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Combinations of two drugs among NS3/4A inhibitors, NS5B inhibitors and non-selective antiviral agents are effective for hepatitis C virus with NS5A-P32 deletion in humanized-liver mice

Authors
  • Doi, Akira1
  • Hikita, Hayato1
  • Kai, Yugo1
  • Tahata, Yuki1
  • Saito, Yoshinobu1
  • Nakabori, Tasuku1
  • Yamada, Ryoko1
  • Kodama, Takahiro1
  • Sakamori, Ryotaro1
  • Murayama, Asako2
  • Nitta, Sayuri3
  • Asahina, Yasuhiro3, 4
  • Suemizu, Hiroshi5
  • Tatsumi, Tomohide1
  • Kato, Takanobu2
  • Takehara, Tetsuo1
  • 1 Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan , Suita, Osaka (Japan)
  • 2 National Institute of Infectious Diseases, Department of Virology II, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan , Tokyo (Japan)
  • 3 Tokyo Medical and Dental University, Department of Gastroenterology and Hepatology, 4-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan , Tokyo (Japan)
  • 4 Tokyo Medical and Dental University, Department of Liver Disease Control, 4-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan , Tokyo (Japan)
  • 5 Central Institute for Experimental Animals, Department of Laboratory Animal Research, 3-25-12 Tonomachi, Kawasaki-ku, Kawasaki, 210-0821, Japan , Kawasaki (Japan)
Type
Published Article
Journal
Journal of Gastroenterology
Publisher
Springer Japan
Publication Date
Jan 25, 2019
Volume
54
Issue
5
Pages
449–458
Identifiers
DOI: 10.1007/s00535-018-01541-x
Source
Springer Nature
Keywords
License
Yellow

Abstract

BackgroundThe emergence of a deletion mutant at hepatitis C virus (HCV) NS5A-P32 (P32del) has recently been reported in a subset of chronic hepatitis C patients who experience virologic failure after direct-acting antiviral drug (DAA) treatment. This mutation confers extremely high resistance to NS5A inhibitors. No effective treatment has been established for cases with this mutation.MethodsWe used a JFH1-based recombinant virus with NS5A from a genotype 1b strain to introduce a P32del mutation. We inoculated human hepatocyte chimeric mice with sera from a patient with ledipasvir/sofosbuvir therapy failure carrying a genotype 1b HCV with NS5A L31M and P32del or from a DAA-naïve patient carrying wild-type virus.ResultsJFH1-based chimeric viruses with P32del showed sufficient levels of replication for in vitro assay despite the suppression of viral growth and infectious virus production. Variants with P32del exhibited severe resistance to all tested NS5A inhibitors, including daclatasvir, ledipasvir, elbasvir and velpatasvir, but were as susceptible to NS3/4A inhibitors, NS5B inhibitors, interferon alfa-2b, and ribavirin as wild-type viruses in the in vitro assay. The P32del mutant virus caused persistent infection in all inoculated chimeric mice with high viral titer and frequency. The virus was resistant to the ledipasvir/GS-558093 (a nucleotide analog inhibitor of NS5B polymerase) regimen but susceptible to either simeprevir plus GS-558093 or peg-interferon alfa-2b, compared to the wild-type virus.ConclusionTherapies combining at least two drugs among NS3/4A inhibitors, NS5B inhibitors and non-selective antiviral agents may be effective for HCV-infected patients with NS5A-P32del.

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