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Journal of Virology, November 2007, p. 12496-12503, Vol. 81, No. 22
0022-538X/07/$08.00+0 doi:10.1128/JVI.01059-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Department of Virology, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands,1 Department of Biological Analysis, Pasteur Institute Ho Chi Minh City, 167 Pasteur, Ho Chi Minh City, Vietnam,2 Center of Excellence in Viral Hepatitis Research, Department of Pediatrics, Chulalongkorn Hospital, Rama IV, Bangkok 10330, Thailand3
Received 16 May 2007/ Accepted 20 August 2007
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9,600 nucleotides in length and displays a high level of sequence diversity caused by high mutation rates and recombination. However, when we performed long distance reverse transcription-PCRs on HCV RNA isolated from serum of chronic HCV patients, not only full-length HCV genomes but also HCV RNAs which varied in size from 7,600 to 8,346 nucleotides and contained large in-frame deletions between E1 and NS2 were amplified. Carefully designed control experiments indicated that these deletion mutants are a bona fide natural RNA species, most likely packaged in virions. Moreover, deletion mutants were detected in sera of patients infected with different HCV genotypes. We observed that 7/37 (18.9%) of genotype 1, 5/43 (11.6%) of genotype 3, and 4/13 (30.7%) of genotype 6 samples contained HCV deletion mutant genomes. These observations further exemplify HCV's huge genetic diversity and warrant studies to explore their biological relevance. |
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Lack of proofreading ability of the viral RNA-dependent RNA polymerase is the driving force behind HCV's genetic diversity. As a result of the large amount (1012) of virions produced each day in chronic hepatitis C patients and the rate of incorrect nucleotide insertions, which reaches the order of 10–3 to 10–4 base substitutions per site per year, HCV quasispecies are generated (22, 26). Recombination may be another mechanism by which genetic diversity is driven, given the recent identification of naturally occurring intergenotypic recombinant viruses (13, 21). Because of the huge genetic diversity, HCVs are currently categorized into six major genotypes and more than 80 subtypes (25).
HCV genetic variation has been studied in relation to epidemiology, response to antiviral therapy, and clinical parameters, using different techniques that have focused on short genomic regions. However, analysis of full-length viral genomes may be necessary to better understand the characteristics of HCV. Previously, we analyzed sera from HCV RNA-positive blood donors from Ho Chi Minh City, Vietnam, in order to analyze the molecular heterogeneity of HCV in Southeast Asia (21). Based on sequence analysis of core and NS5b regions in a set of sera, two samples were identified which contained viruses of different genotypes. Whole-genome analysis and bootscan analysis of one particular sample revealed a recombinant virus with genotype 2i and genotype 6p sequences at the 5' and 3' ends, respectively. Partial characterization of the other sample revealed the presence of a full-length genotype 2i virus and another genotype 6 virus which could be characterized only partially. In the present study, we further characterized this virus by a large-fragment amplification method. Surprisingly, we identified a naturally occurring HCV deletion mutant genotype 6h virus that contained a large in-frame deletion of E1 and E2 genes. Further studies confirmed the existence of circulating HCV E1-E2 deletion mutants in a substantial percentage of chronic hepatitis C patients.
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RNA extraction and large-fragment PCR amplification. Total RNA was isolated from 100 µl serum by proteinase K digestion and phenol-chloroform extraction as previously described (23) and dissolved in 20 µl sterile water. To generate a long fragment of cDNA, reverse transcription (RT) was performed on 10 µl RNA with Expand reverse transcriptase (Roche Diagnostics GmbH) and primer 5460 or 8625 or the 3'UTR, according to the manufacturer's instructions, in a total volume of 30 µl at 42°C for 2 h as described previously (21). Ten-µl volumes of cDNA were amplified with 2.5 units of Expand high-fidelity enzyme mixture (Roche Diagnostics GmbH), 1x Expand PCR buffer, 0.4 mM of each dideoxynucleotide, and 0.4 µM outer primer pairs with a thermal profile that was described previously (21). First-round amplification from each cDNA reaction resulted in three overlapping PCR fragments (primers 16 and 5460, 3227F and 8625, and 4039 and 3'UTR). Next, 2-µl volumes of amplified product were subjected to nested PCR with inner primers to generate overlapping genome fragments (primer pairs s17 and 3277R, 66 [5'-TCCCGCGAGAGCCATAGT-3'] and 3636, 1992 and 4662, 4039 and 7100, 5930 and Pr2, and Pr3 and 9325) under similar conditions as employed for the first PCR. Amplified products were gel purified with the QIAquick gel extraction kit (QIAGEN) and ligated directly into plasmid pCR2.1 (TA cloning kit; Invitrogen). For each amplicon, five positive clones were selected and sequenced.
