HBeAg/anti-HBe system and cell-mediated immunity in patients with HBsAg-positive chronic active hepatitis

Natural killer activity in patients with chronic hepatitis treated with OK432, interferon, adenine arabinoside and glycyrrhizin

Natural killer (NK) activity in the peripheral blood of patients with chronic liver disease was measured using 51Cr labeled K562 cells as target cells. NK activity was elevated but not significantly in patients with chronic hepatitis compared with healthy controls and significantly lower in the patients with hepatocellular carcinoma. The activity decreased in the order of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. Although the level of NK activity in patients with chronic hepatitis did not correlate with the level of alanine aminotransferase (ALT), it tended to be elevated in association with elevation of ALT in patients treated with OK432, interferon-beta, glycyrrhizin or adenine arabinoside. In chronic liver disease, phytohemagglutinin (PHA) skin test showed a positive correlation with NK activity. In all patients who were treated with the immunopotentiator, OK432, and whose HBeAg became negative, NK activity was elevated during the treatment. These results suggest that the NK activity in peripheral blood may be related to hepatocytic injury even if this is not the effector mechanism of the injury.

Peripheral T-cell subsets in asymptomatic hepatitis B-virus carriers

To ascertain whether the abnormalities of circulating T-cell subsets in patients with hepatitis B virus (HBV)-related chronic liver diseases represent the primary immunological process or are secondary to liver disease process, peripheral T-cell subsets were analyzed by indirect immunofluorescence using monoclonal antibodies against total T cells (OKT3), T helper/inducer cells (OKT4), and T suppressor/cytotoxic cells (OKT8), in 30 asymptomatic HBV carriers without biochemical or histological evidence of liver disease, and the results were compared to 15 HBV-induced chronic active liver diseases. The results revealed that OKT4/OKT8 ratios were significantly reduced in 15 hepatitis B e antigen (HBeAg)-positive asymptomatic carriers as compared with controls, with decreased OKT4-positive cells and increased OKT8-positive cells, while T-cell subsets and ratios were normal in 15 hepatitis B e antibody (anti-HBe)-positive asymptomatic carriers. The changes of circulating T-cell subsets in 15 HBe-Ag-positive asymptomatic carriers showed no significant difference from those of 15 HBeAg-positive patients with chronic active liver diseases. These findings suggest that the deranged T-cell subsets in chronic HBV infection are not secondary to liver cell damage, but might represent the underlying immunological abnormalities which are closely related to HBeAg/anti-HBe status, and that the pathogenetic mechanism of liver cell damage in chronic HBV infection may not be simply related to circulating T-cell subsets.

Impaired antibody synthesis in patients with chronic hepatitis B infection

In vitro synthesis of the anti-HBc, anti-HBs and polyclonal IgG and IgM classes of antibodies were determined from supernatants of peripheral blood mono-nuclear cells cultured in the presence of pokeweed mitogen. Thirty-seven patients with chronic hepatitis B and 10 healthy control subjects whose sera were positive for anti-HBs formed the study group. Twenty-four of 37 patients showed histologic evidence of chronic active hepatitis B while the remaining 13 patients had chronic persistent hepatitis B. Lymphocytes from chronic persistent hepatitis B, chronic active hepatitis B and healthy controls secreted similar levels of IgM. However, IgG synthesis was markedly impaired (p less than 0.002) in the chronic persistent hepatitis B group as compared with healthy controls or chronic active hepatitis B patients. In vitro anti-HBc production and serum anti-HBc titers correlated directly with hepatocellular inflammation and inversely with serum hepatitis B virus DNA. Anti-HBc synthesis was significantly higher in chronic active hepatitis B patients who exhibited a more pronounced hepatocellular damage when compared to chronic persistent hepatitis B patients who had little or no liver cell injury.

Cell-mediated immunity in HBeAg-positive homosexuals with chronic liver disease

Chronic liver disease developing after infection with the hepatitis B virus may be due to impairment of cell-mediated immunity (CMI). In a study of CMI by the lymphocyte transformation test to two mitogens and hepatitis B surface antigen (HBsAg) the response to the mitogens, phytohemagglutinin (PHA) and purified protein derivative (PPD), was normal in all of 15 male homosexuals with HBsAg-positive chronic liver disease, indicating a normal non-specific cellular immune response. By contrast, only one of the 15 patients showed a response to HBsAg, which may explain the high prevalence of chronic HBsAg carriage in these patients.