New Antiviral Agents for Hepatitis C

Approximately 120-130 million individuals are chronically infected with hepatitis C virus (HCV) worldwide, although it is curable by therapy. Until recently, treatment of chronic hepatitis C was based on the combination of pegylated interferon-α and ribavirin. A number of models have been developed to study the HCV lifecycle and screen for potential HCV inhibitors. They led to the development of antiviral agents that specifically target a viral function (direct acting antivirals), and host-targeted agents that inhibit HCV replication. Direct acting antivirals in clinical development include NS3-4A protease inhibitors (two of which, telaprevir and boceprevir, have recently been approved for treatment of HCV genotype 1 infection in combination with pegylated interferon-α and ribavirin), nucleoside/nucleotide analogue and non-nucleoside inhibitors of HCV RNA-dependent RNA polymerase, and NS5A inhibitors. Host-targeted agents include cyclophilin inhibitors. This article describes the direct acting antivirals and host-targeted agents that have recently been approved or have been tested in HCV-infected patients and discusses their two current paths of clinical development: with or without interferon-α

Dynamique adaptative des virus hautement variables à un nouvel environnement réplicatif

La lutte pour les ressources est un phénomène qui a débuté dès l'apparition d'organismes reproductifs et dont la description a été initiée par Malthus puis remarquablement synthétisée et étendue à la biologie sous le terme d'évolution par Darwin en 1859 dans De l'origine des espèces . Si le concept est ancien à l'échelle des sciences biologiques, il continue à caractériser des domaines à l'époque insoupçonnés par son auteur tels que la virologie. En effet, les virus hautement variables tels que le virus de l'immunodéficience humaine (VIH), de l'hépatite B (VHB) et de l'hépatite C (VHC) sont présents sous forme de quasi espèce au sein de leur environnement réplicatif, c'est à dire qu'une multitude de virus génétiquement proche mais distincts coexistent au sein de cet espace qu'ils doivent partager selon les mêmes règles générales que les êtres vivants. Ainsi, lorsque des pressions de sélection s'exercent (immunitaires, antivirales ), une redistribution des variants majoritaires est observé au bénéfice de variants minoritaires mieux adaptés à cet environnement changeant. La modélisation mathématique et informatique de la capacité mutationnelle et la dynamique d'adaptation des variants minoritaires au travers de 6 études de cohortes de patients infectés, par la technique ultra-sensible de pyroséquençage haut débit associée à des logiciels originaux ont permis de mettre en évidence, caractériser et évaluer l'impact de marqueurs diagnostics permettant de prédire la résistance aux antiviraux mais aussi de caractériser de nouvelles cibles antivirales.Struggle for resources is a worldwide rule which has been first described by Malthus and extended to whole world of living organisms by Darwin in 1859 in Origin of species . Today, this concept has been enlarged to virological field, and is particularly adapted to describe highly variable viruses like Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) which have a quasispecies distribution in infected patients characterized by the co-existence of a number of distinct but related viral populations. Selection pressure on viral replicative environment (immune, antiviral drug treatment ), generally lead to a redistribution of the viral quasispecies with an increasing of the best adapted minor viral variants at the expense of major viral populations. Mathematical and bioinformatic modelization of this phenomenon through 6 infected patients cohorts by means of ultra-deep sequencing and an original bioinformatic package allowed discovery, characterization and evaluation of new diagnostic markers that could be used to prevent resistance emergence to antiviral drugs and to characterized new therapeutics antiviral targets.PARIS-EST-Université (770839901) / SudocPARIS12-Bib. électronique (940280011) / SudocSudocFranceF

Etude de l'impact de la variabilité génétique de la protéine NS5A du virus de l'hépatite C dans la pathogenèse et la réplication virale

