REVIEW article

Front. Immunol., 10 November 2014

Sec. T Cell Biology

Volume 5 - 2014 | https://doi.org/10.3389/fimmu.2014.00550

The Humoral Immune Response to HCV: Understanding is Key to Vaccine Development

  • 1. Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK

  • 2. Nuffield Department of Medicine, Structural Genomics Consortium, University of Oxford, Oxford, UK

Abstract

Hepatitis C virus (HCV) remains a global problem, despite advances in treatment. The low cost and high benefit of vaccines have made them the backbone of modern public health strategies, and the fight against HCV will not be won without an effective vaccine. Achievement of this goal will benefit from a robust understanding of virus–host interactions and protective immunity in HCV infection. In this review, we summarize recent findings on HCV-specific antibody responses associated with chronic and spontaneously resolving human infection. In addition, we discuss specific epitopes within HCV’s envelope glycoproteins that are targeted by neutralizing antibodies. Understanding what prompts or prevents a successful immune response leading to viral clearance or persistence is essential to designing a successful vaccine.

Introduction

Between 130 and 185 million people worldwide are infected with hepatitis C virus (HCV) and are at risk of cirrhosis, hepatocellular carcinoma, and end-stage liver disease (13). HCV, a member of the Flaviviridae family, is parenterally transmitted. HCV establishes a persistent infection in 60–80% of individuals infected. The treatment for HCV has long been pegylated interferon alpha co-administrated with ribavirin, but the response rates were unsatisfactory with only 50–60% of patients achieving a sustained virologic response (4, 5). The welcomed discovery of new directly acting antiviral drugs (DAAs) is expected to lead to a dramatic increase in cure rates (68). However, it is unlikely that the global HCV problem will be eliminated any time soon. There are numerous challenges that must be overcome first, including the prohibitive cost of treatment and the need for new treatment strategies for patients with advanced liver disease or co-morbidities (9). Another important obstacle is identifying those in need of treatment, since symptoms may be absent or non-specific until after significant liver damage has set in (10).

The development of a protective vaccine is essential in combating the global HCV epidemic. Understanding the immune response in those who spontaneously resolve HCV infections versus those who develop chronic infection is key to the development of prophylactic or therapeutic vaccine (11). So far, developing a HCV vaccine has proven challenging, not least because HCV is genetically highly diverse; there are seven known major genotypes that differ from each other by 30–35%, and over 60 subtypes (12). Indeed, the virus exists as a quasispecies – a swarm of related but distinct sequences – within an infected patient. This diversity is a consequence of HCV’s high replication rate, and an RNA polymerase that lacks any proofreading mechanism. High viral diversity within and between infected individuals poses challenges to vaccine developers: how can we devise a vaccine that will stimulate broadly cross-reactive immune responses to such a changeable foe? The key may well be to target an array of viral epitopes that are functionally constrained, and to enlist both humoral and cellular arms of the adaptive immune response. In particular, it will be important for the vaccine to elicit neutralizing antibodies (nAbs) to block viral access to target cells, and T-cell responses targeting infected cells (13).

Adaptive immune responses are typically delayed during acute HCV infection. HCV RNA can be detected 1–3 weeks following infection, but neither HCV-specific T-cells nor HCV-specific antibodies (Ab) are observed until 1–2 months after infection (1418). Both CD4+ and CD8+ T-cell responses play essential roles in the outcome of infection. CD8+ T-cells limit HCV replication through cytolytic and non-cytolytic immune mechanisms that are highly dependent on CD4+ T-cell function [reviewed in Ref. (1923)]. Vigorous and broadly directed anti-HCV T-cell responses are observed in patients who resolve infection (2427). In patients who progress to chronicity, initial vigorous T-cell responses wane and weaken. Loss of CD4+ T-cell help, a switch to a Treg cell profile, viral epitope escape, and chronic antigen stimulation may all contribute to T-cell exhaustion (23).

It was widely thought that the humoral immune response to HCV played only a peripheral role in HCV infection (24, 28, 29). However, recent studies suggest that B-cells and nAbs may play active roles in the spontaneous resolution of HCV (3033). Typically, an nAb response would be a component of sterilizing antiviral immunity and has long been a quintessential part of vaccine design (13, 34). An HCV vaccine will need to stimulate strong humoral as well as cellular immune responses. The role of humoral immune system in the both the control of HCV infection and in the pathogenesis of liver disease is still unclear. In this review, we hope to outline our current understanding of the humoral immune system’s roles in acute infection, the progression to chronicity, and the spontaneous resolution of HCV infection, and to highlight some of the pressing questions that need to be addressed.

nAb Epitopes

Antibodies produced during acute HCV infection target epitopes within both structural and non-structural (NS) viral proteins. However, all known nAbs target epitopes within the HCV envelope glycoproteins E1 and E2, or the E1E2 heterodimer. The structural proteins core, E1, and E2 are released from the viral polyprotein by cellular signal peptidases. The viral particle contains the nucleocapsid, formed by the close interaction of the HCV RNA genome and core protein, surrounded by a lipid bilayer envelope into which the glycoproteins E1 and E2 are anchored. E1 and E2 form a heterodimer that mediates viral entry. Determining the structure of the E1E2 heterodimer has proven problematic. E2 is required for the correct folding of E1, so that E1’s structure is still uncertain (35, 36). It is thought that the glycans on both the heavily glycosylated E1 and E2 are involved in folding of the E1E2 heterodimer (37). Interestingly, nAbs (AR4 and AR5) have been found that recognize conformational epitopes on the E1E2 heterodimer with broad neutralizing crossreactivity between diverse HCV genotypes (32).

Most nAbs target E2. E2 plays a key role in HCV entry, directly interacting with two of the cellular proteins needed for viral entry, CD81 and scavenger receptor class B type I (SR-BI) (38, 39). CD81 and SB-RI alone are not sufficient for viral entry; tight junction proteins claudin-1 and occludin are also required (40, 41). Other factors, such as the cholesterol absorption receptor Niemann-Pick C1-like 1, epidermal growth factor receptor, ephrin receptor type A2, and most recently, transferrin receptor 1 enhance viral entry (4244).

Two recent reports have shed light on the structure of E2 (45, 46). Most surprisingly, E2 did not adopt the expected, highly extended conformation of class II fusion envelope protein like other members of Flaviviridae, such as Tick-borne encephalitis virus or West Nile virus; instead, HCV E2 was found to be compact and globular (Figure 1), with a central beta sandwich surrounded front and back by short alpha helices, loops, beta sheets, and regions lacking organized structure (45, 46).

Figure 1

The ectodomain of E2 contains three regions of variability that are targeted by nAbs: hyper-variable region (HVR) 1, HVR2, and intergenotypic variable region. HVR1 contains dominant neutralizing epitopes, and its variation leads to immunological escape (4750). HVR1 is a 26–28 amino acid segment located near the amino terminus of E2. HVR1 interacts with SR-BI and is, therefore, likely involved in virus entry, making it an interesting target for nAbs (51, 52). The most-effective nAbs that target HVR1 recognize epitopes found in the C-terminus, where HVR1 interacts with SR-BI (5254). However, HVR1 mutates rapidly and antibodies that recognize HVR1 demonstrate very poor cross-neutralization across different isolates of the same HCV genotype (50, 55, 56). As of yet, no HVR1 nAbs have been found that display broadly cross-reactive neutralizing activity.

CD81 was the first host receptor identified as being a crucial entry factor for HCV and, therefore, the CD81-binding region of E2 is a likely target for nAbs (38). Indeed, numerous broadly nAbs have been found to target the CD81-binding loop (residues 519–535, numbered according to the HCV H77 consensus sequence accession number AF009606) of E2 (30, 32, 45, 5760). Kong and colleagues found evidence to suggest CD81 interacts with both the CD81-binding loop (519–535) and residues 421–453 of E2, making this domain in E2 a most intriguing target for vaccine design (Figure 1) (45). nAbs have also been found that target the less variable region directly downstream of HVR1 (residues 412–421) (6163). However, less than 5% of spontaneous resolvers have nAbs targeting this region, suggesting that this region is not as immunogenic in vivo (64). A highly conserved neutralizing epitope encompassing residues 496–515 is located between the two CD81-binding regions of E2 (Figure 1). Although not directly involved in CD81 binding, binding of nAbs to the 496–515 epitope may cause a conformational change in the CD81-binding region (65). Contrary to what was previously thought, the overlapping residues 502–520 do not contain a fusion peptide (66, 67).

