1 4754 100 NOVEL THERAPEUTIC STRATEGIES FOR CHRONIC HEPATITIS B. THE LAST FEW YEARS HAVE SEEN A RESURGENCE OF ACTIVITY IN THE HEPATITIS B DRUG PIPELINE, WITH MANY COMPOUNDS IN VARIOUS STAGES OF DEVELOPMENT. THIS REVIEW AIMS TO PROVIDE A COMPREHENSIVE OVERVIEW OF THE LATEST ADVANCES IN THERAPEUTICS FOR CHRONIC HEPATITIS B (CHB). WE WILL DISCUSS THE BROAD SPECTRUM OF DIRECT-ACTING ANTIVIRALS IN CLINICAL DEVELOPMENT, INCLUDING CAPSIDS INHIBITORS, SIRNA, HBSAG AND POLYMERASE INHIBITORS. IN ADDITION, HOST-TARGETED THERAPIES (HTT) WILL BE EXTENSIVELY REVIEWED, FOCUSING ON THE LATEST PROGRESS IN IMMUNOTHERAPEUTICS SUCH AS TOLL-LIKE RECEPTORS AND RIG-1 AGONISTS, THERAPEUTIC VACCINES AND IMMUNE CHECKPOINTS MODULATORS. A GROWING NUMBER OF HTT IN PRE-CLINICAL DEVELOPMENT DIRECTLY TARGET THE KEY TO HBV PERSISTENCE, NAMELY THE COVALENTLY CLOSED CIRCULAR DNA (CCCDNA) AND HOLD GREAT PROMISE FOR HBV CURE. THIS EXCITING AREA OF HBV RESEARCH WILL BE HIGHLIGHTED, AND MOLECULES SUCH AS CYCLOPHILINS INHIBITORS, APOBEC3 DEAMINASES AND EPIGENETIC MODIFIERS WILL BE DISCUSSED. 2022 2 5952 39 TARGETING VIRAL CCCDNA FOR CURE OF CHRONIC HEPATITIS B. PURPOSE OF REVIEW: CHRONIC HEPATITIS B (CHB), CAUSED BY HEPATITIS B VIRUS (HBV), IS A MAJOR CAUSE OF ADVANCED LIVER DISEASE AND HEPATOCELLULAR CARCINOMA (HCC) WORLDWIDE. HBV REPLICATION IS CHARACTERIZED BY THE SYNTHESIS OF COVALENTLY CLOSED CIRCULAR (CCC) DNA WHICH IS NOT TARGETED BY ANTIVIRAL NUCLEOS(T)IDE ANALOGUES (NUCS) THE KEY MODALITY OF STANDARD OF CARE. WHILE HBV REPLICATION IS SUCCESSFULLY SUPPRESSED IN TREATED PATIENTS, THEY REMAIN AT RISK FOR DEVELOPING HCC. WHILE FUNCTIONAL CURE, CHARACTERIZED BY LOSS OF HBSAG, IS THE FIRST GOAL OF NOVEL ANTIVIRAL THERAPIES, CURATIVE TREATMENTS ELIMINATING CCCDNA REMAIN THE ULTIMATE GOAL. THIS REVIEW SUMMARIZES RECENT ADVANCES IN THE DISCOVERY AND DEVELOPMENT OF NOVEL THERAPEUTIC STRATEGIES AND THEIR IMPACT ON CCCDNA BIOLOGY. RECENT FINDINGS: WITHIN THE LAST DECADE, SUBSTANTIAL PROGRESS HAS BEEN MADE IN THE UNDERSTANDING OF CCCDNA BIOLOGY INCLUDING THE DISCOVERY OF HOST DEPENDENCY FACTORS, EPIGENETIC REGULATION OF CCCDNA TRANSCRIPTION AND IMMUNE-MEDIATED DEGRADATION. SEVERAL APPROACHES TARGETING CCCDNA EITHER IN A DIRECT OR INDIRECT MANNER ARE CURRENTLY AT THE STAGE OF DISCOVERY, PRECLINICAL OR EARLY CLINICAL DEVELOPMENT. EXAMPLES INCLUDE GENOME-EDITING APPROACHES, STRATEGIES TARGETING HOST DEPENDENCY FACTORS OR EPIGENETIC GENE REGULATION, NUCLEOCAPSID MODULATORS AND IMMUNE-MEDIATED DEGRADATION. SUMMARY: WHILE DIRECT-TARGETING CCCDNA STRATEGIES ARE STILL LARGELY AT THE PRECLINICAL STAGE OF DEVELOPMENT, CAPSID ASSEMBLY MODULATORS AND IMMUNE-BASED APPROACHES HAVE REACHED THE CLINICAL PHASE. CLINICAL TRIALS ARE ONGOING TO ASSESS THEIR EFFICACY AND SAFETY IN PATIENTS INCLUDING THEIR IMPACT ON VIRAL CCCDNA. COMBINATION THERAPIES PROVIDE ADDITIONAL OPPORTUNITIES TO OVERCOME CURRENT LIMITATIONS OF INDIVIDUAL APPROACHES. 