Le virus de l Hépatite C (VHC), de la famille Flaviviridae, est à l origine d une pandémiemondiale. L infection par le VHC provoque le dévelopment d hépatites chroniques, decirrhoses et de carcinomes hépatocellulaires (CHC). Les fonctions de la majorité des protéinesvirales sont connues, mis à part pour NS5A dont la seule fonction directe attribuée à ce jour,équivaut à celle d un facteur d'activation transcriptionnelle. Notre laboratoire a montréprécédemment que les variants de quasiespèce de NS5A isolés à partir du sérum d un mêmepatient présentaient des différences significatives dans leurs propriétés intrinsèques detransactivation. Fort de ces résultats, nous avons analysé des variants de NS5A isolés à partirde tissu hépatique d un patient chroniquement infecté par le VHC de génotype 1b. Cesanalyses ont révélé une compartimentation génétique et fonctionnelle des variants de NS5Aentre le tissu tumoral et le tissu non-tumoral adjacent. Nous avons donc émis l hypothèse queles propriétés transactivatrices de NS5A pourraient jouer un rôle dans la pathogenèse ainsique dans la réplication virale, et que la variabilité naturelle de NS5A pourrait influencer sespropriétés transactivatrices. L objectif de ce travail de thèse était d analyser le rôle despropriétés transactivatrices de NS5A dans la pathogenèse hépatique viro-induite ainsi quedans la réplication virale. Pour étudier le rôle des propriétés de transactivation de NS5A dans la pathogenèse hépatique,nous avons développé des vecteurs lentiviraux pour exprimer dans les hépatocytes primaireshumains les variants choisis de NS5A portants différents potentiels de transactivation. Enutilisant la technologie RNA-Seq d Illumina, l analyse des transcriptomes d hépatocytestransduits exprimant les variants transactivateurs fort et faible de NS5A, sera utiliser pouridentifier les voies cellulaires ciblées par les propriétés transactivatrices de NS5A. Pour lesétudes in vivo, nous avons lancé le développement des souris transgénique permettantl activation conditionnelle de l expression des variants de NS5A avec fort et faible potentielde transactivation, spécifiquement dans le foie. Ces souris transgéniques seront utilisées pourétudier le rôle potentiel des propriétés transactivatrices dans la pathogenèse VHC induite etplus particulièrement dans le développement des cancers. Pour étudier le rôle des propriétés de transactivation de NS5A dans la réplication virale, nousavons utilisé le système de réplicon subgénomique de VHC exprimant les variants de NS5Aprécédemment caractérisés. Pour exercer ses propriétés transactivatrices, NS5A doit êtrelocalisée au moins partiellement dans le noyau. Nous avons démontré qu une partie de NS5Ase retrouve dans noyau et est recruté sur des promoteurs cellulaires, modulant ainsidirectement l expression de gènes cellulaires essentiels pour la réplication de l ARN viral.Nous avons observé que les variants de NS5A avec différents potentiels de transactivation,confèrent différentes capacités de réplication au réplicon subgénomique, et corrèlent avec lepotentiel de transactivation de variant correspondant. En accord avec ces observations,l inhibition de translocation nucléaire de NS5A entraine une inhibition de la réplication virale,suggerant un rôle potentiel des propriétés transactivatrices de NS5A dans la réplication l ARNvirale. En conclusion, nous avons démontré que l activation transcriptionnelle des gènes cellulairespar la NS5A est essentielle pour la réplication de l ARN du VHC. Cette modulation des gènescellulaires pourrait également être impliquée dans les mécanismes de la pathogenèse viroinduite.Nous confirmerons cette hypothèse grâce aux souris NS5A. Par ailleurs, ces résultatspourraient contribuer au développement de nouvelles thérapies anti-VHC, basées surl inhibition de translocation nucléaire de NS5AHepatitis C virus (HCV) causes a chronic infection in the majority of infected patients,ultimately leading to liver cirrhosis and hepatocellular carcinoma (HCC). Although the rolesof the HCV proteins in the viral life cycle are increasingly understood, the precise function ofthe HCV NS5A protein has yet to be elucidated. To date, the only putative direct functionattributed to NS5A is its transcriptional transactivation properties. Our group has previouslyshown that quasispecies variants of NS5A isolated from the serum samples of the samepatient bear different transactivating properties according to their amino acid sequence. Basedon these observations, we performed preliminary phylogenetic and functional analysis ofNS5A variants isolated from liver tissue of individuals infected with HCV of genotype 1b.This analysis revealed genetic and functional compartmentation of NS5A variants in tumoraland adjacent non-tumoral tissue. We hypothesized that the natural variability of NS5A mayimpact its proposed transactivation properties. We also hypothesized that NS5A s putativetransactivation properties could play a role in HCV replication and in liver pathogenesis. Theaim of the study presented in this thesis was to investigate the role of NS5A transactivationproperties in the development of HCV-induced liver pathogenesis as well as in viralreplication. To study the role of NS5A transcriptional activation properties in liver pathogenesis, wedeveloped lentiviral vectors for the expression of selected NS5A variants bearing differenttransactivation potentials in cultured primary human hepatocytes. We now intend to extendthese preparations using RNAseq technology to analyse the, transcriptome of primaryhepatocytes transduced with lentiviral vectors encoding strongly and weakly transactivatingNS5A variants to identify the cellular pathways targeted by NS5A, allowing us to decipherthe role of NS5A mediated host gene regulation in development of HCV inducedpathogenesis. For in vivo studies, we have begun the development of transgenic mice allowingliver-specific conditional expression of NS5A variants with high and low transactivationpotentials. These transgenic mice will be used to study the possible role of NS5Atransactivation properties in development of HCC. To study the role of NS5A transcriptional activation properties in HCV RNA replication, weused the sub-genomic replicon system expressing previously characterized NS5A sequences..Using this system, we have demonstrated that a subset of NS5A protein can translocate to thenucleus and is recruited to cellular promoters of host cell genes known to be required forefficient replication of HCV replicon RNA as well as those implicated in pathogenesis.Moreover, we have shown that NS5A directly regulate the expression of these genes.Consequently, it was observed that replicons encoding NS5A variants with differenttransactivation potentials exhibited different replication capacities, and that this correlatedwith the transactivation potential of the corresponding NS5A variant. In agreement with theseobservations, inhibition of nuclear translocation of NS5A resulted in the inhibition ofreplication of the HCV subgenomic replicon, further confirming the role of NS5Atransactivation properties in viral RNA replication. In conclusion, we have demonstrated that NS5A-mediated transcriptional regulation ofcellular genes is required for HCV replication. Such NS5A-mediated modulation of cellulargenes may also constitute one of the mechanisms involved in HCV-related liver pathogenesisand development of HCC, an aspect which is currently under investigation using the toolsdeveloped during this project. This study will contribute towards deciphering the role ofNS5A in viral replication as well as providing insight into its role in HCV-induced liverpathogenesis...PARIS-EST-Université (770839901) / SudocPARIS12-Bib. électronique (940280011) / SudocSudocFranceF

