and have even been disregarded due to lack of convenient detection, and the strong species specificity of HBV infection has restricted research on their synergistic harm. Hence, our objective was to investigate the molecular mechanisms by which AFB1 exacerbates HBV-related injury. We constructed tree shrew models with 400 μg HBV plasmid and 4 mg/kg AFB1 co-exposure for 4-6 days. Injury and molecule expression resulting from HBV and AFB1 toxicity were observed in vivo and in vitro. Expression datasets of tree shrew livers, human HCC, and pregnane X receptor (PXR) activation were employed to screen vital pathways and target genes. The oncogenic hepatitis B virus x (HBx) protein, HBV-related histopathological damage, metabolic dysregulation, and several cancer-related signaling pathways were enriched in injured tree shrew livers, and PXR signaling was inhibited after co-exposure to HBV and AFB1. Furthermore, in human HCC and HBV-integrated Hep3B and HepG2.215 cells, FTCD Antisense RNA 1 (FTCD-AS1), PXR and mannose-binding lectin-associated serine protease 1 (MASP1) exhibited strong correlation. Overexpression of FTCD-AS1 and PXR alleviated cell damage in exposure to 5 μM AFB1 for 48 h. In summary, inactivation of the FTCD-AS1-PXR-MASP1 axis was pinpointed as the key event in AFB1-enhanced HBV infection, metabolic dysregulation and carcinogenic injury.

Effects of mirror-image nucleosides on DNA replication and transcription in human cells

Mirror-image nucleosides, as potential antiviral drugs, can inhibit virus DNA polymerase to prevent virus replication. Conversely, they may be inserted into the DNA strands during DNA replication or transcription processes, leading to mutations that affect genome stability. Accumulation of significant mutation damage in cells may result in cell aging, apoptosis, and even uncontrolled cell division. We have previously explored the efficiency and fidelity of replication across mirror-image nucleosides within Escherichia coli, and this study focuses on human cells. We constructed several plasmid substrates, each carrying a specific mirror-image nucleoside, to investigate their impact on intracellular DNA replication and transcription processes. The results showed that in HepG2 cells, L-adenosine was the most potent substrate in inhibiting cell replication and transcription. L-cytidine exhibited the highest bypass efficiency in both template strands or nontemplate strands and had the most diverse mutation types. We also observed that L-cytidine induced immunoregulation of the JAK-STAT signaling pathway. Therefore, our results provide a theoretical basis for the disruptions caused by mirror-image nucleosides in replication and transcription and give us some understanding that mirror-image nucleoside drugs can cause cytotoxicity.

Identification of multiple complications as independent risk factors associated with 1-, 3-, and 5-year mortality in hepatitis B-associated cirrhosis patients

BACKGROUND

Hepatitis B-associated cirrhosis (HBC) is associated with severe complications and adverse clinical outcomes. This study aimed to develop and validate a predictive model for the occurrence of multiple complications (three or more) in patients with HBC and to explore the effects of multiple complications on HBC prognosis.

METHODS

In this retrospective cohort study, data from 121 HBC patients treated at Nanjing Second Hospital from February 2009 to November 2019 were analysed. The maximum follow-up period was 10.75 years, with a median of 5.75 years. Eight machine learning techniques were employed to construct predictive models, including C5.0, linear discriminant analysis (LDA), least absolute shrinkage and selection operator (LASSO), k-nearest neighbour (KNN), gradient boosting decision tree (GBDT), support vector machine (SVM), generalised linear model (GLM) and naive Bayes (NB), utilising variables such as medical history, demographics, clinical signs, and laboratory test results. Model performance was evaluated via receiver operating characteristic (ROC) curve analysis, residual analysis, calibration curve analysis, and decision curve analysis (DCA). The influence of multiple complications on HBC survival time was assessed via Kaplan‒Meier curve analysis. Furthermore, LASSO and univariable and multivariable Cox regression analyses were conducted to identify independent prognostic factors for overall survival (OS) in patients with HBC, followed by ROC, C-index, calibration curve, and DCA curve analyses of the constructed prognostic nomogram model. This study utilized bootstrap resampling for internal validation and employed the Medical Information Mart for Intensive Care IV (MIMIC-IV) database for external validation.