2020 3 6712 23 VIRUS-HOST INTERPLAY IN HEPATITIS B VIRUS INFECTION AND EPIGENETIC TREATMENT STRATEGIES. WORLDWIDE, CHRONIC HEPATITIS B VIRUS (HBV) INFECTION IS A MAJOR HEALTH PROBLEM AND NO CURE EXISTS. IMPORTANTLY, HEPATOCYTE INTRUSION BY HBV PARTICLES RESULTS IN A COMPLEX DEREGULATION OF BOTH VIRAL AND HOST CELLULAR GENETIC AND EPIGENETIC PROCESSES. AMONG THE ATTEMPTS TO DEVELOP NOVEL THERAPEUTIC APPROACHES AGAINST HBV INFECTION, SEVERAL OPTIONS TARGETING THE EPIGENOMIC REGULATION OF HBV REPLICATION ARE GAINING ATTENTION. THESE INCLUDE THE EXPERIMENTAL TREATMENT WITH 'EPIDRUGS'. MOREOVER, AS A TARGETED APPROACH, THE PRINCIPLE OF 'EPIGENETIC EDITING' RECENTLY IS BEING EXPLOITED TO CONTROL VIRAL REPLICATION. SILENCING OF HBV BY SPECIFIC REWRITING OF EPIGENETIC MARKS MIGHT DIMINISH VIRAL REPLICATION, VIREMIA, AND INFECTIVITY, EVENTUALLY CONTROLLING THE DISEASE AND ITS COMPLICATIONS. ADDITIONALLY, EPIGENETIC EDITING CAN BE USED AS AN EXPERIMENTAL TOOL TO INCREASE OUR LIMITED UNDERSTANDING REGARDING THE ROLE OF EPIGENETIC MODIFICATIONS IN VIRAL INFECTIONS. AIMING FOR PERMANENT EPIGENETIC REPROGRAMMING OF THE VIRAL GENOME WITHOUT UNSPECIFIC SIDE EFFECTS, THIS BREAKTHROUGH MAY PAVE THE ROADS FOR AN AMBITIOUS TECHNOLOGICAL PURSUIT: TO START DESIGNING A CURATIVE APPROACH UTILIZING MANIPULATIVE MOLECULAR THERAPIES FOR VIRAL INFECTIONS IN VIVO. 2017 4 3263 30 HEPATITIS VIRUS AND HEPATOCELLULAR CARCINOMA: RECENT ADVANCES. HEPATOCELLULAR CARCINOMA (HCC) REMAINS A GLOBAL HEALTH CHALLENGE, CAUSING 600,000 DEATHS EACH YEAR. INFECTIOUS FACTORS, INCLUDING HEPATITIS B VIRUS (HBV), HEPATITIS C VIRUS (HCV) AND HEPATITIS D VIRUS (HDV), HAVE LONG BEEN CONSIDERED THE MAJOR RISK FACTORS FOR THE DEVELOPMENT AND PROGRESSION OF HCC. THESE PATHOGENS INDUCE HEPATOCYTE TRANSFORMATION THROUGH A VARIETY OF MECHANISMS, INCLUDING INSERTIONAL MUTATIONS CAUSED BY VIRAL GENE INTEGRATION, EPIGENETIC CHANGES, AND THE INDUCTION OF LONG-TERM IMMUNE DYSFUNCTION. THE DISCOVERY OF THESE MECHANISMS, WHILE ADVANCING OUR UNDERSTANDING OF THE DISEASE, ALSO PROVIDES TARGETS FOR NEW DIAGNOSTIC AND THERAPEUTIC APPROACHES. IN ADDITION, THE DISCOVERY AND RESEARCH OF CHRONIC HEV INFECTION OVER THE PAST DECADE INDICATE THAT THIS COMMON HEPATITIS VIRUS ALSO SEEMS TO HAVE THE POTENTIAL TO INDUCE HCC. IN THIS REVIEW, WE PROVIDE AN OVERVIEW OF RECENT STUDIES ON THE LINK BETWEEN HEPATITIS VIRUS AND HCC, AS WELL AS NEW DIAGNOSTIC AND THERAPEUTIC APPROACHES TO HCC BASED ON THESE FINDINGS. FINALLY, WE ALSO DISCUSS THE POTENTIAL RELATIONSHIP BETWEEN HEV AND HCC. IN CONCLUSION, THESE ASSOCIATIONS WILL FURTHER OPTIMIZE THE DIAGNOSIS AND TREATMENT OF INFECTION-ASSOCIATED HCC AND CALL FOR BETTER MANAGEMENT POLICIES. 2023 5 6637 26 UNRAVELING THE COMPLEXITY OF HEPATITIS B VIRUS: FROM MOLECULAR UNDERSTANDING TO THERAPEUTIC STRATEGY IN 50 YEARS. HEPATITIS B VIRUS (HBV) IS A WELL-KNOWN HEPADNAVIRUS WITH A DOUBLE-STRANDED CIRCULAR DNA GENOME. ALTHOUGH HBV WAS FIRST DESCRIBED APPROXIMATELY 50 YEARS AGO, THE PRECISE MECHANISMS OF HBV INFECTION AND EFFECTIVE THERAPEUTIC STRATEGIES REMAIN UNCLEAR. HERE, WE FOCUS ON SUMMARIZING THE COMPLICATED MECHANISMS OF HBV REPLICATION AND INFECTION, AS WELL AS GENOMIC FACTORS AND EPIGENETIC REGULATION. ADDITIONALLY, WE DISCUSS IN VIVO MODELS OF HBV, AS WELL AS DIAGNOSIS, PREVENTION AND THERAPEUTIC DRUGS FOR HBV. TOGETHER, THE DATA IN THIS 50-YEAR REVIEW MAY PROVIDE NEW CLUES TO ELUCIDATE MOLECULAR MECHANISMS OF HBV PATHOGENESIS AND SHED NEW LIGHT ON THE FUTURE HBV THERAPIES. 