The Journal of Clinical Investigation RESEARCH ARTICLE SIGLEC-3 (CD33) serves as an immune checkpoint receptor for HBV infection Tsung-Yu Tsai,1,2 Ming-Ting Huang,3 Pei-Shan Sung,3 Cheng-Yuan Peng,2,4 Mi-Hua Tao,5 Hwai-I Yang,3 Wei-Chiao Chang,6 An-Suei Yang,3 Chung-Ming Yu,3 Ya-Ping Lin,3 Ching-Yu Bau,3 Chih-Jen Huang,3 Mei-Hung Pan,3 Chung-Yi Wu,3 Chwan-Deng Hsiao,7 Yi-Hung Yeh,7 Shiteng Duan,8 James C Paulson,8 and Shie-Liang Hsieh3,9,10,11 1PhD Program for Translational Medicine, China Medical University and Academia Sinica, Taichung, Taiwan. 2Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan. 3Genomics Research Center, Academia Sinica, Taipei, Taiwan. 4 School of Medicine, China Medical University, Taichung, Taiwan. 5Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan. 6Department of Clinical Pharmacy, Taipei Medical University, Taipei, Taiwan. 7Institute of Molecular Biology, Academia Sinica, Taipei, Taiwan. 8Department of Molecular Medicine, Scripps Research, La Jolla, California, USA. 9Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. 10Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan. 11Institute for Cancer Biology and Drug Discovery, Taipei Medical University, Taipei, Taiwan. Chronic hepatitis B (CHB) infection is rarely eradicated by current antiviral nucleos(t)ide analogues. We found that α2,6- biantennary sialoglycans of HBV surface antigen (HBsAg) bound human SIGLEC-3 (CD33) by IP and ELISA, and the binding affinity between SIGLEC-3 and α2,6-biantennary sialoglycans was determined by biolayer interferometry (equilibrium dissociation constant [KD]: 1.95 × 10–10 ± 0.21 × 10–10 M). Moreover, HBV activated SIGLEC-3 on myeloid cells and induced immunosuppression by stimulating immunoreceptor tyrosine-based inhibitory motif phosphorylation and SHP-1/-2 recruitment via α2,6-biantennary sialoglycans on HBsAg. An antagonistic anti–SIGLEC-3 mAb reversed this effect and enhanced cytokine production in response to TLR-7 agonist GS-9620 in PBMCs from CHB patients. Moreover, anti–SIGLEC-3 mAb alone was able to upregulate the expression of molecules involved in antigen presentation, such as CD80, CD86, CD40, MHC-I, MHC-II, and PD-L1 in CD14+ cells. Furthermore, SIGLEC-3 SNP rs12459419 C, which expressed a higher amount of SIGLEC-3, was associated with increased risk of hepatocellular carcinoma (HCC) in CHB patients (HR: 1.256, 95% CI: 1.027– 1.535, P = 0.0266). Thus, blockade of SIGLEC-3 is a promising strategy to reactivate host immunity to HBV and lower the incidence of HCC in the CHB patient population. Introduction though patients are able to produce antibodies against HBcAg HBV infection is a worldwide health problem, and chronic HBV and HBeAg. It is still a mystery why CHB patients are unable to infection frequently results in liver cirrhosis and hepatocellu- produce anti-HBsAg antibody during all 4 phases. lar carcinoma (HCC). In HBV-infected hepatocytes, viral DNA The persistent presence of serum HBsAg and viral DNA pro- enters the nucleus and becomes covalently closed circular DNA duced by HBV cccDNA in infected hepatocytes is the prominent (cccDNA), thereby producing a large number of viral proteins, feature of CHB infection (5). The ideal goals for CHB therapy including HBV surface antigen (HBsAg), early antigen (HBeAg), include loss of HBsAg, induction of anti-HBsAg antibody, and core antigen (HBcAg), and X protein (HBx). Chronic HBV (CHB) eradication of cccDNA from the liver (5), but current antiviral treat- infection can be divided into 4 phases (1–3). The immune toler- ments do not induce sufficient anti-HBsAg antibodies to achieve ance phase does occur in young CHB patients, although recent serum HBsAg loss. Present nucleotide analogue treatment results data suggest it is uncommon even in this age group (4). In the in a reduction in HBsAg in only 5%–8% of patients who are HBeAg immune clearance phase, activation of host immunity causes positive and less than 1% of patients who are HBeAg negative liver inflammation, liver fibrosis with repeated episodes of liver (6–8). In the Checkmate 040 study, only 3 of 51 (6%) CHB patients injury, and detectable HBcAg-specific antibody. In the residual with HCC had a limited decline of serum HBsAg level after anti– inactive phase (or low replicative phase), HBeAg seroconversion PD-1 mAb (nivolumab) treatment (9). Another extensive study and decreased viral load are observed. Reactivation of HBV repli- showed 1 in 10 CHB patients had an HBsAg decline when treated cation (viral DNA greater than 2 log10 IU/mL) occurs after remis- with a combination of nivolumab (anti–PD-1 mAb) and GS-4774 sion. Severe liver inflammation is observed in the HBeAg-neg- (therapeutic HBV vaccine) (10). Blockade of the PD-1/PD-L1 ative chronic hepatitis phase (or high replicative phase), even pathway results in reactivation of HBV infection in 6 of 114 (5.3%) cancer patients with CHB infection (11), indicating that the effi- cacy of activating nonspecific T cell–mediated immunity for CHB Conflict of interest: The authors have declared that no conflict of interest exists. treatment is still far from satisfactory. Copyright: © 2021, American Society for Clinical Investigation. It has been reported that HBsAg is able to attenuate IL-12 and Submitted: July 6, 2020; Accepted: April 14, 2021; Published: June 1, 2021. Reference information: J Clin Invest. 