To determine the sensitivity of HCV deletion mutants to RNase, we performed an assay as previously described (14). HCV plasma samples were treated with or without 0.1% Triton X-100 in phosphate-buffered saline at 37°C for 1 h; subsequently, 5 U of RNase A (QIAGEN) was added and incubation continued for 1 h. In order to degrade RNase A before RNA extraction, proteinase K was added to each reaction mixture and incubated at 37°C for 15 min prior to adding lysis buffer. RNA was extracted as previously described (23) and was analyzed by RT-PCR.
Large-fragment PCR and deletion mutant amplification using specific primers. In order to avoid mismatch of degeneracy primers, specific primers were designed for large-fragment PCR of specific samples. Moreover, primers overlapping the deletion region of specific samples were designed and used for the deletion mutant amplification described in this study (Table 1). Conditions for RT-PCR were identical to the protocol described above.
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TABLE 1. Primers used for amplification HCV of specific samples
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Southern blot hybridization. Ten-µl aliquots of PCR amplification products were loaded on a 0.8% agarose-Tris-borate-EDTA buffer gel. DNA samples were denatured in 0.5 N NaOH and 1.5 M NaCl for 45 min and neutralized in 1 M Tris-HCl (pH 7.4) and 1.5 M NaCl for 45 min before transfer to Hybond N+ membranes (Amersham) by electroblotting (Amersham) in 1x Tris-borate-EDTA buffer according to the manufacturer's instructions. The blots were air dried for 30 min and UV irradiated for 10 min. The hybridization procedure was conducted as described elsewhere (6) with biotin-labeled probe specific for the 5'UTR (5'-ATTCCGGTGTACTCACCGGTTCCG-3', nucleotides 149 to 174) at 50°C for 3 h. Membranes were washed and incubated with streptavidin-beta peroxidase conjugate (Roche) at 42°C for 45 min. After several washes the blots were visualized with enhanced chemiluminescence detection reagents (Roche) according to the protocol of the manufacturer and by exposure to hyperfilm (Amersham) for 1 to 5 min.
Preparation of synthetic complete and deletion mutant HCV RNA.
HCV large-fragment amplicons were cloned into plasmid pCR2.1 (TA cloning kit; Invitrogen) under control of the T7 promoter. Plasmids were linearized with BamHI and purified by QIAquick PCR purification (QIAGEN), and in vitro transcription was performed as described elsewhere (2). Reaction mixtures contained
1 µg of linearized DNA template, 5.0 mM ribonucleoside triphosphate mix, 40 U RNaseOUT (Invitrogen), 1x reaction buffer, and 50 U T7 RNA polymerase (Invitrogen) in a total volume of 20 µl. After 2 h at 37°C, 5 U DNase I (QIAGEN) was added and incubation was prolonged for 1 h. DNase-treated synthetic RNA was purified by phenol-chloroform extraction and used as a template for RT-PCR.
DNA sequencing and sequence analysis. Sequence reactions on PCR products and plasmids were performed using the BigDye Terminator cycle sequencing ready reaction kit (Applied Biosystems) and an ABI Prism 3100 autosequencer (Applied Biosystems). Multiple sequence alignments were generated with the BioEdit program (version 7.0.1).
Nucleotide sequence accession numbers. New sequences reported in this study have been submitted to GenBank and have been assigned the following accession numbers: RP21.complete (EF420126), RP21.deletion (EF420127), RP30.complete (EF420128), RP30.deletion (EF420129), D88.complete (EF420130), D88.deletion (EF420131), D33.complete (EF420132), D33.deletion (EF420133), and D54.deletion (EF420134).
