Our studies reveal that cell culture produced HCV JFH1 infectious virions contain apoE which allows them to productively infect hepatocytes through interactions with the LDL-R. These observations confirm and extend the observations of Chang, et al., who demonstrated that apoE antibody was able to block the entry HCV RNA from cell culture derived virus into Huh7.5 cells (
Chang et al., 2007). Our results reveal that anti-apoE antibody blocks an HCV entry pathway of productive infection. We also showed that apoE antibody was directed against infectious particles, as infectivity was reduced following immunoprecipitation of particles containing apoE and HCV RNA. Although primary hepatocytes do not efficiently support productive infection with patient HCV isolates, it has been demonstrated that entry of patient derived HCV RNA depends on expression of LDL-R in cultured hepatocytes (
Molina et al., 2007). Similarly, we observed that modulating LDL-R levels with 25-HC, siRNA or by LDL-R overexpression controlled productive infection with HCV. Collectively, these results support the idea that HCV entry contributed through the LDL-R pathway leads to productive virus infection as opposed to nonspecific uptake of lipoprotein associated virions.
Early studies of the physical properties of HCV virions derived from patient sera demonstrated a lower than expected density (1.08g/mL) compared to other flaviviruses (
Miyamoto et al., 1992). It was subsequently determined that this low density was due to HCV association with β-lipoproteins which include LDL and VLDL (
Thomssen et al., 1992). Prince et al. found that most of the patient derived HCV RNA was in the VLDL fraction (
Prince et al., 1996). Other studies have demonstrated that HCV RNA contained within the VLDL and LDL serum fractions of HCV patients was able to be endocytosed by target cells and that this apparent virus entry activity could be blocked by anti-LDL-R and anti-ApoE antibodies (
Agnello et al., 1999). Consistent with these observations, we observed that infectious HCV fractionated at a similar density (1.06g/mL) in vitro and importantly was associated with apoE. Furthermore, pretreatment of cells with the LDL-R ligands, β-VLDL (50ug/mL treatment) and to a lesser extent LDL (100ug/mL treatment), reduced subsequent HCV infection. These observations agree with other reports that pretreatment of cultured cells with either VLDL (50–62.5μg/mL treatment) or with LDL (125–200μg/mL treatment), but not HDL, blocked binding of patient-derived HCV to cultured human fibroblasts (
Monazahian et al., 1999;
Germi et al., 2002;
Andre et al., 2002). Thus patient-derived and cell culture derived HCV particles can compete with LDL and VLDL/β-VLDL for binding to human cells. It should be noted that HDL has been implicated as a factor that enhances the infectivity of HCV and HCV pseudoparticles in vitro (
Catanese et al., 2007). While we did not directly assess the role of HDL for enhancement f HCV infectivity, our studies show that in the presence of exogenous excess HDL, HCV infectivity is not reduced. Thus, HDL may serve to enhance HCV infectivity through processes independent of cell-binding and entry. Our studies indicate that cell binding by HCV may more closely resemble the VLDL/IDL interaction with target cells than the LDL interaction inasmuch as highly infectious virus contains apoE and is most sensitive to competition for target cells by exogenous VLDL.
VLDL is produced in hepatocytes wherein lipids stored in droplets within the endoplasmic reticulum (ER) are transferred to a growing apoB core through the actions of microsomal transfer protein (MTP) (
Hussain et al., 2008). The growing lipoprotein particle acquires additional triglycerides, cholesterol, and apoE, and is secreted from the cell through the golgi apparatus. HCV core protein localizes to the surface of lipid droplets and is able to interact with viral structural proteins assembled on the ER (
Miyanari et al., 2007). Furthermore, intracellular membranes containing the HCV replicase are enriched in MTP, apoB and apoE (
Huang et al., 2007), and inhibition of the expression or activity of either of these factors blocks the release of infectious HCV (
Chang et al., 2007;
Gastaminza et al., 2008). Thus, the release of infectious HCV is dependent on virions being packaged as a VLDL-like particle, which ultimately facilitates infection efficiency through LDL-R interactions of target cells expressing the full complement of HCV co-receptors.
We propose a model in which HCV is secreted from hepatocytes as a VLDL-like lipoviral particle (LVP) containing at least HCV core, RNA, E1, E2 apoB and apoE. In common with natural VLDL derived particles, the HCV LVP could bind initially to cell surface glycosaminoglycans, such as heparin sulfate, in a relatively non specific interaction mediated by either E2 or apoE as both have been shown to bind heparin sulfate (
Morikawa et al., 2007;
Saito et al., 2003). In terms of the LDL-R, these initial interactions with the target cells could permit the LVP to a specific interaction between apoE and/or apoB and the LDL-R. Such an interaction could depend the processing/lipid removal of the LVP by lipoprotein lipase, which has also been reported to be involved in HCV entry (
Andreo et al., 2007). By this model the infectious virus particle could mediate a stable interaction with the target cell that promotes the E2-CD81 interaction, subsequent endocytosis, pH-dependent fusion, and the final entry steps directed by claudin-1 and occludin (
Evans et al., 2007;
Ploss et al., 2009). Whereas apoE- LDL-R interaction is probably not essential for entry in vitro since infection was not completely blocked by excess β-VLDL, apoE antibody, or LDL-R knockdown, and because viral E2 protein can interact directly with surface expressed receptors, we propose that efficient and perhaps natural HCV infection are supported by the LVP/LDL-R interaction on target cells during the intial processes of cell binding by the virus. Indeed our siRNA knockdown experiments confirm that both CD81 and claudin-1 function in HCV entry, and recent studies define human occludin as the species-specific factor that is essential for HCV infection (
Ploss et al., 2009). While we did not observe any defects in HCV entry upon knockdown of the majority of SR-BI expression, it is likely that only a small amount of SR-B1 is required to facilitate infection. SR-BI may additionally represent an alternative pathway for entry possibly involving E2 or apoE binding since antibodies against SR-BI have been reported to reduce HCV cell entry (
Kapadia et al., 2007;
Catanese et al., 2007;
Maillard et al., 2006). Interestingly, a mutation in E2 has been reported which shows decreased dependence on SR-BI and increased dependence on CD81 for entry, indicating that SR-BI usage by HCV is conditional and might be modulated by viral adaptive mutations (
Grove et al., 2008). Variations in E2 have also been reported to influence HCV genotype differences in SR-BI dependent entry of HCV pseudoparticles (
Lavillette et al., 2005).
The production of HCV as an LVP may serve as a mechanism to both enhance infection and escape immune detection by co-opting the host lipid delivery system. It may also help to explain the hepatotropism of HCV, as apolipoproteins regulate the recycling of lipid particles to the liver. Moreover, the nature of the HCV virion as a VLDL derived LVP implies that modulating lipoprotein metabolism could play a role in the treatment or management of HCV infection. Indeed, microsomal transfer protein and long chain acylCoA synthetase-3 have already been identified as enzymes required for efficient release of HCV from infected cells (
Huang et al., 2007;
Yao and Ye, 2008). The grapefruit flavonoid naringenin has also been shown to reduce HCV release from cells by interfering with lipid metabolism, which could possibly alter the composition of the LVP (
Nahmias et al., 2008). Omega-3 fatty acid supplementation alters lipid metabolism and reduces VLDL production in humans (
Bays et al., 2008). Together these observations suggest that therapeutic or dietary modulation of specific lipid could be considered as an avenue to regulate LVP production and impart control of HCV infection.