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. 2025 Sep 11;9(3):189–198. doi: 10.1016/j.livres.2025.09.002

Table 2.

Carcinogenic mechanisms of HBx.

Mechanisms Function Source of evidence Reference
Activating a variety of transcription factors Promoting NF-κB to inhibit TNF-α and Fas-mediated apoptosis Cell experiments (hepatoma cell lines: HepG2 and Huh7) 75
Stimulating the transcription factors CREB and ATF-2 Cell experiments (hepatoma cell line: HepG2) 76
Disrupting the Smc5/6 complex and relieving transcriptional repression Cell experiments (hepatoma cell lines: HepG2 and HepAD38) 77
+ animal experiments (human liver chimeric uPA-SCID mice)
Interacting with oncogenes and tumor suppressor genes Inhibiting tumor suppressive genes (inhibiting p53 and inactivating the RB gene) Cell experiments (hepatocyte cell line: THLE-5b; hepatoma cell lines: Hep3B, SK-Hep-1, HepG2, Huh7, 97L, PLC/PRF/5, and SMMC7721) 78, 79, 80
+ animal experiments (HBx-transgenic mice and Balb/c nude mice)
+ clinical samples (paired HCC samples, n = 51)
Activating oncogenes: the Ras-GTP complex Cell experiments 81
Stimulating cytoplasmic signaling pathways Activating the mTOR signaling pathway Cell experiments (hepatoma cell lines: HepG2, Hep3B, Huh7, and Hep2.2.15) 82
+ animal experiments (DEN-induced HCC mouse model and spontaneous HCC mouse model)
+ clinical samples (paired HCC samples, n = 80)
Affecting the Fas/FasL signaling pathway Cell experiments (hepatoma cell lines: HepG2, SNU-354, SNU-368, SNU-387, SNU-398, and SNU-423) 83,84
+ animal experiments (HBx homozygote transgenic mice)
+ clinical samples (paired HCC samples, n = 15)
Interacting with noncoding RNAs Affecting miRNAs, such as miR-122 and miR-152 Cell experiments (hepatocyte cell line: LO2; hepatoma cell lines: Hepa1-6, HepG2, HepG2.2.15, and Huh7) 85,86
+ animal experiments (HBx-transgenic mice)
+ clinical samples (chronic hepatitis B samples, n = 22; severe chronic hepatitis B samples, n = 19; normal liver tissues, n = 10; paired HCC samples, n = 20)
Affecting lncRNA, such as lncRNA DLEU2 and LINC01431X Cell experiments (hepatoma cell lines: HepG2, HLCZ01, HepAD38, Huh7, and HepG2.2.15) 87
+ animal experiments (hydrodynamic injection mouse model)
+ clinical samples (para-tumor tissues, n = 41)

Abbreviations: ATF-2, activating transcription factor-2; CREB, cAMP response element binding protein; DEN, diethylnitrosamine; HBx, hepatitis B virus X; HCC, hepatocellular carcinoma; lncRNA, long-stranded noncoding RNA; miRNA, microRNA; mTOR, mammalian target of rapamycin; NF-κB, nuclear factor-kappa B; RB, retinoblastoma; Smc5/6, structural maintenance of chromosomes 5/6; TNF-α, tumor necrosis factor-alpha.