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FIG. 1. Identification of an HCV genotype 6h virus with a deletion in the E1-NS2 region in a patient (D54) doubly infected with genotypes 2i and 6h. (A) RT-PCR analysis (nucleotides 66 to 3636) of HCV RNA from sample D54 (lane 1) and sample D42 (lane 2) and the subsequent Southern blot analysis are shown in the left and right panels, respectively. Amplicons were separated in 0.8% agarose gels along with a marker (M) for which the molecular masses are given on the left side (in kilobase pairs). The deletion mutant and wild-type HCV genome are indicated on the right side. (B) The upper panel depicts the genome organization of HCV, with boxes indicating the coding regions for the core protein (C), envelope 1 and 2 (E1 and E2) proteins, p7, and nonstructural proteins 1 to 5 (NS1 to NS5). Also indicated are the 5' and 3' UTRs and the nucleotide and amino acid numbers, according to the numbering system for the prototype strain HCV-H (accession number M67463). In the lower panel, black lines indicate the D54 full-length (genotype 2i, DQ155561) and deletion (genotype 6h) sequences. The shaded box displays the position of the in-frame deletion region ( 674).
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FIG. 2. HCV deletion mutants occur in the serum of patients chronically infected with HCV genotypes 1, 3, or 6. (A and B) RT-PCR products obtained from HCV genotype 1 (G1; P21), genotype 3 (G3; R30), and genotype 6 (G6; D33 and D88) serum samples, using degenerate primers for amplification of HCV nucleotides 66 to 3636 (A) and 1992 to 3636 (B), were separated on 0.8% agarose gels. The molecular mass marker (M) is indicated on the left side in kilobase pairs. (C) Schematic representation of complete and deletion genomes determined for the different HCV genotypes. The upper panel depicts the genome organization of HCV as in Fig. 1. Forward and reverse primers to detect complete and deletion HCV genomes are presented. In the lower panel, black lines indicate the full-length and deletion sequences. The shaded boxes display the positions of the in-frame deletion region.
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FIG. 3. Consensus sequence alignments of different HCV full-length complete genomes (com) and deletion mutants (del). Nucleotide differences between complete and deletion mutant sequences are shown in bold. Residues identical to the major sequence are indicated by a dash, the deletion region is indicated by dots, and slashes indicate discontinuous sequences of the deletion regions. The nucleotide positions are presented above the sequences (numbering system for the prototype strain HCV-H), and sample names are indicated in the left-hand column. Complement nucleotide codes: R = T or C; Y = G or A.
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FIG. 4. Experimental confirmation of HCV E1-E2 deletion mutants. (A to C) RT-PCR (left panel) and Southern blot analysis (right panel) of HCV genotype 1 (P21), genotype 3 (R30), and genotype 6 (D33 and D88), using sequence-specific primers to amplify the regions 5'UTR to NS3 (nucleotides 17 to 3277) (A), 5'UTR to core (nucleotides 17 to 750) (B), and NS3 to NS5 (nucleotides 4039 to 8625) (C). Amplicons were separated in 0.8% agarose gels along with a marker (M) for which the molecular masses are given on the left side in kilobase pairs. (D) Gel electrophoresis of RT-PCR products amplified from RNA of samples P21, R30, D33, and D88 with primer 3636 and a junction site primer overlapping the deleted region that was specifically designed for each sample (Table 1). The molecular mass marker (M) is indicated on the left side (in kilobase pairs).
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FIG. 5. HCV deletion mutants are bona fide RNA species. (A) Comparison of RT-PCR amplification of HCV nucleotides 66 to 3636 (left panel) and Southern blot analysis (right panel) of HCV genotype 1 (P21), genotype 3 (R30), and genotype 6 (D33 and D88) serum samples, using Expand reverse transcriptase (lanes 1, 3, 5, and 7) and Transcriptor reverse transcriptase (lanes 2, 4, 6, and 8). (B) RT-PCR analysis of in vitro-transcribed full-length HCV RNA (left panel) and deletion mutant RNA (right panel) of sample P21 (genotype 1), using primer 3636 and either primer 66 or a junction site primer overlapping the deleted region (DelFP). Reactions were performed in the presence (+) or absence (–) of T7 RNA polymerase. As controls, a cDNA clone containing either full-length or deletion mutant HCV (C) or RNA isolated from the P21 serum sample (P) was used. The molecular mass marker (M) is shown in kilobase pairs on the left side. The amplicons representing deletion forms (Del) are indicated with an arrow.
