Detection and significance of PD-1.3 SNP (rs ) and IL28B SNP (rs ) in patients with current or past hepatitis B virus (HBV) infection

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1 Detection and significance of PD-1.3 SNP (rs ) and IL28B SNP (rs ) in patients with current or past hepatitis B virus (HBV) infection Asterios Saitis 1, Nikolaos K. Gatselis 1, Kalliopi Azariadi 1, Kalliopi Zachou 1, George K. Koukoulis 2, George N. Dalekos 1 1 Department of Medicine and Research Laboratory of Internal Medicine, School of Medicine, Thessaly University, Larissa, Greece 2 Department of Pathology, School of Medicine, Thessaly University, Larissa, Greece

2 Thomas et al, Nature 2009 Ge et al, Nature 2009 Chronic Hepatitis C IL28B polymorphism (rs ) Response to Peg-IFN +RIBA Spontaneous HCV clearance

3 Chronic Hepatitis C PD1.3 polymorphism (rs ) Asociation analysis of PD-1 polymorphism with response to antiviral treatment Genotypes SVR (n=210) NR (n=197) p value PD-1.3 <0.05 G/G 150 (71.4%) 164 (83.2%) G/A 50 (23.8%) 29 (14.7%) A/A 10 (4.8%) 4 (2.1%) OR (95% CI) G/G G/A or AA 10 0 Response (n=210) Non-Response (n=197) Vidal-Castiñeira et al. Journal of Hepatology 2012

4 Chronic Hepatitis B IL28B polymorphism PD1.3 polymorphism Susceptibility to HBV infection? Determinants of interferon response?

5 Chronic Hepatitis B Chronic infection 4-5% Chronic hepatitis 0.8-1% Past infection 95% Determinants Age of infection Genetic? Genetic? EASL Clinical Practice Guidelines, Journal of Hepatology 2017

6 Chronic Hepatitis B Inteferons HBsAg clearance 48-week duration or Nucleoside/ Nucleotide analogues High efficacy High safety Per os therapy Genetic determinants of IFN response? EASL Clinical Practice Guidelines, Journal of Hepatology 2017

7 Study Design 401 HBV patients chronic hepatitis N=208 chronic infection N=100 past infection N=93 IFN-treated N=78 IL28B & PD1.3 polymorphism Clinical- Laboratory features Treatment Response

8 Fluorescence ( ) Fluorescence ( ) Methods Allelic Discrimination Endpoint C T Allele specific fluorescent DNA Probes Allele y samples Heterozygous samples Allele x samples Cycles Fluorescence ( ) Gatselis et al, J Hepatol 2013; 58: S187

9 Methods IL28B genotyping In house allelic end point discrimination assay Residual DNA of serum samples Direct sequencing Gatselis et al, J Hepatol 2013; 58: S187

10 Methods PD1.3 genotyping In house allelic end point discrimination assay Genomic DNA of total blood samples In house PCR restriction fragment length polymorphism (RFLP)

11 Results IL28B & Susceptibility to HBV infection N=403 Chronic Hepatitis B Chronic HBV infection Past Infection TT 18% CC 41% TT 10% CC 40% TT 11% CC 46% CT 41% CT 50% CT 43%

12 Results PD1.3 & Susceptibility to HBV infection N=120 Chronic hepatitis B Chronic infection Past infection GA 19% GA 21% GA 20% AA 3% GG 81% GG 79% GG 77%

13 Study Design 401 HBV patients chronic hepatitis N=208 chronic infection N=100 past infection N=93 IFN-treated N=78 IL28B & PD1.3 polymorphism Clinical- Laboratory features Liver Disease Progression

