Decrease of Serum Angiotensin Converting Enzyme Levels Upon Telbivudine Treatment for Chronic Hepatitis B Virus Infection and Negative Correlations Between the Enzyme Levels and Estimated Glumerular Filtration Rates

Background: during antiviral therapy for chronic hepatitis b, renal function impairment could be a critical concern when oral nucleot(s)ide analogues were used. paradoxically, long-term telbivudine treatment was associated with an increase of estimated glomerular filtration rate (egfr) through unknown mechanisms. objectives: we aimed to investigate changes in serum protein abundances associated with renal function in response to antiviral treatments. materials and methods: primarily, a transcriptomic assay was performed to identify differentially expressed genes in peripheral blood cells caused by the telbivudine treatment. two genes coding angiotensin converting enzyme (ace) and complement factor h (cfh) were screened from 14 candidate renal function-related genes. ace and cfh production were further investigated using enzyme-linked immunoassays. results: verification studies showed no significant change of serum cfh levels, but there was a significant reduction of serum ace levels by continuous telbivudine treatment for 330.00 ± 0.85 days (34 patients; paired t-test, p = 0.022). serum hbv dna and alt levels also decreased (p = 0.008 and < 0.001, respectively). a significant increase in egfr was found (33 patients, paired t-test, p = 0.002) at 708.64 ± 31.63 days. patients’ egfrs were negatively correlated with serum ace levels (r = -0.375, p = 0.002) but not with serum hbv dna and alt levels (p = 0.241 and 0.088 respectively). significant decreases of the ace levels were also observed upon entecavir treatment (20 patients; paired t-test, p = 0.020) at 412.88 ± 36.92 days. no significant correlation was found between serum ace levels and egfrs (r = -0.239, p = 0.138) in entecavir-treated patients. conclusions: we discovered a consistent reduction of serum ace levels by two oral antiviral monotherapies, entecavir and telbivudine. serum ace levels were negatively correlated with egfrs in telbivudine treated patients.