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FIG. 6. The HCV RNA genotype 1 (P21) deletion mutant circulating in plasma is protected from RNase A digestion. The P21 serum sample was treated with or without 0.1% Triton X-100 and 1 µg RNase A before RNA extraction. RT-PCR amplifications of nucleotides 66 to 3636 (deletion mutant; left panel) or 1992 to 3636 (full-length; middle panel) or of the deletion mutant with a junction site primer overlapping the deleted region (DelFP) and primer 3636 (deletion mutant; right panel) are shown. The molecular mass marker (M) is indicated on the left side (in kilobase pairs).
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20% of chronic HCV patients infected with genotypes 1, 3, and 6. It is of note that our discovery seems to validate the claims of subgenomic HCV in liver biopsy specimens of chronic HCV patients and liver transplant recipients (12, 29). The region where the deletion occurs is similar in all studies, but in contrast to our findings, those authors reported also the presence of out-of-frame deletion genomes. Moreover, our findings generalize the detection of HCV deletion mutants to a significant portion of the chronic hepatitis C patients infected with different genotypes. The deletion genomes contain essential parts for autonomous HCV replication (5'UTR, core, and NS2-NS5-3'UTR), regions similar to what has been described for the artificially constructed subgenomic replicons (17, 28), and may therefore represent naturally occurring replicons. Interestingly, both full-length genome and mutant genome were resistant to degradation by RNase A, suggesting that both RNA forms are packaged in virions. Assuming that HCV particle assembly requires functional E1/E2 glycoproteins, the deletion mutants can only be packaged and secreted from cells when cells are coinfected with a wild-type virus with a full-length genome.
The HCV deletion mutants are highly reminiscent of defective interfering (DI) particles described for many viruses (10), including members of the Flaviviridae family, such as tick-borne encephalitis virus, Murray Valley encephalitis virus, Dengue virus, West Nile virus, and Japanese encephalitis virus (1, 3, 15, 19, 30). DI viruses are mutants that arise spontaneously when the standard wild-type virus is passaged in tissue culture at high multiplicities of infection. The DI genomes contain cis-acting signals required for replication but lack part or most of the region encoding viral proteins (4). These smaller viruses can be complemented by coinfection with a helper (wild-type) virus and might interfere with the replication of helper virus through competition for limiting factors in the host cell (16). To our knowledge, most, if not all, DI particles have been discovered in laboratory settings, and HCV is the first positive-stranded RNA virus for which defective genomes have been described in a natural human infection in vivo.
Methods to quantify and determine the heterogeneity of HCV genomes are currently used routinely to guide antiviral therapy and to study the evolution and epidemiology of this virus. The existence of deletion mutants in chronic hepatitis C patients further exemplifies the huge diversity of HCV and has some major implications. First, viral load quantification methods based on amplification of the 5'UTR (20) detect both defective and complete genomes. Considering a high amount of circulating HCV deletion mutant, it may be of interest to differentiate between these genomic HCV forms in order to further unravel the pathogenesis of HCV and response to antiviral therapy. However, given the fact that only a fraction of the patients harbor deletion mutants, a large panel of samples from well-characterized patients needs to be screened. Last, but not least, it has been proposed that defective viruses may play a significant role in the establishment and maintenance of chronic infection in vivo (11), despite the fact that most if not all data come from in vitro experiments (15, 30). Whether HCV deletion genomes play a role in the persistence of HCV infection remains to be delineated.
We thank Vu Thuy Yen, Jan Brouwer, Paula van Luijt, Kavita Bedi, and Apiradee Theamboonlers for technical assistance and Ron Fouchier for valuable discussions.
Published ahead of print on 29 August 2007. ![]()
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