published_or_final_version / abstract / Surgery / Doctoral / Doctor of Philosophy

published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

Hepatitis C Virus (HCV) infects 170 million people worldwide. The current treatment regimen, which is combination therapy with pegylated interferon (PegIFN) and Ribavirin (Rib), cures only 50% of the patients infected with the most prevalent HCV genotype. Therefore, there is a pressing need to understand the molecular mechanism of interferon resistance and to develop a prognostic tool to predict who will respond to treatment before initiation of therapy. It has been firmly established that the virus-host interaction plays an important role in determining treatment outcomes. My thesis investigated the host factors that are involved in interferon resistance with an aim to provide insights into the molecular mechanism of IFN resistance. cDNA microarray analysis identified 18 differentially expressed hepatic genes from pretreatment liver tissues of responders (Rs) and non-responders (NRs). Based on the differential expression levels of these 18 genes, a prognostic tool was developed to predict who will respond to therapy, with a positive predicting value (PPV) of 96%. Most of these 18 genes are interferon stimulated genes (ISGs) and they are more highly expressed in NR livers, indicating that preactivation of interferon signaling in the pre-treatment liver tissues contributes to NR. 3 out of the 18 genes are involved in an ubiquitin-like ISG15/USP18 signaling pathway that plays an important role in interferon response. Over-expression of USP18 and ISG15 in the pretreatment liver tissues of NR promotes HCV production and blunts interferon anti-HCV activity. There exists a distinct cell-type specific ISG activation in the pretreatment liver tissues of Rs and NRs. Up-regulation of the two ISGs that I tested (ISG15 and MxA) was found mainly in hepatocytes in NRs while ISG activation was preferentially observed in macrophages in Rs. Taking all these data together, pre-activation of interferon signaling and cell-type specific gene activation in the pretreatment liver tissues of patients infected with HCV are associated with treatment non-response. HCV exploits the host interferon system to favour its persistence by enhanced replication /secretion stimulated by a few ISGs (ISG15, USP18) in response to IFN. The developed prognostic tool can be used to stratify patients for treatment and the novel insights of the molecular mechanism of IFN resistance in HCV patients offer potential drug targets for future development.

Hepatitis delta virus (HDV) is the smallest known human RNA pathogen. It requires the human hepatitis B virus (HBV) for virion production and transmission, and is hence closely associated with HBV in natural infections. HDV RNA encodes only two viral proteins - the small and the large delta antigens. Due to its limited coding capacity, HDV needs to exploit host factors to ensure its propagation. However, few human proteins are known to interact with the HDV RNA genome. The current study has identified several host proteins interacting with an HDV-derived RNA promoter by multiple approaches: mass spectrometry of a UV-crosslinked ribonucleoprotein complex, RNA affinity chromatography, and screening of a library of purified RNA-binding proteins. Co-immunoprecipitation, both in vitro and ex vivo, confirmed the interactions of eEF1A1, p54nrb, PSF, hnRNP-L, GAPDH and ASF/SF2 with both polarities of the HDV RNA genome. In vitro transcription assays suggested a possible involvement of eEF1A1, GAPDH and PSF in HDV replication. At least three of these proteins, eEF1A1, GAPDH and ASF/SF2, have also been shown to associate with potato spindle tuber viroid (PSTVd) RNA. Because HDV’s structure and mechanism of replication share many similarities with viroids, subviral helper-independent plant pathogens, I transfected human hepatocytes with RNA derived from PSTVd. Here, I show that PSTVd RNA can replicate in human hepatocytes. I further demonstrate that a mutant of HDV, lacking the delta antigen coding region (miniHDV), can also replicate in human cells. However, both PSTVd and miniHDV require the function of the small delta antigen for successful replication. Our discovery that HDV and PSTVd RNAs associate with similar RNA-processing pathways and translation machineries during their replication provides new insight into HDV biology and its evolution.