2013 6 6479 43 TOWARD A NEW ERA OF HEPATITIS B VIRUS THERAPEUTICS: THE PURSUIT OF A FUNCTIONAL CURE. HEPATITIS B VIRUS (HBV) INFECTION, ALTHOUGH PREVENTABLE BY VACCINATION, REMAINS A GLOBAL HEALTH PROBLEM AND A MAJOR CAUSE OF CHRONIC LIVER DISEASE. ALTHOUGH CURRENT TREATMENT STRATEGIES SUPPRESS VIRAL REPLICATION VERY EFFICIENTLY, THE OPTIMAL ENDPOINT OF HEPATITIS B SURFACE ANTIGEN (HBSAG) CLEARANCE IS RARELY ACHIEVED. MOREOVER, THE THORNY PROBLEMS OF PERSISTENT CHROMATIN-LIKE COVALENTLY CLOSED CIRCULAR DNA AND THE PRESENCE OF INTEGRATED HBV DNA IN THE HOST GENOME ARE IGNORED. THEREFORE, THE SCIENTIFIC COMMUNITY HAS FOCUSED ON DEVELOPING INNOVATIVE THERAPEUTIC APPROACHES TO ACHIEVE A FUNCTIONAL CURE OF HBV, DEFINED AS UNDETECTABLE HBV DNA AND HBSAG LOSS OVER A LIMITED TREATMENT PERIOD. A DEEPER UNDERSTANDING OF THE HBV LIFE CYCLE HAS LED TO THE INTRODUCTION OF NOVEL DIRECT-ACTING ANTIVIRALS THAT EXERT THEIR FUNCTION THROUGH MULTIPLE MECHANISMS, INCLUDING INHIBITION OF VIRAL ENTRY, TRANSCRIPTIONAL SILENCING, EPIGENETIC MANIPULATION, INTERFERENCE WITH CAPSID ASSEMBLY, AND DISRUPTION OF HBSAG RELEASE. IN PARALLEL, ANOTHER CATEGORY OF NEW DRUGS AIMS TO RESTORE DYSREGULATED IMMUNE FUNCTION IN CHRONIC HEPATITIS B ACCOMPANIED BY LETHARGIC CELLULAR AND HUMORAL RESPONSES. STIMULATION OF INNATE IMMUNITY BY PATTERN-RECOGNITION RECEPTOR AGONISTS LEADS TO UPREGULATION OF ANTIVIRAL CYTOKINE EXPRESSION AND APPEARS TO CONTRIBUTE TO HBV CONTAINMENT. IMMUNE CHECKPOINT INHIBITORS AND ADOPTIVE TRANSFER OF GENETICALLY ENGINEERED T CELLS ARE BREAKTHROUGH TECHNOLOGIES CURRENTLY BEING EXPLORED THAT MAY ELICIT POTENT HBV-SPECIFIC T-CELL RESPONSES. IN ADDITION, SEVERAL CLINICAL TRIALS ARE ATTEMPTING TO CLARIFY THE ROLE OF THERAPEUTIC VACCINATION IN THIS SETTING. ULTIMATELY, IT IS INCREASINGLY RECOGNIZED THAT ELIMINATION OF HBV REQUIRES A TREATMENT REGIMEN BASED ON A COMBINATION OF MULTIPLE DRUGS. THIS REVIEW DESCRIBES THE RATIONALE FOR PROGRESSIVE THERAPEUTIC INTERVENTIONS AND DISCUSSES THE LATEST FINDINGS IN THE FIELD OF HBV THERAPEUTICS. 2021 7 3742 19 INSIGHTS FOR HEPATITIS C VIRUS RELATED HEPATOCELLULAR CARCINOMA GENETIC BIOMARKERS: EARLY DIAGNOSIS AND THERAPEUTIC INTERVENTION. THE CURRENT REVIEW EXPLORES THE ROLE OF EMERGING MOLECULAR CONTRIBUTING FACTORS IN LIVER CARCINOGENESIS ON TOP OF HEPATITIS C VIRUS (HCV). HERE WE WILL TRY TO DISCUSS THE ROLE GENETIC AND EPIGENETIC FACTORS IN PATHOGENESIS OF HEPATOCELLULAR CARCINOMA. UNDERSTANDING THE ROLE OF THESE FACTORS WILL HELP IN DISCOVERING THE MYSTERY OF LIVER CARCINOGENESIS ON TOP OF CHRONIC HCV INFECTION. MOREOVER, USE OF THE STUDIED MOLECULAR FACTORS WILL PROVIDE THE HEPATOLOGISTS WITH TAILORED DIAGNOSTIC PROMISING BIOMARKERS AND FLATTEN THE WAY FOR ESTABLISHMENT OF EMERGING MOLECULAR TREATMENT BASED ON EXPLORING THE MOLECULAR SUBSCRIPTION OF THIS AGGRESSIVE LIVER CANCER. 2016 8 3806 38 INTRACELLULAR INTERFERON SIGNALLING PATHWAYS AS POTENTIAL REGULATORS OF COVALENTLY CLOSED CIRCULAR DNA IN THE TREATMENT OF CHRONIC HEPATITIS B. INFECTION WITH THE HEPATITIS B VIRUS (HBV) IS STILL A MAJOR GLOBAL HEALTH THREAT AS 250 MILLION PEOPLE WORLDWIDE CONTINUE TO BE CHRONICALLY INFECTED WITH THE VIRUS. WHILE PATIENTS MAY BE TREATED WITH NUCLEOSIDE/NUCLEOTIDE ANALOGUES, THIS ONLY SUPPRESSES HBV TITRE TO SUB-DETECTION LEVELS WITHOUT ELIMINATING THE PERSISTENT HBV COVALENTLY CLOSED CIRCULAR DNA (CCCDNA) GENOME. AS A RESULT, HBV INFECTION CANNOT BE CURED, AND THE VIRUS REACTIVATES WHEN CONDITIONS ARE FAVORABLE. INTERFERONS (IFNS) ARE CYTOKINES KNOWN TO INDUCE POWERFUL ANTIVIRAL MECHANISMS THAT CLEAR VIRUSES FROM INFECTED CELLS. THEY HAVE BEEN SHOWN TO INDUCE CCCDNA CLEARANCE, BUT THEIR USE IN THE TREATMENT OF HBV INFECTION IS LIMITED AS HBV-TARGETING IMMUNE CELLS ARE EXHAUSTED AND HBV HAS EVOLVED MULTIPLE MECHANISMS TO