Most of the identified nAbs target regions within E2 that interact with the viral entry factors CD81 and SR-BI. Occludin is also thought to interact directly with E2 (68); perhaps mapping of this interaction will allow the development of novel nAbs. In contrast, claudin-1 has not been shown to interact directly with E2. Would targeting the viral epitope that recognizes claudin-1 prevent entry? Perhaps we know that blocking claudin-1 prevents E2/CD81/claudin-1 interaction, thereby preventing HCV entry (69). Targeting host factors such as SR-BI, CD81, occludin, or claudin-1 may provide novel therapy options that could be used in conjunction with current treatments (70).

Few nAbs have been identified that specifically target E1 (11, 71). Whether this is due to the poor immunogenicity of E1 is still unclear. Anti-E1 Abs are only detected at low levels in HCV patients (72, 73). A recent study reported that patients develop almost sevenfold more antibodies to E2 than to E1 (study in four patients); however, the E1-specific Abs contributed largely to the overall neutralization of HCVpp, despite the relatively low number of E1-specific Abs compared to E2 (74). Anti-E1 Abs have proven difficult to induce in vaccines expressing the E1E2 heterodimer, and are more efficiently induced by expressing E1 alone (75). Whether this is due to the immunodominance of E2 or the masking of E1 neutralizing epitopes by E2 is unknown. Two broadly neutralizing epitopes in E1 encompass residues 192–202 (76) and 264–327 (65, 74, 77). Little is known about the structure, function, and interactions of E1. We know that E1 is involved in E2 folding (78). It is uncertain how E1-specific nAbs mediate their activity. It has been suggested that E1 may contain the element needed for envelope membrane fusion; as such E1 and the (as yet unidentified) fusion epitope it may contain remain an intriguing target for nAbs (79).

The HCV virion forms a complex with low-density and very low-density lipoproteins, forming a lipoviral particle (80). Studies of lipoviral particles showed that host lipoprotein apoE was incorporated into particles with significantly more apoE incorporated than E2 (81, 82). Lipoproteins limit the amount E1E2 to be seen on the surface of the lipoviral particle (82).

Interestingly, many HCV diagnostic assays detect Abs directed against both structural and NS HCV proteins. Why are NS proteins targeted? There is little evidence to suggest they are incorporated into the viral particle, yet NS3-specific Abs are detected before envelope-specific Abs during acute HCV infection (17). It is not yet clear when and in what form the NS proteins are exposed to B-cells. Perhaps NS protein-specific Abs are produced in response to debris from damaged cells. Abs binding to non-neutralizing targets may aid in clearance through opsonization.

Systems for Studying Abs

The study of Ab responses in HCV infection was long hampered by the lack of a cell culture system or permissive small animal model. Early in vivo studies, conducted in chimpanzees, confirmed the presence of nAbs in plasma from a human being with chronic HCV infection (83). Initial in vitro research on the effect of nAbs in HCV exploited E2/CD81 interaction to perform a neutralization of binding assay with recombinant E2 (38). This system was limited, as it could only evaluate putative neutralizing epitopes overlapping with the E2/CD81-binding region, and likely underestimated the quantity and complexity of nAbs present. Virus-like particles (VLP), produced in a baculovirus system, expressed the E1E2 glycoproteins in a more native conformation (84). The development of retroviral pseudoparticles (HCVpp) expressing unmodified E1E2 glycoproteins that has permitted a more in-depth study of HCV-specific nAbs (50, 85). The HCVpp system is adaptable to allow the expression of E1E2 glycoproteins from diverse HCV genotypes as well as the expression of patient-derived E1E2 (86). This allows patient sera to be screened for neutralizing activity against autologous viral envelope glycoproteins. E1E2 sequences may be cloned from patients’ serial samples, permitting the study of quasispecies and nAb co-evolution over time. Unfortunately, a disadvantage of this system is that the structure and neutralization requirements of HCVpp are still significantly different from those of authentic hepatocyte-derived HCV. The cell cultured derived HCV system (HCVcc) (8790) may help overcome some of the limitations of the HCVpp system.

Humoral Immune Response in Infection

While the majority of HCV-infected patients progress to chronic hepatitis with persistent viremia, a significant number (up to 40%) of patients spontaneously clear the infection depending on factors such as, race, sex, and genetics (9195). It is widely accepted that the cellular immune response can mediate clearance of HCV infection [reviewed in Ref. (23)], but the role of the humoral immune response in acute infection and spontaneous clearance is not fully understood. nAbs are produced in response to HCV infection, but their contribution to control of infection is unclear (83). The acute humoral immune response to HCV has proved challenging to study, as most often patients are asymptomatic and unaware of their infection status; many studies have been retrospective. Typically, IgM is the first immunoglobulin isotype produced by the humoral system in response to infection; however, HCV-specific IgM has not proved a good marker of acute HCV infection as HCV-specific IgM is readily detected in chronically infected patients (96, 97), and HCV-specific IgM and IgG are both almost simultaneously detected in acute infection (98, 99).

There is much evidence to support the theory that Abs have a limited impact on HCV disease outcome as HCV seroconversion is delayed (15, 17, 100, 101), nAbs that target E1E2 are readily detected in the serum of chronically infected patients (29, 102104), HCV-specific Ab titers wane in patients who have controlled the infection (17, 29, 105, 106), and there are numerous reports of the clearance of HCV infection in the absence of any detected HCV-specific Ab response (15, 28, 107110).

In contrast, there is striking evidence supporting a role for Abs in control of HCV infection and more interestingly in preventing reinfection. Early induction of cross-reactive nAbs during acute infection strongly correlates with the spontaneous clearance of HCV (31, 33, 50, 73, 111, 112). Conversely, in patients who became persistently infected (>1 year), nAbs were delayed and initially had a narrow neutralizing range, which widened over time (31, 33, 73). In one remarkable case, a patient with established chronic HCV developed a broadly reactive nAb response followed by spontaneous viral clearance (111). Even in chronicity, nAbs may mediate some control of HCV infection as hypogammaglobulinemic patients experience a more rapid and severe progression of disease (113), and patients treated with rituximab show an increase in viral load, which returns to pretreatment levels after completion of treatment (114). Studies in cohorts of intravenous drug users have shown that individuals who spontaneously resolved one episode of HCV infection were more likely to clear a subsequent HCV infection (31, 91, 94, 115), and the time taken to clear the reinfection was significantly shorter (31, 115). Similar to observations in cohorts of intravenous drug users, >80% of chimpanzees that have previously spontaneously cleared HCV, rapidly clear a second infection (16, 109, 116), supporting the hope that protective immunity may be an achievable goal. More work is needed to elucidate the contribution of Abs to the clearance of in HCV in reinfection.

Passive immunization with nAbs can mediate protection: chimpanzees passively immunized with rabbit antisera specific for E1 and E2 were somewhat protected against HCV (117). Recently, HCV1, a human monoclonal Ab targeting E2, has been shown to prevent HCV infection and to reduce the viral load in chronically infected chimpanzees (118). Passive immunity is possible in human beings – it is best highlighted by the Gammagard incident (119). In the early 1990s, the makers of Gammagard (an immunoglobulin product prepared from pooled human plasma), in a move to improve the safety of their product, excluded sera containing anti-HCV Abs from the donor pool; unfortunately, the pooled preparations that removed the HCV seropositive serum lots transmitted HCV to patients (120, 121). Removing HCV-specific Abs from the product removed the protection provided by nAbs previously present. Subsequent screening of the product found HCV RNA (122). HCV-specific Abs provide immunity; however, it is not a sterilizing immunity, as demonstrated by the presence of high-titer nAbs in many patients with persistent HCV infection.

