The Impact of Interferon Lambda 3 Gene Polymorphism on Natural Course and Treatment of Hepatitis C
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Hindawi Publishing Corporation Clinical and Developmental Immunology Volume 2012, Article ID 849373, 9 pages doi:10.1155/2012/849373 Review Article The Impact of Interferon Lambda 3 Gene Polymorphism on Natural Course and Treatment of Hepatitis C F. Bellanti, 1 G. Vendemiale,1, 2 E. Altomare,1 and G. Serviddio1 1 Department of Medical and Occupational Sciences, C.U.R.E. Centre for Liver Disease Research and Treatment, University of Foggia, Italy 2 IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy Correspondence should be addressed to G. Serviddio, [email protected] Received 28 April 2012; Accepted 2 July 2012 Academic Editor: Domenico Sansonno Copyright © 2012 F. Bellanti et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Host genetic factors may predict the outcome and treatment response in hepatitis C virus (HCV) infection. Very recently, three landmark genome-wide association studies identified single nucleotide polymorphisms near the interleukin 28B (IL28B) region which were more frequent in responders to treatment. IL28B encodes interferon (IFN)λ3, a type III IFN involved in host antiviral immunity. Favourable variants of the two most widely studied IL28B polymorphisms, rs12979860 and rs8099917, are strong pretreatment predictors of early viral clearance and sustained viral response in patients with genotype 1 HCV infection. Further investigations have implicated IL28B in the development of chronic HCV infection versus spontaneous resolution of acute infection and suggest that IL28B may be a key factor involved in host immunity against HCV. This paper presents an overview about the biological activity and clinical applications of IL28B, summarizing the available data on its impact on HCV infection. Moreover, the potential usefulness of IFNλ in the treatment and natural history of this disease is also discussed. 1. Introduction progression. Currently, pegylated interferon (PEG-IFN) plus ribavirin (RBV) is considered the standard of care for chronic More than 20 years after the discovery of the hepatitis C hepatitis C, but the rate of SVR is around 50% in patients virus (HCV) in 1989, it is now well established that HCV with HCV genotype 1, the most common genotype [5, 6]. infection affects all countries, leading to a major global health Because PEG-IFN/RBV therapy is costly and often accompa- problem that requires widespread active interventions for its nied by several adverse effects, pre-treatment predictions of prevention and control [1]. Prevalence data estimate that those patients who are unlikely to benefit from this regimen 130–170 million persons, or 2-3% of the world population enables ineffective treatment to be avoided. Viral load and are infected with HCV [2]. HCV infection is characterized viral genotypes and the stage of liver disease strongly predict by two distinct outcomes: in about 30% of cases, innate the response to HCV treatment [7, 8]. Moreover, host genetic andadaptiveimmuneresponsesachieveapermanentcontrol differences may influence the response to HCV treatment. of infection, referred to as spontaneous HCV clearance; Recently, through a genome-wide association study (GWAS) however, most frequently, the host immune responses fail of patients infected by genotype 1 HCV, it has been reported and chronic infection is established [3]. Chronic hepatitis that single nucleotide polymorphisms (SNPs) linked to C is highly heterogeneous in clinical presentation and out- the cytokine IFNλ3 (also known as IL28B) are strongly comes. This heterogeneity may be dependent on virus geno- associated with a response to PEG-IFN/RBV therapy [9– type but is also largely related to host factors that have been 12]. There has subsequently been rapidly increasing data clearly proven to affect the severity and rapidity of disease regarding the significance of the IL28B polymorphism not progression [4]. The successful eradication of HCV in chron- only in response to therapy but also in spontaneous clearance ically infected patients, defined as a sustained virological of acute HCV infection. Clinically available tests then made response (SVR), is associated with a reduced risk of disease IL28B genotype testing become part of the standard of care. 2 Clinical and Developmental Immunology Genetic analysis of the host may thus predict which patients clinical setting has started for hepatitis C: pegylated rHu are more likely to respond to treatment, taking into account IFNλ (PEG-IFNλ) has now been evaluated in two phase that IL28B genotype is only one of many factors that can 1 clinical trials [28, 29]. The initial phase 1A study was influence response rates