14 Results Chronic HBV Hepatitis Clinical & laboratory features N IL28B genotype CC CT or TT P value AST, IU/l, mean ±SD ± ± ALT, IU/l, mean ±SD ± ± γgt, IU/l, mean ±SD ± ± Bilirubin, mg/dl, mean ±SD ± ± Albumin, g/dl, mean ±SD ± ± Prothrombin time, sec, mean ±SD ± ± Platelets, 10 9 /μl, mean ±SD ± ± Baseline HBV DNA, IU/ml, mean ±SD ± ± Fibrosis at Baseline: (frequencies, %) Baseline Cirrhosis: (frequencies, %) Progression to Cirrhosis: (frequencies, %) F0-F2 F3-F4 yes no yes no (69.2%) 12(31.8%) 11 (14%) 58 (86%) 3(5%) 56(95%) 31 (44.9%) 31 (77.5%) 33(30%) 78(70%) 6 (7.6%) 73 (92.4%) Progression to Decompensation: yes (frequencies, %) no (1.4%) 67(98.6%) 8 (28.6%) 103 (64.3%) HCC development : (frequencies, %) yes no (11.8%) 61 (88.4%) 14 (14.4%) 97(85.6%) 1.000

15 Results Chronic HBV Hepatitis IL28B & Baseline Cirrhosis Genotypes IL28B Non- Cirrhotic (n=135) Cirrhotic (n=44) p value CC 58 (84.5%) 11(15.5%) <0.05 CT or TT 78 70%) 33 (30%) CC Cirrhosis 16% P<0.05 Cirrhosis 30% CT or TT Non-Cirrhosis 84% Non-Cirrhosis 70%

16 Results Chronic HBV Hepatitis Clinical & laboratory features N PD1.3 genotype GA or AA GG P value AST, IU/l, mean ±SD ± ± ALT, IU/l, mean ±SD 34 80± ± γgt, IU/l, mean ±SD ± ± Bilirubin, mg/dl, mean ±SD ± ± Albumin, g/dl, mean ±SD ± ± Prothrombin time, sec, mean ±SD ± ± Platelets, 10 9 /μl, mean ±SD ± Baseline HBV DNA, IU/ml, mean ±SD ± ± Fibrosis at Baseline: (frequencies, %) Baseline Cirrhosis: (frequencies, %) Progression to Cirrhosis: (frequencies, %) F0-F2 F3-F4 yes no yes no (80.0%) 1 (20.0%) 11 (14%) 58 (86%) 0 (0%) 5 (100%) 10 (62.5%) 6 (37.5%) 33(30%) 78(70%) 2 (10.5%) 17 (89.5%) Progression to Decompensation: yes (frequencies, %) no 33 0 (0 %) 6(100%) 4 (14.8%) 23 (85.2%) HCC development : (frequencies, %) yes no 33 0 (0 %) 6(100%) 4 (14.8%) 23 (85.2%) 1.000

17 Results Chronic HBV Hepatitis PD1.3 & Baseline HBV DNA Genotypes PD1.3 HBV-DNA (n=132) p value GA or AA ± <0.05 GG ± Baseline HBV DNA p< GA or AA GG

18 Study Design 401 HBV patients chronic hepatitis N=208 chronic infection N=100 past infection N=93 IFN-treated N=78 IL28B & PD1.3 polymorphism Treatment Response

19 Results IFN-treated patients IL28B & Response to IFN treatment N= CC CT or TT Response Non-Response

20 Results IFN-treated patients PD1.3 & Response to IFN treatment N= GG GA or GA 0 Response Non-Response

21 Conclusions PD-1.3 (rs ) and IL28B (rs ) SNPs were successfully genotyped by in-house assays No influence of IL28B & PD1.3 polymorphisms on genetic susceptibility to HBV infection

22 Conclusions Association of IL28B polymorphism with baseline advanced liver fibrosis Prognostic Significance of IL28B rs for response to interferon treatment

23 Conclusions-Perspective Association of PD1.3 polymorphism with baseline HBV DNA levels Larger studies to determine the prognostic significance of PD1.3 polymorphism in interferon treatment

24 Thank you for your attention This study has been supported by Asklepios GILEAD Grants (Greece)