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592
Immune markers for HBsAg spontaneous seroconversion
in HBeAg-ve chronic hepatitis B patients with raised
ALT
Ashish Vyas1, Barjesh C. Sharma2, Shiv K. Sarin2, Nirupma Trehanpati1;
1Molecular and Cellular Medicine, Institute of Liver and
Biliary Sciences, New Delhi, India; 2Hepatology, Institute of Liver
and Biliary Sciences, Delhi, India
Background: The incidence of HBsAg spontaneous seroconversion
is 0.5-1%, much lower in HBeAg negative patients.
The immune mechanisms regulating this seroconversion are
not well understood. IL-21 secreting T follicular helper (TFH)
cells regulate B cell maturation and HBeAg seroconversion.
We undertook to investigate the role of IL21, IL17 and TNF-α
secreting TFH cells, plasma B cells and dendritic cells (DCs)
in HBsAg seroconversion. Patients and Methods: Untreated
HB eAg-ve chronic hepatitis B patients (n=131) with raised
ALT (>40 IU/ml), were followed-up for spontaneous HBsAg
seroconversion for a median of 8months. Patients, who seroconverted
(Gr. I, n=11) were compared with a matched group
who did not seroconvert, and had high (Gr. II, >2,000 IU/
ml, n=10) or low (Gr. III, <2000 IU/ml, n=10) HBV DNA.
Serum IL21 levels by EIA and, cell phenotypes (dendritic, B
and TFH cells) were measured in PBMCs by Flowcytometry.
TNF-α and IL-17A secreting cells were studied after stimulation
with HBsAg (207-339) and HBcAg (340-388) overlapping
pooled peptides. Results- Of 131, eleven patients (Gr.1) seroconverted,
with appearance of anti-HBs>10IU/ml and HBV
DNA loss. All had HBV DNA >2,000 IU/ml at baseline. In
Gr. I, compared to Gr. II and III, serum IL-21 levels (865 vs.
276 vs.111 p<0.0001,p<0.001), CD4+CXCR5 (12.3 vs. 4.0
vs. 2.2, p=0.01, p=0.001), CD4+CXCR5+ICOS+TFH cells
(20.0 vs. 10.0 vs. 15.5, p=0.01, p=0.001), HBsAg specific
IL-17 (9.0 vs. 3.0 vs.1.9 p=0.02, p=0.001) and TNF-α producing
TFH17 cells (82 vs. 1.0 vs. 1.1 p=0.01, p=0.001),
plasma B cells; CD19+CD38+ (15.0 vs. 5.5 vs. 6.0 p=0.001)
myeloid(14.1 vs. 7.1 vs. 7.2 p=0.001 ) and plasmocytoid DCs
( 2.6 vs. 0.18 vs. 0.01 p=0.01, p=0.001 )were significantly
increased in Gr.1 compared to Gr. 2 & 3. IL-21 and plasma B
cells correlated with anti-HBs titers in seroconverters (R2=0.52,
P=0.003) (R2=0.9, P=0.02, 0.01) in Gr.1 than Gr. 2&3. Conclusions:
Functional TFH cells and potent anti-HBs producing
plasma B cells play a major role in HBsAg seroconversion.
High levels of IL-21 regulate this serocoversion and can serve
as a new therapeutic immune modulatory tool
Disclosures:
The following people have nothing to disclose: Ashish Vyas, Barjesh C. Sharma,
Shiv K. Sarin, Nirupma Trehanpati
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