Based on a large number of experimental

Based on a large number of experimental Ku-0059436 and clinical studies performed during the past several years, it is now generally accepted that HCV infection produces an

increase in oxidative stress in infected hepatocytes. One important mediator of such increased oxidative stress is the HCV core protein.27, 28 In parallel with these observations are a series of observations in numerous systems, including experimental systems with expression of HCV, showing that HMOX1 helps to protect numerous cells and tissues against the potentially damaging effects of excess oxidative stress. These actions are based on the ability of HMOX1 to decrease free or loosely bound heme, which can act as a potent prooxidant, and to

increase production of carbon monoxide, biliverdin, and bilirubin, which have potent antioxidant and anti-inflammatory and antifibrogenic effects.6-8, 29, 30 HMOX1 has also emerged Midostaurin mouse as an important antiapoptotic enzyme.31 Overexpression or induction of HMOX1 suppresses HCV replication and increases resistance of hepatocytes to oxidant injury.19, 20 Regulation of expression of the HMOX1 gene is complex. However, we and others have shown that among the important sites for regulation are a series of expanded AP-1 sites, also called antioxidant responsive elements,31 Maf protein responsive elements, and metalloporphyrin-responsive elements in the 5′-UTR of HMOX genes, across many species.32-36 Bach1 plays a key role in tonic repression of

expression of the HMOX1 gene. It does so by forming heterodimers with small Maf proteins and blocking transcriptional activation of the gene. Bach1 contains several consensus binding sites (all containing CP motifs), which when they bind heme, lead to a change in conformation of the protein with marked reduction in affinity for Maf proteins and subsequent derepression and increase in activity of HMOX1 gene expression.9, 10, 12 In view of the above, it is not surprising that HMOX1 activity might be increased in HCV infection, and, indeed, we and others have shown this to be the case.5 Nevertheless, in some other experimental systems and also in some clinical studies, a decrease selleck products in expression of HMOX1 has been observed in the setting of chronic hepatitis C.37, 38 These findings suggest that patients with genetic or other factors that lead to lower levels of HMOX1 gene expression may be at increased risk for development of chronic hepatitis C infection after acute HCV exposure and/or with greater risks of development of more rapidly progressive liver disease due to HCV infection. In this regard, there are at least two known genetic factors that influence levels of expression of HMOX1—namely, the length of GT repeats in the 5′-UTR and the presence of a single-nucleotide polymorphism at position -413 (A/T, rs2071746) in the HMOX1 promoter region.

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