Resumo: A composição de quasiespécies do vírus da Hepatite C (HCV) pode ter implicações importantes com relação à persistência viral e à resposta a terapia baseada em Interferon. A região NS5A completa foi analisada para avaliar se a composição de quasiespécies do HCV 1a/1b está relacionada à resposta ao tratamento combinado de interferon peguilado (PEGIFN) e ribavirina. Seiscentos e noventa seqüências correspondentes a região não estrutural 5A (NS5A) completa foram geradas a partir de amostras coletadas antes, durante a após a administração da terapia de pacientes respondedores, não respondedores e respondedores ao final do tratamento. Este estudo apresenta evidências de que a homogeneidade da composição de quasiespécies, e a baixa complexidade e diversidade da região NS5A em amostras préterapia estão associados à resposta virológica sustentada. Portanto, a alta diversidade e complexidade de quasiespécies podem fornecer ao vírus melhores oportunidades de evadir a terapia antiviral. Análises filogenéticas não demonstraram o agrupamento das seqüências de acordo os padrões específicos de resposta ao tratamento. Contudo, o agrupamento distinto de seqüências pré e pós-terapia foi observado, sugerindo que um processo adaptativo ocorreu durante o período analisado. Adicionalmente, a dinâmica evolutiva da composição de quasiespécies demonstrou estar sob pressão seletiva purificadora ou purificadora relaxada, o que é condizente com a população de quasiespécies diversificada no pré-terapia, seguida de um aumento em freqüência de quasiespécies predominantes nas amostras pós-tratamento, provavelmente devido a conferirem alguma vantagem ao vírus. Estes resultados sugerem que a diversidade de quasiespécies da região NS5A pode ser importante para o entendimento dos mecanismos de baixa resposta virológica sustentada em pacientes com Hepatite C crônica / Abstract: The quasispecies composition of Hepatitis C virus (HCV) could have important implications with regard to viral persistence and response to interferon-based therapy. The complete NS5A was analyzed to evaluate whether the composition of NS5A quasispecies of HCV 1a/1b is related to responsiveness to combined interferon pegylated (PEG-IFN) and ribavirin therapy. Six hundred and ninety full-length NS5A sequences were generated from samples collected before, during and after treatment from virological sustained responder, non-responder and the end-of-treatment responder patients. This study provides evidence that homogeneity of quasispecies composition, low diversity and less complexity of the NS5A region pre-therapy are associated with viral clearance. Therefore, higher diversity and complexity of quasispecies could offer the virus a better opportunity of evading anti-viral therapy. Phylogenetic relationships concerning complete NS5A sequences obtained from patients did not demonstrate clustering associated with specific response patterns. However, distinctive clustering of pre/post-therapy sequences was observed, suggesting that an evolutionary process occurred during the time course examined. In addition, the evolution of quasispecies over time was subjected to purifying or relaxed purifying selection. This could explain the initial diversified composition of quasispecies at baseline, followed by an increase in the frequency of a predominant quasispecies in 'after treatment' samples of non-responders and end-of-treatment responders, probably because it offers some advantage for the virus. These results suggest that quasispecies diversity of the NS5A region could be important for elucidating the mechanism underlying treatment failure in patients infected with chronic hepatitis C / Orientador: Paula Rahal / Coorientador: Isabel Maria Vicente Guedes Carvalho-Mello / Banca: Camila Malta Romano / Banca: Jonny Yokosawa / Banca: Maurício Lacerda Nogueira / Banca: Fátima Pereira de Souza / Doutor

Made available in DSpace on 2014-06-11T19:32:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-25Bitstream added on 2014-06-13T20:03:27Z : No. of bitstreams: 1 jardim_acg_dr_sjrp.pdf: 1650863 bytes, checksum: 6ecdc00802358d3e90fac9c3024108d4 (MD5) / A composição de quasiespécies do vírus da Hepatite C (HCV) pode ter implicações importantes com relação à persistência viral e à resposta a terapia baseada em Interferon. A região NS5A completa foi analisada para avaliar se a composição de quasiespécies do HCV 1a/1b está relacionada à resposta ao tratamento combinado de interferon peguilado (PEGIFN) e ribavirina. Seiscentos e noventa seqüências correspondentes a região não estrutural 5A (NS5A) completa foram geradas a partir de amostras coletadas antes, durante a após a administração da terapia de pacientes respondedores, não respondedores e respondedores ao final do tratamento. Este estudo apresenta evidências de que a homogeneidade da composição de quasiespécies, e a baixa complexidade e diversidade da região NS5A em amostras préterapia estão associados à resposta virológica sustentada. Portanto, a alta diversidade e complexidade de quasiespécies podem fornecer ao vírus melhores oportunidades de evadir a terapia antiviral. Análises filogenéticas não demonstraram o agrupamento das seqüências de acordo os padrões específicos de resposta ao tratamento. Contudo, o