Vaccine Trials

Vaccination has been the most-effective strategy used to control infections that have been a major public health concern. The hepatitis B virus (HBV) vaccine has proven a great success, greatly reducing the number of HBV infections worldwide (123). All successful viral vaccines that have been developed to date induce nAbs (13). However, an HCV vaccine has remained elusive. Most HCV vaccine trials have been conducted in chimpanzees, the best model permitting challenge with infectious HCV. A meta-analysis of HCV vaccine trials in chimpanzees has shown that the vaccines with greatest success contained part or all of the HCV envelope region inducing nAb responses, generating humoral or both humoral and cellular immune responses (124). Recently, a recombinant E1E2 vaccine (derived from HCV 1a) induced protective humoral immune responses in chimpanzees challenged with homologous or heterologous HCV 1a strains (125), and was approved for phase I clinical trial in human beings. In the clinical trial, the recombinant E1E2 vaccine induced antibody and cellular responses in healthy volunteers (126). Further investigation showed the vaccine-induced nAbs against heterologous HCV 1a strains in some healthy volunteers, and one volunteer (out of 16 tested) produced broadly cross-neutralizing Abs against all 7 HCV genotypes (127). A prophylactic vaccine that blocks all infection upon exposure would be ideal. However, preventing the progression of HCV infection to chronicity through a therapeutic vaccine may be a more realistic goal (124, 128, 129).

Escape and Evasion of the Humoral Immune Response

Neutralizing antibodies are induced during HCV infection, which in some patients contribute to the spontaneous clearance of infection, yet the majority of infected patients progress to chronicity. How does HCV evade the humoral immune response to progress to chronicity? Several mechanisms may contribute to evasion of sterilizing Ab-mediated clearance. These include sequence changes, decoy epitopes, epitope masking, lipid shielding, induction of interfering antibodies, and the ability to move from one cell to another in a neutralization-resistant fashion (Figure 2).

Figure 2

Hepatitis C virus’ error-prone replication mechanism permits rapid escape from Ab-mediated and other pressures. Each day, an estimated 1012 new HCV virions are produced in the infected liver (130); it is estimated that thousands of virions bearing each possible single and double nucleotide substitution are made daily in an infected person (131). The resulting quasispecies swarm provides the raw material for selection of nAb-resistant populations (50, 132, 133). In fact, there are numerous reports that link viral sequence evolution, particularly within the E2 glycoprotein, to nAb escape in chronic infection (Figure 2A) (49, 50, 132, 133). Host nAb responses lag behind the rapidly mutating E2 sequences within the quasispecies (50, 132). That nAbs fail to neutralize the dominant viral strain at a given time, yet successfully neutralize previously dominant viral strains in the same patient, clearly demonstrates the continued evolution and escape of the virus under selective pressure from nAbs, with the humoral immune system always, alas, one step behind (132).

It has been suggested that HVR1 of E2 acts as an immunological decoy (Figure 2B) (71, 134). HVR1 is highly immunogenic, but is not essential for viral entry/infection (135); however, HVR1 deletion mutants are far more sensitive to Ab-mediated neutralization, suggesting that HVR1 also acts to conceal epitopes sensitive to neutralization (134136). nAb selection drives HVR1 sequence evolution in chronically infected patients, while HVR1 remains stable over time in immunoglobulin-deficient patients (137139). While HVR1 was predicted to be close to the CD81-binding site, Kong and colleagues have suggested that HVR1 lies on the opposite side of E2 molecule, where it masks a hydrophobic surface that is very sensitive to nAbs (45).

E1 and E2 are heavily glycosylated, particularly the immunodominant E2 (Figure 2C). E2 contains up to 11 N-linked glycosylation sites, most of them highly conserved across the different genotypes [reviewed in Ref. (140)]. The N-linked glycans of the ectodomains of E1E2 are reported to contribute almost 50% to the apparent molecular weight of these proteins, and are thought to limit nAbs’ access to key neutralization epitopes (35, 141). These glycans are also essential for the structure and function of E1E2, and play critical roles in viral entry (37, 142144). Removal of the glycan shield increases the sensitivity of HCVpp to nAb activity (143).

The HCV particle is closely associated with lipoproteins (145), and this association reduces HCV’s buoyant density. Low-density and very low-density virions are more infectious than high-density particles (146, 147). The neutralization of HCVcc by nAbs increased with virion density, suggesting that lipoproteins masked neutralizing epitopes (148). Significantly more host-derived apoE was incorporated into HCV virions than E2, making it far more difficult for the humoral immune system to target E2 (82). Interestingly, apoC-I, the major structural protein of high-density lipoproteins (HDL), is also incorporated in virions (82, 149, 150). SR-BI binds HDL and is a known HCV entry factor, suggesting that HCV has evolved to exploit the normal HDL – SR-BI interaction to avoid the humoral immune system and expedite the virus lifecycle (151). Lipoproteins aid HCV evasion of humoral immunity through two mechanisms: first, the close association of HCV with low-density and very low-density lipoproteins cloaks the virus, thus protecting it from nAbs (Figure 2D) (82, 152) and secondly, HDL expedites virus entry (153).

In vitro and in vivo data suggest that HCV can spread by cell-to-cell transmission (22, 154, 155). Such cell-to-cell spread may enable HCV to bypass extracellular fluids, thereby denying nAbs access to viral particles; indeed, this mechanism appears to be resistant to Ab-mediated neutralization (Figure 2E) (156). CD81, claudin-1, occludin, and SR-BI have pivotal roles in the lateral transmission of HCV, although virions that were not dependent on SR-BI for transmission were significantly more sensitive to nAbs (156, 157). The importance of SR-BI in cell-to-cell spread of HCV would suggest that targeting SR-BI might be valuable for preventing cell-to-cell transmission and avoidance of the humoral immune response. It is, therefore, critical we elucidate the mechanism of cell-to-cell transmission.

Competition between interfering Abs and nAbs can disrupt virus neutralization by nAbs (Figure 2F). Interfering Abs are proposed to work in two ways: first, by directly competing with nAbs for the same epitope; second, by binding an epitope near a neutralizing epitope, thereby masking it. The role of interfering Abs in HCV is controversial (158163). Abs binding E2 residues 436–447 interfere with nAbs binding to a CD81-binding domain containing E2 residues 412–421 (58). In contrast, a second study failed to find any interfering activity and reported the neutralizing activity was augmented by Abs binding both the 436–447 region and 412–421 region concurrently (162). Further study is needed to tease apart the mechanisms of interference, especially when considering using monoclonal Abs in passive immunizations and vaccine design.

Ideally, an effective HCV vaccine will need to generate a broad and highly reactive immune response at the first signs of HCV infection, before the virus has the chance to unleash its many immune escape mechanisms. A vaccine would need to target multiple antigenic determinants, thus raising the genetic barrier for mutational escape.

Looking Forward

The new DAAs will dramatically improve HCV outcome. However, the development of a prophylactic or therapeutic vaccine is needed to control the global HCV problem. Successful vaccine development is dependent on our understanding of the immune response to HCV infection. In particular, it is imperative that we understand why some patients clear the virus naturally and how they are protected from reinfection. The relativity low cost and high benefit of vaccines have made them the cornerstone of modern public health strategies. To date, all successful viral vaccines elicit nAbs (123). The burning question of whether the humoral immune system can mediate or contribute to the clearance of HCV is still unanswered. In the majority of HCV infections, slow development of an nAb response allows HCV to establish widespread and persistent infection. For the lucky minority, the humoral immune system mounts a rapid, broad attack on HCV, contributing to spontaneous clearance of infection. Perhaps the question is far too simple. Our immune system by its very nature is a multifaceted entity, where no one part acts in isolation from the whole. Would the question of the role of B-cells in HCV be best addressed by taking a systems approach to the problem? Is it the failure of CD4+ T helper cells that ultimately leads to the failure of the humoral immune response, and thus the failure to control the infection? Do the other immune cells remain silent or do they engage with B-cells? As we enter the big data era in science, we may be better positioned to answer some of these questions.