2021;131(11):e141965. IFN-α secretion in DCs stimulated with TLR-3 ligands (12, 13). https://doi.org/10.1172/JCI141965. Moreover, HBV has been shown to suppress poly (I:C) + IFN-γ– 1 RESEARCH ARTICLE The Journal of Clinical Investigation induced IL-12 as well as TLR-2 ligand–induced TNF-α expression Results in DCs (14). However, the underlying molecular mechanism is Glycan structure on HBsAg. Since glycosylation is species specific, still unknown. Furthermore, TLR-7 agonist GS-9620 has been we compared the sialoglycans in HBV from CHB patients (hHBV) shown to induce IFN-α and reduce the HBsAg serum level in and transgenic mice (mHBV). The hHBV (genotype C) and mHBV HBV-infected chimpanzees (15), but GS-9620 is unable to elim- (genotype D) were harvested from human and mouse sera, inate cccDNA in human hepatic cells (16) or to reduce the HBsAg respectively, by CsCl2 ultracentrifugation followed by nano-flow serum level in clinical trials (17). These observations suggest that LC-MS/MS analysis to determine glycan structures. We found that an alternative approach is needed to develop a better strategy to the P142SDGN146CTCIPIPSSWAF158 peptide fragment of human treat CHB patients. HBsAg (hHBsAg) contained the Neu5Ac(α2-6)-Gal(β1-4)-GlcNAc HBV has been reported to contain a biantennary α2–6 linked conjugated to Asn-146 (Figure 1, A and B). We further determined sialoglycan [Neu5Ac(α2-6)-Gal(β1-4)-GlcNAc(β1-2)-Man], which the linkage of the terminal sialic acid to galactose by pseudo-MS is identical to human biantennary α2–6 linked sialoglycans (18, (Figure 1C), where the low m/z 274.12 and m/z 292.15 suggests 19), at Asn-146 of HBsAg (20, 21). Sialoglycans can modulate host the presence of Neu5Ac(α2-6)-Gal(β1-4)-GlcNAc (38). Approxi- immune responses via binding to the sialic acid–binding Ig-like lec- mately 92.1% of peptides contained biantennary N-glycans with tins (SIGLECs) (22). SIGLECs comprise 2–17 extracellular Ig-like either 2 terminal sialic acids (biS2, 56.2%) or 1 terminal sialic acid domains and a ligand-binding N-terminal V set domain. Except (biS1, 35.9%) (Figure 1D). In contrast, peptide P142SDGN146CT- for SIGLEC-14, -15, and -16, the majority of human SIGLECs con- CIPIPSSWAF158 of mHBV did not contain an N-glycan conjugated tain a cytoplasmic immunoreceptor tyrosine-based inhibitory to Asn-146 (Figure 1E). Thus, we conclude that the biantennary motif (ITIM), which recruits the protein tyrosine phosphatase 1/2 Neu5Ac(α2-6)-Gal(β1-4)-GlcNAc(β1-2)-Man conjugated to Asn- (SHP-1/-2) to attenuate cell activation (23, 24). The downstream 146 in HBsAg was only observed in hHBV but not mHBV. signaling of myeloid inhibitory SIGLECs (such as SIGLEC-3, -7, and Interactions between HBV Asn-146 sialoglycan and human -9) is similar to that of the ITIM-containing immune checkpoint SIGLEC-3. Because the biantennary sialoglycan on HBsAg is sim- receptor programmed cell death protein-1 (PD-1) and cytotoxic T ilar to the ligands of human SIGLEC-3, -7, and -9 (22), we asked lymphocyte–associated antigen 4 (CTLA4) (25–27), which are suc- whether the HBV virion interacts with any of these 3 SIGLECs. To cessfully targeted by antagonistic mAbs for cancer immunotherapy address this question, recombinant SIGLEC-ECD.Fc fusion pro- (28–31). Moreover, correlations between SNPs in the genes encod- teins (comprising the extracellular domain of SIGLEC-3, -7, and -9 ing SIGLECs and various diseases have been reported, such as the and human IgG1 Fc portion) were used to pull down HBV virions, SIGLEC-3 (CD33) SNP associated with Alzheimer disease (32), the which were purified from human sera (genotype C) (Figure 2A) SIGLEC-9 SNP associated with chronic obstructive pulmonary dis- and mouse sera (genotype D) (Figure 2B) followed by Western blot ease (COPD) (33), and the SIGLEC-8 SNP associated with bronchi- analysis using HRP-conjugated anti-HBsAg antibodies (see com- al asthma (34). These observations suggest that SIGLECs may play plete unedited blots in the supplemental material). We found that critical roles in various human diseases. HRP-conjugated anti-HBsAg antibody could detect 6 bands corre- Because activation of SIGLECs downregulates TLR-induced sponding to glycosylated and unglycosylated HBsAg (large, mid- cytokine release in DCs (35, 36), we sought to identify SIGLECs dle, and small) of hHBV and mHBV (Figure 2, A and B).