Hepatitis B virus (HBV) genotype C and the basic core promoter (BCP) mutations were reported to be associated with the development of hepatocellular carcinoma (HCC). In this study the full sequences of HBV genomes were analyzed in order to find the other predictors of HCC development. We determined the full sequences of HBV genomes in 24 genotype C carriers who developed HCC (HCC group) at the beginning of follow-up and at the time of HCC diagnosis, and 20 patients who did not develop HCC (non-HCC group) served as a control. The number of nucleotide and amino acid substitutions in most regions was higher in the HCC group than in the non-HCC group, and the following substitutions and deletions were found more frequently in the HCC group than in the non-HCC group: G1317A and T1341C/A/G in the X promoter region were detected in 13 and six of the HCC cases, four and none of the non-HCC cases, respectively; and pre-S2 deletion was detected in eight HCC and none of the non-HCC cases. Compared with the wild type X promoter, the mutant type X promoters, M1 (G1317A), M2 (T1341C), and M4 (T1341G) showed increases in activity of 2. (1) Infection with HBV leads to a wide spectrum of clinical presentations ranging from an ASC state to chronic hepatitis with progression to HCC in some patients. HCC is one of the major malignant diseases in the world, ranking as the fifth most common cancer, and it is believed that chronic HBV infection is a major global cause of HCC.(2) HBV consists of four ORFs: the X, precore/core, pre-S/S, and Pol regions. Among these, the X and pre-S/S regions have been reported to function as transcriptional transactivators. (3)(4)(5) The domain between nt 221 and 573 in the pre-S/S region was termed the transactivator region, and its 3′-deleted form was shown to exert a transcriptional transactivator function. (6) Although substitutions and deletions in the pre-S1/pre-S2/S region were reported in relation to the development of liver disease, (7,8) it remains unclear whether differences in the full length sequence of HBV exist at different stages of infection, particularly between patients who develop HCC and those who do not. Kajiya et al. analyzed the full sequence of serial serum samples obtained from a patient who underwent long-term follow-up from the time prior to development of symptoms to the chronic active hepatitis stage, and suggested that pre-S1 deletions and substitutions in the CP region may participate cooperatively in the progression of the disease.(9) Takahashi et al. studied the full length nucleotide sequence of HBV genome in sera from 40 Japanese patients with HBsAg positive HCC, and reported frequent deletions and missense mutations in the preS2 region. (10) In the present study, the full length sequence of the HBV genome were analyzed in the sera of patients who did not have HCC at the beginning of follow-up and developed HCC thereafter, and in those of patients who did not develop HCC during followup served as the control group, in order to find the predicators of HCC development.
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