Hepatitis C Virus (HCV) Genotype 1 Subtype Identification in New HCV Drug Development and Future Clinical Practice

International audienceBACKGROUND: With the development of new specific inhibitors of hepatitis C virus (HCV) enzymes and functions that may yield different antiviral responses and resistance profiles according to the HCV subtype, correct HCV genotype 1 subtype identification is mandatory in clinical trials for stratification and interpretation purposes and will likely become necessary in future clinical practice. The goal of this study was to identify the appropriate molecular tool(s) for accurate HCV genotype 1 subtype determination. METHODOLOGY/PRINCIPAL FINDINGS: A large cohort of 500 treatment-naïve patients eligible for HCV drug trials and infected with either subtype 1a or 1b was studied. Methods based on the sole analysis of the 5' non-coding region (5'NCR) by sequence analysis or reverse hybridization failed to correctly identify HCV subtype 1a in 22.8%-29.5% of cases, and HCV subtype 1b in 9.5%-8.7% of cases. Natural polymorphisms at positions 107, 204 and/or 243 were responsible for mis-subtyping with these methods. A real-time PCR method using genotype- and subtype-specific primers and probes located in both the 5'NCR and the NS5B-coding region failed to correctly identify HCV genotype 1 subtype in approximately 10% of cases. The second-generation line probe assay, a reverse hybridization assay that uses probes targeting both the 5'NCR and core-coding region, correctly identified HCV subtypes 1a and 1b in more than 99% of cases. CONCLUSIONS/SIGNIFICANCE: In the context of new HCV drug development, HCV genotyping methods based on the exclusive analysis of the 5'NCR should be avoided. The second-generation line probe assay is currently the best commercial assay for determination of HCV genotype 1 subtypes 1a and 1b in clinical trials and practice

Antiviral drug-resistant HBV: Standardization of nomenclature and assays and recommendations for management

Substantial advances have been made in the treatment of chronic hepatitis B in the past decade. Approved treatments for chronic hepatitis B include 2 formulations of interferon and 4 nucleos(t)ide analogues (NAs). Sustained viral suppression is rarely achieved after withdrawal of a 48-week course of NA therapy, necessitating long, and in many cases, indefinite treatment with increasing risk of development of drug resistance. Antiviral resistance and poor adherence are the most important factors in treatment failure of hepatitis B. Thus, there is a need to standardize nomenclature relating to hepatitis B antiviral resistance, and to define genotypic, phenotypic, and clinical resistance to NA therapy. (H EPATOLOGY 2007;46:254–265.)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56065/1/21698_ftp.pd

Interferon (IFN)-γ-Inducible Protein-10: Association with Histological Results, Viral Kinetics, and Outcome during Treatment with Pegylated IFN-α2a and Ribavirin for Chronic Hepatitis C Virus Infection

BackgroundWe investigated associations between interferon (IFN)-γ-inducible protein (IP)-10 and liver histological results, viral kinetic response, and treatment outcome in patients infected with hepatitis C virus (HCV) genotypes 1-4 MethodsPlasma IP-10 was monitored before, during, and after treatment with pegylated IFN-α2a and ribavirin in 265 HCV-infected patients ResultsIn univariate analyses, a low baseline IP-10 level was significantly associated with low baseline viral load, rapid viral response (RVR), a sustained viral response (SVR), body mass index <25 kg/m2, and less-pronounced fibrosis, inflammation, and steatosis (for HCV genotypes other than 3). When the results of the univariate analyses were included in multivariate analyses, a low plasma IP-10 level, low baseline viral load, and genotype 2 or 3 infection were independent predictors of an RVR and SVR. IP-10 levels decreased 6 weeks into treatment and remained low in patients with an SVR. By contrast, plasma levels of IP-10 rebounded in patients who had detectable HCV RNA after the completion of treatment. Using cutoff IP-10 levels of 150 and 600 pg/mL for predicting an SVR in patients infected with HCV genotype 1 yielded a specificity and sensitivity of 81% and 95%, respectively ConclusionBaseline IP-10 levels are predictive of the response to HCV treatmen