EVADE AND SUPPRESS IFN SIGNALLING. THUS, TO FULLY UTILIZE IFN-MEDIATED INTRACELLULAR MECHANISMS TO EFFECTIVELY ELIMINATE HBV, INSTEAD OF DIRECT IFN ADMINISTRATION, NOVEL STRATEGIES TO SUSTAIN IFN-MEDIATED ANTI-CCCDNA AND ANTIVIRAL MECHANISMS NEED TO BE DEVELOPED. THIS REVIEW WILL CONSOLIDATE WHAT IS KNOWN ABOUT HOW IFNS ACT TO ACHIEVE ITS INTRACELLULAR ANTIVIRAL EFFECTS AND HIGHLIGHT THE CRITICAL INTERFERON-STIMULATED GENE TARGETS AND EFFECTOR MECHANISMS WITH POTENT ANTI-CCCDNA FUNCTIONS. THESE INCLUDE CCCDNA DEGRADATION BY APOBECS AND CCCDNA SILENCING AND TRANSCRIPTION REPRESSION BY EPIGENETIC MODIFICATIONS. IN ADDITION, THE MECHANISMS THAT HBV EMPLOYS TO DISRUPT IFN SIGNALLING WILL BE DISCUSSED. DRUGS THAT HAVE BEEN DEVELOPED OR ARE IN THE PIPELINE FOR COMPONENTS OF THE IFN SIGNALLING PATHWAY AND HBV TARGETS THAT DETRACT IFN SIGNALLING MECHANISMS WILL ALSO BE IDENTIFIED AND DISCUSSED FOR UTILITY IN THE TREATMENT OF HBV INFECTIONS. TOGETHER, THESE WILL PROVIDE USEFUL INSIGHTS INTO DESIGN STRATEGIES THAT SPECIFICALLY TARGET CCCDNA FOR THE ERADICATION OF HBV. 2021 9 2240 33 EPIGENETIC MODULATION IN CHRONIC HEPATITIS B VIRUS INFECTION. THE HUMAN HEPATITIS B VIRUS (HBV) IS A SMALL-ENVELOPED DNA VIRUS CAUSING ACUTE AND CHRONIC HEPATITIS. DESPITE THE EXISTENCE OF AN EFFECTIVE PROPHYLACTIC VACCINE AND THE STRONG CAPACITY OF APPROVED ANTIVIRAL DRUGS TO SUPPRESS VIRAL REPLICATION, CHRONIC HBV INFECTION (CHB) CONTINUES TO BE A MAJOR HEALTH BURDEN WORLDWIDE. BOTH THE INABILITY OF THE IMMUNE SYSTEM TO RESOLVE CHB AND THE UNIQUE REPLICATION STRATEGY EMPLOYED BY HBV, WHICH FORMS A STABLE VIRAL COVALENTLY CLOSED CIRCULAR DNA (CCCDNA) MINICHROMOSOME IN THE HEPATOCYTE NUCLEUS, ENABLE INFECTION PERSISTENCE. KNOWLEDGE OF THE COMPLEX NETWORK OF INTERACTIONS THAT HBV ENGAGES WITH ITS HOST IS STILL LIMITED BUT ACCUMULATING EVIDENCE INDICATES THAT EPIGENETIC MODIFICATIONS OCCURRING BOTH ON THE CCCDNA AND ON THE HOST GENOME IN THE COURSE OF INFECTION ARE ESSENTIAL TO MODULATE VIRAL ACTIVITY AND LIKELY CONTRIBUTE TO PATHOGENESIS AND CANCER DEVELOPMENT. THUS, A DEEPER UNDERSTANDING OF EPIGENETIC REGULATORY PROCESSES MAY OPEN NEW VENUES TO CONTROL AND EVENTUALLY CURE CHB. THIS REVIEW SUMMARIZES MAJOR FINDINGS IN HBV EPIGENETIC RESEARCH, FOCUSING ON THE EPIGENETIC MECHANISMS REGULATING CCCDNA ACTIVITY AND THE MODIFICATIONS DETERMINED IN INFECTED HOST CELLS AND TUMOR LIVER TISSUES. 2020 10 915 26 CHRONIC HEPATITIS B VIRUS AND HEPATITIS C VIRUS INFECTIONS AND CANCER: SYNERGY BETWEEN VIRAL AND HOST FACTORS. HEPATITIS B VIRUS (HBV) OR HEPATITIS C VIRUS (HCV) INFECTIONS REPRESENT MAJOR CAUSES OF CHRONIC LIVER DISEASE AND HEPATOCELLULAR CARCINOMA. DESPITE INDUCING SHARED PATHOLOGICAL EVENTS LEADING TO ONCOGENIC TRANSFORMATION, THESE TWO VIRUSES PRESENT PROFOUND DIFFERENCES IN THEIR MOLECULAR FEATURES, LIFE CYCLE AND INTERPLAY WITH HOST FACTORS, WHICH SIGNIFICANTLY DIFFERENTIATE THE PROGNOSTIC AND THERAPEUTIC APPROACH TO THE RELATED DISEASES. IN THE PRESENT REVIEW, WE REPORT THE MAIN MECHANISMS INVOLVED IN THE MULTISTEP PROCESS LEADING FROM HCV/HBV INFECTION AND CANCER DEVELOPMENT, DISCUSSING SIDE-BY-SIDE THE ANALOGIES AND DIFFERENCES BETWEEN THE TWO VIRUSES. SUCH EVENTS CAN BE BROADLY CATEGORIZED INTO (A) DIRECT ONCOGENIC EFFECTS, INVOLVING INTEGRATION IN THE HOST GENOME (IN THE CASE OF HBV) AND CHROMOSOMAL INSTABILITY, INTERFERENCE WITH ONCOSUPPRESSOR PATHWAYS, INDUCTION OF OXIDATIVE