PT  - JOURNAL ARTICLE
AU  - Upkar S Gill
AU  - Laura J Pallett
AU  - Patrick T F Kennedy
AU  - Mala K Maini
TI  - Liver sampling: a vital window into HBV pathogenesis on the path to functional cure
AID  - 10.1136/gutjnl-2017-314873
DP  - 2018 Apr 01
TA  - Gut
PG  - 767--775
VI  - 67
IP  - 4
4099  - http://gut.bmj.com/content/67/4/767.short
4100  - http://gut.bmj.com/content/67/4/767.full
SO  - Gut2018 Apr 01; 67
AB  - In order to optimally refine the multiple emerging drug targets for hepatitis B virus (HBV), it is vital to evaluate virological and immunological changes at the site of infection. Traditionally liver biopsy has been the mainstay of HBV disease assessment, but with the emergence of non-invasive markers of liver fibrosis, there has been a move away from tissue sampling. Here we argue that liver biopsy remains an important tool, not only for the clinical assessment of HBV but also for research progress and evaluation of novel agents. The importance of liver sampling has been underscored by recent findings of specialised subsets of tissue-resident immune subsets capable of efficient pathogen surveillance, compartmentalised in the liver and not sampled in the blood. Importantly, the assessment of virological parameters, such as cccDNA quantitation, also requires access to liver tissue. We discuss strategies to maximise information obtained from the site of infection and disease pathology. Fine needle aspirates of the liver may allow longitudinal sampling of the local virus/host landscape. The careful utilisation of liver tissue and aspirates in conjunction with blood will provide critical information in the assessment of new therapeutics for the functional cure of HBV.