title: Whole genome analysis of hepatitis B virus from four cases of fulminant hepatitis: genetic variability and its potential role in disease pathogenicity.
abstract: The precore stop-codon variant of hepatitis B virus (HBV) has been associated with fulminant hepatitis but is also found in patients with persistent infection and chronic hepatitis. We have examined the possibility that the severe outcome of infection in patients with fulminant disease may be a result of additional genomic variation. We sequenced the entire HBV genome from three patients of Greek and one patient of Chinese origin with fulminant hepatitis, and from two patients with hepatitis B e antigen (HBeAg) positive chronic infection from the same regions, using direct sequencing of amplified viral DNA. Three of the fulminant cases were infected with the precore stop-codon variant HBeAg negative) and the fourth with the wild-type (HBeAg) positive virus. We compared sequences from our four fulminant isolates, and an additional fulminant isolate reported by others, with HBeAg positive carriers from the same regions and 12 published HBV genomes. There was a higher number of nucleotide and amino-acid substitutions throughout the HBV genome in the precore variant fulminant sequences than in the wild type. A cluster of mutations previously identified in the X region (126-132) in sequences reported in Japanese patients and encompassing the Enhancer II-Core Promoter region (1751-1768), were not found in our patients. We conclude that although there are no changes common to all sequences of HBV isolates from fulminant cases, some of these changes are in recognized cis-acting regulatory elements, whilst others are in the immediate vicinity of such elements. The effect of these mutations on viral genome transcription must now be determined.
authors.affiliation: Department of Medicine, Imperial College School of Medicine, St Mary's Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Alexopoulou
authors.forename: P
authors.initials: P
authors.lastname: Karayiannis
authors.forename: S J
authors.initials: SJ
authors.lastname: Hadziyannis
authors.forename: J
authors.initials: J
authors.lastname: Hou
authors.forename: J
authors.initials: J
authors.lastname: Pickering
authors.forename: K
authors.initials: K
authors.lastname: Luo
authors.forename: H C
authors.initials: HC
authors.lastname: Thomas
mesh_terms: D000595:Amino Acid Sequence; D018388:Codon, Terminator / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D015967:Gene Expression Regulation, Viral; D014644:Genetic Variation; D016679:Genome, Viral; D006509:Hepatitis B / Q000235:genetics*; D006513:Hepatitis B e Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000235:genetics* / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008969:Molecular Sequence Data; D016254:Mutagenesis, Insertional; D016133:Polymerase Chain Reaction; D011401:Promoter Regions, Genetic; D017422:Sequence Analysis, DNA; D017386:Sequence Homology, Amino Acid; D015534:Trans-Activators / Q000235:genetics; D054334:Viral Regulatory and Accessory Proteins
chemical_list: D018388:Codon, Terminator; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D015534:Trans-Activators; D054334:Viral Regulatory and Accessory Proteins; C057628:hepatitis B virus X protein