Hepatitis B virus (HBV) infection is a major threat to global public health, which can result in many acute and chronic liver diseases. HBV, a member of the family Hepadnaviridae, is a small enveloped DNA virus containing a circular genome of 3.2 kb. Located upstream of the S-open-reading frame of the HBV genome is the pre-S region, which is vital to the viral life cycle. The pre-S region has high variability and many mutations in the pre-S region are associated with several liver diseases, such as fulminant hepatitis (FH), liver cirrhosis (LC), and hepatocellular carcinoma (HCC). In addition, the pre-S region has been applied in the development of several pre-S-based materials and systems to prevent or treat HBV infection. In conclusion, the pre-S region plays an essential role in the occurrence, diagnosis, and treatment of HBV-related liver diseases, which may provide a novel perspective for the study of HBV infection and relevant diseases.
K E Y W O R D Shepatitis B virus (HBV), pre-S mutants, occult HBV infection
| INTRODUCTIONHepatitis B is a non-negligible, life-threatening liver infection caused by the hepatitis B virus (HBV). It can progress to chronic infection, putting infected people at enormous risk of developing liver cirrhosis (LC), hepatocellular carcinoma (HCC), and even causing death. 1 A total of 257 million people worldwide have been chronically infected with HBV as of 2016, and it results in an estimated 887,000 deaths annually. 2 Hepatitis B has imposed huge burdens on many countries, and it remains a global public health problem that requires an urgent response.HBV belongs to the family Hepadnaviridae and is a small enveloped DNA virus. The viral genome is a partially double-stranded DNA with approximately 3200 base pairs. Based on the sequence divergence of the full HBV genome, 10 genotypes (A to J) and several subtypes of HBV have been identified, with different geographical distributions. 3 Four partially overlapping open-reading frames (ORFs) in the viral genome (pre-S/S, pre-C/C, P, and X) are responsible for encoding essential proteins for the viral life cycle. Among them, the pre-S/S ORF encodes three enveloped/surface proteins, that is, Large (L), Middle (M), and Small (S) proteins. 4 In fact, in addition to encoding surface proteins, the pre-S domain is reported to have many other important functions in the HBV life cycle, such as mediating HBV infection, forming viral particles, and inducing host immune responses. 5 The pre-S region has high variability, and mutations of the pre-S region have been confirmed to be related to several different acute and chronic liver diseases, which are of great clinical significance. 6 Moreover, the pre-S domain has displayed good