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Recent genome-wide association studies showed that four single-nucleotide polymorphisms (SNPs) in human leukocyte antigen (HLA)-DP (rs3077and rs9277535) and HLA-DQ (rs2856718 and rs7453920) were associated with chronic hepatitis B virus (HBV) infection in Japanese populations. More than 75% of hepatocellular carcinoma (HCC) patients are attributable to persistent infection of hepatitis B virus (HBV), especially in China. We genotyped these four SNPs in 1,300 HBV-positive HCC patients, 1,344 persistent HBV carriers, and 1,344 persons with HBV natural clearance from Southeast China to further test the associations of HLA-DP/DQ variants and with risk of both HBV clearance and HCC development. Logistic regression analyses showed that HLA-DQ rs2856718 significantly decreased host HCC risk, whereas three SNPs were associated with HBV clearance (HLA-DP rs9277535 as well as HLA-DQ rs7453920 and rs2856718). In addition, HLA-DP rs3077 showed an approaching significant effect on susceptibility to HBV persistent infection and HCC development when considering multiple testing adjustments. Taken together, we report, for the first time, that genetic variants in the HLA-DP and HLA-DQ loci may be marker SNPs for risk of both HBV clearance and HCC development. (HEPATOLOGY 2012;55:1426-1431 H epatocellular carcinoma (HCC) is one of the most common cancers worldwide, with a particularly high prevalence in East and Southeast Asia and sub-Saharan Africa, whereas China alone accounts for more than 50% of all cases. 1 Among the major risk factors for HCC, chronic infection with hepatitis B virus (HBV) is of particular interest for its coherent distribution with the HCC prevalence. It is estimated that 75%-85% of HCC patients are attributable to persistent infection of HBV, especially in developing countries. 1 Persistent HBV infection or HBV clearance is influenced by complex factors of viral infection, host age, environmental factors, and genetic makeup, with most studies that identified susceptibility loci at the human leukocyte antigen (HLA) class II region at 6p21. [2][3][4][5][6] Recently, Koichi et al. conducted a two-stage genomewide association study (GWAS) (179 cases and 934 controls for GWA scan) and identified two SNPs (rs3077 and rs9277535) in HLA-DP for persistent HBV infection in Asians. 7 The same group also performed a second GWAS, with an increased sample size of 458 Japanese persistent HBV infection cases and 2,056 controls for additional GWA scan, and they found such an association with another two SNPs
Key Points
Question
Is chronic hepatitis B virus infection associated with a higher risk of any cancer type when compared with individuals without hepatitis B virus?
Findings
This population-based cohort study of 496 732 Chinese individuals found that hepatitis B surface antigen seropositivity was associated with the risk of hepatocellular carcinoma, stomach cancer, colorectal cancer, oral cancer, pancreatic cancer, and lymphoma. The associations were validated in an independent population and tissue-based studies.
Meaning
Chronic hepatitis B virus infection was associated with nonliver cancer, especially digestive system cancers.
Genome-wide association studies (GWAS) have recently identified KIF1B as susceptibility locus for hepatitis B virus (HBV)–related hepatocellular carcinoma (HCC). To further identify novel susceptibility loci associated with HBV–related HCC and replicate the previously reported association, we performed a large three-stage GWAS in the Han Chinese population. 523,663 autosomal SNPs in 1,538 HBV–positive HCC patients and 1,465 chronic HBV carriers were genotyped for the discovery stage. Top candidate SNPs were genotyped in the initial validation samples of 2,112 HBV–positive HCC cases and 2,208 HBV carriers and then in the second validation samples of 1,021 cases and 1,491 HBV carriers. We discovered two novel associations at rs9272105 (HLA-DQA1/DRB1) on 6p21.32 (OR = 1.30, P = 1.13×10−19) and rs455804 (GRIK1) on 21q21.3 (OR = 0.84, P = 1.86×10−8), which were further replicated in the fourth independent sample of 1,298 cases and 1,026 controls (rs9272105: OR = 1.25, P = 1.71×10−4; rs455804: OR = 0.84, P = 6.92×10−3). We also revealed the associations of HLA-DRB1*0405 and 0901*0602, which could partially account for the association at rs9272105. The association at rs455804 implicates GRIK1 as a novel susceptibility gene for HBV–related HCC, suggesting the involvement of glutamate signaling in the development of HBV–related HCC.
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