Statements

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

  • 1

    SeeffLB. The history of the “natural history” of hepatitis C (1968-2009). Liver Int (2009) 29(Suppl 1):8999.10.1111/j.1478-3231.2008.01927.x

  • 2

    HajarizadehBGrebelyJDoreGJ. Epidemiology and natural history of HCV infection. Nat Rev Gastroenterol Hepatol (2013) 10:55362.10.1038/nrgastro.2013.107

  • 3

    Mohd HanafiahKGroegerJFlaxmanADWiersmaST. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology (2013) 57:133342.10.1002/hep.26141

  • 4

    MannsMPMchutchisonJGGordonSCRustgiVKShiffmanMReindollarRet alPeginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet (2001) 358:95865.10.1016/S0140-6736(01)06102-5

  • 5

    HadziyannisSJSetteHJrMorganTRBalanVDiagoMMarcellinPet alPeginterferon-alpha2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. Ann Intern Med (2004) 140:34655.10.7326/0003-4819-140-5-200403020-00010

  • 6

    HeimMH. 25 years of interferon-based treatment of chronic hepatitis C: an epoch coming to an end. Nat Rev Immunol (2013) 13:53542.10.1038/nri3463

  • 7

    ScheelTKRiceCM. Understanding the hepatitis C virus life cycle paves the way for highly effective therapies. Nat Med (2013) 19:83749.10.1038/nm.3248

  • 8

    TseMT. All-oral HCV therapies near approval. Nat Rev Drug Discov (2013) 12:40911.10.1038/nrd4036

  • 9

    MannsMPvon HahnT. Novel therapies for hepatitis C – one pill fits all?Nat Rev Drug Discov (2013) 12:595610.10.1038/nrd4050

  • 10

    ThomasDL. Global control of hepatitis C: where challenge meets opportunity. Nat Med (2013) 19:8508.10.1038/nm.3184

  • 11

    WangYKeckZYFoungSK. Neutralizing antibody response to hepatitis C virus. Viruses (2011) 3:212745.10.3390/v3112127

  • 12

    SmithDBBukhJKuikenCMuerhoffASRiceCMStapletonJTet alExpanded classification of hepatitis C virus into 7 genotypes and 67 subtypes: updated criteria and genotype assignment web resource. Hepatology (2014) 59:31827.10.1002/hep.26744

  • 13

    BurtonDRPoignardPStanfieldRLWilsonIA. Broadly neutralizing antibodies present new prospects to counter highly antigenically diverse viruses. Science (2012) 337:1836.10.1126/science.1225416

  • 14

    CourouceAMBouchardeauFGiraultALe MarrecN. Significance of NS3 and NS5 antigens in screening for HCV antibody. Lancet (1994) 343:8534.10.1016/S0140-6736(94)92054-0

  • 15

    ThimmeROldachDChangKMSteigerCRaySCChisariFV. Determinants of viral clearance and persistence during acute hepatitis C virus infection. J Exp Med (2001) 194:1395406.10.1084/jem.194.10.1395

  • 16

    DahariHMajorMZhangXMihalikKRiceCMPerelsonASet alMathematical modeling of primary hepatitis C infection: noncytolytic clearance and early blockage of virion production. Gastroenterology (2005) 128:105666.10.1053/j.gastro.2005.01.049

  • 17

    NetskiDMMosbrugerTDeplaEMaertensGRaySCHamiltonRGet alHumoral immune response in acute hepatitis C virus infection. Clin Infect Dis (2005) 41:66775.10.1086/432478

  • 18

    SagnelliECoppolaNMarroccoCCovielloGBattagliaMMessinaVet alDiagnosis of hepatitis C virus related acute hepatitis by serial determination of IgM anti-HCV titres. J Hepatol (2005) 42:64651.10.1016/j.jhep.2004.12.027

  • 19

    BowenDGWalkerCM. Adaptive immune responses in acute and chronic hepatitis C virus infection. Nature (2005) 436:94652.10.1038/nature04079

  • 20

    CallendretBWalkerC. A siege of hepatitis: immune boost for viral hepatitis. Nat Med (2011) 17:2523.10.1038/nm0311-252

  • 21

    ThimmeRBinderMBartenschlagerR. Failure of innate and adaptive immune responses in controlling hepatitis C virus infection. FEMS Microbiol Rev (2012) 36:66383.10.1111/j.1574-6976.2011.00319.x

  • 22

    DustinLBCashmanSBLaidlawSM. Immune control and failure in HCV infection-tipping the balance. J Leukoc Biol (2014) 96:53548.10.1189/jlb.4RI0214-126R

  • 23

    ParkSHRehermannB. Immune responses to HCV and other hepatitis viruses. Immunity (2014) 40:1324.10.1016/j.immuni.2013.12.010

  • 24

    ThimmeRBukhJSpangenbergHCWielandSPembertonJSteigerCet alViral and immunological determinants of hepatitis C virus clearance, persistence, and disease. Proc Natl Acad Sci U S A (2002) 99:156618.10.1073/pnas.202608299

  • 25

    LauerGMBarnesELucasMTimmJOuchiKKimAYet alHigh resolution analysis of cellular immune responses in resolved and persistent hepatitis C virus infection. Gastroenterology (2004) 127:92436.10.1053/j.gastro.2004.06.015

  • 26

    RehermannB. Hepatitis C virus versus innate and adaptive immune responses: a tale of coevolution and coexistence. J Clin Invest (2009) 119:174554.10.1172/JCI39133

  • 27

    RehermannB. Pathogenesis of chronic viral hepatitis: differential roles of T cells and NK cells. Nat Med (2013) 19:85968.10.1038/nm.3251

  • 28

    CooperSEricksonALAdamsEJKansoponJWeinerAJChienDYet alAnalysis of a successful immune response against hepatitis C virus. Immunity (1999) 10:43949.10.1016/S1074-7613(00)80044-8

  • 29

    LogvinoffCMajorMEOldachDHeywardSTalalABalfePet alNeutralizing antibody response during acute and chronic hepatitis C virus infection. Proc Natl Acad Sci U S A (2004) 101:1014954.10.1073/pnas.0403519101

  • 30

    LawMMaruyamaTLewisJGiangETarrAWStamatakiZet alBroadly neutralizing antibodies protect against hepatitis C virus quasispecies challenge. Nat Med (2008) 14:257.10.1038/nm1698

  • 31

    OsburnWOFisherBEDowdKAUrbanGLiuLRaySCet alSpontaneous control of primary hepatitis C virus infection and immunity against persistent reinfection. Gastroenterology (2010) 138:31524.10.1053/j.gastro.2009.09.017

  • 32

    GiangEDornerMPrentoeJCDreuxMEvansMJBukhJet alHuman broadly neutralizing antibodies to the envelope glycoprotein complex of hepatitis C virus. Proc Natl Acad Sci U S A (2012) 109:620510.10.1073/pnas.1114927109

  • 33

    OsburnWOSniderAEWellsBLLatanichRBaileyJRThomasDLet alClearance of hepatitis C infection is associated with the early appearance of broad neutralizing antibody responses. Hepatology (2014) 59:214051.10.1002/hep.27013

  • 34

    CortiDLanzavecchiaA. Broadly neutralizing antiviral antibodies. Annu Rev Immunol (2013) 31:70542.10.1146/annurev-immunol-032712-095916

  • 35

    MichalakJPWychowskiCChoukhiAMeunierJCUngSRiceCMet alCharacterization of truncated forms of hepatitis C virus glycoproteins. J Gen Virol (1997) 78(Pt 9):2299306.

  • 36

    LiuJZhuLXKongYYLiGDWangY. Purification and application of C-terminally truncated hepatitis C virus E1 proteins expressed in Escherichia coli. World J Gastroenterol (2005) 11:5037. Available from: http://www.wjgnet.com/1007-9327/11/503.asp

  • 37

    GoffardACallensNBartoschBWychowskiCCossetFLMontpellierCet alRole of N-linked glycans in the functions of hepatitis C virus envelope glycoproteins. J Virol (2005) 79:84009.10.1128/JVI.79.13.8400-8409.2005

  • 38

    PileriPUematsuYCampagnoliSGalliGFalugiFPetraccaRet alBinding of hepatitis C virus to CD81. Science (1998) 282:93841.10.1126/science.282.5390.938

  • 39

    ScarselliEAnsuiniHCerinoRRoccaseccaRMAcaliSFilocamoGet alThe human scavenger receptor class B type I is a novel candidate receptor for the hepatitis C virus. EMBO J (2002) 21:501725.10.1093/emboj/cdf529

  • 40

    EvansMJVon HahnTTscherneDMSyderAJPanisMWolkBet alClaudin-1 is a hepatitis C virus co-receptor required for a late step in entry. Nature (2007) 446:8015.10.1038/nature05654

  • 41

    PlossAEvansMJGaysinskayaVAPanisMYouHDe JongYPet alHuman occludin is a hepatitis C virus entry factor required for infection of mouse cells. Nature (2009) 457:8826.10.1038/nature07684

  • 42

    LupbergerJZeiselMBXiaoFThumannCFofanaIZonaLet alEGFR and EphA2 are host factors for hepatitis C virus entry and possible targets for antiviral therapy. Nat Med (2011) 17:58995.10.1038/nm.2341

  • 43

    SainzBJrBarrettoNMartinDNHiragaNImamuraMHussainSet alIdentification of the Niemann-Pick C1-like 1 cholesterol absorption receptor as a new hepatitis C virus entry factor. Nat Med (2012) 18:2815.10.1038/nm.2581

  • 44

    MartinDNUprichardSL. Identification of transferrin receptor 1 as a hepatitis C virus entry factor. Proc Natl Acad Sci U S A (2013) 110:1077782.10.1073/pnas.1301764110

  • 45

    KongLGiangENieusmaTKadamRUCogburnKEHuaYet alHepatitis C virus E2 envelope glycoprotein core structure. Science (2013) 342:10904.10.1126/science.1243876

  • 46

    KhanAGWhidbyJMillerMTScarboroughHZatorskiAVCyganAet alStructure of the core ectodomain of the hepatitis C virus envelope glycoprotein 2. Nature (2014) 509:3814.10.1038/nature13117

  • 47

    KatoNSekiyaHOotsuyamaYNakazawaTHijikataMOhkoshiSet alHumoral immune response to hypervariable region 1 of the putative envelope glycoprotein (gp70) of hepatitis C virus. J Virol (1993) 67:392330.

