Metabolic characterization of the natural progression of chronic hepatitis B.
Worldwide, over 350 million people are chronically infected with the hepatitis B virus (HBV) and are at increased risk of developing progressive liver diseases. The confinement of HBV replication to the liver, which also acts as the central hub for metabolic and nutritional regulation, emphasizes the interlinked nature of host metabolism and the disease. Still, the metabolic processes operational during the distinct clinical phases of a chronic HBV infection-immune tolerant, immune active, inactive carrier, and HBeAg-negative hepatitis phases-remains unexplored.



To investigate this, we conducted a targeted metabolomics approach on serum to determine the metabolic progression over the clinical phases of chronic HBV infection, using patient samples grouped based on their HBV DNA, alanine aminotransferase, and HBeAg serum levels.



Our data illustrate the strength of metabolomics to provide insight into the metabolic dysregulation experienced during chronic HBV. The immune tolerant phase is characterized by the speculated viral hijacking of the glycerol-3-phosphate-NADH shuttle, explaining the reduced glycerophospholipid and increased plasmalogen species, indicating a strong link to HBV replication. The persisting impairment of the choline glycerophospholipids, even during the inactive carrier phase with minimal HBV activity, alludes to possible metabolic imprinting effects. The progression of chronic HBV is associated with increased concentrations of very long chain triglycerides together with citrulline and ornithine, reflective of a dysregulated urea cycle peaking in the HBV envelope antigen-negative phase.



The work presented here will aid in future studies to (i) validate and understand the implication of these metabolic changes using a thorough systems biology approach, (ii) monitor and predict disease severity, as well as (iii) determine the therapeutic value of the glycerol-3-phosphate-NADH shuttle.
Department of Analytical Biosciences, Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333, CC, Leiden, The Netherlands.|Netherlands Metabolomics Centre, Leiden University, Einsteinweg 55, 2333, CC, Leiden, The Netherlands.
Johannes C
JC
Schoeman
Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Wytemaweg 80, Room Na-1011, 3015, CE, Rotterdam, The Netherlands.
Jun
J
Hou
Department of Analytical Biosciences, Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333, CC, Leiden, The Netherlands.|Netherlands Metabolomics Centre, Leiden University, Einsteinweg 55, 2333, CC, Leiden, The Netherlands.
Amy C
AC
Harms
Department of Analytical Biosciences, Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333, CC, Leiden, The Netherlands.|Netherlands Metabolomics Centre, Leiden University, Einsteinweg 55, 2333, CC, Leiden, The Netherlands.|Present address: Discovery Sciences, Janssen R&D, Turnhoutseweg 30, 2340, Beerse, Belgium.
Rob J
RJ
Vreeken
Department of Analytical Biosciences, Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333, CC, Leiden, The Netherlands.|Netherlands Metabolomics Centre, Leiden University, Einsteinweg 55, 2333, CC, Leiden, The Netherlands.
Ruud
R
Berger
Department of Analytical Biosciences, Leiden Academic Center for Drug Research, Leiden University, Einsteinweg 55, 2333, CC, Leiden, The Netherlands.|Netherlands Metabolomics Centre, Leiden University, Einsteinweg 55, 2333, CC, Leiden, The Netherlands.
Thomas
T
Hankemeier
Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Wytemaweg 80, Room Na-1011, 3015, CE, Rotterdam, The Netherlands. p.a.boonstra@erasmusmc.nl.
Andre
A
Boonstra
D000328:Adult; D002853:Chromatography, Liquid; D018450:Disease Progression; D005260:Female; D020404:Glycerophospholipids / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000276:immunology / Q000473:pathology* / Q000821:virology; D006801:Humans; D008297:Male; D013058:Mass Spectrometry; D053858:Metabolic Networks and Pathways; D055432:Metabolomics / Q000379:methods*; D008875:Middle Aged
D020404:Glycerophospholipids
Chronic hepatitis B; Clinical phases; Liver; Metabolomics; Viral hijacking