3 Endogenous IFN-α is a crucial component of the innate immune response, and like other type I IFNs, it exerts its effect through the induction of IFN-stimulated genes (ISGs), which have direct or indirect antiviral properties.4, 5 PEG-IFN-α treatment has a similar effect, serving to stimulate and sustain this immune response. Administration of PEG-IFN-α causes an immediate decline in HCV viral load over 24-48 hours.4 During this time period a rapid “first-phase” viral decline is thought to reflect superior IFN-α efficacy and is associated with a greater likelihood of ultimately achieving viral eradication,6-8 or sustained virologic

response (SVR), defined as undetectable HCV RNA at 24 weeks following cessation of therapy. A number of studies have reported the modulation of hepcidin, the chief iron regulatory hormone, by type 1 IFNs in cell culture.9-11 In particular, hepcidin induction by IFN-α has recently been described.10,

Selleck SB203580 11 Hepcidin itself is an important element of the innate immune system and its production Epacadostat chemical structure may be stimulated acutely by inflammation or iron excess.12, 13 Through its inhibitory interaction with the iron exporter ferroportin, hepcidin functions to limit iron release from macrophages and duodenal enterocytes, thereby lowering plasma iron levels.14, 15 In this setting, systemic iron withdrawal is thought to represent an important innate immune response mechanism.12 Here we hypothesized that the direct stimulation of hepcidin by IFN-α and the subsequent responses could be of clinical relevance. To explore this further we availed ourselves Protein kinase N1 of a previously described cohort of HCV patients from whom blood samples had been taken to characterize the responses to PEG-IFN-α/RBV over the first 24 hours of treatment.7 We also sought to investigate the induction of hepcidin by IFN-α at a molecular level. CRP, C-reactive protein; EVR, early virologic response; HCV, hepatitis C virus; IP-10, interferon-γ-inducible protein-10; PEG-IFN-α, pegylated interferon

alpha; qPCR, quantitative real-time polymerase chain reaction; RBV, ribavirin; SI, serum iron; STAT, signal transducer and activator of transcription; SVR, sustained virologic response; TS, transferrin saturation. Thirty-one patients with chronic HCV monoinfection were enrolled at the Centre for Liver Disease, Mater Misericordiae University Hospital, Dublin (Table 1). The study cohort has been described in detail elsewhere.7 Written informed consent was obtained from all patients and the study was approved by the hospital Research Ethics Committee. Combination treatment consisted of weekly PEG-IFN-α injections and twice-daily weight-based RBV orally for 24 and 48 weeks in genotype 3 and genotype 1 patients, respectively. Blood samples were taken prior to the first dose of PEG-IFN-α/RBV (time 0, T = 0), and subsequently at 6, 12, and 24 hours (T = 6, T = 12, T = 24, respectively).