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新型抗病毒靶点为乙型肝炎病毒和丁型肝炎病毒的创新治疗概念提供了可能。

New antiviral targets for innovative treatment concepts for hepatitis B virus and hepatitis delta virus.

机构信息

INSERM, U1052, Lyon 69003, France; Cancer Research Center of Lyon (CRCL), Lyon 69008, France; University of Lyon, UMR_S1052, UCBL, 69008 Lyon, France.

INSERM, U1052, Lyon 69003, France; Cancer Research Center of Lyon (CRCL), Lyon 69008, France; University of Lyon, UMR_S1052, UCBL, 69008 Lyon, France; Hospices Civils de Lyon (HCL), 69002 Lyon, France; Institut Universitaire de France (IUF), 75005 Paris, France.

出版信息

J Hepatol. 2016 Apr;64(1 Suppl):S117-S131. doi: 10.1016/j.jhep.2016.02.016.

Abstract

Current therapies of chronic hepatitis B (CHB) remain limited to pegylated-interferon-alpha (PegIFN-α) or any of the five approved nucleos(t)ide analogues (NUC) treatments. While viral suppression can be achieved in the majority of patients with the high-barrier-to-resistance new-generation of NUC, i.e. entecavir and tenofovir, HBsAg loss is achieved by PegIFN-α and/or NUC in only 10% of patients, after a 5-year follow-up. Attempts to improve the response by administering two different NUC or a combination of NUC and PegIFN-α have not provided a dramatic increase in the rate of functional cure. Because of this and the need of long-term NUC administration, there is a renewed interest regarding the understanding of various steps of the HBV replication cycle, as well as specific virus-host cell interactions, in order to define new targets and develop new antiviral drugs. This includes a direct inhibition of viral replication with entry inhibitors, drugs targeting cccDNA, siRNA targeting viral transcripts, capsid assembly modulators, and approaches targeting the secretion of viral envelope proteins. Restoration of immune responses is a complementary approach. The restoration of innate immunity against HBV can be achieved, with TLR agonists or specific antiviral cytokine delivery. Restoration of adaptive immunity may be achieved with inhibitors of negative checkpoint regulators, therapeutic vaccines, or autologous transfer of engineered HBV-specific T cells. Novel targets and compounds will readily be evaluated using both relevant and novel in vitro and in vivo models of HBV infection. The addition of one or several new drugs to current therapies should offer the prospect of a markedly improved response to treatments and an increased rate of functional cure. This should lead to a reduced risk of antiviral drug resistance, and to a decreased incidence of cirrhosis and hepatocellular carcinoma (HCC).

摘要

目前慢性乙型肝炎 (CHB) 的治疗方法仍然局限于聚乙二醇干扰素-α (PegIFN-α) 或五种已批准的核苷(酸)类似物 (NUC) 治疗药物。虽然新一代具有高耐药屏障的 NUC,即恩替卡韦和替诺福韦,可以使大多数患者实现病毒抑制,但在 5 年随访后,只有 10%的患者通过 PegIFN-α 和/或 NUC 实现 HBsAg 丢失。通过给予两种不同的 NUC 或 NUC 与 PegIFN-α 的联合治疗来尝试提高反应率,并没有显著增加功能性治愈的比率。由于这一点以及长期使用 NUC 的需求,人们对理解 HBV 复制周期的各个步骤以及特定的病毒-宿主细胞相互作用重新产生了兴趣,以便确定新的靶点并开发新的抗病毒药物。这包括通过进入抑制剂直接抑制病毒复制、靶向 cccDNA 的药物、靶向病毒转录物的 siRNA、衣壳组装调节剂以及靶向病毒包膜蛋白分泌的方法。恢复免疫反应是一种补充方法。可以通过 TLR 激动剂或特定抗病毒细胞因子的传递来恢复针对 HBV 的先天免疫。通过抑制负性检查点调节剂、治疗性疫苗或自体转移工程化的 HBV 特异性 T 细胞,可以恢复适应性免疫。恢复免疫反应是一种补充方法。可以通过 TLR 激动剂或特定抗病毒细胞因子的传递来恢复针对 HBV 的先天免疫。通过抑制负性检查点调节剂、治疗性疫苗或自体转移工程化的 HBV 特异性 T 细胞,可以恢复适应性免疫。新型靶点和化合物将很容易使用相关和新颖的 HBV 感染体外和体内模型进行评估。在当前治疗方法的基础上添加一种或几种新药,有望显著改善治疗反应并提高功能性治愈率。这将降低抗病毒药物耐药的风险,并降低肝硬化和肝细胞癌 (HCC) 的发生率。

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