|
Howard J. Worman and Feng Lin Departments
of Medicine and of Anatomy and Cell Biology, College of Physi
cians and Surgeons, Columbia University, 630 West 168th Street, New
York, NY 100
32, USA
Introduction of Authors: Howard J. Worman is Associate Professor of
Medicine an
d Anatomy and Cell Biology at Columbia Universitys College of
Physicians and
Surgeons and Director of the Division of Digestive and Liver
Diseases of the Med
ical Service at the New York-Presbyterian Hospital
Columbia-Presbyterian Campu
s. He has over 70 scientific papers as well as publications on liver
diseases fo
r the lay audience.
Correspondence to: Dr. Howard J. Worman, Depar
tment of Medicine, College of Physi
cians and Surgeons, Columbia University, 630 West 168th Street, New
York, NY 100
32, USA
Telephone:
212-305-8156, Fax. 212-305-6443
Email. hjw14@columbia.edu
Received:
2000-05-25
Accepted: 2000-06-15
Subject
headings: hepatitis
C; molecular biology; viral hepatitis; anti-viral agents
Worman HJ, Lin F. Molecular biology of liver disorders: the
hepatitis C virus and molecular targets for drug development.
World J Gastroentero, 2000;6(4):465-469
INTRODUCTION
Molecular biology has made a tremendous impact on the diagnosis
and treatment of
liver diseases[1,2]. In particular, advances in molecular
biology made
possible the discovery of the virus that causes hepatitis C. In this
review, we
use hepatitis C as an example of the impact that molecular biology
has made in t
he area of liver disorders. We emphasize how our growing
understanding of the he
patitis C virus (HCV) has lead to the identification of targets for
development
of new treatments.
THE HEPATITS C VIRUS (HCV)
Basic molecular virology of HCV
Investigators at Chiron Corporation were the first to
discover HCV and r
eported
this in a landmark paper published in 1989[3]. The virus
was identified
by antibody screening of cDNA expression libraries made from DNA and
RNA from th
e plasma of chimpanzees. These chimpanzees were inoculated with
serum from human
s with what was then called post-transfusion non-A,
non-B
hepatitis. The
DNA expression library was screened with antibodies from sera of
other patients
with non-A,
non-B
hepatitis. This led to the isolation of clones that we
re derived from portions of the viral genome and encoded fragments
of viral poly
peptides. Treatment with RNase and DNase showed that HCV was a
positive-strande
d RNA virus[3]. In an accompanying paper, the
investigators who discover
ed HCV and their collaborators showed that the vast majority of
individuals with
chronic non-A,
non-B hepatitis
had antibodies against the newly identifi
ed viral polypeptides[4].
After
the discovery of HCV, its entire genome was cloned and sequenced i
n several laboratories[5-8]. HCV is a member of the
Flavivaridae family.
Once HCV infects cells, the positive, single stranded RNA genome is
translated
into a polyprotein of 3010 to 3033 amino acids, depending upon the
strain (Figur
e 1).
The viral RNA is not capped and translation occurs via an internal
ribosom
e entry site (IRES) at the 5′end
of the viral RNA[9,10]. The mechanis
m of translation of uncapped viral RNA therefore differs from that
used by virtu
ally all cellular mRNAs which are capped at their 5′
ends.
Both
host cell and viral proteases cleave the HCV polyprotein into severa
l smaller polypeptides (Figure 1). The major structural proteins are
core prote
in and two envelope proteins called E1 and E2. Core protein forms
the nucleocap
sid of the mature virion and E1 and E2 are present in the viral
envelope. A sma
ll polypeptide called P7 is also generated as a result of cleavage
at the E2-NS
2 junction but its function is not clear. Four major non-structural
proteins ca
lled NS2, NS3, NS4, and NS5 are generated, two of which, NS4 and
NS5, are furth
er
processed into smaller polypeptides called NS4A, NS4B, NS5A, and
NS5B. The non
-
structural proteins have enzymatic functions that are critical for
viral replica
tion in cells, such as RNA helicase (NS3), protease (NS2, NS3-NS4A
complex) and
RNA polymerase (NS5B) activities. NS5A has been implicated in
determining sensi
tivity to interferon alpha.