to PEG-IFN/RBV therapy in HCV designed to evaluate the safety, tolerability, pharmacokinetic, infection and should be interpreted in the context of other and pharmacodynamic activity of a single dose of PEG-IFNλ clinical factors predicting SVR. in healthy volunteers; a few participants developed reversible, dose-related increases in liver transaminases, but PEG-IFNλ 2. The IFNλ Family did not induce fever, fatigue, or any overt haematological changes [28]. The phase 1B study has been conducted in IFNλ was identified during the recent years and classified as a patients with chronic genotype 1 HCV infection, mostly non new group, type III IFN. The IFNλ gene family is composed responders to PEG-IFN/RBV therapy; PEG-IFNλ induced of three distinct genes: IFNλ1 (IL29), IFNλ2 (IL28A), and significant decreases in the levels of HCV, was well tolerated, IFNλ3 (IL28B) [13, 14]. The members of this IFN family and did not induce any significant haematological toxicities interact through unique receptors that are distinct from type such as neutropenia, thrombocytopenia, or anemia [29]. I(IFNα/β)andtypeII(IFNγ) IFN receptors. The receptor However, this study lacks a direct comparison between IFNλ for type III IFN is composed of the unique IFNλR1 chain, and IFNα and the influence of viral and patient genotypes, also called IL28Rα and the IL10R2 chain, which is shared and it is not clear whether the antiviral effects are mediated with IL10, IL22, and IL26 receptor complexes (Figure 1)[15]. directly or through the stimulation of immune cells or IL28A, IL28B, and IL29 are clustered together on chromo- both. Since the presumed effects of IFNλ on viral clearance some 19 (19q13.13 region) and are coexpressed together with observed in the GWAS are mediated through treatment with other type I IFNs (IFNα and IFNβ) by virus-infected cells exogenous IFNα, it is conceivable that although IFNλ may [13, 14]. IFNλRsareexpressedatvariablelevelsonmost be less potent than IFNα as a direct antiviral, taken together cell types, and they mediate signalling resulting in induction these cytokines may have an additive effect [24]. of many of the same genes that are induced by signalling through IFNα/β Rs [13]. Very interestingly, hepatocytes from 3. The Effect of IFNλ3Polymorphismon liver biopsy specimens have a high IFNλ receptor expression IFNλ Biology (IL28Rα), while no expression is evidenced on fibroblasts, endothelial cells, adipocytes, or primary central nervous IL28B/IFNλ3 may harbour the ability to induce potent system cells [16–18]. innate antiviral responses in vitro via signalling through Signalling through type I (IFNα/β) or type III (IFNλ) the IL28 receptor complex, whose expression has been IFN receptor complexes results in the formation of a verified on a variety of cells, including lymphocytes [24, transcription factor complex known as IFN-stimulated gene 30, 31]. Moreover, studies performed in vivo showed that factor 3 (ISGF3), which consists of three proteins: STAT1, IL28B/IFNλ3 had the potential to induce helper T-cell type STAT2 and IRF-9 (also known as ISGF3γ or p48). After it 1-biased adaptive cellular immune responses [32]. IFNλ3 is fully assembled, ISGF3 translocates to the nucleus where has significant influence on antigen-specific CD8+ T-cell it binds to IFN-stimulated response elements (ISREs) in function, especially in regards to cytotoxicity, since it is a the promoters of various IFN-stimulated genes classically potent effector of the immune system with special emphasis associated with the antiviral phenotype, including OAS1, on CD8+ T-cell killing functions [32]. MX1, IRF7,andEIF2AK2 [double-stranded RNA-activated IFNλ3 is to date the only member of type III interferons protein kinase (PKR)] [19]. The proteins encoded by these with genetic variations associated with differential expression genes mediate the antiviral activity induced by the IFNs [20]. profiles for downstream genes involved in the immune As a result, the downstream biological activities induced by response and outcome for a disease that exhibits symptoms either IFNα or IFNλ are very similar, including induction of of dysregulation of the immune response. In 2009, three antiviral and antiproliferative activity in many cell types. genome-wide association studies reported an association There are currently very limited available data comparing between SVR and two SNPs located near the gene region the different biological activity of the three IFNλs. Biological encoding IFNλ3 (IL28B; rs12980275 and rs8099917) in activity ultimately depends on the receptor cytoplasmic HCV-infected patients treated with PEG-IFN/RBV com- domains, which are not related, and these may trigger over- bination therapy [9–11]. Further subsequent studies well lapping but different