Call Girls Hosur Just Call 7001305949 Top Class Call Girl Service Available
Hbv genotypes in libya
1. Distribution of Hepatitis B Virus
genotypes in Libya using PCRbased diagnostics
Presented By:
Milud.A.Salem
2. Introduction to Hepatitis B
Virus
350 million people are infected with HBV
worldwide¹.
HBV infection develop to CHB, cirrhosis or
HCC¹.
Libya has an intermediate prevalence of the
HBV infection reaching around 2.2%².
¹Hu and Hirshfield, 2006. Advanced techniques in diagnostic microbiology, pp. 342-343
²Elzouki et al. Journal of Gastroenterology. 2006; 21 (2):114
3. ≥8% - high
2-7% - intermediate
< 2 - low
Terrault and Wright 1998. Sleisenger and fordtran's gastrointestinal and liver Disease, pp.1123-1170
6. Genotypes of HBV
Classified into 9 genotypes to date (A-I) based
on 8% or more of DNA sequence differences.
HBV genotypes were found to have varied
geographic distributions.
Schaefer S. World Journal of Gastroenterology. 2007, 13(1):14-21.
7. HBV genotypes have clinical significance:
1) Disease severity:
genotypes C and D are more associated with
sever liver disease than genotypes B and A¹.
genotype D has a high rate of developing HCC².
2) Induction of chronicity:
CHB is more often induced in patients with
genotype A than with genotypes B and C³
¹Chan et al. Journal of Clinical Microbiology. 2003; 41:1277–1279
²Thakur et al. Journal of Gastroenterology and Hepatology. 2002; 17:165–170
³Schaefer. Journal of Viral Hepatitis. 2005; 12:111-124.
8. 3) Prevalence of seroconversion:
genotypes A and B have a higher seroconversion
rate than genotypes D and C, respectively¹.
4) Mutations variants:
precore variant is common with genotypes D and
B in comparison with genotypes A and C,
respectively. the core promoter mutation is more
frequent in individuals with genotype C than
genotype B ²
¹Mahtab et al. Hepatobiliary and Pancreatic Diseases International. 2008; 7(2): 457-464.
²Lindh et al. Journal of Infection Disease. 1999; 179:775–782.
9. 5) Viraemia levels:
high DNA levels in HBV genotype D patients with
HBeAg negative, and in HBV genotype C patients
with HBeAg positive.¹
6) Response to anti-viral drugs and vaccines:
The response to IFN is higher with genotypes A and
B than genotypes D and C, respectively², while the
response don’t vary between genotypes A and D
with lamivudine³ but higher with genotype C than B³.
The immune escape after vaccination occurred in
region with genotype D prevalence .
4
¹Westland et al.Gastroenterology. 2003; 125:107-116.
²Zhang et al.Journal of Medical Virology. 1996; 48:8–16.
³Buti et al. Journal of Hepatology. 2002; 36:445-446.
4Carman et al. Lancet. 1990; 336 (8711): 325–329
10. Objective of this study
To determine genotypes of HBV among
Libyan patients who were referred to the
St.James clinical Laboratory, Tripoli, using
INNO-LiPA HBV genotyping assay
11. Materials and Methods
HBV-DNA quantification
clinical plasma specimens
DNA purification
RoboGene® HBV quantification kit
DNA Quantification
Rotor-Gene 3000™
12. BV
H
e ® kit
Gen tion
ob o i fi c a
R nt
qua
H
RC
SEA
RE 0
T
ET e 300
B
OR -Gen
C or
Rot
13. Materials and Methods
HBV Genotyping
clinical plasma isolates
DNA purification
Wizard® SV genomic DNA purification system, Promega
Outer amplification
INNO-LiPA primer
Gel electrophoresis
2% agarose gel
+
Genotyping using
INNO- LiPA assay
-
Nested amplification
INNO-LiPA primer
14. mic m,
eno yste
g
S V i on s
®
ard rificat
Wiz pu
t
NA ega ki
D
m
Pro
r
TT l Cycle
RBE rma
CO The
RBE RCH
CO EA
RES
15. s
e si
hor )
p
tro Plus
c
el e X L
g el el
ini
M em (G
t
sys
O
NN
I
iP A
-L
VG
HB
ot y
en
kit
ing
p
16. Materials and Methods
INNO-LiPA major steps
Denaturation
5 min
Denaturation of amplified
Biotinylated DNA
Hybridization
60 min
Hybridization with specific
