2. Outline:
• Introduction.
• Life cycle and Spaces.
• Expected.
• Evidence based Literature and Text books.
• Which immune responses are believed to be protective..?
• Vaccine.
• Abbreviation.
• References.
2
3. Introduction*
• The hepatitis C virus is ssRNA virus.
• Has 6 genotypes.
• Frequency 143 million and Deaths=496,000
• Human and chimpanzee only.
3
4. 4
• consists of a core of (RNA),
surrounded by protective shell
of protein encased in a lipid
envelope of cellular origin.
• Two envelope Glycoprotien E1
and E2, are embedded in the
lipid envelop.
Introduction (cont.)
Structure:
5. Introduction(cont.)
Pathology
15% of cases develop
acute. But, rarely
does have liver failure .The
infection resolves
spontaneously more
frequently in young and
females.
85% of cases develop a
chronic infection .they
experience minimal
symptoms during the
initial stage but, after
several years they may
have cirrhosis or HCC.
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6. Spaces and life cycle
The virus replicates mainly in the hepatocytes cytoplasm (ER) of liver but, may
also replicate in peripheral blood mononuclear cells.
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7. Expected immunity.
Innate immunity:
• Liver Macrophage ,DCs and NK cells as they are enriched in liver may play a role…
• Interferons as the main cytokines.
Adaptive immunity:
• CD 4 TH1 > TH2
• CD 8 cytotoxic (CMI) may be the main effector agent against HCV..
• Antibodies may have a role as virus present in blood and ADCC..
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10. Evidence based –Innate immunity (cont.)
Step number (1)
The first line of immunity against
HCV relies on cell-intrinsic innate
immunity within hepatocyte cells .
10
11. PRR PAMP
1-RIG-I ,pkr-1
(Cytosolic PRR)
dsRNA
from the Internal ribosome entry side.
from accumulation after HCV infection
from dying cells later.
2-TLR 3 dsRNA
3-TLR 7,8* ssRNA
Evidence based-Innate Immunity (cont.)
11
12. Evidence based innate
immunity (cont.)
Viral RNA sensing by
RIGs -> MAVS-->
IRF3,7ISG .
INF β,γ.
Similar, occurs by
viral RNA sensing by
TLR3TRIFISG..
INF β,γ .
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13. 13
Evidence based-Innate
immunity (cont.)
Hepatic DC , APC
step number (2)
• Liver resident and migratory APCs
uptake apoptotic bodies from
destroyed HCV-infected
hepatocytes and present HCV
derived epitopes to both CD4 and
CD8 T cell in the context of MHC
class II and MHC class I ,
respectively.
Liver
Macrophage
Kupffer cells
Circulating
macrophage
14. Evidence based Innate Immunity (cont.)
Controversy of DCs…!
function of DCs is controversial…!
1-recently demonstrated that sustained hyperresponsiveness of DCs was associated with
resolution of HCV infection better priming of HCV-specific T cells.*
2-Another groups Also, have reported that DCs are defective in HCV response to and may
induce proliferation of T reg chronic infection.**
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15. Evidence based Innate Immunity (cont.)
KCs and fibrosis…!
• KCs produce profibrogenic factors and yet also represent a major source of matrix
breakdown and turnover -cirrhosis.
• Nitric oxide produced by activated KCs may also promote DNA damage HCC .
• it has recently been postulated that KC-derived IL-6 contributes to HCC development
so, Estrogen inhibition of IL-6 production MAY reduces HCC risk in females.*
15
16. Evidence based Innate immunity (cont.)
Step number (3) …NK cells
• NK cells are highly enriched in the liver and are expected to play a major role in
controlling hepatotropic infections.
• NK cells from acutely infected individuals and during chronic infection were
biased toward cytotoxicity rather than cytokine production.
• ADCC..!
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17. Evidence based Adaptive immunity (cont.)
Step number (4)…CD4
• HCV-specific CD4 and CD8 T cell appear late around 6–8 weeks after primary HCV
infection May be indicative of the capacity of the virus to evade the innate
immune system.
• CD4 helper T cell support responses of CD8T cells and B cell through production
of Th1 and Th2 cytokine respectively.
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18. Evidence based Adaptive Immunity (cont.)
Step number (5) …..Neutralizing Antibodies
• Most of these Abs have NO antiviral activity. However, only a small subset is able
to prevent virus binding, entry or post-entry steps of the viral lifecycle.
• ADCC is not fully understood ,also the role of Tfh * cells in this process is still
unknown.
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19. Evidence based Adaptive Immunity (cont.)
Step number (6)…CD8
• The main adaptive effector cells involved in HCV clearance.
• CD8 T cells eliminate HCV-infected cells through direct cytotoxic
mechanisms(granules, perforin and granzyme) or non-cytolytic mechanisms
through secretion of the antiviral cytokines IFN g and TNF a.
