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Review : Personalized treatment of hepatitis B
( Anna S Lok ) 대한간학회 2015 Clinical and Molecular Hepatology(대한간학회지) Vol.21 No.1
There are seven approved drugs for treatment of hepatitis B. Professional guidelines provide a framework for managing patients but these guidelines should be interpreted in the context of the individual patient’s clinical and social circumstances. Personalized management of hepatitis B can be applied based on prediction of the individual patient’s risk of cirrhosis and hepatocellular carcinoma to guide the frequency and intensity of monitoring and urgency of treatment. It can also be applied to decisions regarding when to start treatment, which drug to use, and when to stop based on the individual patient’s disease characteristics, preference, comorbidities and other mitigating circumstances. (Clin Mol Hepatol 2015;21:1-6)
Ito, Kiyoaki,Kim, Kyun-Hwan,Lok, Anna Suk-Fong,Tong, Shuping American Society for Microbiology 2009 Journal of virology Vol.83 No.8
<B>ABSTRACT</B><P>Hepatitis B e antigen (HBeAg) is a secreted version of hepatitis B virus (HBV) core protein that promotes immune tolerance and persistent infection. It is derived from a translation product of the precore/core gene by two proteolytic cleavage events: removal of the amino-terminal signal peptide and removal of the carboxyl-terminal arginine-rich sequence. Four RXXR motifs are present at the carboxyl terminus of the HBeAg precursor, with the first two fused as <SUP>151</SUP>RRGRSPR<SUP>157</SUP>. Genotype A possesses two extra amino acids at the first motif (<SUP>151</SUP>RRDRGRSPR<SUP>159</SUP>), which weakens the first motif and separates it from the second one. Western blot analysis of patient sera revealed a single HBeAg form for genotypes B to D but two additional forms of larger sizes for genotype A. Site-directed mutagenesis and transfection experiments with human hepatoma cell lines indicated that HBeAg of genotype B is derived from cleavage at the first (<SUP>151</SUP>RRGR<SUP>154</SUP>) motif. The major HBeAg form of genotype A corresponds to cleavage at the second (<SUP>156</SUP>RSPR<SUP>159</SUP>) motif, and the other two forms are cleavage products of the first (<SUP>151</SUP>RRDR<SUP>154</SUP>) and third (<SUP>166</SUP>RRRR<SUP>169</SUP>) motifs, respectively. Only the cleavage product of the third motif of genotype A was observed in furin-deficient LoVo cells, and an inhibitor of furin-like proprotein convertases blocked cleavage of the first and second motifs in human hepatoma cells. In conclusion, our study reveals genotypic differences in HBeAg processing and implicates furin as the major enzyme involved in the cleavage of the first and second RXXR motifs.</P>
Hepatitis B Screening and Vaccination Practices in Asian American Primary Care
( Danny Chu ),( Ju Dong Yang ),( Anna S Lok ),( Tram Tran ),( Eduardo Bruno Martins ),( Elizabeth Fagan ),( Franck Rousseau ),( W Ray Kim ) 대한소화기학회 2013 Gut and Liver Vol.7 No.4
Background/Aims: Screening for hepatitis B virus (HBV) is recommended in populations with anticipated prevalence ≥2%. This study surveyed HBV screening and vaccination practices of Asian American primary care providers (PCPs). Methods: Approximately 15,000 PCPs with Asian surnames in the New York, Los Angeles, San Francisco, Houston, and Chicago areas were invited to participate in a web-based survey. Asian American PCPs with ≥25% Asian patients in their practice were eligible. Results: Of 430 (2.9%) survey respondents, 217 completed the survey. Greater than 50% followed ≥200 Asian patients. Although 95% of PCPs claimed to have screened patients for HBV, 41% estimated that ≤25% of their adult Asian patients had ever been screened, and 50% did not routinely screen all Asian patients. In a multivariable analysis, the proportion of Asian patients in the practice, provider geographic origin and the number of liver cancers diagnosed in the preceding 12 months were significantly associated with a higher likelihood of screening for HBV. Over 80% of respondents reported that ≤50% of their adult Asian patients had received the HBV vaccine. Conclusions: Screening and vaccination for HBV in Asian American patients is inadequate. Measures to improve HBV knowledge and care by primary-care physicians are critically needed. (Gut Liver 2013; 7:450-457)