HCV infects 170 million persons worldwide and is a serious global health problem. Genotype-3a is the dominant genotype in newly diagnosed infections within the UK and has a high response rate to interferon therapy, with up to 70% patients achieving a sustained virological response (SVR). The reason(s) for this are unknown; therefore the aim was to assess host and viral factors that determine treatment outcome of subtype-3a infection. Full-length subtype-3a viral sequence analysis identified 2 novel regions of hypervariability within E2 - HVR495 and HVR575, that are subject to positive selection pressure. A 5 amino-acid insertion found only in subtype-3a and a putative glycosylation site were contained within HVR575. These data suggest that HVR495 and HVR575 may serve as major antigenic sites in subtype-3a HCV infection. Successful treatment of chronic subtype-3a infection was not associated with pre-treatment quasispecies diversity and complexity, PePHD, HVR495 or HVR575 sequence. Different patterns of quasispecies variation were observed in patients that failed treatment. Subtype-3a specific CD8+ T-cell responses in chronic infection target non-structural proteins, in contrast to pre-dominant genotype-1 core-specific CD4+ T-cell responses. SVR was associated with a decline in subtype-3a specific and non-specific T-cell responses, and also total lymphocyte counts, which all recovered after treatment. These data do not support the theory that clearance of subtype-3a is associated with an enhancement of antiviral T-cell responses. Overlapping peptides detected a greater number of subtype-3a T-cell responses compared with peptides representing putative predicted CD8 epitopes. Therefore subtype-3a HCV is distinct from genotype-1 in terms of genome sequence, effect of treatment on quasispecies and subtype-3a specific T-cell responses, further emphasising the importance in understanding this distinct subtype.

For both influenza viruses and hepatitis C viruses, T cell responses to conserved antigens are one strategy for the human host to control the spread of infection. Such T cell responses can be generated with the use of viral vectored vaccines. Initially I show that the viral vectored vaccine MVA-NP+M1 can boost memory T cell responses to influenza A virus in adults aged over 50 years old. However within this group, MVA-NP+M1 had reduced immunogenicity in adults who were aged over 70 years old. The influenza virus-specific T cell responses comprised both CD4 and CD8 T cells, and were capable of secreting multiple Th1 cytokines. I then show that MVA-NP+M1 can be safely co-administered alongside seasonal influenza vaccine. The combination does not interfere with the peak T cell response that normally occurs 1 week following MVA-NP+M1. There was a statistically significant increase in antibodies to the H3N2 strain when the vaccines were co-administered, suggesting that the MVA-NP+M1 can act as an adjuvant. The efficacy of MVA-NP+M1 in humans had been previously evaluated in an influenza virus challenge study. I used a whole blood transcriptome approach to improve the classification of outcomes following influenza virus challenge. For subjects with laboratory-confirmed influenza, individuals with moderate/severe symptoms were found to have a distinct transcriptional signature comprising over 2,000 genes. I used a machine learning algorithm to reduce this variation down to just six genes (CCL2, SEPT4, LAMP3, RTP4, MT1G and OAS3). I validated this finding using expression data from an independently conducted challenge experiment. Data from these six genes was successfully able to predict symptomatic and asymptomatic cases with 89% and 100% accuracy respectively. To induce T cell responses to hepatitis C virus, I used the vaccines ChAd3-NSmut and MVA-NSmut in a prime-boost regimen. While the combination was highly immunogenic in healthy young adults, MVA-NSmut alone was unable to prime immune responses. The magnitude of T cell responses to the vaccine immunogen was correlated with the breadth of the T cell responses to different epitopes. Re-administration of the same two vaccines after a short time interval (8 weeks) did not improve upon previous peaks in T cell response. However with a longer time interval (> 34 weeks), some individuals were able to achieve higher frequencies of virus-specific T cells compared to the first round of vaccines. A whole blood transcriptome approach was used to study gene expression in volunteers vaccinated with ChAd3-NSmut and MVA-NSmut. Vaccination with MVA-NSmut results in a very strong, but relatively short-lived host gene expression signature. In contrast, the transcriptional response seen following ChAd3-NSmut was much less pronounced. A comparison of the functional analysis of gene lists from both vaccines showed that similar pathways were being activated and repressed.