• But,CD8 needs to persists its action…!
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20. Evidence based adaptive (cont.)
Exhausted CD8…!
T17/ Treg Balance
Step number (7)..T17
Early induction of IL-21 producing Th17 cells is
critical to limit exhaustion of CD8 T cells
Step number (8) ..T reg
T reg contributes to exhaustion
and inhibition of CD4 and CD8
through production of the Tim-
3,Gal-9 ,IL-10 and TGF-B
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21. HCV Evasion of innate immunity
The Swiss Army knife..!
NS3-NS4A is serine protease activity to block RIG-I and TLR3 By splicing MAVS and
TRIF downstream -prevents activation of the pathway during acute infection
abrogates IFN induction Delay in Adaptive response ...!
What about NK cells….!
Recombinant HCV E2 protein was reported to directly bind CD81 on the surface of
NK cells inhibit its functions.
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23. HCV Evasion from Adaptive
Immunity (cont.)
from neutralizing antibodies
• Escape mutations quasispecies.
• direct cell–cell transmission
CD8+ T cell dysfunction
• Escape mutations For CD8+ T cell
epitopes.
• lack of CD4+ help may contribute to CD8+
T cell dysfunction.
• Impaired production of antiviral cytokines
as by suppression regulatory T cells.
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25. Which immune responses are believed to be protective.!
Studies of depletion..!
• One study of CD4 depletion in chimpanzees ,first they temporarily
controlled viremia then viral titers increased again and These data supports
the concept that HCV-specific CD8 T cells are the main antiviral effector cells
while HCV specific CD4 T cells have important helper functions to prevent
viral escape from the CD8 T cell response..*
• HCV and HIV co-infection..!**
• One study of KC depletion leading to attenuated liver injury…!***
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26. Vaccine.
• No approved vaccine of HCV.
• Some trials working to include several components of the adaptive immune
response as successful vaccination strategy because, vaccine-induced CD8+ T
cell responses may fail when sufficient CD4+ T cell help is missing.
• Regarding therapeutic immune strategies, restoration of CD8+ T cell
function may be a promising concept.
• 2013 The revolution of new HCV drugs (sofosbuvir) and preventive
medicine..!
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Entry into host cells occur through complex interactions between virions and cell-surface molecules for example ( CD81, LDL receptor, ..)
The virus replicates on intracellular membranes of The endoplasmic reticulumin particular are deformed into uniquely shaped membrane structures termed 'membranous webs’.
*S. Abdel-Hakeem ,H. Shoukry , Front Immunol. 2014; 5: 274.
-Activation of these PRRs drives theinnate antiviral and proinflammatory responses that :
1- limit virus replication.
2- recruit adaptive immune cells and enhance their effector actions at the site of infection.
*Yuwei Zhang, Scientific Reports 6, Article number: 29447 (2016)
*Ralf Bartenschlager,Springer. Berlin, 2013
*Sandy Pelletiera, et journal of virology,(2013).
**Silvia Della Bella, Immunology. 2007 Jun; 121(2): 283–292.
Profibrognic factors e.g.( transforming growth factor β and platelet-derived growth factor) .
*Prieto J. Hepatol. 2008 Feb;48(2):380-1.
Also, tolerogenic nature of the liver environment
The time required for viral antigens to reach the draining lymph nodes to be presented by professional APCs.
* follicular helper cells (TFH cells): A distinct subset of CD4+ T cells found in B cell follicles of secondary lymphoid organs. ICOS (inducible T cell co‑stimulator)-dependent TFH cells have a crucial role in the selection and survival of B cells that differentiate to plasma cells or memory B cells.
Due to the relatively conserved binding region of E2 to the CD8 receptor on the liver cells, this discovery is expected to pave the way to design a HCV vaccine which will stimulate antibody response with neutralizing effects on broad range of virus strains.
*Lynn B. Dustin, Curr Drug Targets. 2017; 18(7): 826–843.
*Ralf Bartenschlager,Springer. Berlin, 2013.
Virus escape mutations :Mutations generating viral protein products that can no longer be recognized by virus-specific antibodies or T cells. Viruses with a high rate of mutation, such as hepatitis C virus (HCV) and HIV, rely on escape mutations as a mechanism of immune evasion
*Eui-Cheol Shin, Pil Soo Sung & Su-Hyung Park et, Nature Reviews Immunology 16, 509–523.
* Shoukry NH, J Exp Med. 2003 Jun 16;197(12):1645-55.
** Y. Chen, R. Feeney & T. Chung , Nature Reviews Gastroenterology & Hepatology 11, 362–371 (2014).
***Mathis Heydtmann, J. Virol. April 2009 vol. 83 no. 7 2796-2802.