STRESS, PROMOTION OF ANGIOGENESIS, EPITHELIAL-MESENCHYMAL TRANSITION, ALTERATIONS IN THE EPIGENETIC ASSET AND INTERACTION WITH NON-CODING RNAS; AND (B) INDIRECT ACTIVITIES MOSTLY MEDIATED BY HOST EVENTS, INCLUDING CHRONIC INFLAMMATION SUSTAINED BY PECULIAR CYTOKINE NETWORKS (SUCH AS INTERLEUKIN-6 AND LYMPHOTOXINS), METABOLIC DYSFUNCTIONS PROMOTED BY STEATOHEPATITIS, INTERPLAY WITH GUT MICROBIOTA AND FIBROTIC EVENTS (MAINLY IN HCV INFECTION). THIS SCENARIO SUGGESTS THAT THE INTEGRATED STUDY OF VIRAL AND HOST FACTORS MAY LEAD TO THE SUCCESSFUL DEVELOPMENT OF NOVEL BIOMARKERS AND TARGETS FOR THERAPY. 2015 11 1052 35 CLINICAL IMPLICATIONS OF HEPATITIS B VIRUS RNA AND COVALENTLY CLOSED CIRCULAR DNA IN MONITORING PATIENTS WITH CHRONIC HEPATITIS B TODAY WITH A GAZE INTO THE FUTURE: THE FIELD IS UNPREPARED FOR A STERILIZING CURE. . CHRONIC HEPATITIS B VIRUS (HBV) INFECTION HAS LONG REMAINED A CRITICAL GLOBAL HEALTH ISSUE. COVALENTLY CLOSED CIRCULAR DNA (CCCDNA) IS A PERSISTENT FORM OF THE HBV GENOME THAT MAINTAINS HBV CHRONICITY. DECADES OF EXTENSIVE RESEARCH RESULTED IN THE TWO THERAPEUTIC OPTIONS CURRENTLY AVAILABLE: NUCLEOT(S)IDE ANALOGS AND INTERFERON (IFN) THERAPY. A PLETHORA OF RELIABLE MARKERS TO MONITOR HBV PATIENTS HAS BEEN ESTABLISHED, INCLUDING THE RECENTLY DISCOVERED ENCAPSIDATED PREGENOMIC RNA IN SERUM, WHICH CAN BE USED TO DETERMINE TREATMENT END-POINTS AND TO PREDICT THE SUSCEPTIBILITY OF PATIENTS TO IFN. ADDITIONALLY, HBV RNA SPLICE VARIANTS AND CCCDNA AND ITS EPIGENETIC MODIFICATIONS ARE ASSOCIATED WITH THE CLINICAL COURSE AND RISKS OF HEPATOCELLULAR CARCINOMA (HCC) AND LIVER FIBROSIS. HOWEVER, NEW ANTIVIRALS, INCLUDING CRISPR/CAS9, APOBEC-MEDIATED DEGRADATION OF CCCDNA, AND T-CELL THERAPIES AIM AT COMPLETELY ELIMINATING HBV, AND IT IS CLEAR THAT THE DIAGNOSTIC ARSENAL FOR DEFINING THE LONG-AWAITED STERILIZING CURE IS MISSING. IN THIS REVIEW, WE DISCUSS THE CURRENTLY AVAILABLE TOOLS FOR DETECTING AND MEASURING HBV RNAS AND CCCDNA, AS WELL AS THE STATE-OF-THE-ART IN CLINICAL IMPLICATIONS OF THESE MARKERS, AND DEBATE NEEDS AND GOALS WITHIN THE CONTEXT OF THE STERILIZING CURE THAT IS SOON TO COME. 2018 12 3256 24 HEPATITIS B VIRUS-ASSOCIATED HEPATOCELLULAR CARCINOMA AND HEPATIC CANCER STEM CELLS. CHRONIC HEPATITIS B VIRUS (HBV) INFECTION IS LINKED TO HEPATOCELLULAR CARCINOMA (HCC) PATHOGENESIS. DESPITE THE AVAILABILITY OF A HBV VACCINE, CURRENT TREATMENTS FOR HCC ARE INADEQUATE. GLOBALLY, 257 MILLION PEOPLE ARE CHRONIC HBV CARRIERS, AND CHILDREN BORN FROM HBV-INFECTED MOTHERS BECOME CHRONIC CARRIERS, DESTINED TO DEVELOP LIVER CANCER. THUS, NEW THERAPEUTIC APPROACHES ARE NEEDED TO TARGET ESSENTIAL PATHWAYS INVOLVED IN HCC PATHOGENESIS. ACCUMULATING EVIDENCE SUPPORTS EXISTENCE OF HEPATIC CANCER STEM CELLS (HCSCS), WHICH CONTRIBUTE TO CHEMOTHERAPY RESISTANCE AND CANCER RECURRENCE AFTER TREATMENT OR SURGERY. UNDERSTANDING HOW HCSCS FORM WILL ENABLE DEVELOPMENT OF THERAPEUTIC STRATEGIES TO PREVENT THEIR FORMATION. RECENT STUDIES HAVE IDENTIFIED AN EPIGENETIC MECHANISM INVOLVING THE DOWNREGULATION OF THE CHROMATIN MODIFYING POLYCOMB REPRESSIVE COMPLEX 2 (PRC2) DURING HBV INFECTION, WHICH RESULTS IN RE-EXPRESSION OF HCSC MARKER GENES IN INFECTED HEPATOCYTES AND HBV-ASSOCIATED LIVER TUMORS. HOWEVER, THE GENESIS OF HCSCS REQUIRES, IN ADDITION TO THE EXPRESSION OF HCSC MARKERS CELLULAR CHANGES, REWIRING OF METABOLISM, CELL SURVIVAL, ESCAPE FROM PROGRAMMED CELL DEATH, AND IMMUNE EVASION. HOW THESE CHANGES OCCUR IN CHRONICALLY HBV-INFECTED HEPATOCYTES IS NOT YET UNDERSTOOD. IN THIS REVIEW, WE WILL PRESENT THE BASICS ABOUT HBV INFECTION AND HEPATOCARCINOGENESIS. NEXT, WE WILL DISCUSS STUDIES DESCRIBING THE MUTATIONAL LANDSCAPE OF LIVER CANCERS AND HOW EPIGENETIC MECHANISMS LIKELY ORCHESTRATE CELLULAR REPROGRAMING OF HEPATOCYTES TO ENABLE FORMATION OF HCSCS. 