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CccDNA

Intermediate DNA structure in viral replication

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Through Virus, Covalent bond and Transcription (biology)

cccDNA was first described in bacteriophages, but it was also found in some cell cultures where an infection of DNA viruses (Polyomaviridae) was detected. cccDNA is typical of Caulimoviridae and Hepadnaviridae, including the hepatitis B virus (HBV). cccDNA in HBV is formed by conversion of capsid-associated relaxed circular DNA (rcDNA). Following hepatitis B infections, cccDNA can remain following clinical treatment in liver cells and can rarely reactivate. The relative quantity of cccDNA present is an indicator for HBV treatment.

Background of cccDNA and the Hepatitis B virus

Closed covalent circular DNA (cccDNA) is a unique DNA structure that forms in response to infection of a cell. Genomic DNA enters the cell nucleus, and partially double-stranded DNA is then converted into cccDNA.

CccDNA is primarily seen in the context of the Hepatitis B virus (HBV). Approximately 257 million people worldwide are chronically infected with the virus, placing them at high risk for developing cirrhosis and hepatocellular carcinoma (HCC). Chronic infection is characterized by the persistence of the cccDNA minichromosome in the nuclei of host hepatocytes (liver cells). Current treatments are unable to completely clear the viral minichromosome from the host hepatocytes, and as a result aim to "functionally cure" the host, which requires a blockade of the viral cccDNA through transcriptional silencing. The infected individual cannot be completely cured without a clearance of cccDNA from infected hepatocytes, which at present is not possible.

The HBV pathogen is a small, blood-transmitted virus with high tissue and species specificity that is transmitted through exposure to infected blood or bodily fluids. The only cells that the virus can infect are hepatocytes, and these are reached by means of the bloodstream after infection. Hepatocytes are cells from liver tissue that are involved in protein synthesis and storage. While this disease can be prevented by vaccination, high-risk individuals such as infants can have as high as a 90% chance of chronic liver disease if not previously vaccinated. As a result, the CDC recommends the first dose of hepatitis B vaccine be administered immediately at birth. CccDNA and its persistence in the nucleus remains the main obstacle for an effective cure and is therefore the reason for the rigorous hepatitis B vaccination schedule.

In practice, the only known organism that makes use of cccDNA is the Hepatitis B Virus. More specifically, cccDNA is a reactive intermediate that significantly contributes to infections of hepatocytes. The persistence of cccDNA throughout the duration of the infection has been a key player in the prevalence of HBV. Research indicates that cccDNA is actually the primary reason that historically, there has been little progress toward eradicating HBV. In many cases, even after the infection has been resolved, cccDNA can still be detected. Currently, therapy for HBV involves nucleotide analogues (NAs), which initially were implemented in clinical use in the late 1990s. Though many different therapeutic techniques have been trialed over the years, a cure for HBV has yet to be discovered. Researchers attribute this to the continued inability to disable the cccDNA. Future therapies will need to focus directly on eliminating this factor.

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