oligonucleotide probes
immobilized on membrane-based
strips
Stringent wash
30 min
Remove unbound
DNA
Color development
60 min
Incubate with conjugate
and substrate resulting in
purple brown precipitate
17. Results and discussion
HBV-DNA quantification
121 clinical plasma isolates
DNA purification
RoboGene® HBV quantification kit
DNA Quantification
Rotor-Gene 3000™
DNA quantity in samples ranged from
50 IU/ ml and 3.6x10ˉ IU/ml
18. Results and discussion
HBV-DNA purification and amplification
clinical plasma isolates
DNA quantity > 1000 IU/ml (85/121 samples)
DNA purification
Wizard® SV genomic DNA purification system, Promega
Outer amplification
INNO-LiPA primer
54 samples
-
Gel electrophoresis
Nested amplification
2% agarose gel
INNO-LiPA primer
31 samples +
+ 33 samples
Genotyping using
INNO- LiPA assay
19. 456
411 415
1
3
5´
CATC CTGCTGCTATGCCTCATC TTCTTG TTGGTTCTTCTGGATTA TCAAGGTATGTTGCCCG TTTGTCCTCTAATTCC AGGATCAACAACAACCAGTACG
GTAG GACGACGATACGGAGTAGAAGAACAACCAAGAAGACCTAAT AGTTCCATACAACGGGCAAACAGGAGATTAAGGTCCTAGTTGTTGTTGGT CATGC
GGACCATGCAAAACCTGCACGACTCCTGCTCAAGGCA ACTCTATGTTTCCCTCATGTTGCTG TACAAAACCTACGGATGGAAATTGCACCTGTATTCCCAT
CCTGGTACGTTTTGGACGTGCTGAGGACGAGTTCCGTTGAGATACAAAGGGAGTACAACGACATGTTTTGGATGCCTACCTTTAACGTGGACATAAGGGTA
CCCATCGT CCTGGGCTTTCGCAAAATACCTATGGGAGTGGGCCTCAGTCCGTTTCTCT TGGCTCAGTTTACTAGTGCCATT TGTTCAGTGGTTCGTAGGG
GGGTAGCAGGACCCGAAAGCGTTTTATGGATACCCTCACCCGGAGTCAGGCAAAGAGAACCGAGTCAAATGATCACGGTAAACAAGTCACCAAGCATCCC
798
CTTTCCC CCACTGTTTGGCTTTCAGCTATATGGATGATGTGGTATTGGGGGCCAAGACTGTACAGCATCGTGAGTCCCTTTATACCG CTGTTACCAATTTT
GAAAGGGGGTGACAAACCGAAAGTCGATATACCTACTACACCATAACCCCCGGTTCTGACATGTCGTAGCACTCAGGGAAATATGGC GACAATGGTTAAAA
4
824
2
3´
837
CTTTTGT CTCTG GGTATACATTTAA END OF HbsAg
GAAAACAGAGAC CCATATGTAAATT
Outer amplification fragment
Nested amplification fragment
Osiowy and Giles. Journal of clinical Virology; 2003: 5473-5477.
1= sense outer primer sequence
2= anti-sense outer primer sequence
3= sense nested primer sequence
4= anti-sense nested primer sequence
21. Results and discussion
HBV genotypes
Denaturation
5 min
Denaturation of amplified
Biotinylated DNA
Hybridization
60 min
Hybridization with specific
oligonucleotide probes
immobilized on membrane-based
strips
Stringent wash
30 min
Remove unbound
DNA
Color development
60 min
Incubate with conjugate
and substrate resulting in
purple brown precipitate
26. Results and discussion
HBV genotypes
(60 samples) Genotypable using INNO- LiPA assay
Genotype A
1 patient
Genotype E
1 patient
Genotype D
54 patients
1.7%
1.7%
90%
Mixed
genotype D/E
4 patients
6.6%
27. Conclusion
These results showed that HBV genotype D is
the most prevalent genotype in Libya.
This study agree with other studies in
Mediterranean and Middle East countries where
HBV genotype D is predominates.
HBV D/E hybrid may represent CHB patients
or IDUs.¹
¹ Chen et al.Journal of Medical Virology. 2004; 74: 536-542.
28. Author
Study
place
Detection
method
Samples
.No
%Genotypes
A
B
C
D
E
109
91
84.6
Italy
LiPA
272
Sharara et al.
((2004
Lebanon
/
67
Zekri et al.
((2007
Egypt
Type-specific
primers
70
10
Al ashgar et al.
((2008
Saudi
Arabia
INNO-LiPA
54
5.6
85.2
Basaras et al.
((2007
Spain
INNO-LiPA
14
28.6
64.3
Bahri et al.
((2006
Tunisia
RFLP
138
8
80
9
Khelifa and
( Thibault (2009
Algeria
sequencing
75
5
93
2
This study
)(2009
Libya
INNO-LiPA
60
1.7
90
1.7
D/E
100
RFLP
A/E
Alavian et al.
((2006
Iran
Ezzikouri, et al.
((2008
Morocco
Dal Molin et al,
((2006
INNO-LiPA
26
73
98
25.7
8.6
2
15.7
37.1
5.6
3.6
7.1
6.6
29. Recommendation
Further studies are needed to explore the
nucleotide sequences of HBV genotype D
isolates in Libya.
*This work may open new avenues for further
studying the molecular virology of HBV.
*HBV genotype D may need to be broken down
into sub-genotype.