  • 48

    van DoornLJCaprilesIMaertensGDeleysRMurrayKKosTet alSequence evolution of the hypervariable region in the putative envelope region E2/NS1 of hepatitis C virus is correlated with specific humoral immune responses. J Virol (1995) 69:7738.

  • 49

    FarciPShimodaACoianaADiazGPeddisGMelpolderJCet alThe outcome of acute hepatitis C predicted by the evolution of the viral quasispecies. Science (2000) 288:33944.10.1126/science.288.5464.339

  • 50

    DowdKANetskiDMWangXHCoxALRaySC. Selection pressure from neutralizing antibodies drives sequence evolution during acute infection with hepatitis C virus. Gastroenterology (2009) 136:237786.10.1053/j.gastro.2009.02.080

  • 51

    BartoschBVitelliAGranierCGoujonCDubuissonJPascaleSet alCell entry of hepatitis C virus requires a set of co-receptors that include the CD81 tetraspanin and the SR-B1 scavenger receptor. J Biol Chem (2003) 278:4162430.10.1074/jbc.M305289200

  • 52

    VieyresGDubuissonJPatelAH. Characterization of antibody-mediated neutralization directed against the hypervariable region 1 of hepatitis C virus E2 glycoprotein. J Gen Virol (2011) 92:494506.10.1099/vir.0.028092-0

  • 53

    BartoschBBukhJMeunierJCGranierCEngleREBlackwelderWCet alIn vitro assay for neutralizing antibody to hepatitis C virus: evidence for broadly conserved neutralization epitopes. Proc Natl Acad Sci U S A (2003) 100:14199204.10.1073/pnas.2335981100

  • 54

    HsuMZhangJFlintMLogvinoffCCheng-MayerCRiceCMet alHepatitis C virus glycoproteins mediate pH-dependent cell entry of pseudotyped retroviral particles. Proc Natl Acad Sci U S A (2003) 100:72716.10.1073/pnas.0832180100

  • 55

    ShimizuYKIgarashiHKiyoharaTCabezonTFarciPPurcellRHet alA hyperimmune serum against a synthetic peptide corresponding to the hypervariable region 1 of hepatitis C virus can prevent viral infection in cell cultures. Virology (1996) 223:40912.10.1006/viro.1996.0497

  • 56

    SaboMCLucaVCRaySCBukhJFremontDHDiamondMS. Hepatitis C virus epitope exposure and neutralization by antibodies is affected by time and temperature. Virology (2012) 422:17484.10.1016/j.virol.2011.10.023

  • 57

    FlintMMaidensCLoomis-PriceLDShottonCDubuissonJMonkPet alCharacterization of hepatitis C virus E2 glycoprotein interaction with a putative cellular receptor, CD81. J Virol (1999) 73:623544.

  • 58

    ZhangPWuCGMihalikKVirata-TheimerMLYuMYAlterHJet alHepatitis C virus epitope-specific neutralizing antibodies in Igs prepared from human plasma. Proc Natl Acad Sci U S A (2007) 104:844954.10.1073/pnas.0703039104

  • 59

    DhillonSWitteveldtJGathererDOwsiankaAMZeiselMBZahidMNet alMutations within a conserved region of the hepatitis C virus E2 glycoprotein that influence virus-receptor interactions and sensitivity to neutralizing antibodies. J Virol (2010) 84:5494507.10.1128/JVI.02153-09

  • 60

    KeckZYSahaAXiaJWangYLauPKreyTet alMapping a region of hepatitis C virus E2 that is responsible for escape from neutralizing antibodies and a core CD81-binding region that does not tolerate neutralization escape mutations. J Virol (2011) 85:1045163.10.1128/JVI.05259-11

  • 61

    TarrAWOwsiankaAMTimmsJMMcclureCPBrownRJHicklingTPet alCharacterization of the hepatitis C virus E2 epitope defined by the broadly neutralizing monoclonal antibody AP33. Hepatology (2006) 43:592601.10.1002/hep.21088

  • 62

    PotterJAOwsiankaAMJefferyNMatthewsDJKeckZYLauPet alToward a hepatitis C virus vaccine: the structural basis of hepatitis C virus neutralization by AP33, a broadly neutralizing antibody. J Virol (2012) 86:1292332.10.1128/JVI.02052-12

  • 63

    KeckZYAngusAGWangWLauPWangYGathererDet alNon-random escape pathways from a broadly neutralizing human monoclonal antibody map to a highly conserved region on the hepatitis C virus E2 glycoprotein encompassing amino acids 412-423. PLoS Pathog (2014) 10:e1004297.10.1371/journal.ppat.1004297

  • 64

    TarrAWOwsiankaAMJayarajDBrownRJHicklingTPIrvingWLet alDetermination of the human antibody response to the epitope defined by the hepatitis C virus-neutralizing monoclonal antibody AP33. J Gen Virol (2007) 88:29913001.10.1099/vir.0.83065-0

  • 65

    KachkoAKochnevaGSivolobovaGGrazhdantsevaALupanTZubkovaIet alNew neutralizing antibody epitopes in hepatitis C virus envelope glycoproteins are revealed by dissecting peptide recognition profiles. Vaccine (2011) 30:6977.10.1016/j.vaccine.2011.10.045

  • 66

    KreyTD’AlayerJKikutiCMSaulnierADamier-PiolleLPetitpasIet alThe disulfide bonds in glycoprotein E2 of hepatitis C virus reveal the tertiary organization of the molecule. PLoS Pathog (2010) 6:e1000762.10.1371/journal.ppat.1000762

  • 67

    LavieMSarrazinSMontserretRDescampsVBaumertTFDuverlieGet alIdentification of conserved residues in hepatitis C virus envelope glycoprotein E2 that modulate virus dependence on CD81 and SRB1 entry factors. J Virol (2014) 88:1058497.10.1128/JVI.01402-14

  • 68

    SourisseauMMichtaMLZonyCIsraelowBHopcraftSENarbusCMet alTemporal analysis of hepatitis C virus cell entry with occludin directed blocking antibodies. PLoS Pathog (2013) 9:e1003244.10.1371/journal.ppat.1003244

  • 69

    FofanaIKriegerSEGrunertFGlaubenSXiaoFFafi-KremerSet alMonoclonal anti-claudin 1 antibodies prevent hepatitis C virus infection of primary human hepatocytes. Gastroenterology (2010) 139:e9514.10.1053/j.gastro.2010.05.073

  • 70

    XiaoFFofanaIHeydmannLBarthHSoulierEHabersetzerFet alHepatitis C virus cell-cell transmission and resistance to direct-acting antiviral agents. PLoS Pathog (2014) 10:e1004128.10.1371/journal.ppat.1004128

  • 71

    WahidADubuissonJ. Virus-neutralizing antibodies to hepatitis C virus. J Viral Hepat (2013) 20:36976.10.1111/jvh.12094

  • 72

    Leroux-RoelsGEsquivelCADeleysRStuyverLElewautAPhilippeJet alLymphoproliferative responses to hepatitis C virus core, E1, E2, and NS3 in patients with chronic hepatitis C infection treated with interferon alfa. Hepatology (1996) 23:816.10.1053/jhep.1996.v23.pm0008550052

