Coinfection of Clonorchis sinensis and hepatitis B virus: clinical liver indices and interaction in hepatic cell models

Background In China, people infected with hepatitis B virus (HBV) are commonly found in areas with a high prevalence of Clonorchis sinensis , a trematode worm. Published studies have reported that the progression of hepatitis B is affected by coinfection C. sinensis . Methods Clinical data from a total of 72 patients with C. sinensis and HBV (as sole infection or with coinfections) and 29 healthy individuals were analysed. We also incubated the hepatic stellate cell line LX-2 with total proteins from C. sinensis adult worms ( Cs TPs) and HBV-positive sera. In addition, the human hepatoblastoma cell line HepG2.2.15 was treated with the antiviral drug entecavir (ETV), Cs TPs and the anti- C. sinensis drug praziquantel (PZQ). Results Our clinical data indicated that the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB) and hyaluronic acid (HA) were significantly higher in patients with coinfection than in those infected with HBV only. In cell models, compared with the model in which LX-2 cells were incubated with HBV-positive sera (HBV group), transcripts of alpha-smooth muscle actin and types I and III collagen were significantly elevated in the models of LX-2 cells treated with Cs TPs and HBV-positive sera ( Cs TP+HBV group), while the messenger RNA levels of tumour necrosis factor-α, interleukin (IL)-1β and IL-6 in the Cs TP+HBV group were clearly lower. The HBV surface antigen and hepatitis B e-antigen levels were higher in the HepG2.2.15 cells treated with ETV and Cs TPs than in those in the ETV group and in the cells administered a mixture of ETV, Cs TPs and PZQ. Conclusions These results confirmed that C. sinensis and HBV coinfection could aggravate the progression of liver fibrosis. Cs TPs might promote chronic inflammation of the liver in individuals with HBV infection, resulting in the development of hepatic fibrosis. Graphic abstract