RESULTS

The GBDT model exhibited the highest area under the curve (AUC) and emerged as the optimal model for predicting the occurrence of multiple complications. The key predictive factors included posthospitalisation fever (PHF), body mass index (BMI), retinol binding protein (RBP), total bilirubin (TB) levels, and eosinophils (EOS). Kaplan-Meier analysis revealed that patients with multiple complications had significantly worse OS than those with fewer complications. Additionally, multivariable Cox regression analysis, informed by least absolute shrinkage and LASSO selection, identified hepatocellular carcinoma (HCC), multiple complications, and lactate dehydrogenase (LDH) levels as independent prognostic factors for OS. The prognostic model demonstrated 1-year, 3-year, and 5-year OS ROC AUCs of 0.802, 0.793, and 0.817, respectively. For the internal validation cohort, the corresponding AUC values were 0.797, 0.832, and 0.835. In contrast, the external validation cohort yielded a 1-year ROC AUC of 0.707. Calibration curves indicated good consistency of the model, and DCA demonstrated the model's clinical utility, showing high net benefits within certain threshold ranges. Compared with the univariable models, the multivariable ROC curves indicated higher AUC values for this prognostic model, and the model also possessed the best c-index.

CONCLUSION

The GBDT prediction model provides a reliable tool for the early identification of high-risk HBC patients prone to developing multiple complications. The concurrent occurrence of multiple complications is an independent prognostic factor for OS in patients with HBC. The constructed prognostic model demonstrated remarkable predictive performance and clinical applicability, indicating its crucial role in enhancing patient outcomes through timely and targeted interventions.

Epidemiology of liver diseases: global disease burden and forecasted research trends

We assessed the global incidence, mortality, and disability-adjusted life years (DALYs) associated with various liver diseases, including alcohol-related liver disease (ALD), hepatitis B/C virus infections (HBV or HCV), liver cancer, metabolic dysfunction-associated steatotic liver disease (MASLD), and other chronic liver diseases, from the 2019 Global Burden of Disease study. Additionally, we analyzed the global trends in hepatology research and drug development. From 2000 to 2019, prevalence rates increased for ALD, MASLD and other liver diseases, while they decreased for HBV, HCV, and liver cancer. Countries with a high socio-demographic index (SDI) exhibited the lowest mortality rates and DALYs. The burden of liver diseases varied due to factors like sex and region. In nine representative countries, MASLD, along with hepatobiliary cancer, showed highest increase in funding in hepatology research. Globally, the major research categories in hepatology papers from 2000 to 2019 were cancer, pathobiology, and MASLD. The United States (U.S.) was at the forefront of hepatology research, with China gradually increasing its influence over time. Hepatologists worldwide are increasingly focusing on studying the communication between the liver and other organs, while underestimating the research on ALD. Cancer, HCV, and MASLD were the primary diseases targeted for therapeutic development in clinical trials. However, the proportion of new drugs approved for the treatment of liver diseases was relatively low among all newly approved drugs in the U.S., China, Japan, and the European Union. Notably, there were no approved drug for the treatment of ALD in the world.

A model based on chitinase 3-like protein for expecting liver severity of hepatitis B virus infections in the immune tolerance phase

BACKGROUND

The question of whether to treat patients with chronic hepatitis B (CHB) during the immune tolerance (IT) period is a matter of ongoing debate, as it is difficult to discern different levels of liver disease severity. We created and assessed a novel diagnostic model for identifying significant liver tissue damage in individuals with CHB in IT phase.

METHODS

From November 2018 to December 2022, a cross-sectional study of 311 patients with chronic hepatitis B virus infection (HBV DNA > 30 IU/mL) at Ningbo No. 2 Hospital, Ningbo, China, who underwent liver biopsy, including 44 patients in IT phase. Utilizing univariate regression analyses and logistics analysis, and model was developed and validated to predict the severity of hepatic inflammatory and fibrosis in CHB patients and in IT phase.

RESULTS

Chitinase 3-like Protein (CHI3L1), albumin (ALB), alanine transaminase (ALT) / aspartate aminotransferase (AST) were identified as independent predictors of liver lesion severity in CHB patients with IT. The three were combined to build the model (named as CAA index), which demonstrated good performance. The CAA index achieved an area under the receiver operating characteristic curve (AUC) of 0.916 (95 % CI, 0.820-1.000) and AUC of validation group was 0.875 (95 % CI, 0.683-1.000).