  • 73

    PestkaJMZeiselMBBlaserESchurmannPBartoschBCossetFLet alRapid induction of virus-neutralizing antibodies and viral clearance in a single-source outbreak of hepatitis C. Proc Natl Acad Sci U S A (2007) 104:602530.10.1073/pnas.0607026104

  • 74

    LuoKLiSJiangLZuoTQingJShiXet alCombinatorial library based profiling of antibody response against hepatitis C virus in human. J Gen Virol (2014).10.1099/vir.0.069278-0

  • 75

    GarronePFluckigerACMangeotPEGauthierEDupeyrot-LacasPMancipJet alA prime-boost strategy using virus-like particles pseudotyped for HCV proteins triggers broadly neutralizing antibodies in macaques. Sci Transl Med (2011) 3:94ra71.10.1126/scitranslmed.3002330

  • 76

    KeckZYSungVMPerkinsSRoweJPaulSLiangTJet alHuman monoclonal antibody to hepatitis C virus E1 glycoprotein that blocks virus attachment and viral infectivity. J Virol (2004) 78:725763.10.1128/JVI.78.13.7257-7263.2004

  • 77

    MeunierJCRussellRSGoossensVPriemSWalterHDeplaEet alIsolation and characterization of broadly neutralizing human monoclonal antibodies to the E1 glycoprotein of hepatitis C virus. J Virol (2008) 82:96673.10.1128/JVI.01872-07

  • 78

    BrazzoliMHeleniusAFoungSKHoughtonMAbrignaniSMerolaM. Folding and dimerization of hepatitis C virus E1 and E2 glycoproteins in stably transfected CHO cells. Virology (2005) 332:43853.10.1016/j.virol.2004.11.034

  • 79

    LavilletteDPecheurEIDonotPFresquetJMolleJCorbauRet alCharacterization of fusion determinants points to the involvement of three discrete regions of both E1 and E2 glycoproteins in the membrane fusion process of hepatitis C virus. J Virol (2007) 81:875265.10.1128/JVI.02642-06

  • 80

    LindenbachBDRiceCM. The ins and outs of hepatitis C virus entry and assembly. Nat Rev Microbiol (2013) 11:688700.10.1038/nrmicro3098

  • 81

    ChangKSJiangJCaiZLuoG. Human apolipoprotein e is required for infectivity and production of hepatitis C virus in cell culture. J Virol (2007) 81:1378393.10.1128/JVI.01091-07

  • 82

    CataneseMTUryuKKoppMEdwardsTJAndrusLRiceWJet alUltrastructural analysis of hepatitis C virus particles. Proc Natl Acad Sci U S A (2013) 110:950510.10.1073/pnas.1307527110

  • 83

    FarciPAlterHJWongDCMillerRHGovindarajanSEngleRet alPrevention of hepatitis C virus infection in chimpanzees after antibody-mediated in vitro neutralization. Proc Natl Acad Sci U S A (1994) 91:77926.10.1073/pnas.91.16.7792

  • 84

    BaumertTFItoSWongDTLiangTJ. Hepatitis C virus structural proteins assemble into viruslike particles in insect cells. J Virol (1998) 72:382736.

  • 85

    BartoschBDubuissonJCossetFL. Infectious hepatitis C virus pseudo-particles containing functional E1-E2 envelope protein complexes. J Exp Med (2003) 197:63342.10.1084/jem.20021756

  • 86

    TarrAWOwsiankaAMSzwejkABallJKPatelAH. Cloning, expression, and functional analysis of patient-derived hepatitis C virus glycoproteins. Methods Mol Biol (2007) 379:17797.10.1007/978-1-59745-393-6_13

  • 87

    LindenbachBDEvansMJSyderAJWolkBTellinghuisenTLLiuCCet alComplete replication of hepatitis C virus in cell culture. Science (2005) 309:6236.10.1126/science.1114016

  • 88

    WakitaTPietschmannTKatoTDateTMiyamotoMZhaoZet alProduction of infectious hepatitis C virus in tissue culture from a cloned viral genome. Nat Med (2005) 11:7916.10.1038/nm0805-905b

  • 89

    ZhongJGastaminzaPChengGKapadiaSKatoTBurtonDRet alRobust hepatitis C virus infection in vitro. Proc Natl Acad Sci U S A (2005) 102:92949.10.1073/pnas.0503596102

  • 90

    GottweinJMScheelTKJensenTBLademannJBPrentoeJCKnudsenMLet alDevelopment and characterization of hepatitis C virus genotype 1-7 cell culture systems: role of CD81 and scavenger receptor class B type I and effect of antiviral drugs. Hepatology (2009) 49:36477.10.1002/hep.22673

  • 91

    MicallefJMKaldorJMDoreGJ. Spontaneous viral clearance following acute hepatitis C infection: a systematic review of longitudinal studies. J Viral Hepat (2006) 13:3441.10.1111/j.1365-2893.2005.00651.x

  • 92

    PageKHahnJAEvansJShiboskiSLumPDelwartEet alAcute hepatitis C virus infection in young adult injection drug users: a prospective study of incident infection, resolution, and reinfection. J Infect Dis (2009) 200:121626.10.1086/605947

  • 93

    ThomasDLThioCLMartinMPQiYGeDO’HuiginCet alGenetic variation in IL28B and spontaneous clearance of hepatitis C virus. Nature (2009) 461:798801.10.1038/nature08463

  • 94

    PageKOsburnWEvansJHahnJALumPAsherAet alFrequent longitudinal sampling of hepatitis C virus infection in injection drug users reveals intermittently detectable viremia and reinfection. Clin Infect Dis (2013) 56:40513.10.1093/cid/cis921

  • 95

    GrebelyJPageKSacks-DavisRVan Der LoeffMSRiceTMBruneauJet alThe effects of female sex, viral genotype, and IL28B genotype on spontaneous clearance of acute hepatitis C virus infection. Hepatology (2014) 59:10920.10.1002/hep.26639

  • 96

    LauGKLesniewskiRJohnsonRGDavisGLLauJY. Immunoglobulin M and A antibodies to hepatitis C core antigen in chronic hepatitis C virus infection. J Med Virol (1994) 44:14.10.1002/jmv.1890440102

  • 97

    YamaguchiNTokushigeKYamauchiKHayashiN. Humoral immune response in Japanese acute hepatitis patients with hepatitis C virus infection. Can J Gastroenterol (2000) 14:5938.

  • 98

    ChenPJWangJTHwangLHYangYHHsiehCLKaoJHet alTransient immunoglobulin M antibody response to hepatitis C virus capsid antigen in posttransfusion hepatitis C: putative serological marker for acute viral infection. Proc Natl Acad Sci U S A (1992) 89:59715.10.1073/pnas.89.13.5971

  • 99

    NikolaevaLIBlokhinaNPTsurikovaNNVoronkovaNVMiminoshviliMIBraginskyDMet alVirus-specific antibody titres in different phases of hepatitis C virus infection. J Viral Hepat (2002) 9:42937.10.1046/j.1365-2893.2002.00369.x

  • 100

    AlterHJPurcellRHShihJWMelpolderJCHoughtonMChooQLet alDetection of antibody to hepatitis C virus in prospectively followed transfusion recipients with acute and chronic non-A, non-B hepatitis. N Engl J Med (1989) 321:1494500.10.1056/NEJM198911303212202

  • 101

    DustinLBRiceCM. Flying under the radar: the immunobiology of hepatitis C. Annu Rev Immunol (2007) 25:7199.10.1146/annurev.immunol.25.022106.141602

  • 102

    ChenMSallbergMSonnerborgAWeilandOMattssonLJinLet alLimited humoral immunity in hepatitis C virus infection. Gastroenterology (1999) 116:13543.10.1016/S0016-5085(99)70237-4

  • 103

    SteinmannDBarthHGisslerBSchurmannPAdahMIGerlachJTet alInhibition of hepatitis C virus-like particle binding to target cells by antiviral antibodies in acute and chronic hepatitis C. J Virol (2004) 78:903040.10.1128/JVI.78.17.9030-9040.2004

  • 104

    KaplanDESugimotoKNewtonKValigaMEIkedaFAytamanAet alDiscordant role of CD4 T-cell response relative to neutralizing antibody and CD8 T-cell responses in acute hepatitis C. Gastroenterology (2007) 132:65466.10.1053/j.gastro.2006.11.044

  • 105

    TakakiAWieseMMaertensGDeplaESeifertULiebetrauAet alCellular immune responses persist and humoral responses decrease two decades after recovery from a single-source outbreak of hepatitis C. Nat Med (2000) 6:57882.10.1038/75063

  • 106

    SemmoNLucasMKrashiasGLauerGChapelHKlenermanP. Maintenance of HCV-specific T-cell responses in antibody-deficient patients a decade after early therapy. Blood (2006) 107:45701.10.1182/blood-2005-11-4522

  • 107

    BassettSEThomasDLBraskyKMLanfordRE. Viral persistence, antibody to E1 and E2, and hypervariable region 1 sequence stability in hepatitis C virus-inoculated chimpanzees. J Virol (1999) 73:111826.

