Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2019; 25(38): 5826-5837
Published online Oct 14, 2019. doi: 10.3748/wjg.v25.i38.5826
Hepatitis C virus clearance and less liver damage in patients with high cholesterol, low-density lipoprotein cholesterol and APOE ε4 allele
Karina Gonzalez-Aldaco, Sonia Roman, Rafael Torres-Valadez, Claudia Ojeda-Granados, Luis A Torres-Reyes, Arturo Panduro
Karina Gonzalez-Aldaco, Sonia Roman, Rafael Torres-Valadez, Claudia Ojeda-Granados, Luis A Torres-Reyes, Arturo Panduro, Department of Molecular Biology in Medicine, Civil Hospital of Guadalajara “Fray Antonio Alcalde” and Health Sciences Center, University of Guadalajara, Guadalajara 44280, Jalisco, Mexico
Author contributions: Panduro A conceived the study and clinically evaluated all patients. Gonzalez-Aldaco K carried out experimental work, statistical analysis, and drafted the manuscript. Roman S revised all experimental data and copyedited the English version. Torres-Valadez R carried out clinical and laboratory work. Ojeda-Granados C performed the clinical nutrition evaluation, and Torres-Reyes LA revised all biostatistical analysis. All authors contributed intelligently, critically revised, and approved the final version of the manuscript.
Supported by Programa para el Desarrollo Profesional Docente (PRODEP) to Gonzalez-Aldaco K, No. UDG-PTC-1422; and Consejo Nacional de Ciencia y Tecnologí a (CONACYT) to Panduro A, No. 2017-01-5254.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board, Health Sciences Center, University of Guadalajara, Certificate #CI-00612.
Informed consent statement: All participants signed an informed consent before participating in the study.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Arturo Panduro, MD, PhD, FAASLD, Professor, Department of Molecular Biology in Medicine Civil Hospital of Guadalajara “Fray Antonio Alcalde”, Hospital 278, Guadalajara 44280, Jalisco, Mexico.
Telephone: +52-33-36147743 Fax: +52-33-36147743
Received: June 18, 2019
Peer-review started: June 20, 2019
First decision: August 28, 2019
Revised: September 9, 2019
Accepted: September 27, 2019
Article in press: September 27, 2019
Published online: October 14, 2019
Research background

The interplay between lipids and hepatitis C virus (HCV) can modulate the course of HCV infection. Cholesterol improves the rate of sustained virological response and immune response against HCV. On the other hand, the three APOE alleles mediate lipid levels by interacting with environmental factors such as diet. Currently, a high prevalence of lipid alterations, obesity, and an uneven distribution of the APOE alleles is notorious among the Mexican population. Herein, we investigate the effect of APOE polymorphisms and the lipid profile on the outcome of the HCV infection in patients from Mexico. To the best of our knowledge, this study is the first in reporting the effect of APOE alleles in the course of HCV infection in a Latin American population.

Research motivation

HCV is a leading cause of chronic liver disease worldwide. Although it is expected to be eliminated by 2030, HCV infection still represents an unsolvable problem in many developing countries. At present, the factors impacting on the clinical outcome of HCV infection in Latin American countries are not fully known. Understanding the role of metabolic abnormalities and the participation of cholesterol and APOE polymorphisms in the outcome HCV infection could favor the implementation of earlier strategies of detection and treatment in these populations.

Research objectives

This study aimed to investigate the effect of APOE polymorphisms and the lipid profile on the outcome of the HCV infection in patients with an admixture genetic background living in West Mexico.

Research methods

A total of 299 positive anti-HCV positive patients were enrolled from January 2014 to December 2016. Clinical records were elaborated by a physician. Quantitative assessment of serum RNA was performed by a standardized quantitative reverse PCR assay. After testing, the study population was divided into two groups: Spontaneous clearance (SC) and chronic hepatitis C infection (CHC) patients. Biochemical determinations were tested through a Vitros 250 analyzer, and liver stiffness was assessed by a certified physician using transitional elastography. The APOE genotype was determined using a 5’ allelic discrimination method. Data analysis was performed using IBM SPSS Statistics version 21.0 for windows.

Research results

Patients who presented SC were mainly overweight, had higher levels of total cholesterol, LDL-c, and triglycerides than CHC patients. The APOE ε4 allele was significantly associated with spontaneous HCV clearance status and with less fibrosis than non- ε4 alleles carriers among chronic patients. Levels of LDL-c ≥ 101.5 mg/dL and BMI ≥ 26.6 kg/m2 were associated with SC status; while ALT ≥ 50.5 IU/L was negatively associated.

Research conclusions

The present study suggests that APOE ε4 allele and LDL-c confer a protective effect in the course of the HCV infection in the context of high BMI. Levels of LDL-c, BMI, and ALT may help in the estimation of the risk of chronicity in HCV-infected patients.

Research perspectives

In our view, an individualized therapy accounting the host´s genetic, environmental, and metabolic factors could aid in the clinical management of HCV infection, especially in populations with a high prevalence of overweight and obesity.