Hepatitis C virus (HCV), a non-cytopathic positive-stranded RNA virus, is one of the most common causes of chronic liver diseases such as chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. Upon HCV infection, the majority of patients fail to clear the virus and progress to chronic hepatitis C. Chemokines are small chemotactic cytokines that direct the recruitment of immune cells and coordinate immune responses upon viral infection. Chemokine production during acute HCV infection contributes to the recruitment of immune cells with antiviral effector functions and subsequent viral clearance. In chronic HCV infection, however, continuous production of chemokines due to persistent viral replication might result in incessant recruitment of inflammatory cells to the liver, giving rise to persistence of chronic inflammation and liver injury. In this review, we will summarize the roles of chemokines in acute and chronic settings of HCV infection and the clinical relevance of chemokines in the treatment of hepatitis C.
Antiviral Agents/therapeutic use ; Chemokines/*metabolism ; Hepatitis C/drug therapy/*immunology/*metabolism ; Hepatitis C, Chronic/drug therapy/*immunology/*metabolism ; Humans

OBJECTIVETo investigate the immunocytodynamic changes in the livers of chronic hepatitis C patients treated with IFN alpha-2b and ribavirin and to find new bases for an effective immune regulation therapy.

METHODSForty-two chronic hepatitis C patients were treated with combined IFN alpha-2b and ribavirin and their peripheral blood and liver tissues were collected before the treatment for analyses. After the treatment, peripheral blood and liver tissue specimens were obtained from only 11 patients. All the specimens were exposed to three monoclonal antibody fluorescence dyes, and the CD45+ cells with triple colors were analyzed using flow cytometry.

RESULTSCompared to the control groups, the positive rates of CD56+, CD57+, CD161+ cells in the livers of those with chronic hepatitis C sharply decreased (Probability value less than 0.01), and CD56+T cells had decreased mildly; CD28 from the CD56+T cells decreased mildly, but the expression of CD152 increased (P<0.05); the positive rates of CD83+CD1a+ cells had decreased mildly, and the positive rates of CD80+CD11c+ and the CD86+CD11c+ cells significantly decreased (P<0.01). After the treatment, the CD56+, CD161+, CD56+T, CD161+T, CD80+CD11c+, CD86+CD11c+ cells in the responding group increased.

CONCLUSIONCombined interferon alpha-2b and ribavirin treatment can improve the suppressed cell immunity function.

Adult ; Aged ; Antigens, CD ; metabolism ; Antiviral Agents ; therapeutic use ; CTLA-4 Antigen ; Female ; Hepatitis C, Chronic ; drug therapy ; immunology ; Humans ; Interferon-alpha ; therapeutic use ; Killer Cells, Natural ; immunology ; Liver ; immunology ; Male ; Middle Aged ; Recombinant Proteins ; Ribavirin ; therapeutic use

Peg-interferon and ribavirin has been the standard therapy of chronic hepatitis C for the past 15 years in Korea. However, the treatment paradigm is changing. Direct acting agents (DAAs) are oral pills that can be easily taken. In addition, DAAs are more effective and have less adverse reactions compared to the previously used drugs. Chronic hepatitis C is hard to treat because the virus is error-prone virus. Host immunity is helpless against the hepatitis C virus since it evades the host immunity through various complex mechanisms. There are 6 genotypes. Quasispecies can co-exist even in the same patients. The treatment strategy is based on the combination of the individual drug corresponding to each step of viral replication process. NS5B nucleosides are the most powerful and effective drug available until now. Other drugs with different mechanisms of action can be used to provide synergy. NS5A and NS5B inhibition drugs currently belong to the leading group amongst many DAAs. These drugs will soon be available in Korea. We have to know the merits and adverse drug reactions of the new drug.
Antiviral Agents/*therapeutic use ; Drug Therapy, Combination ; Enzyme Inhibitors/therapeutic use ; Genotype ; Guidelines as Topic ; Hepacivirus/genetics ; Hepatitis C, Chronic/*drug therapy/immunology/virology ; Humans ; Viral Nonstructural Proteins/antagonists & inhibitors/metabolism

OBJECTIVETo investigate the dynamic changes that occur in T cell subsets, particularly involving the surface expression of programmed death 1 (PD-1), in response to pegylated (Peg)-interferon (IFN) a-2a therapy in patients with chronic hepatitis C virus (HCV) infection.

METHODSTwenty-five patients with HCV genotype 1b chronic infection and 10 healthy controls were enrolled in the study. All the HCV patients received combination antiviral therapy of Peg-IFNa-2a (180 mug/week) plus ribavirin. At treatment weeks 0 (baseline), 4, 12, 24 and 48, the level of PD-1 protein expression on the surface of total peripheral CD8+ and CD4+ T cells was determined by flow cytometry and the level of PD-1 mRNA expression in peripheral blood mononuclear cells (PBMCs) was determined by reverse transcription-polymerase chain reaction. Independent student's t-test were used to compare mean values between the two groups, repeat measure variance analysis was used to compare mean values among multiple groups, and Pearson's correlation coefficient was used to assess correlation significance.

RESULTSOver the course of antiviral therapy, the proportions of CD4+ T cells and CD8+ T cells, as well as the CD4+/CD8+ ratio, increased (F = 81.23, 39.28, and 7.01 respectively; all P less than 0.01). In contrast, the PD-1 protein expression frequency on CD4+ T cells and CD8+ T cells significantly declined (F = 100.11 and 158.40 respectively; all P less than 0.01). The PD-1-mRNA expression level in PBMCs was: 1.40+/-0.26 at baseline, 1.30+/-0.27 at week-4, 1.14+/-0.18 at week-12, 1.06+/-0.26 at week-24, and 0.83+/-0.25 at week-48 (F = 20.09; P less than 0.01). A positive correlation existed between the PD-1 protein expression frequencies on CD4+ T cells and CD8+ T cells and the HCV RNA load detected at baseline (r = 0.82 and 0.75 respectively; all P less than 0.01).

CONCLUSIONThe ability of Peg-IFN-a-2a-based antiviral therapy to suppress HCV replication may involve reduction of PD-1 protein expression on the surface of CD8+ T cells and CD4+ T cells.

Adolescent ; Adult ; Antiviral Agents ; therapeutic use ; CD4-CD8 Ratio ; Case-Control Studies ; Female ; Hepatitis C, Chronic ; drug therapy ; immunology ; Humans ; Interferon-alpha ; therapeutic use ; Male ; Middle Aged ; Polyethylene Glycols ; therapeutic use ; Programmed Cell Death 1 Receptor ; metabolism ; Recombinant Proteins ; therapeutic use ; Ribavirin ; therapeutic use ; T-Lymphocyte Subsets ; metabolism ; Young Adult