2018 13 6115 29 THE EPIGENETIC CONTROL OF HEPATITIS B VIRUS MODULATES THE OUTCOME OF INFECTION. EPIGENETIC MODIFICATIONS ARE STABLE ALTERATIONS IN GENE EXPRESSION THAT DO NOT INVOLVE MUTATIONS OF THE GENETIC SEQUENCE ITSELF. IT HAS BECOME INCREASINGLY CLEAR THAT EPIGENETIC FACTORS CONTRIBUTE TO THE OUTCOME OF CHRONIC HEPATITIS B VIRUS (HBV) INFECTION BY AFFECTING CELLULAR AND VIRION GENE EXPRESSION, VIRAL REPLICATION AND THE DEVELOPMENT OF HEPATOCELLULAR CARCINOMA. HBV PERSISTS IN THE NUCLEUS OF INFECTED HEPATOCYTES AS A STABLE NON-INTEGRATED COVALENTLY CLOSED CIRCULAR DNA (CCCDNA) WHICH FUNCTIONS AS A MINICHROMOSOME. THERE ARE TWO MAJOR FORMS OF HBV EPIGENETIC REGULATION: POSTTRANSLATIONAL MODIFICATION OF HISTONE PROTEINS ASSOCIATED WITH THE CCCDNA MINICHROMOSOME AND DNA METHYLATION OF VIRAL AND HOST GENOMES. THIS REVIEW EXPLORES HOW HBV CAN INTERPHASE WITH HOST EPIGENETIC REGULATION IN ORDER TO EVADE HOST DEFENCES AND TO PROMOTE ITS OWN SURVIVAL AND PERSISTENCE. WE FOCUS ON THE EFFECT OF CCCDNA BOUND-HISTONE MODIFICATIONS AND THE METHYLATION STATUS OF HBV DNA IN REGULATING VIRAL REPLICATION. INVESTIGATION OF HBV EPIGENETIC CONTROL HAS IMPORTANT CLINICAL CORRELATES WITH REGARDS TO THE DEVELOPMENT OF POTENTIAL THERAPEUTIC REGIMENS THAT WILL SUCCESSFULLY ERADICATE HBV INFECTION AND DEAL WITH HBV REACTIVATION IN THOSE UNDERGOING TREATMENT WITH DEMETHYLATING AGENTS. 2015 14 3103 19 GENOMIC LANDSCAPE OF HCC. INTRODUCTION: HEPATOCELLULAR CARCINOMA (HCC) IS A LEADING CAUSE OF CANCER RELATED MORTALITY IN THE WORLD AND IT HAS LIMITED TREATMENT OPTIONS. UNDERSTANDING THE MOLECULAR DRIVERS OF HCC IS IMPORTANT TO DEVELOP NOVEL BIOMARKERS AND THERAPEUTICS. PURPOSE OF REVIEW: HCC ARISES IN A COMPLEX BACKGROUND OF CHRONIC HEPATITIS, FIBROSIS AND LIVER REGENERATION WHICH LEAD TO GENOMIC CHANGES. HERE, WE SUMMARIZE STUDIES THAT HAVE EXPANDED OUR UNDERSTANDING OF THE MOLECULAR LANDSCAPE OF HCC. RECENT FINDINGS: RECENT TECHNOLOGICAL ADVANCES IN NEXT GENERATION SEQUENCING (NGS) HAVE ELUCIDATED SPECIFIC GENETIC AND MOLECULAR PROGRAMS INVOLVED IN HEPATOCARCINOGENESIS. WE SUMMARIZE THE MAJOR SOMATIC MUTATIONS AND EPIGENETIC CHANGES HAVE BEEN IDENTIFIED IN NGS-BASED STUDIES. WE ALSO DESCRIBE PROMISING MOLECULAR THERAPIES AND IMMUNOTHERAPIES WHICH TARGET SPECIFIC GENETIC AND EPIGENETIC MOLECULAR EVENTS. SUMMARY: THE GENOMIC LANDSCAPE OF HCC IS INCREDIBLY COMPLEX AND HETEROGENEOUS. PROMISING NEW DEVELOPMENTS ARE HELPING US DECIPHER THE MOLECULAR DRIVERS OF HCC AND LEADING TO NEW THERAPIES. 