Evaluation of fully automated chemiluminescent enzyme immunoassays for hepatitis B core-related antigen components, phosphorylated and non-phosphorylated hepatitis B core antigens: clinical significance and dynamics during hepatitis B e antigen seroc

To assess the performance and clinical relevance of three assays-hepatitis B core-related antigen (HBcrAg), hepatitis B core antigen (HBcAg), and phosphorylated HBcAg (pHBcAg)-in quantifying HBcrAg, a critical biomarker of hepatitis B virus (HBV) infection, fully automated chemiluminescent enzyme immunoassays (CLEIA) for two HBcAg variants were developed. Cutoff values for HBcAg and pHBcAg assays were established at 2.50 and 2.10 LogU/mL, respectively. The strong correlations among components (<i>r</i> = 0.896-0.970) were observed by using purchased 100 plasma samples. When the dynamics of HBcrAg components were analyzed by using a series of hepatitis B e antigen (HBeAg) seroconversion panel, alongside correlations with HBV markers, distinct dynamics and molecular profiles were observed. For the assessment of the clinical relevance of these assays, serum samples were obtained from 102 HBV-infected patients treated with nucleos(t)ide analog (NA). Both HBcAg and pHBcAg levels were significantly reduced during NA therapy, but in different patterns, suggesting HBV activity independent of HBV DNA and persistent HBcrAg components derived from pc-mRNA. OptiPrep density gradient ultracentrifugation analysis identified pHBcAg as the dominant component in high-density fractions. Immunoprecipitation and Western blotting confirmed that HBcAg components were predominantly enveloped by hepatitis B surface antigen (HBsAg), with pHBcAg identified as the major component of empty viral particles. Although the limitation in sample size in this study, the revealed distinct dynamics of HBcAg, pHBcAg, and HBcrAg during seroconversion and treatment suggest these assays could serve as independent biomarkers for monitoring intrahepatic HBV activity and treatment efficacy.IMPORTANCEThis study evaluates novel fully automated chemiluminescent enzyme immunoassay (CLEIA) systems for hepatitis B core antigen (HBcAg) and phosphorylated HBcAg (pHBcAg) and identifies pHBcAg as the predominant component of hepatitis B virus (HBV)-derived empty viral particles, challenging previous assumptions and providing new insights into HBV biomarkers. HBcAg and pHBcAg show distinct dynamics in hepatitis B e seroconversion and nucleos(t)ide treatment from the other biomarkers including hepatitis B core-related antigen (HBcrAg), HBV RNA, and HBV DNA. The developed CLEIA systems for HBcAg and pHBcAg show promise as tools for monitoring intrahepatic HBV activity, immune clearance, and noninfectious viral replication. Incorporating these biomarkers into clinical practice could refine HBV management strategies, improve reactivation risk prediction, and advance precision medicine approaches.