HCV replication and interactions with host cells
Little is known about the fundamental aspects of HCV
replication, primarily beca
use a robust cell culture has not been established. Although viral
proteins and
RNA components involved in critical steps in HCV replication are
known, very li
ttle is understood about the mechanistic details or the role of
accessory host c
ell factors. Some of the basic steps in HCV replication that occur
in infected
cells are outlined here.
After
infection of cells, HCV RNA must be translated into protein. HCV RN
A translation is initiated by internal ribosome binding, not by 5′-end
depend
ent
mechanisms[9,10]. Internal initiation is specified by an
IRES ele
me
nt. Such elements were first discovered in the genomes of
picornaviruses[11
]. The IRES is believed to require the set of canonical
translation initiatio
n factors in order to function. In addition, IRES function is also
thought to be
dependent on other cell proteins. However,
Figure 1(PDF)
HCV proteins and their functions. The positive-stranded RNA of about
10,000 nuc
leotides is translated into a polyprotein of approximately 3000
amino acids. The
polyprotein is proteolytically cleaved into several smaller
proteins. Core, E1,
and E2 are structural polypeptides. Core protein is the virus
nucleocapsid and E
1 and E2 are viral envelope proteins. A small polypeptide known as
P7 (not shown
) is also produced by additional cleavage between E2 and NS2. The
major non-str
uctural proteins are NS2, NS3, NS4, and NS5. NS4 is further
processed into NS4A
a
nd NS4B and NS5 into NS5A and NS5B. NS2 and part of NS3 are
proteases that proce
ss the viral polyprotein. NS3 also has RNA-helicase activity. NS4A
is a cofacto
r for the NS3 protease and NS5B is an RNA-dependent, RNA polymerase.
The functi
ons of NS4B and NS5A are less well understood but NS5A is thought to
play a role
in determining sensitivity to interferon. no single cell protein has
been shown to be dispensable for the function of all IRESes.
HCV RNA must be unwound for efficient
protein synthesis to occur. This process
is catalyzed by a RNA helicase that is part of the viral NS3
protein. The three
-dimensional structure of the HCV NS3 helicase domain has been
determined and d
etails about its function are emerging[12-14]. At the
present time, it
is not known if host cell co-factors are necessary for optimal
functioning of
the NS3 helicase. Cellular RNA helicases have also been shown to
bind to the HCV
core protein[15-17], however, it is not known if they
also play a rol
e in unwinding viral RNA.
After
its synthesis, the HCV polyprotein is processed into the structural
and no
nstructural proteins. Proteolytic cleavages between structural
polypeptides are
catalyzed by signal peptidase in the endoplasmic reticulum. Two
virally encode
d proteases, NS2 and NS3, catalyze the other cleavages of the HCV
polyprotein.
The NS3 protease contains a trypsin-like fold and a zinc-binding
site and is c
omplexed with the viral protein NS4A[18,19].
HCV
RNA must be replicated to produce more virions. The viral protein
NS5B is a
n RNA-dependent RNA polymerase. NS5B bears some similarity and motif
organizati
on to poliovirus polymerase and human immunodeficiency virus 1
(HIV-1) reverse
transcriptase but adopts a unique shape due to extensive
interactions between th
e fingers and thumb polymerase subdomains that encircle its active
site[20
]. The precise mechanism of action of the HCV NS5B polymerase
is not known. C
ellular or viral protein or RNA binding partners that function as
subunits or in
itiation factors may be necessary for optimal activity.
The
replication rate of HCV in human hosts is estimated to be extremely
high. I
t appears that the estimated half-life of a viral particle is 2.7 h
with pr
oduction and clearance of about one trillion viral particles a day[21]
.
This rate of virion production is approximately 1,000 times greater
than that e
stimated for HIV-1. Factors responsible for the high rate of HCV
replication ar
e not entirely understood. This rapid rate of replication can
explain the develo
pment of mutant strains or quasispecies that occur after HCV
infection. It may a
lso make development of an effective vaccine difficult.