  • 108

    RazviSSchneiderLJonasMMCunningham-RundlesC. Outcome of intravenous immunoglobulin-transmitted hepatitis C virus infection in primary immunodeficiency. Clin Immunol (2001) 101:2848.10.1006/clim.2001.5132

  • 109

    MajorMEMihalikKPuigMRehermannBNascimbeniMRiceCMet alPreviously infected and recovered chimpanzees exhibit rapid responses that control hepatitis C virus replication upon rechallenge. J Virol (2002) 76:658695.10.1128/JVI.76.13.6586-6595.2002

  • 110

    PostJJPanYFreemanAJHarveyCEWhitePAPalladinettiPet alClearance of hepatitis C viremia associated with cellular immunity in the absence of seroconversion in the hepatitis C incidence and transmission in prisons study cohort. J Infect Dis (2004) 189:184655.10.1086/383279

  • 111

    RaghuramanSParkHOsburnWOWinkelsteinEEdlinBRRehermannB. Spontaneous clearance of chronic hepatitis C virus infection is associated with appearance of neutralizing antibodies and reversal of T-cell exhaustion. J Infect Dis (2012) 205:76371.10.1093/infdis/jir835

  • 112

    Esteban-RiescoLDepaulisFMoreauABacqYDuboisFGoudeauAet alRapid and sustained autologous neutralizing response leading to early spontaneous recovery after HCV infection. Virology (2013) 444:909.10.1016/j.virol.2013.05.037

  • 113

    BjoroKFrolandSSYunZSamdalHHHaalandT. Hepatitis C infection in patients with primary hypogammaglobulinemia after treatment with contaminated immune globulin. N Engl J Med (1994) 331:160711.10.1056/NEJM199412153312402

  • 114

    EnnishiDTeruiYYokoyamaMMishimaYTakahashiSTakeuchiKet alMonitoring serum hepatitis C virus (HCV) RNA in patients with HCV-infected CD20-positive B-cell lymphoma undergoing rituximab combination chemotherapy. Am J Hematol (2008) 83:5962.10.1002/ajh.21022

  • 115

    Sacks-DavisRAitkenCKHiggsPSpelmanTPedranaAEBowdenSet alHigh rates of hepatitis C virus reinfection and spontaneous clearance of reinfection in people who inject drugs: a prospective cohort study. PLoS One (2013) 8:e80216.10.1371/journal.pone.0080216

  • 116

    BassettSEGuerraBBraskyKMiskovskyEHoughtonMKlimpelGRet alProtective immune response to hepatitis C virus in chimpanzees rechallenged following clearance of primary infection. Hepatology (2001) 33:147987.10.1053/jhep.2001.24371

  • 117

    FarciPShimodaAWongDCabezonTDe GioannisDStrazzeraAet alPrevention of hepatitis C virus infection in chimpanzees by hyperimmune serum against the hypervariable region 1 of the envelope 2 protein. Proc Natl Acad Sci U S A (1996) 93:153949.10.1073/pnas.93.26.15394

  • 118

    MorinTJBroeringTJLeavBABlairBMRowleyKJBoucherENet alHuman monoclonal antibody HCV1 effectively prevents and treats HCV infection in chimpanzees. PLoS Pathog (2012) 8:e1002895.10.1371/journal.ppat.1002895

  • 119

    YuMYBartoschBZhangPGuoZPRenziPMShenLMet alNeutralizing antibodies to hepatitis C virus (HCV) in immune globulins derived from anti-HCV-positive plasma. Proc Natl Acad Sci U S A (2004) 101:770510.10.1073/pnas.0402458101

  • 120

    YuMWMasonBLGuoZPTankersleyDLNedjarSMitchellFDet alHepatitis C transmission associated with intravenous immunoglobulins. Lancet (1995) 345:11734.10.1016/S0140-6736(95)91002-6

  • 121

    HealeyCJSabharwalNKDaubJDavidsonFYapPLFlemingKAet alOutbreak of acute hepatitis C following the use of anti-hepatitis C virus – screened intravenous immunoglobulin therapy. Gastroenterology (1996) 110:11206.10.1053/gast.1996.v110.pm8613001

  • 122

    BreseeJSMastEEColemanPJBaronMJSchonbergerLBAlterMJet alHepatitis C virus infection associated with administration of intravenous immune globulin. A cohort study. JAMA (1996) 276:15637.

  • 123

    ZanettiARVan DammePShouvalD. The global impact of vaccination against hepatitis B: a historical overview. Vaccine (2008) 26:626673.10.1016/j.vaccine.2008.09.056

  • 124

    DahariHFeinstoneSMMajorME. Meta-analysis of hepatitis C virus vaccine efficacy in chimpanzees indicates an importance for structural proteins. Gastroenterology (2010) 139:96574.10.1053/j.gastro.2010.05.077

  • 125

    MeunierJCGottweinJMHoughtonMRussellRSEmersonSUBukhJet alVaccine-induced cross-genotype reactive neutralizing antibodies against hepatitis C virus. J Infect Dis (2011) 204:118690.10.1093/infdis/jir511

  • 126

    FreySEHoughtonMCoatesSAbrignaniSChienDRosaDet alSafety and immunogenicity of HCV E1E2 vaccine adjuvanted with MF59 administered to healthy adults. Vaccine (2010) 28:636773.10.1016/j.vaccine.2010.06.084

  • 127

    LawJLChenCWongJHockmanDSanterDMFreySEet alA hepatitis C virus (HCV) vaccine comprising envelope glycoproteins gpE1/gpE2 derived from a single isolate elicits broad cross-genotype neutralizing antibodies in humans. PLoS One (2013) 8:e59776.10.1371/journal.pone.0059776

  • 128

    LiangTJ. Current progress in development of hepatitis C virus vaccines. Nat Med (2013) 19:86978.10.1038/nm.3183

  • 129

    XueJZhuHChenZ. Therapeutic vaccines against hepatitis C virus. Infect Genet Evol (2014) 22:1209.10.1016/j.meegid.2014.01.008

  • 130

    NeumannAULamNPDahariHGretchDRWileyTELaydenTJet alHepatitis C viral dynamics in vivo and the antiviral efficacy of interferon-alpha therapy. Science (1998) 282:1037.10.1126/science.282.5386.103

  • 131

    RongLDahariHRibeiroRMPerelsonAS. Rapid emergence of protease inhibitor resistance in hepatitis C virus. Sci Transl Med (2010) 2:30ra32.10.1126/scitranslmed.3000544

  • 132

    von HahnTYoonJCAlterHRiceCMRehermannBBalfePet alHepatitis C virus continuously escapes from neutralizing antibody and T-cell responses during chronic infection in vivo. Gastroenterology (2007) 132:66778.10.1053/j.gastro.2006.12.008

  • 133

    LiuLFisherBEDowdKAAstemborskiJCoxALRaySC. Acceleration of hepatitis C virus envelope evolution in humans is consistent with progressive humoral immune selection during the transition from acute to chronic infection. J Virol (2010) 84:506777.10.1128/JVI.02265-09

  • 134

    BankwitzDSteinmannEBitzegeioJCiesekSFrieslandMHerrmannEet alHepatitis C virus hypervariable region 1 modulates receptor interactions, conceals the CD81 binding site, and protects conserved neutralizing epitopes. J Virol (2010) 84:575163.10.1128/JVI.02200-09

  • 135

    FornsXThimmeRGovindarajanSEmersonSUPurcellRHChisariFVet alHepatitis C virus lacking the hypervariable region 1 of the second envelope protein is infectious and causes acute resolving or persistent infection in chimpanzees. Proc Natl Acad Sci U S A (2000) 97:1331823.10.1073/pnas.230453597

