Overall Hepatitis C Virus (HCV) chronically infects ~185 million people worldwide and is a major cause of liver failure and hepatocellular carcinoma. With the advent of oral, interferon-sparing HCV regimens, it has become much easier to safely and effectively treat HCV infection. However, HCV control is not likely to be achieved with treatment alone. Identification of those with HCV infection is challenging, therapies are too costly for countries with the highest incidence, reinfection can occur following treatment, transmission of drug-resistant HCV is possible, and treatment does not fully reverse severe liver damage even when cure is achieved. There is a rising epidemic of acute HCV infection in adolescents and young adults in the United States that gives new urgency to prophylactic vaccine development efforts. However, numerous challenges for vaccine development remain, including limited populations in which candidate vaccines can be tested, the enormous sequence diversity of HCV, and incomplete understanding of what mediates protective immunity. The study of immune responses to HCV has provided important insight into protective immunity. However, more research is needed to identify clear correlates of immunity to assess in healthy volunteers before candidate vaccines are tested in the limited at-risk populations available. The overall goal of this proposed research is to define the innate, humoral, and T cell responses that allow protective immunity against the broadest array of infecting hepatitis C viruses by studying people who are repeatedly exposed to and control HCV. This research will include an assessment of the earliest innate response to infection as well as the downstream adaptive response to help select a vaccine adjuvant that enhances induction of protective responses. The sequence of HCV will be compared before and after induction of adaptive immune responses to better understand how the virus, with its remarkable sequence diversity, is able to evade immune responses. The knowledge gained about humoral responses to HCV will be used to design vaccines to elicit antibodies that neutralize HCV infection. Understanding protective T cell responses will enhance creation of a vaccine that induces T cells capable of clearing cells infected with any virus that evades the frontline neutralizing antibodies. In sum, we anticipate that the proposed research studying people who are repeatedly exposed but don't develop persistent HCV infection will define correlates of protective immunity to target in vaccine design.

Public Health Relevance

Overall HCV is a common infection, but often silent until the late stages of disease and there is no vaccine to prevent it. We have developed a cohort of people at high risk of HCV infection so that we can determine how the infection is fought by the immune system. We are studying people in this cohort who are infected many times, but never become chronically infected so that we can learn how they fight the infection in order to design an effective vaccine to prevent HCV. Project 1: Mechanisms Driving Breadth of HCV Neutralization During Repeated Control of Acute Infection in Humans Project Leader (PL): Ray, S. DESCRIPTION (provided by applicant): The primary objective of Project 1 is to study mechanisms driving increased breadth of neutralizing antibody responses during repeated HCV infections that are successfully cleared. We have recently demonstrated that anti-HCV humoral immune responses drive the evolution of HCV proteins E1 and E2 during acute and chronic infection, indicating that neutralizing antibodies detected in our in vitro assays reduce viral fitness in vivo. We have also demonstrated that neutralizing antibodies form clusters of similar specificities by testing them against natural HCV variants that we have cloned in a functional library. We hypothesize that repeated stimulation with varying HCV envelope sequences during reinfection drives broadening of the neutralizing antibody response. Thus, we propose the following aims to elucidate the mechanisms driving HCV neutralization breadth during acute reinfection: (I) to examine dynamic changes in anti-HCV binding and neutralizing activity during HCV re-infection, (II) to determine the mechanistic basis for changes in neutralizing activity by characterizing the circulating B cell repertoire, and (III) to identify key HCV envelope sequence changes that drive broadening of neutralization during reinfection. We anticipate that accomplishing these aims in collaboration with Dr. Cox (project 2) and Dr. Shaw (Project 3) will reveal patterns of antigenic exposure that drive shifts in the B cell response, in a manner that will help guide vaccine design and increase understanding of the host-pathogen interaction.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Program--Cooperative Agreements (U19)
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Special Emphasis Panel (ZAI1)
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Koshy, Rajen
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Johns Hopkins University
Internal Medicine/Medicine
Schools of Medicine
United States
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Kinchen, Valerie J; Cox, Andrea L; Bailey, Justin R (2018) Can Broadly Neutralizing Monoclonal Antibodies Lead to a Hepatitis C Virus Vaccine? Trends Microbiol 26:854-864
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