The Role of Natural Killer and Natural Killer T Cells in Chronic Hepatitis B infection

Hepatitis B is a noncytopathic virus, which exclusively replicates within the liver and affects 350 million people worldwide [1]. Chronic infection can lead to variable disease manifestations such as cirrhosis, decompensated liver disease and hepatocellular carcinoma causing 1 million deaths per year [2]. These important clinical outcomes are a consequence of the host immune response to HBV, which constitutes a double-edged sword responsible for both viral clearance and hepatocellular damage. <br> <br> The precipitants for natural history milestones such as HBV-related hepatic flares (HF) and hepatitis B e Antigen (HBeAg) seroconversion remain unknown. Virus-specific and non-specific cytotoxic T lymphocytes (CTLs), T regulatory (Treg) cells, Natural Killer (NK), Natural Killer T (NKT) cells and dendritic cells (DCs) have been postulated to play a role [3]. The contribution of these immune cells and the nature of their interaction in the immune pathogenesis of HBV-related liver disease require further characterization. The logistical restraints of longitudinal, peripheral and intrahepatic sampling of the human host as well as inadequate small animal and cell culture models have hampered investigation of these immune mechanisms. As a caveat to human based studies in HBV, the circulating immunological cells may not reflect the phenotype and function of equivalent cells sequestered within the human liver. Current knowledge about the immune response to HBV is extrapolated from transgenic mouse models, many of which are models of viral replication rather than liver injury. <br> <br> Natural Killer (NK) and Natural Killer T (NKT) cells are cytotoxic lymphocytes that constitute a key effector arm of the innate immune system. Efforts to characterise the immunological determinants of Hepatitis B virus (HBV) infection have focused on the adaptive immune system whilst overlooking the potential interaction between virus, hepatocyte and NK or NKT cells, which play an important role in host defense against viral pathogens through direct cytotoxicity and the production of proinflammatory and immune regulatory cytokines. There is debate as to whether NK or NKT cells are effectors of antiviral activity or mediators of hepatic injury and fibrogenesis in chronic hepatitis B infection. NK and NKT cells have been implicated in the pathogenesis of liver disease due to other hepatotropic viruses such as hepatitis C and E as well as autoimmune liver disease, as shown in animal models of liver injury [4]. Human intrahepatic lymphocytes consist of 30%-50% NK and 5-10% NKT cells. Peripheral blood lymphocytes contain 13% NK cells and 2% NKT cells [5]. The hepatic enrichment of NK and NKT cells reflects their role as regulators at the interface between the innate and adaptive immune response to liver disease. NK and NKT cells in the peripheral and intrahepatic compartments share effector functions such as direct killing of viral-infected cells and cytokine production. The latter is considered the more important effector function in CHB [4]. NK and NKT cells demonstrate reciprocal interactions (“crosstalk”) with hepatic macrophages, Kupffer cells (KC), DCs and T cells as part of an amalgamated immune response to HBV [4]. <br> <br> The role of NK and NKT cells in the initiation and orchestration of a dynamic host immune response against HBV-related liver disease is investigated in this thesis. This hepatotrophic virus has evolved direct and indirect strategies to evade or inhibit the large hepatic reservoir of NK and NKT cells. In this thesis, I will focus on the dynamic phenotype and function of NK and NKT cells throughout the different phases of HBV infection, which so far have been poorly characterized. I will also examine the effect of activated NK and NKT cells on liver injury, fibrosis, and their attenuation following <br> HBV treatment, which remains controversial. Understanding the role of NK and NKT cells in the pathogenesis of CHB may help to develop new biomarkers for disease and treatment activity and design novel immunotherapies