agrupamento distinto de seqüências pré e pós-terapia foi observado, sugerindo que um processo adaptativo ocorreu durante o período analisado. Adicionalmente, a dinâmica evolutiva da composição de quasiespécies demonstrou estar sob pressão seletiva purificadora ou purificadora relaxada, o que é condizente com a população de quasiespécies diversificada no pré-terapia, seguida de um aumento em freqüência de quasiespécies predominantes nas amostras pós-tratamento, provavelmente devido a conferirem alguma vantagem ao vírus. Estes resultados sugerem que a diversidade de quasiespécies da região NS5A pode ser importante para o entendimento dos mecanismos de baixa resposta virológica sustentada em pacientes com Hepatite C crônica / The quasispecies composition of Hepatitis C virus (HCV) could have important implications with regard to viral persistence and response to interferon-based therapy. The complete NS5A was analyzed to evaluate whether the composition of NS5A quasispecies of HCV 1a/1b is related to responsiveness to combined interferon pegylated (PEG-IFN) and ribavirin therapy. Six hundred and ninety full-length NS5A sequences were generated from samples collected before, during and after treatment from virological sustained responder, non-responder and the end-of-treatment responder patients. This study provides evidence that homogeneity of quasispecies composition, low diversity and less complexity of the NS5A region pre-therapy are associated with viral clearance. Therefore, higher diversity and complexity of quasispecies could offer the virus a better opportunity of evading anti-viral therapy. Phylogenetic relationships concerning complete NS5A sequences obtained from patients did not demonstrate clustering associated with specific response patterns. However, distinctive clustering of pre/post-therapy sequences was observed, suggesting that an evolutionary process occurred during the time course examined. In addition, the evolution of quasispecies over time was subjected to purifying or relaxed purifying selection. This could explain the initial diversified composition of quasispecies at baseline, followed by an increase in the frequency of a predominant quasispecies in ‘after treatment’ samples of non-responders and end-of-treatment responders, probably because it offers some advantage for the virus. These results suggest that quasispecies diversity of the NS5A region could be important for elucidating the mechanism underlying treatment failure in patients infected with chronic hepatitis C

The current treatment for hepatitis C virus (HCV) infection – combination therapy with pegylated interferon and ribavirin – elicits sustained responses in only ~50% of the patients treated. Greater cumulative exposure to ribavirin increases response to interferon-ribavirin combination therapy. A key limitation, however, is the toxic sideeffect of ribavirin, hemolytic anemia, which often necessitates a reduction of ribavirin dosage and compromises treatment response. Maximizing treatment response thus requires striking a balance between the antiviral and hemolytic activities of ribavirin. Current models of viral kinetics describe the enhancement of treatment response due to ribavirin. Ribavirin-induced anemia, however, remains poorly understood and precludes rational optimization of combination therapy. Here, we develop a new mathematical model of the population dynamics of erythrocytes that quantitatively describes ribavirin-induced anemia in HCV patients. Based on the assumption that ribavirin accumulation decreases erythrocyte lifespan in a dose-dependent manner, model predictions capture several independent experimental observations of the accumulation of ribavirin in erythrocytes and the resulting decline of hemoglobin in HCV patients undergoing combination therapy, estimate the reduced erythrocyte lifespan in patients and describe inter-patient variations in the severity of ribavirin-induced anemia. Further, model predictions estimate the threshold ribavirin exposure beyond which anemia becomes intolerable and suggest guidelines for the usage of growth hormones. A small fraction of the population (~30%) with polymorphisms in the ITPA gene shows protection from ribavirin-induced anemia. The optimum dosage of ribavirin that can be tolerated is then dependent on the ITPA polymorphisms. Coupled with a previous population pharmacokinetic study, our model yields a facile formula for estimating the optimum dosage given a patient’s weight, creatinine clearance, pretreatment hemoglobin levels, and ITPA polymorphism. The reduced lifespan we predict is in agreement with independent measurements from breath tests as well as estimates derived from in vitro studies of ATP depletion. The latter estimates also agree with the extent of ATP depletion due to ribavirin that we predict from a detailed analysis of the nucleoside metabolism in erythrocytes. Our model thus facilitates in conjunction with models of viral kinetics the rational identification of treatment protocols. Our formula for optimum dose presents an avenue for personalizing ribavirin dosage. By keeping anemia tolerable, the predicted optimal dosage may improve adherence, reduce the need for drug monitoring, and increase response rates.