Very Low-density Lipoprotein-triacylglyceride Promotes Hepatitis B Virus Reactivation

ABSTRACT: Metabolic dysfunction-associated steatotic liver disease (MASLD) inhibits hepatitis B virus (HBV) activity while simultaneously exacerbating liver fibrosis/cirrhosis (LF/LC) in chronic HBV (CHB)-infected patients. To date, no model is available to investigate this discrepancy. The established HBV-MASLD-LF/LC mouse model in this report mimics the promotion of LF/LC and suppression of HBV levels by MASLD. Very low-density lipoprotein (VLDL)-loading triacylglyceride (TAG) was positively correlated with the HBV titer and LC/LF in both HBV+ patients and the HBV-MASLD-LF/LC mouse model. TAG treatment could upregulate the HBV titer and fibrotic markers in vitro, thus demonstrating a causal relationship. Hepatocyte-specific VLDL receptor knockout (VRKO) reduced the HBV titer but promoted LF/LC in the HBV-MASLD-LF/LC mouse model. VLDL-TAG was reduced in VRKO HBV-MASLD-LF/LC mice compared to wild-type mice. The VLDL level and VLDL-loading are considered LF/LC risk factors in hepatitis B e antigen-negative CHB patients (considered at low risk of developing LF/LC). In conclusion, this report explains the discrepancies in HBV, MASLD, and LF/LC at the physiological level. VLDL-TAG is considered a novel risk factor of HBV reactivation and deserves further study.