DRUG TARGETS FOR THE TREATMENT OF HCV INFECTION
Non-specific
anti-viral agents for HCV infection
The currently available drugs for
the treatment of hepatitis C are anti-viral a
gents not specifically directed against HCV. The United States Food
and Drug Adm
inistration (FDA) has approved several preparations of recombinant
interferon al
pha for the treatment of chronic hepatitis C. Interferon alpha is a
suboptimal t
reatment in that only about 20% or less of patients who complete a
one year cour
se of treatment respond successfully as determined by the inability
to detect HC
V in serum 6 mo after the drug is stopped[22]. Numerous
adverse even
ts are also associated with interferon alpha, most notably flu-like
symptoms, n
eutropenia, thrombocytopenia, and depression. Interferon alpha must
be administe
red by injection 3 times a week. Newer preparations of interferon
alpha-2b c
omplexed with polyethylene glycol have been developed[23].
These so-cal
led PEG-ylated
interferon alphas are released more slowly and evenly into
the bloodstream and need only be administered by injection once a
week. PEG
-ylated
interferon alphas will likely be approved for the treatment of chron
ic hepatitis C in the United States in the year 2000 or 2001.
The combination of interferon alpha-2b
plusing oral ribavirin is approved in
many countries for the treatment of chronic hepatitis C. Combination
treatment
for 6 mo leads to no detectable virus in serum 6 mo after stopping
thera
py in approximately 40% of subjects[24-26]. The major
adverse event as
sociated with ribavirin is hemolytic anemia, which in rare cases can
be life thr
eatening. VX-497 is a compound in development that inhibits inosine
monophospha
te dehydrogenase and may have anti viral affects similar to those of
ribavirin
[27]. VX-497 is being studied in combination with
interferon alpha to e
stablish if it is as effective as ribavirin with a similar or
preferable adverse
events profile.
Other!cytokines have also been tested in
the treatment of HCV infection.
A recent report of a pilot study suggests that interleukin-10 may
slow the deve
lopment of liver fibrosis in subjects with chronic hepatitis C[28].
Inte
rleukin-10, however, was not shown to have anti-viral activity
against HCV.
Agents directed against HCV non-structural proteins
The next generation of drugs for the treatment of hepatitis
C will likely be dir
ected against non-structural HCV proteins with known enzymatic
activities. Thre
e major targets are the NS3 protease, NS3 helicase, and NS5B
RNA-directed RNA p
o
lymerase. The fact that these proteins have enzymatic activities
that can be mea
sured in vitro make them amenable to high-throughput
screening techniques f
avored by pharmaceutical chemists. This obviates the need to grow
HCV in cell cultures or in small animals, tasks that have eluded
investigators.
The three-dimensional structure of the HCV
NS3 protease domain has been determi
ned by X-ray crystallography[18,19]. In addition, the
structure of the
NS3 protease domain complexed with an inhibitor has recently been
established[29]. Armed with this knowledge, chemists can
use rationale drug design to
synthesis compounds to inhibit protease activity. Rational drug
design can be c
ombined with combinatorial chemistry in which a library of thousands
or more str
ucturally similar molecules is tested against the target. By
combining rational
drug design and combinatorial chemistry with high throughput
screening technique
s that measure enzymatic activity, N3S protease inhibitors can be
identified, fu
rther developed and ultimately tested in infected chimpanzees and
humans.
Similar
methods can be used to identify inhibitors of the N3S helicase
domain an
d NS5B RNA-dependent RNA polymerase. The three-dimensional
structures of these
proteins are also known[12-14]. Although human cells have
RNA helicas
es, their mechanism of action is probably different than RNA
helicases of viruses[30]. Animal cells do not have
RNA-dependent RNA polymerases, making N
S5B an attractive target for an anti-viral agent.
Agents directed against HCV RNA
HCV RNA differs from cellular mRNA. First, it has a unique
ribonucleotide seque
nce. Second, as outlined above, HCV RNA is uncapped and translation
is initiate
d via an IRES. Third, the viral RNA must be efficiently packaged
into the matur
e virions. These features make the HCV RNA a potential target for
anti-viral dr
ugs.
Ribozymes
are catalytic RNA molecules that can be designed to cleave speci
fic RNA sequences. Ribozymes therefore have potential utility as
drugs against
RNA viruses, including HCV. Investigators at Ribozyme
Pharmaceuticals have deve
loped ribozymes against conserved genomic sequences in HCV[31].