2020 15 4335 37 MICRORNAS: SMALL MOLECULES WITH SIGNIFICANT FUNCTIONS, PARTICULARLY IN THE CONTEXT OF VIRAL HEPATITIS B AND C INFECTION. A MICRORNA (MIRNA) IS DEFINED AS A SMALL MOLECULE OF NON-CODING RNA (NCRNA). ITS MOLECULAR SIZE IS ABOUT 20 NUCLEOTIDES (NT), AND IT ACTS ON GENE EXPRESSION'S REGULATION AT THE POST-TRANSCRIPTION LEVEL THROUGH BINDING TO THE 3'UNTRANSLATED REGIONS (UTR), CODING SEQUENCES, OR 5'UTR OF THE TARGET MESSENGER RNAS (MRNAS), WHICH LEADS TO THE SUPPRESSION OR DEGRADATION OF THE MRNA. IN RECENT YEARS, A HUGE EVOLUTION HAS IDENTIFIED THE ORIGIN AND FUNCTION OF MIRNAS, FOCUSING ON THEIR IMPORTANT EFFECTS IN RESEARCH AND CLINICAL APPLICATIONS. FOR EXAMPLE, MICRORNAS ARE KEY PLAYERS IN HCV INFECTION AND HAVE IMPORTANT HOST CELLULAR FACTORS REQUIRED FOR HCV REPLICATION AND CELL GROWTH. ALTERED EXPRESSION OF MIRNAS AFFECTS THE PATHOGENICITY ASSOCIATED WITH HCV INFECTION THROUGH REGULATING DIFFERENT SIGNALING PATHWAYS THAT CONTROL HCV/IMMUNITY INTERACTIONS, PROLIFERATION, AND CELL DEATH. ON THE OTHER HAND, CIRCULATING MIRNAS CAN BE USED AS NOVEL BIOMARKERS AND DIAGNOSTIC TOOLS FOR HCV PATHOGENESIS AND EARLY THERAPEUTIC RESPONSE. MOREOVER, MICRORNAS (MIRNA) HAVE BEEN INVOLVED IN HEPATITIS B VIRUS (HBV) GENE EXPRESSION AND ADVANCED ANTIVIRAL DISCOVERY. THEY REGULATE HBV/HCV REPLICATION AND PATHOGENESIS WITH DIFFERENT PATHWAYS INVOLVING FACILITATION, INHIBITION, ACTIVATION OF THE IMMUNE SYSTEM (INNATE AND ADAPTIVE), AND EPIGENETIC MODIFICATIONS. IN THIS SHORT REVIEW, WE WILL DISCUSS HOW MICRORNAS CAN BE USED AS PROGNOSTIC, DIAGNOSTIC, AND THERAPEUTIC TOOLS, ESPECIALLY FOR CHRONIC HEPATITIS VIRUSES (HBV AND HCV), AS WELL AS HOW THEY COULD BE USED AS NEW BIOMARKERS DURING INFECTION AND ADVANCED TREATMENT. 2023 16 3254 16 HEPATITIS B VIRUS X PROTEIN AND HEPATOCARCINOGENESIS. CHRONIC HEPATITIS B VIRUS (HBV) INFECTION IS ONE OF THE MOST ASSOCIATED FACTORS IN HEPATOCARCINOGENESIS. HBV IS ABLE TO INTEGRATE INTO THE HOST GENOME AND ENCODE THE MULTI-FUNCTIONAL HEPATITIS B VIRUS X PROTEIN (HBX). ALTHOUGH THE MECHANISM BETWEEN HBX AND CARCINOGENESIS IS STILL ELUSIVE, RECENT STUDIES HAVE SHOWN THAT HBX WAS ABLE TO INFLUENCE VARIOUS SIGNALING PATHWAYS, AS WELL AS EPIGENETIC AND GENETIC PROCESSES. THIS REVIEW WILL EXAMINE AND SUMMARIZE RECENT LITERATURE ABOUT HBX'S ROLE IN THESE VARIOUS PROCESSES. 2016 17 2538 20 EPIGENETICS IN HEPATOCELLULAR CARCINOMA: AN UPDATE AND FUTURE THERAPY PERSPECTIVES. HEPATOCELLULAR CARCINOMA (HCC), THE PREDOMINANT FORM OF ADULT LIVER MALIGNANCIES, IS A GLOBAL HEALTH CONCERN. ITS DISMAL PROGNOSIS HAS PROMPTED RECENT SIGNIFICANT ADVANCES IN THE UNDERSTANDING OF ITS ETIOLOGY AND PATHOGENESIS. THE DEREGULATION OF EPIGENETIC MECHANISMS, WHICH MAINTAIN HERITABLE GENE EXPRESSION CHANGES AND CHROMATIN ORGANIZATION, IS IMPLICATED IN THE DEVELOPMENT OF MULTIPLE CANCERS, INCLUDING HCC. THIS REVIEW SUMMARIZES THE CURRENT KNOWLEDGE OF EPIGENETIC MECHANISMS IN THE PATHOGENESIS OF HCC, WITH AN EMPHASIS ON HCC MEDIATED BY CHRONIC HEPATITIS B VIRUS INFECTION. THIS REVIEW ALSO DISCUSSES THE ENCOURAGING OUTCOMES AND LESSONS LEARNT FROM EPIGENETIC THERAPIES FOR HEMATOLOGICAL AND OTHER SOLID CANCERS, AND HIGHLIGHTS THE FUTURE POTENTIAL OF SIMILAR THERAPIES IN THE TREATMENT OF HCC. 2014 18 3250 25 HEPATITIS B VIRUS INFECTION, MICRORNAS AND LIVER DISEASE. HEPATITIS B VIRUS (HBV) ATTACKS THE LIVER AND CAN CAUSE BOTH ACUTE AS WELL AS CHRONIC LIVER DISEASES WHICH MIGHT LEAD TO LIVER CIRRHOSIS AND HEPATOCELLULAR CARCINOMA. REGARDLESS OF THE AVAILABILITY OF A VACCINE AND NUMEROUS TREATMENT OPTIONS, HBV IS A MAJOR CAUSE OF MORBIDITY AND MORTALITY ACROSS THE WORLD. RECENTLY,MICRORNAS (MIRNAS) HAVE EMERGED AS IMPORTANT MODULATORS OF GENE FUNCTION. STUDIES ON THE ROLE OF MIRNA IN THE REGULATION OF HEPATITIS B VIRUS GENE EXPRESSION HAVE BEEN THE FOCUS OF MODERN ANTIVIRAL RESEARCH. MIRNAS CAN REGULATE VIRAL REPLICATION AND PATHOGENESIS