CONCLUSIONS

CHI3L1 serves as an independent measure of liver fibrosis and inflammation in CHB. This diagnostic model has some value in assessing the severity of the patient's liver lesion severity and may be a reliable non-invasive diagnostic model helping determine whether treatment is necessary among CHB patients in IT phase.

Affordable infectious pathogen detection using a dual-mode biosensor integrating exonuclease III-assisted target recycling amplification with high-throughput 96-well microplate format

The ongoing challenge of infectious pathogens highlights the need for accurate and accessible methods to discern their genetic signatures, especially in resource-limited settings. In response to this crucial requirement, we introduce an affordable large-scale screening platform for infectious pathogen detection, using Hepatitis B virus (HBV) as a fundamental model. This proposed biosensor integrates an exonuclease III-assisted target recycling amplification strategy within a high-throughput 96-well microplate format. The HBV DNA target binds to a capture probe DNA and exonuclease III digests the probe to release the target. This mechanism enables the target to engage in binding cycles with new probes, each digested in turn, increasing detection sensitivity for even small quantities of HBV DNA. The implemented approach incorporates a biotin-streptavidin interaction allowing the undigested capture probe DNA to bind to a 5'-biotin-modified detection probe for effective HBV DNA quantification. This interaction generates a signal that, following the enzyme-substrate reaction, can be detected on-site using a smartphone, offering either optical or electrochemical readouts. The developed biosensor was capable of detecting HBV DNA with a detection limit of 5.62 fM and provided a considerable linear range covering concentrations from 100 fM to 100 nM. The determination of HBV DNA quantities in spiked human serum was achieved with a recovery of 90.0 % - 107.4 % as well. The results suggest that the developed dual-mode biosensor offers an adaptable and cost-effective approach for detecting infectious diseases, with promising applications in medical diagnostics and environmental monitoring to support public health efforts.

Cognitive Impairments in Viral Hepatitis Patients: Causes, Manifestations, and Impact on Quality of Life

Viral hepatitis, primarily caused by hepatitis B virus and hepatitis C virus, is widely recognized for its impact on liver function, but emerging evidence suggests it also affects cognitive function. This review explores the causes, manifestations, and impact of cognitive impairments in patients with viral hepatitis, to better understand this often-overlooked aspect of the disease. A literature review was conducted, focusing on studies published in PubMed up to August 2024. Key areas covered include the pathophysiological mechanisms behind cognitive impairment in viral hepatitis, clinical manifestations observed in affected patients, the implications for their daily functioning and overall well-being, and the tools used in cognitive assessments. Common manifestations included deficits in attention, memory, executive function, and psychomotor speed. These cognitive challenges can significantly impact daily activities, occupational performance, and social interactions, contributing to reduced quality of life. Cognitive impairments in viral hepatitis patients represent a significant concern that extends beyond liver health. Recognizing and addressing these cognitive issues are crucial for improving patient outcomes. Enhanced diagnostic strategies and targeted interventions are needed to better manage cognitive symptoms and support affected individuals in maintaining their quality of life. This narrative review aims to enhance clinical practice and inform future research directions.

Advances, challenges and future applications of liver organoids in experimental regenerative medicine

The liver is a vital organ responsible for numerous metabolic processes in the human body, including the metabolism of drugs and nutrients. After liver damage, the organ can rapidly return to its original size if the causative factor is promptly eliminated. However, when the harmful stimulus persists, the liver's regenerative capacity becomes compromised. Substantial theoretical feasibility has been demonstrated at the levels of gene expression, molecular interactions, and intercellular dynamics, complemented by numerous successful animal studies. However, a robust model and carrier that closely resemble human physiology are still lacking for translating these theories into practice. The potential for liver regeneration has been a central focus of ongoing research. Over the past decade, the advent of organoid technology has provided improved models and materials for advancing research efforts. Liver organoid technology represents a novel in vitro culture system. After several years of refinement, human liver organoids can now accurately replicate the liver's morphological structure, nutrient and drug metabolism, gene expression, and secretory functions, providing a robust model for liver disease research. Regenerative medicine aims to replicate human organ or tissue functions to repair or replace damaged tissues, restore their structure or function, or stimulate the regeneration of tissues or organs within the body. Liver organoids possess the same structure and function as liver tissue, offering the potential to serve as a viable replacement for the liver, aligning with the goals of regenerative medicine. This review examines the role of liver organoids in regenerative medicine.