  • 136

    PrentoeJJensenTBMeulemanPSerreSBScheelTKLeroux-RoelsGet alHypervariable region 1 differentially impacts viability of hepatitis C virus strains of genotypes 1 to 6 and impairs virus neutralization. J Virol (2011) 85:222434.10.1128/JVI.01594-10

  • 137

    BoothJCKumarUWebsterDMonjardinoJThomasHC. Comparison of the rate of sequence variation in the hypervariable region of E2/NS1 region of hepatitis C virus in normal and hypogammaglobulinemic patients. Hepatology (1998) 27:2237.10.1002/hep.510270134

  • 138

    GaudULangerBPetropoulouTThomasHCKarayiannisP. Changes in hypervariable region 1 of the envelope 2 glycoprotein of hepatitis C virus in children and adults with humoral immune defects. J Med Virol (2003) 69:3506.10.1002/jmv.10296

  • 139

    LeeWMPolsonJECarneyDSSahinBGaleMJr. Reemergence of hepatitis C virus after 8.5 years in a patient with hypogammaglobulinemia: evidence for an occult viral reservoir. J Infect Dis (2005) 192:108892.10.1086/432917

  • 140

    HelleFDuverlieGDubuissonJ. The hepatitis C virus glycan shield and evasion of the humoral immune response. Viruses (2011) 3:190932.10.3390/v3101909

  • 141

    WhidbyJMateuGScarboroughHDemelerBGrakouiAMarcotrigianoJ. Blocking hepatitis C virus infection with recombinant form of envelope protein 2 ectodomain. J Virol (2009) 83:1107889.10.1128/JVI.00800-09

  • 142

    FalkowskaEKajumoFGarciaEReinusJDragicT. Hepatitis C virus envelope glycoprotein E2 glycans modulate entry, CD81 binding, and neutralization. J Virol (2007) 81:80729.10.1128/JVI.00459-07

  • 143

    HelleFGoffardAMorelVDuverlieGMckeatingJKeckZYet alThe neutralizing activity of anti-hepatitis C virus antibodies is modulated by specific glycans on the E2 envelope protein. J Virol (2007) 81:810111.10.1128/JVI.00127-07

  • 144

    HelleFVieyresGElkriefLPopescuCIWychowskiCDescampsVet alRole of N-linked glycans in the functions of hepatitis C virus envelope proteins incorporated into infectious virions. J Virol (2010) 84:1190515.10.1128/JVI.01548-10

  • 145

    BartenschlagerRPeninFLohmannVAndreP. Assembly of infectious hepatitis C virus particles. Trends Microbiol (2011) 19:95103.10.1016/j.tim.2010.11.005

  • 146

    AndrePKomurian-PradelFDeforgesSPerretMBerlandJLSodoyerMet alCharacterization of low- and very-low-density hepatitis C virus RNA-containing particles. J Virol (2002) 76:691928.10.1128/JVI.76.14.6919-6928.2002

  • 147

    LindenbachBDMeulemanPPlossAVanwolleghemTSyderAJMckeatingJAet alCell culture-grown hepatitis C virus is infectious in vivo and can be recultured in vitro. Proc Natl Acad Sci U S A (2006) 103:38059.10.1073/pnas.0511218103

  • 148

    GroveJNielsenSZhongJBassendineMFDrummerHEBalfePet alIdentification of a residue in hepatitis C virus E2 glycoprotein that determines scavenger receptor BI and CD81 receptor dependency and sensitivity to neutralizing antibodies. J Virol (2008) 82:120209.10.1128/JVI.01569-08

  • 149

    MeunierJCRussellRSEngleREFaulkKNPurcellRHEmersonSU. Apolipoprotein c1 association with hepatitis C virus. J Virol (2008) 82:964756.10.1128/JVI.00914-08

  • 150

    MerzALongGHietMSBruggerBChlandaPAndrePet alBiochemical and morphological properties of hepatitis C virus particles and determination of their lipidome. J Biol Chem (2011) 286:301832.10.1074/jbc.M110.175018

  • 151

    DreuxMPietschmannTGranierCVoissetCRicard-BlumSMangeotPEet alHigh density lipoprotein inhibits hepatitis C virus-neutralizing antibodies by stimulating cell entry via activation of the scavenger receptor BI. J Biol Chem (2006) 281:1828595.10.1074/jbc.M602706200

  • 152

    Di LorenzoCAngusAGPatelAH. Hepatitis C virus evasion mechanisms from neutralizing antibodies. Viruses (2011) 3:2280300.10.3390/v3112280

  • 153

    DreuxMBosonBRicard-BlumSMolleJLavilletteDBartoschBet alThe exchangeable apolipoprotein ApoC-I promotes membrane fusion of hepatitis C virus. J Biol Chem (2007) 282:3235769.10.1074/jbc.M705358200

  • 154

    TimpeJMStamatakiZJenningsAHuKFarquharMJHarrisHJet alHepatitis C virus cell-cell transmission in hepatoma cells in the presence of neutralizing antibodies. Hepatology (2008) 47:1724.10.1002/hep.21959

  • 155

    WitteveldtJEvansMJBitzegeioJKoutsoudakisGOwsiankaAMAngusAGet alCD81 is dispensable for hepatitis C virus cell-to-cell transmission in hepatoma cells. J Gen Virol (2009) 90:4858.10.1099/vir.0.006700-0

  • 156

    BrimacombeCLGroveJMeredithLWHuKSyderAJFloresMVet alNeutralizing antibody-resistant hepatitis C virus cell-to-cell transmission. J Virol (2011) 85:596605.10.1128/JVI.01592-10

  • 157

    CataneseMTLoureiroJJonesCTDornerMVon HahnTRiceCM. Different requirements for scavenger receptor class B type I in hepatitis C virus cell-free versus cell-to-cell transmission. J Virol (2013) 87:828293.10.1128/JVI.01102-13

  • 158

    ZhangPZhongLStrubleEBWatanabeHKachkoAMihalikKet alDepletion of interfering antibodies in chronic hepatitis C patients and vaccinated chimpanzees reveals broad cross-genotype neutralizing activity. Proc Natl Acad Sci U S A (2009) 106:753741.10.1073/pnas.0902749106

  • 159

    LapierrePTroeschMAlvarezFSoudeynsH. Structural basis for broad neutralization of hepatitis C virus quasispecies. PLoS One (2011) 6:e26981.10.1371/journal.pone.0026981

  • 160

    DuanHKachkoAZhongLStrubleEPandeySYanHet alAmino acid residue-specific neutralization and nonneutralization of hepatitis C virus by monoclonal antibodies to the E2 protein. J Virol (2012) 86:1268694.10.1128/JVI.00994-12

  • 161

    SauttoGManciniNDiottiRASolforosiLClementiMBurioniR. Anti-hepatitis C virus E2 (HCV/E2) glycoprotein monoclonal antibodies and neutralization interference. Antiviral Res (2012) 96:829.10.1016/j.antiviral.2012.07.013

  • 162

    TarrAWUrbanowiczRAJayarajDBrownRJMckeatingJAIrvingWLet alNaturally occurring antibodies that recognize linear epitopes in the amino terminus of the hepatitis C virus E2 protein confer noninterfering, additive neutralization. J Virol (2012) 86:273949.10.1128/JVI.06492-11

  • 163

    KeckZWangWWangYLauPCarlsenTHPrentoeJet alCooperativity in virus neutralization by human monoclonal antibodies to two adjacent regions located at the amino terminus of hepatitis C virus E2 glycoprotein. J Virol (2013) 87:3751.10.1128/JVI.01941-12

Summary

Keywords

HCV, HCV/E2 glycoprotein, monoclonal antibodies, viral antibodies, chronic infection, acute infection, neutralizing antibodies

Citation

Cashman SB, Marsden BD and Dustin LB (2014) The Humoral Immune Response to HCV: Understanding is Key to Vaccine Development. Front. Immunol. 5:550. doi: 10.3389/fimmu.2014.00550

Received

01 September 2014

Accepted

16 October 2014

Published

10 November 2014

Volume

5 - 2014

Edited by

Ivo Paul Touw, Erasmus University Medical Center, Netherlands

Reviewed by

Koji Yasutomo, University of Tokushima, Japan; Jean Dubuisson, Centre National de la Recherche Scientifique, France

Copyright

*Correspondence: Lynn B. Dustin, The Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, UK e-mail:

This article was submitted to T Cell Biology, a section of the journal Frontiers in Immunology.

Disclaimer

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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