These ri
bozymes cut the viral RNA at specific sequences and are able to
inhibit HCV RNA
-directed protein synthesis and HCV RNA replication in in vitro
systems. It
is anticipated that a ribozymes against HCV will be tested in human
clinical tr
ials in the next couple of years.
HCV
RNA is translated by internal ribosome binding mediated by an IRES[9,1
0]. The IRES adopts a tertiary structure that is necessary for
function[
32,33]. Interference with IRES structure or function is a
logical approach to
attacking HCV replication. Antisense olignucleotides targeted to a
stem-loop s
tructure within the IRES have been shown effective at inhibiting HCV
gene expres
sion[34,35]. Other small molecule inhibitors can
potentially be designed
to inhibit HCV IRES function, which can be measured using in
vitro assays a
daptable to high throughput screening methods.
HCV
RNA genomes must be packaged into newly synthesized virions. This is
likely mediated by specific interactions between sequences in RNA
and core prote
in. Synthetic oligonucleotides corresponding to sequences in the 5′
region of
the HCV genome have been shown to bind to core protein[36].
Agents that
block HCV RNA binding to core protein could be useful as inhibitors
of virion pr
oduction.
Agents directed against other targets of HCV
HCV presumably gains access to hepatocytes, and possibly
other cells, by b
inding to a plasma membrane protein receptor or receptors. HCV
envelope protein
s E1 and E2 have been shown to interact with plasma membranes of
hepatocytes and
other cells[37]. E1 and E2 may form a heteromeric complex[38],
however, it is not clear if their association is necessary for
binding to cell m
embranes.
The receptors for HCV entry into liver
cells are also not presently known. Howe
ver, an interaction between HCV E2 and a plasma membrane protein
CD81 has been described and characterized in some detail[39,40].
It is difficult to est
ablish if this interaction mediates HCV entry into cells, primarily
because a ro
bust cell culture system for HCV is not currently available. Even if
CD81 or oth
er proteins that bind to HCV E1 and E2 are not receptors that
mediate viral entr
y, knowledge of these interactions could lead to the development of
drugs that i
nhibit the binding of HCV to cells. Additional experimental work
that may lead t
o the definitive identification of HCV receptors could also lead to
the developm
ent of viral entry inhibitors. Structural analysis of the
interactions of viral
envelope proteins with cellular receptors should be of tremendous
value in the d
evelopment of drugs as it will be in the case of HIV-1[41,42].
The core protein of HCV is another
potential target for the development of anti
-viral drugs. In infected cells, HCV core protein is synthesized on
the endopla
smic reticulum membrane with a large domain facing the cytoplasm[43].
HC
V core protein has been shown to form multimers[44]and
the self-intera
ction of core protein is likely important in the assembly of the
virion nucleoca
psid. HCV core protein expression may also influence critical
processes that hav
e implications for cellular pathophysiology. Core protein may play a
role in tra
nsformation and oncogenesis[45]or be involved in
regulating apoptosis a
s it has been shown to bind to the cytoplasmic domain of
lymphotoxin-βreceptor,
a member of the tumor necrosis receptor protein family[46].
HCV core protein also binds to a cellular RNA helicase and this
interaction
may adversely affect host cell protein synthesis and provide the
viral RNA with
enhanced access to the cell's protein synthesis machinery[15-17].
Inhi
bitors of core protein self-assembly or its interactions with other
cellular pr
oteins could therefore be useful in the treatment of hepatitis C.
CONCLUSIONS
The innovative application of standard technique in molecular
biology led to the
discovery of HCV. The development of treatments for HCV infection
has lagged o
ur understanding of the molecular biology of the virus because
neither a small a
nimal model of the disease nor a robust cell culture system for the
virus curren
tly exist. Recent advancements such as the development of sub-genomic
replic
ons[47]
and an infectious viral RNA clone that can infect chimpanzees
[48]may partially overcome these limitations.
Nonetheless, based on our
present understanding of the molecular biology of HCV, several steps
in the vir
al life cycle can currently be targeted for the development of
anti-viral drugs
.
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