Expression of NS4 HCV in liver cells of HIV/HCV co-infected patients

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1 Expression of NS4 HCV in liver cells of HIV/HCV co-infected patients Associated prof. N.V. Matsiyeuskaya, D.Sci (Med), associated prof. M.G. Zubritskiy, MD.PHD Grodno state medical university, Belarus Grodno regional pathological anatomical bureau, Belarus

2 HIV/HCV co-infection in Belarus Incidence of HCV infection among HIV-infected patients prevails the general population index in more than 10 times, in 2013 it made up from 35.6% to 40.8% among HIV-infected patients in different regions of Belarus. The patients with HIV/HCV coinfection have a high incidence liver cirrhosis (15.7%) compared to HIV-infection without HCV co-infection (5%, p <0,05). The rate of liver cirrhosis The average term of liver cirrhosis development in HIV/HCV co-infected patients reduces to 9,5 ± 2,4 years.

3 Structure (%) of the leading causes of death among HIV-infected patients (Grodno, Belarus: , n=230) 22,4 17,1 15,3 13,7 12,4 10,5 8,6 Factors contributing to "liver" mortality include the absence of ART, high frequency of hepatotoxic factors: HCV co-infection (83.3%), drug use (75%), alcohol abuse (79.2%).

4 NS4 HCV NS4 HCV: NS4A and NS4B NS4A protein is a 54 amino acid-long protein which acts as an activating cofactor of NS3-4A serine protease for processing at the 3/4A, 4A/4B, 4B/5A, and 5A/5B sites (Bartenschlager et al., 1994; Failla et al., 1994; Tanji et al., 1995). NS3-4A is tagged point for some direct anti-hcv agents (DAA) boceprevir, telaprevir, simiprevir NS4B has been implicated in modulation of NS5B's RNA dependent RNA polymerase activity, has a possible role in HCV carcinogenesis, impairment of ER function, and regulation of both viral and host translation. NS4B's apparent key role in the establishment of the replication (and possible early assembly) platform represented by the membranous web places NS4B in a particularly prominent position in the viral life cycle (Lindenbach et al., 2005; Wakita et al., 2005; Zhong et al., 2005) 2nd Central and Eastern European Meeting on Viral Hepatitis and Co-infection with HIV 6-7 October 2016, Bucharest, Romania

5 Aim of study: to evaluate correlation between expression of NS4 HCV and p24 HIV, HLA-DP, DQ, DR in liver tissue of HIV/HCV co-infected patients

6 Patients Liver samples of 18 dead anti HCV + HIV-infected patients were included in study Mean age of patients was 36,1±5,1, males - 7 (38,9%), females - 11 (61,1%); AIDS 15 (83,3), ART 12 (66,7%). Liver cirrhosis - 6 (33,3%), chronic hepatitis C (CHC) of mild activity in 12 (66,7%) patients. None of patients received antiviral therapy of CHC

7 Material and methods Immunohistochemical studies were performed using streptavidin-biotin method («Dako») in formalin-fixed, paraffin embedded specimens of the liver. Mouse monoclonal antibodies (anti-hiv p24, anti-human CD4, anti-human CD8, anti-human HLA-DP, DQ, DR antigen, anti-human CD56) and polyclonal rabbit antibodies (Anti-Herpes Simplex Virus types 1 and 2) were used in a standard dilution (DakoCytomation). To determine NS4 HCV in the cell cytoplasm murine anti-hepatitis C (AbDserotec) antibodies were used, to determine TNF-α in the liver cells monoclonal mouse antihuman TNF-α (AbDserotec) was used. Evaluation of IHC results was performed on a light microscope (magnification 100, 200, 400) in 6 random fields of view. Localization of staining in cells was evaluated as well as the percentage and intensity of positively stained cells. On this basis the degree of marker expression in points was determined. Scoring criteria: 0 points negative staining, 1 low intensity, 2 moderate intensity, 3 pronounced intensity.

