The inflammatory immune responses of the host to HCV antigens induce hepatocyte damage, which is followed by the regeneration of hepatocytes and the development of fibrosis, important features in the pathogenesis of HCC. Men have a higher prevalence of HCC than women, varying between 2:1 and 4:1 (
56). Etiological factors such as HBV and HCV play a role in this process, and genetic and hormonal factors may also be important (
10,
34,
36).
Androgen is a ligand and major activator of AR signaling (
1,
27,
46). Androgen binds to AR, inducing a conformational change, and then AR forms a homodimer and is phosphorylated at several sites. These active ARs stabilize the ligand-receptor homodimer, making the ligand-receptor complex for translocation to the nucleus. The AR-ligand complex then initiates gene transcription by binding to specific AREs in the promoter regions of target genes. After DNA binding, RNA polymerase machinery is recruited to the initiation site and the transcription of AR-regulated genes begins (
13).
There are other well-known AR activation pathways, including STAT3 (
48) and PI3K/AKT (
57) in an androgen-independent manner. We and others have shown that HCV can activate various cytoplasmic signaling pathways, including JAK/STAT (
5,
35,
41) and PI3K/AKT (
4,
58). Because HCV replicates in the cytoplasm, irrespective of androgen treatment, it may activate AR by affecting preexisting cytosolic cellular signaling pathways. We have shown that HCV activates STAT3 phosphorylating S
727 and enhances AR activation. The presence of DHT further increases AR activity. IL-6, an inflammatory cytokine, induces upregulation of AR expression through the activation of STAT3 in prostate cancer cell line LNCaP (
25).
Translocation of STAT3 into the nucleus needs both phosphorylated Y
705STAT3 and phosphorylated S
727STAT3. HCV core can increase both the phosphorylated forms of STAT3 (Fig. ). However, the effect of NS5A on phosphorylated S
727STAT3 is weaker. This may be a reason why NS5A did not activate androgen response gene expression in spite of containing several proline-rich sequences consistent with Src homology 3-binding sites found in cellular signaling molecules (
47).
The early stage of hepatocarcinogenesis is not well understood pathologically and clinically. Even early HCC lesions are more often overt HCC that already have an arterial blood supply, rather than extremely well differentiated and supplied by the portal vein as generally believed (
19). It is well known that vascular (portal) invasion portends a poor prognosis (
37). The status of angiogenesis in HCC correlates with disease progression and prognosis. VEGF is a primary androgen-responsive gene in the liver, which is the subset regulated directly by AR-occupied AREs (
6). VEGF expression in HCC tissues was thought to be related to the histological grade (
49). VEGF plays a central role in mediating angiogenesis in HCC (
50). We have shown that AR enhances VEGF mRNA expression in HCV-infected Huh-7 cells more efficiently than in mock-infected cells. Moreover, androgen and HCV strongly induce angiogenesis. We have demonstrated that STAT3 is phosphorylated at S
727 in the presence of HCV core, which subsequently activates AR. VEGF is modulated by AR in neoplastic growth. Therefore, we hypothesize that HCV-mediated activation of AR may increase VEGF function, resulting in the development of angiogenesis in liver. In conclusion, we have identified HCV core as an activator of AR, which may have implications for HCC as a male-dominant disease.