It appears they are using adenovirus associated vector 8 that is strongly hepatotropic as vehicle to introduce the permanent production of the interfering hairpin RNA.
while this virus is known not to produce obvious disease, it can mildly integrate into the host genome and also produce a few new proteins that can cause at least mild tcell activation with their epitopes. Furthermore a strong bcell response is typical, resulting in circulating neutralizing antibodies against the vector virus.
thus to eliminate or reduce the hbv infection, a new presumably harmless chronic viral liver infection is produced.
The final efficacy against hbv also remains to be seen, a 90% transcription reduction, eg might still not be sufficient to achieve the hbsag seroconversion desired.
But then you have a new guest in the liver, with unclear long term effects.
The use of this technology might be warranted against diseases with strong pathologies for which no good alternative therapy exists. For hepatitis b and C we have to wait and see.
As Benitec frequently stated, there is no turning back from the treatment:
"yet the genetic change is long-lasting, because the shRNA continues to be expressed for long periods, potentially up to years from the integrated DNA construct (Sci Trans Med 2010)."
I think it would require a lengthy period of observation, maybe be long after the disease is cured, that the introduced DNA is safe.
The approach is quite fascinating, if several target sequences could be used it might even be possible to overcome the adaptive power. I do not know how they intend to get the plasmid into the human liver cells.
The e ag related mutations are not relevant to the adaptive mutations in this context. It is the same problem all interfering RNA have to block a dynamic genome like hbv from functioning.
Two major problems remain with this approach.
First the plasmid has to be successfully inserted into the liver cells.
Second, the recognition region of the interfering RNA made from the short hairpin RNA is fairly short. If even a single nucleotide mutation is present, or generated through mutation, the binding will be too weak to work.
this means, that the system is quite vulnerable to mutational adaption of the HBV virus to this transcription efficacy reducing machinery.
Hi Sorte, thanks for the news: 98.5% elimination of circulating hbv after a single treatment is indeed amazing.
Here is a video that shows how their techinque of ddRNAi works.
https://www.youtube.com/watch?v=UuicPthdT70