Diagnosis and Treatments of HBV Infection: Past, Present and the Future

Transfusion represented one of the major risks for hepatitis B virus (HBV) transmission in the past; however, in the last few decades, the implementation of vaccination and chemotherapy programs together with blood safety measures has contributed to a continual reduction in the risk for transfusion-mediated HBV infection. Paradoxically, the efforts to improve transfusion security may have the unintended but inevitable effect on spawning future insecurity, i.e., vaccine- and drug-induced HBV mutants may complicate diagnostic testings and thus screening strategies have to be developed accordingly. Fortunately, recent advances in cellular immunotherapies and the related research hold a great promise and give hope that a functional cure for HBV may be obtained for chronic and even occult hepatitis B infection (OBI) cases for which no drug are currently available. Although much of this work is still in its infancy, the blood components (peripheral blood mononuclear cells) are the primary source materials and its impact has already been felt. The overarching goal of this paper is to review these recent advances derived from the intercalating interplay between the virus and blood, which, although they seem to evolve differently in their own pathways, the evolutions converge in one very important point - they all support the view that the patients' own immunity is probably the best construct to cope with HBV. As described here, incorporating aspects of adoptive cell therapies in addition to the current sets of vaccine and chemotherapeutic regimen has the potential to significantly advance our ability in controlling HBV infections. It is convincing enough that, the blood components, once representing an emergent viral threat in blood transfusion, may become otherwise a powerful tool to kick the virus out of the patients through immunologically genetic modifications.

關鍵字

Hepatitis B virus ； Occult hepatitis B infection ； Adoptive cell therapies

並列摘要

輸血是B型肝炎傳染的一個主要因素，然而在過去的數十年內，實施疫苗接種和化學療法的療程以及血液安全檢驗措施已有助於不斷降低B型肝炎因輸血而感染的風險。但應注意的是，提高輸血安全性努力的過程可能使未來大幅增加意料之外但不可避免的後果，即疫苗和藥物誘導的HBV突變株將會使診斷和監測的策略更趨複雜。值得慶幸的是，細胞免疫療法和其研究的最新進展極具希望，並為以前許多沒有對應藥物的慢性B型肝炎甚至是潛伏性B型肝炎（OBI）病例中去達到功能性治癒提供了新的曙光。儘管許多工作仍處於搖籃期，但以周邊血單核球之血液成分作為原料的細胞治療產品與步驟已做出實質層面上的改變與影響。本文的總體目標是回顧由病毒和血液之間環環相扣的交互作用下所衍生最新的進展，儘管各研究所得結論有所差異，但都支持並彙整至以下此重要的觀點：患者自身的免疫力可能是應對B型肝炎病毒的最佳方法。如本所述，除目前的疫苗和化學治療方案外，結合各種免疫療法將顯著提升我們對B型肝炎病毒感染控制的潛力。結合免疫學遺傳改質血液細胞將使過去的感染源成為未來消滅B型肝炎病毒之武器。

並列關鍵字

B型肝炎病毒；潛伏性B型肝炎感染；嵌合抗原受體T細胞

國際替代計量

Diagnosis and Treatments of HBV Infection: Past, Present and the Future

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