8 Material and methods Assessment of structural changes of liver tissue was performed by semiquantitative method using Knodell RG and V. Serov scale, which helped to calculate histological activity index (HAI), set the stage of fibrosis and the degree of steatosis by Hornboll. Statistical analysis was performed on a personal computer using the package «Statistica», version 10. Data are presented as Me and interquartile ranges (IQRs).

9 EXPRESSION OF NS4 HCV IN HEPATOCYTES (HC) OF HIV/HCV CO-INFECTED PATIENTS Distribution of HIV/HCV + patients according to clinical data in dependence of NS4 expression NS4 HCV+ N=9 NS4 HCV N=9 Age 37,4+5,6 34,8+5,6 >0,05 women 5 6 >0,05 p Distribution of the patients according to NS4 expression NS4 HCV+ 9 9 NS4 HCV- men 4 3 >0,05 IDU 5 2 >0,05 AIDS 6 9 >0,05 ART 8 4 >0,05 NS4 HCV moderate expression in HC

10 Expression of p24 HIV, HLA-DP at Kupffer cells in patients with productive HCV infection (NS4+) of HC vs non productive HCV infection (NS4-) Маркер p24 HIV in KC HLA-DP, DQ, DR in KC HIV/HCV, n=9 HIV/HCV, n=9 productive HCV infection (NS4+) of HC 1, abs/% >1, abs/% Me, IQR non productive HCV infection (NS4-) of HC 1, abs/% >1, abs/% Me, IQR 4/44,4 3/33,3 1 (1 2) * 1/5,6 0 0 (0 0) 4/44,4 2/11,1 1 (0 1) * (0 0) KC Kupffer cells, HC hepatocytes, *- p<0,05, Mann- Whitney U Positive correlation (Spearman): between expression of NS4 HCV in HC and Liver Cirrhosis presence: R=0,37 (p=0,03) HLA-DP, DQ, DR in liver tissue

11 Productive HIV infection (p24 HIV+) in hepatocytes and Kupffer cells of HIV/HCV+patient KC A electron microscopy p24 HIV+ in HC C B Polychromatic staining with azure II p24 HIV+ in KC D

12 Expression of immunological markers in hepatocytes and Kupffer cells in patients with productive HIV infection (p24+) of HC and KC vs. non productive HIV (p24-) Маркер NS4 in HC HCV HSV1 in HC HLA-DP, DQ, DR+ in KC TNF-α in KC HIV/HCV, n=8 HIV/HCV, n=10 productive HIV infection (p24+) of HC and KC non productive HIV infection (p24-) of HC and KC 1 points, abs/% >1points, abs/% Me, IQRs 1points, abs/% >1 points, abs/% Me, IQRs 4/50,0 3/37,5 1,0 (1,0-2/ (0,0-0,0) 2,0) * 5/62,0 2/25 1,0 (1,0-1,0) * 3/30 1/10 0 (0,0-0,1) 3/37,5 2/25 0,5 (0,0-1,0) * 1/ (0,0-0,0) 6/75,0 0 1 (0,5-1,0) * 1/ (0,0-0,0) KC Kupffer cells, HC hepatocytes; *- p<0,05, Mann-Whitney U

13 Expression of HSV 1 (3 points) in hepatocytes of HIV and HCV-infected patient, 34 yrs., AIDS

14 Conclusions Synergism in expression of replicative markers of HCV (NS4) and HIV (p24) in liver cells of HIV/HCV co-infected patients has been established which associated with activation of Kupffer cells, and higher expression of HSV1 in liver cells. We can propose that effect of DAA in HIV/HCV co-infected patients may be enhanced by achievement of strong HIV suppression.

15 Acknowledgments Grodno State medical university, Belarus Prof. V.A. Snezhitskiy, D.Sci (Med) corresponding member of NAS of Belarus Prof. V.M. Tsyrcunov, D.Sci (Med) Prof. V.P. Andreev, MD. PHD Senior researcher R.I. Kravchuk, MD. PHD Grodno regional pathological anatomical bureau Associated prof. N.I. Prokopchik, MD. PHD Gomel regional pathological anatomical bureau V.N. Tischenko - pathomorphologist