The HBV RNAse H has been cloned into the PET43a vector, which contains the NusA protein which works as a solubilizing fusion protein. The fusion NUS-RNAse H protein was cleaved by enterokinase; the cleaved RNAse H is about 17 Kda which remains soluble and active. A fluorescence assay utilizing a quenching mechanism was used to characterize the activity of NUS-RNAse H and cleaved RNAse H proteins. The beacon is a RNA:DNA hybrid oligonucleotide labeled with a 5'DABCYL and a 3'fluorescein, when RNAse H digests the RNA, DABCYL is released resulting in high fluorescence. The digestion of the RNA was also confirmed by gel analysis. The protein was identified by N-terminal amino acid sequence analysis of the fusion protein, SDS-PAGE, western blot utilizing HBV positive sera for primary antibodies, and enzyme immunoassay by peroxidase labeling of HBV RNAse H. Structural analysis of the protein was done by circular dichroism, tryptophan fluorescence, the generation of a model from HIV RNAse H and initial crystals which unfortunately did not diffract. The ability to produce good amounts soluble RNAse H, the development of a sensitive assay to test for activity and the solution of the crystal structure will help develop new anti-viral inhibitors.

The Hepatitis B core antigen (HBcAg) has been proposed to be an ideal candidate for use as an adjuvant due to its immunogenicity, and tolerance to manipulations such as insertions of epitopes or covalent attachment of ligands. HBcAg is a complex macromolecule containing protein and nucleic acid. We investigated the effect of the removal and reconstitution of nucleic acids upon its structure. It’s been shown that the RNA content of hepadnavirus core antigens can be reduced significantly, but not be completely removed. Following removal of some of the RNA, antigens retain the ability to bind added nucleic acids, in particular, "immune-enhancing" synthetic oligonucleotides without affecting the structure of antigen or disrupting its ability to spontaneously self-assemble into core particles. The removal and addition of nucleic acids was successfully applied to an altered woodchuck core antigen, with a nucleic acid-based malaria epitope addition, giving rise to a potential vaccine adjuvant platform for malaria.

Hepatitis C Virus (HCV) infection represents a worldwide pandemic and is currently the leading cause of cirrhosis and liver transplantation. After transplantation recurrence is almost universal with 96% of patients testing positive for viral RNA and exhibiting histological evidence of infection within the first year. Type I interferons (IFN) and interferon inducible genes are responsible for the innate antiviral state and single nucleotide polymorphisms (SNPs) within these genes may affect the patients ability to respond post-transplantation. We hypothesize the elucidation of associations between SNPs in Type-I Interferon and Interferon inducible genes and HCV recurrence post-liver transplantation might help to identify HCV patients with different prognosis and improve liver transplant recipient selection. 100 HCV positive patients were genotyped using Allelic Discrimination on an ABI Prism 7700 sequence detector (Applied Biosystems) for SNPs in IFNB1, OAS-1, and ISG-15 to establish a relationship between SNPs and clinical complications post-transplantation. Quantitative real-time polymerase chain reaction (QPCR) was also run to determine the relationship between SNPs or disease state and the level of RNA expression. Results were collected and analyzed using Fishers exact test, Kaplan-Meir method, and the log-rank test. Results obtained indicated that SNPs in OAS-1 are associated with HCV recurrence within 12 months post-orthotopic liver transplantation (OLT) and OAS-1 SNP genotypes were significantly associated with the development of fibrosis within the first year. Additionally we observed an association between the SNP genotypes of OAS-1 and ISG-15 and CMV infection post-OLT. A significant distribution of ISG-15 genotypes was also found to correlate with acute rejection. These findings might help identify patients at high risk of developing complications within the first year.

The leading causes of liver disease are Hepatitis C virus infection and chronic alcohol abuse. Alcohol accelerates liver disease in HCV but the mechanisms are poorly understood. The identification of molecular gene expression profiles on human liver tissue was performed using microarrays. Samples were obtained from alcoholic-cirrhotic, HCV-cirrhotic, HCV/alcohol-cirrhotic and control non-cirrhotic liver tissue. Probe set expression summaries were calculated using RMA. Probe set level linear models were fit where probe set expression was modeled by HCV status, alcohol status, and the interaction between HCV and Alcohol. HCV cirrhosis was associated with up-regulation of genes related to viral and immune response, apoptosis and inflammation. There were down-regulation of genes in the ubiquititin-proteasome system in alcoholic cirrhosis. The interaction of HCV and alcohol revealed negative interaction for genes involved in apoptosis and immune response. There was a negative estimate for genes involved in class II restricted antigen presentation.