IN A NUMBER OF DIFFERENT WAYS, WHICH INCLUDEFACILITATION, DIRECT OR INDIRECT INHIBITION, ACTIVATION OF IMMUNE RESPONSE, EPIGENETIC MODULATION, ETC. NEVERTHELESS, THESE MECHANISMS CAN APPROPRIATELY BE USED WITH A DIAGNOSTICAND/OR THERAPEUTIC APPROACH. THE PRESENT REVIEW IS AN ATTEMPT TO CLASSIFY SPECIFIC MIRNAS THAT ARE REPORTED TO BE ASSOCIATED WITH VARIOUS ASPECTS OF HEPATITIS B BIOLOGY, IN ORDER TO PRECISELY PRESENT THE PARTICIPATION OF INDIVIDUAL MIRNAS IN MULTIPLE ASPECTS RELATING TO HBV. 2015 19 3275 25 HEPATOCELLULAR CARCINOMA: THERAPEUTIC ADVANCES IN SIGNALING, EPIGENETIC AND IMMUNE TARGETS. HEPATOCELLULAR CARCINOMA (HCC) REMAINS A GLOBAL MEDICAL BURDEN WITH RISING INCIDENCE DUE TO CHRONIC VIRAL HEPATITIS AND NON-ALCOHOLIC FATTY LIVER DISEASES. TREATMENT OF ADVANCED DISEASE STAGES IS STILL UNSATISFYING. BESIDES FIRST AND SECOND GENERATION TYROSINE KINASE INHIBITORS, IMMUNE CHECKPOINT INHIBITORS HAVE BECOME CENTRAL FOR THE TREATMENT OF HCC. NEW MODALITIES LIKE EPIGENETIC THERAPY USING HISTONE DEACETYLASE INHIBITORS (HDACI) AND CELL THERAPY APPROACHES WITH CHIMERIC ANTIGEN RECEPTOR T CELLS (CAR-T CELLS) ARE CURRENTLY UNDER INVESTIGATION IN CLINICAL TRIALS. DEVELOPMENT OF SUCH NOVEL DRUGS IS CLOSELY LINKED TO THE AVAILABILITY AND IMPROVEMENT OF NOVEL PRECLINICAL AND ANIMAL MODELS AND THE IDENTIFICATION OF PREDICTIVE BIOMARKERS. THE CURRENT STATUS OF TREATMENT OPTIONS FOR ADVANCED HCC, EMERGING NOVEL THERAPEUTIC APPROACHES AND DIFFERENT PRECLINICAL MODELS FOR HCC DRUG DISCOVERY AND DEVELOPMENT ARE REVIEWED HERE. 2019 20 2165 29 EPIGENETIC MECHANISMS IN HEPATITIS B VIRUS-ASSOCIATED HEPATOCELLULAR CARCINOMA. CHRONIC INFECTION OF THE LIVER BY THE HEPATITIS B VIRUS (HBV) IS ASSOCIATED WITH INCREASED RISK FOR DEVELOPING HEPATOCELLULAR CARCINOMA (HCC). A MULTITUDE OF STUDIES HAVE INVESTIGATED THE MECHANISM OF LIVER CANCER PATHOGENESIS DUE TO CHRONIC HBV INFECTION. CHRONIC INFLAMMATION, EXPRESSION OF SPECIFIC VIRAL PROTEINS SUCH AS HBX, THE INTEGRATION SITE OF THE VIRAL GENOME INTO THE HOST GENOME, AND THE VIRAL GENOTYPE, ARE KEY PLAYERS CONTRIBUTING TO HCC PATHOGENESIS. IN ADDITION, THE GENETIC BACKGROUND OF THE HOST AND EXPOSURE TO ENVIRONMENTAL CARCINOGENS ARE ALSO PREDISPOSING PARAMETERS IN HEPATOCARCINOGENESIS. DESPITE THE PLETHORA OF STUDIES, THE MOLECULAR MECHANISM OF HCC PATHOGENESIS REMAINS INCOMPLETELY UNDERSTOOD. IN THIS REVIEW, THE FOCUS IS ON EPIGENETIC MECHANISMS INVOLVED IN THE PATHOGENESIS OF HBV-ASSOCIATED HCC. EPIGENETIC MECHANISMS ARE DYNAMIC MOLECULAR PROCESSES THAT REGULATE GENE EXPRESSION WITHOUT ALTERING THE HOST DNA, ACTING BY MODIFYING THE HOST CHROMATIN STRUCTURE VIA COVALENT POST-TRANSLATIONAL HISTONE MODIFICATIONS, CHANGING THE DNA METHYLATION STATUS, EXPRESSION OF NON-CODING RNAS SUCH AS MICRORNAS AND LONG NONCODING RNAS, AND ALTERING THE SPATIAL, 3-D ORGANIZATION OF THE CHROMATIN OF THE VIRUS-INFECTED CELL. HEREIN, STUDIES ARE DESCRIBED THAT PROVIDE EVIDENCE IN SUPPORT OF DEREGULATION OF EPIGENETIC MECHANISMS IN THE HBV-INFECTED/-REPLICATING HEPATOCYTE AND THEIR CONTRIBUTION TO HEPATOCYTE TRANSFORMATION. IN CONTRAST TO GENETIC MUTATIONS WHICH ARE PERMANENT, EPIGENETIC ALTERATIONS ARE DYNAMIC AND REVERSIBLE. ACCORDINGLY, THE IDENTIFICATION OF ESSENTIAL MOLECULAR EPIGENETIC TARGETS INVOLVED IN HBV-MEDIATED HCC PATHOGENESIS OFFERS THE OPPORTUNITY FOR THE DESIGN AND DEVELOPMENT OF NOVEL EPIGENETIC THERAPEUTIC APPROACHES. 2021