Serre Stéphanie B N, Jensen Sanne B, Ghanem Lubna, Humes Daryl G, Ramirez Santseharay, Li Yi-Ping, Krarup Henrik, Bukh Jens, Gottwein Judith M
Copenhagen Hepatitis C Program (CO-HEP), Department of Infectious Diseases and Clinical Research Centre, Hvidovre Hospital, and Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Section of Molecular Diagnostics, Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.
Antimicrob Agents Chemother. 2016 May 23;60(6):3563-78. doi: 10.1128/AAC.02929-15. Print 2016 Jun.
Hepatitis C virus (HCV) NS3 protease inhibitors (PIs) are important components of novel HCV therapy regimens. Studies of PI resistance initially focused on genotype 1. Therefore, knowledge about the determinants of PI resistance for the highly prevalent genotypes 2 to 6 remains limited. Using Huh7.5 cell culture-infectious HCV recombinants with genotype 1 to 6 NS3 protease, we identified protease positions 54, 155, and 156 as hot spots for the selection of resistance substitutions under treatment with the first licensed PIs, telaprevir and boceprevir. Treatment of a genotype 2 isolate with the newer PIs vaniprevir, faldaprevir, simeprevir, grazoprevir, paritaprevir, and deldeprevir identified positions 156 and 168 as hot spots for resistance; the Y56H substitution emerged for three newer PIs. Substitution selection also depended on the specific recombinant. The substitutions identified conferred cross-resistance to several PIs; however, most substitutions selected under telaprevir or boceprevir treatment conferred less resistance to certain newer PIs. In a single-cycle production assay, across genotypes, PI treatment primarily decreased viral replication, which was rescued by PI resistance substitutions. The substitutions identified resulted in differential effects on viral fitness, depending on the original recombinant and the substitution. Across genotypes, fitness impairment induced by resistance substitutions was due primarily to decreased replication. Most combinations of substitutions that were identified increased resistance or fitness. Combinations of resistance substitutions with fitness-compensating substitutions either rescued replication or compensated for decreased replication by increasing assembly. This comprehensive study provides insight into the selection patterns and effects of PI resistance substitutions for HCV genotypes 1 to 6 in the context of the infectious viral life cycle, which is of interest for clinical and virological HCV research.
丙型肝炎病毒(HCV)NS3蛋白酶抑制剂(PIs)是新型HCV治疗方案的重要组成部分。对PI耐药性的研究最初集中在1型基因型上。因此,关于高流行的2至6型基因型PI耐药性决定因素的了解仍然有限。我们使用具有1至6型NS3蛋白酶的Huh7.5细胞培养感染性HCV重组体,确定了蛋白酶第54、155和156位是在用首个获批的PIs(特拉匹韦和波普瑞韦)治疗时选择耐药性替代位点的热点。用新型PIs(万尼普明、法达普明、simeprevir、格佐普明、帕瑞普明和地德普明)治疗2型基因型分离株时,确定第156和168位是耐药热点;三种新型PIs出现了Y56H替代。替代选择也取决于特定重组体。所确定的替代导致对几种PIs产生交叉耐药性;然而,在特拉匹韦或波普瑞韦治疗下选择的大多数替代对某些新型PIs的耐药性较低。在单周期生产试验中,跨基因型来看,PI治疗主要降低病毒复制,而PI耐药性替代可挽救这种降低。所确定的替代对病毒适应性产生不同影响,这取决于原始重组体和替代情况。跨基因型来看,耐药性替代引起的适应性损害主要是由于复制减少。所确定的大多数替代组合增加了耐药性或适应性。耐药性替代与适应性补偿替代的组合要么挽救了复制,要么通过增加组装来补偿复制减少。这项全面研究深入了解了在感染性病毒生命周期背景下HCV 1至6型基因型PI耐药性替代的选择模式和影响,这对临床和病毒学HCV研究具有重要意义。