慢性乙型肝炎功能性治愈的药物研发:近期进展

Drug development for chronic hepatitis B functional cure: Recent progress.

作者信息

Liu Ting, Wang He, Zhao Yue, Wang Ying-Xin, Xing Xue, Gao Peng

机构信息

Department of Clinical Laboratory, The Second Affiliated Hospital of Dalian Medical University, Dalian 116021, Liaoning Province, China.

Graduate School Base Office, Dalian Medical University, Dalian 116000, Liaoning Province, China.

出版信息

World J Hepatol. 2025 Apr 27;17(4):105797. doi: 10.4254/wjh.v17.i4.105797.

Abstract

Chronic hepatitis B virus (HBV) infection affects approximately 254 million individuals globally, contributing to significant morbidity and mortality due to HBV-related liver failure and cirrhosis, which result in millions of fatalities each year. Although approved antiviral nucleos(t)ide analogues can effectively suppress HBV replication, their ability to reduce hepatitis B surface antigen (HBsAg) levels in plasma remains limited. The clinical application of the immunomodulator interferon-alpha is restricted by concerns regarding its safety and the severity of associated adverse reactions, rendering long-term administration challenging. Therefore, current drug development efforts for chronic hepatitis B aim to achieve a functional cure, which is defined as HBsAg serological clearance and sustained suppression of HBV DNA. This review discusses recent advancements in novel direct-acting therapeutic strategies for the treatment of chronic hepatitis B by focusing on the progresses in HBV entry inhibitors, monoclonal antibodies, RNA interferences, and other agents that directly target the virus. Furthermore, we discuss the development of immunomodulatory therapies, including TLR-7/8 agonists, immune checkpoint inhibitors, and therapeutic vaccines. In the end, we conclude by highlighting the importance of the rational combination-strategy design to improve the functional cure rate of HBV.

摘要

慢性乙型肝炎病毒(HBV)感染全球约2.54亿人,因HBV相关肝衰竭和肝硬化导致严重发病和死亡,每年造成数百万例死亡。尽管已批准的抗病毒核苷(酸)类似物可有效抑制HBV复制,但其降低血浆中乙型肝炎表面抗原(HBsAg)水平的能力仍然有限。免疫调节剂α干扰素的临床应用因对其安全性和相关不良反应严重程度的担忧而受到限制,长期给药具有挑战性。因此,目前针对慢性乙型肝炎的药物研发致力于实现功能性治愈,即HBsAg血清学清除和HBV DNA的持续抑制。本综述通过关注HBV进入抑制剂、单克隆抗体、RNA干扰和其他直接靶向病毒的药物的进展,讨论了治疗慢性乙型肝炎的新型直接作用治疗策略的最新进展。此外,我们还讨论了免疫调节疗法的发展,包括TLR-7/8激动剂、免疫检查点抑制剂和治疗性疫苗。最后,我们强调合理联合策略设计对于提高HBV功能性治愈率的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f385/12038417/6013ea9b78f6/105797-g001.jpg

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