Specific mutations in the C-terminus domain of HBV surface antigen significantly correlate with low level of serum HBV-DNA in patients with chronic HBV infection

Background: To define HBsAg-mutations correlated with different serum HBV-DNA levels in HBV chronically-infected drug-naive patients. Methods: This study included 187 patients stratified into the following ranges of serum HBV-DNA:12-2000IU/ml, 2000-100,000IU/ml, and >100,000IU/ml. HBsAg-mutations were associated with HBV-DNA levels by applying a Bayesian-Partitional-Model and Fisher-exact test. Mutant and wild-type HBV genotype-D genomes were expressed in Huh7 cells and HBsAg-production was determined in cell-supernatants at 3 days-post-transfection. Results: Specific HBsAg-mutations (M197T,-S204N-Y206C/H-F220L) were significantly correlated with serum HBV-DNA <2000IU/ml (posterior-probability>90%, P<0.05). The presence of Y206C/H and/or F220L was also associated with lower median (IQR) HBsAg-levels and lower median (IQR) transaminases (for HBsAg:250[115-840] IU/ml for Y206C/H and/or F220L versus 4300[640-11,838] IU/ml for wild-type, P=0.023; for ALT:28[21-40] IU/ml versus 53[34-90] IU/ml, P<0.001). These mutations were localized in the HBsAg C-terminus, known to be involved in virion and/or HBsAg secretion. The co-occurrence of Y206C+F220L was found significant by cluster-analysis, (. P=0.02). In addition, in an in-vitro model Y206C+F220L determined a 2.8-3.3 fold-reduction of HBsAg-amount released in supernatants compared to single mutants and wt (Y206C+F220L=5,679IU/ml; Y206H=16,305IU/ml; F220L=18,368IU/ml; Y206C=18,680IU/ml; wt=14,280IU/ml, P<0.05). Conclusions: Specific HBsAg-mutations (compartmentalized in the HBsAg C-terminus) correlated with low-serum HBV-DNA and HBsAg-levels. These findings can be important to understand mechanisms underlying low HBV replicative potential including the inactive-carrier state. \u2022An integrative approach of sequence analyses, mathematical models and phenotypic assays was used in this work.\u2022Novel HBsAg-genetic markers correlated with different levels of serum HBV-DNA in HBV chronically-infected patients.\u2022Mutations compartmentalized at the C-terminus of the HBsAg correlated with HBV-DNA 642,000UI/ml and low HBsAg titer.\u2022The impact of such markers on the release of HBsAg has been validated with an invitro model