An estimated 130 million people worldwide are chronically infected with hepatitis C virus (HCV) making it a leading cause of liver disease worldwide. Because the currently available therapy of pegylated interferon-alpha and ribavirin is only effective in a subset of patients, the development of new HCV antivirals is a healthcare imperative. This review discusses the experimental models available for HCV antiviral drug research, recent advances in HCV antiviral drug development, as well as active research being pursued to facilitate development of new HCV-specific therapeutics.
KeywordsHepatitis C virus; Chronic liver disease; Experimental model systems; High throughput screening; Drug targets Hepatitis C virus (HCV), a member of the Flaviviridae family of enveloped positive-strand RNA viruses, is a leading cause of liver disease worldwide. Although HCV infection is usually asymptomatic and 10-30% of infected individuals successfully clear the infection [2,145], 70% of infections persist with the risk of progressive liver complications, such as fibrosis, cirrhosis, steatosis, insulin resistance, and/or hepatocellular carcinoma (HCC) [4,5,43,71,111,133,148,149], which can ultimately necessitate liver transplantation if HCV infection is not successfully treated (Fig. 1).To date, combination pegylated interferon-alpha (pIFN-α) and ribavirin [52] is the licensed standard of care (SOC) treatment for HCV; however, several limitations restrict its use and efficacy. First, because viral, host, and environmental factors significantly affect the success of SOC treatment (reviewed in [162]), numerous contraindications limit the number of patients eligible for therapy. Of those who are treated, sustained virological response (SVR) is only achieved in ~80% of individuals infected with genotypes 2 or 3 and 40%-50% of individuals infected with genotypes 1 or 4 [3]. In addition, therapy itself has a spectrum of toxic side effects and complications, which severely limit patient compliance and thus treatment efficacy [45]. Hence, with an estimated 130 million people worldwide chronically infected [4], and the number of HCV patients needing medical care is expected to increase dramatically over the next decade [171], the development of new more specific HCV antivirals is a healthcare imperative. This review will discuss the experimental models available for HCV antiviral drug research, the most recent advances in HCV antiviral drug development, as well as future research directions focused on developing new HCV-specific therapeutics.
HCV EXPERIMENTAL SYSTEMS AVAILABLE FOR ANTIVIRAL DRUG RESEARCHSince it's discovery in 1989 as the causative agent on non-A non-B hepatitis [37], the HCV lifecycle and host-virus interactions that determine infection outcome have been difficult to study because experimental HCV cell culture infection systems and suitable small animal models have not been readily available. Consequently, the development of preventive vaccines and anti-HCV therapeutics has been severely hampered. Notably however...