Nucleos(t)ide analogs in the prevention of hepatitis B virus related hepatocellular carcinoma

Figure 2 Hepatitis B virus has unique virus-specific mechanisms to induce carcinogenesis in the liver. The integration of hepatitis B virus (HBV)-DNA into the host genome alters DNA expression by gene and/or chromosomal deletions/translocations, and epigenetic changes (aberrant DNA methylation, miRNA changes). Viral protein HBV protein X may cause interference with transcription and signaling pathways leading to altered p53 mediated apoptosis and angiogenesis by up-regulation of vascular endothelial growth factor (VEGF), hypoxia inducible factor-1 (HIF-1) and angiopoietin-2 (ANG2). HBV preS/S proteins cause endoplasmic reticulum stress and mitochondrial dysfunction leading to oxidative stress.