Sustained liver HBsAg loss and clonal T and B cell expansion upon therapeutic DNA vaccination require low HBsAg levels
Authors: Conceição-Neto Nádia , Pierson Wim , Vacca Maurizio , Beyens Matthias , De Clerck Ben , Aerts Liese , Voeten Birgit , De Pooter Dorien , Verschueren Lore , Dockx Koen , Vandenberk Mathias , De Troyer Ewoud , Verwilt Kato , Van Hove Carl , Verslegers Mieke , Bosseler Leslie , Crabbe Marjolein , Krishna Vinod , Nájera Isabel , Van Gulck Ellen 
Published: September 2023

AbstractBackground & AimsSuppression of HBV DNA, inhibition of HBsAg production and therapeutic vaccination to reverse HBV-specific T-cell exhaustion in chronic HBV patients are likely required to achieve functional cure. In the AAV-HBV mouse model, therapeutic vaccination can be effective in clearing HBsAg when hepatitis B surface (HBsAg) levels are low. The factor(s) required for mounting an effective immune control of HBV infection are unclear. Using a single-cell approach, we investigated the liver immune environment in the context of different levels of HBsAg as well as upon sustained HBsAg loss through treatment with an HBV specific GalNAc-siRNA followed by therapeutic vaccination.MethodsC57BL/6 mice were transduced with a range of rAAV-HBV DNA to express different HBsAg levels. Mice were treated with GalNAc-siRNA targeting HBV transcripts to lower the HBsAg levels and then vaccinated 4 times with a DNA vaccine encoding HBV Core, Pol and Surface. We used single-cell RNA-sequencing on homogenised liver resident cells, paired with single-cell V(D)J receptor sequencing to understand the changes in the liver immune microenvironment.ResultsTreatment with GalNAc-HBV siRNA followed by therapeutic vaccination, achieved a sustained HBsAg loss in all mice. This was accompanied by an induction of CD4 follicular helper T-cell responses, polyclonal activation of CD8 T-cells in the liver and clonal expansion of plasma cells that were responsible for antibody production.ConclusionsThis study provides novel insight into the immune changes in the liver at the single-cell level, highlighting the correlation between the induced reduction in HBsAg levels and the clonal expansion of CD4 follicular helper T-cells, CD8 cytotoxic T-cells, plasma cells, and ISG-producing neutrophils in the liver upon HBV siRNA and subsequent therapeutic vaccine treatment.Lay SummaryChronic hepatitis B infection is characterized by a complex interplay between immune responses and viral replication in the liver. To achieve functional cure a combination of different treatments is likely required. In this study single-cell approach was used to understand the liver microenvironment in the context of different HBsAg levels followed by therapeutic vaccination in AAV-HBV mouse model and to identify key factors required to achieve functional cure.Graphical abstractHighlightsAAV-HBV transduced mice sequentially treated with GalNAc-siRNA and therapeutic vaccine showed sustained HBsAg loss.The sustained HBsAg loss correlates with increased proportion and clonal expansion of CD4 follicular helper T-cells, CD8 cytotoxic T-cells, plasma cells, and ISG producing neutrophils in the liver.Baseline levels of HBsAg are important to determine outcome of therapeutic vaccination in mice.