In patients with HCV infection, hepatocellular steatosis is a cofactor for fibrosis, disease progression and chronicity (
5). In steatosed hepatocytes, alteration of lipid metabolism results in the accumulation of larger LDs. Here we showed that HCV capsid protein alone is sufficient to increase the intracellular LD content. Core expressing cells showed higher amounts of intracellular lipids and this increased lipid content was due to core localization on LD surface. The cells expressing a mutant core protein not targeted to LDs (PP mutant) had lower amounts of intracellular lipids, evident that core localization on LD surface is required for the accumulation of intracellular LDs. Moreover, when core was expressed in cells with LDs in increased number and size, a state similar to liver steatosis, core expression was higher than normal cells. Core expression appears to increase the intracellular LD content, and an increased LD content in turn increases core expression, a state mimicking the favorable condition for HCV replication. HCV may interfere with lipid metabolism and results in steatosis by utilizing at least three distinct, non-mutually exclusive mechanisms; impaired secretion, increased de novo synthesis, and impaired degradation (
15). The results of the current study showed that in core expressing cells LDs were located in a perinuclear region, while in PP mutant core expressing cells LDs were distributed in the whole cytoplasm, just like in naive cells. The intracellular LD content was also higher in core expressing cells as compared to uninfected or pp mutant core expressing cells. This indicates that core protein is responsible for redistribution and enhanced accumulation of LDs, which was shown to be associated with efficient virion production and blocking LDs redistribution through microtubule network resulted in reduced release of infectious progeny (
16). The expression of HCV replicon lacking the core protein resulted in no enhancement of LDs in cultured Huh-7 cells (
10) indicating that expression of this protein alone caused LD accumulation. HCV core interferes with lipid synthesis machinery through a number of unrelated mechanisms, which involve host factors like apolipoprotein B (ApoB), cholesterol, very-low density lipoprotein (VLDL) assembly and/or secretion, microsomal triglyceride transfer protein (MTP) activity, sterol regulatory element binding protein (SREBP)-1c signaling pathway, peroxisome proliferators-activated receptor (PPAR)-α (reviewed in (
15)). Our results showed that HCV hijacks lipid biosynthesis and degradation pathways and uses it for its own benefits. Core protein interferes with lipid degradation pathway and resulted in increased intracellular LDs. Core protein expression was higher in cells with increased LDs compared to cells having low intracellular LDs. Increased intracellular LDs content provides favorable environment for efficient viral replication, which supported the fact that HCV does not have a latent phase (
17). Throughout the course of the infection, which can be decades long in many patients, there is constant production of viral RNA, proteins and infectious particles. Increased LDs content and efficient viral replication could be one of the possible mechanisms for viral persistence in chronic patients. LDs and LD-associated ER-membranes supply lipids for nascent HCV to produce efficient infectious HCV virion (
18,
19). Core protein localized on LDs recruits the replication complexes to the LD-associated membranes via the core-NS5A interaction for virus assembly (
20,
21). Disruption of core-LD association impaired infectious viral particles production (
10). LD-dependent HCV production pathway may be an important component of future strategies for the prevention and treatment of HCV infection. The limitation of the study was that we did not use full-length HCV cell culture model to confirm that increased core expression mimics increased HCV virion production. Persistent HCV infection depends on both host and viral factors (
22-
27). Viral genotype (
22,
23), viral immune escape mutations, adaptations (
23,
24), host genetic factors (
25,
26), and HCV specific INF-γ responses (
27) are important in patients' prognosis. HCV is endemic in Pakistan, with more than 10 million infected individuals (
28). The common prevalent genotype is 3a (
29), which is worse than all other viral genotypes regarding steatosis development (
4). In patients with genotype 3 infection, steatosis severity is directly linked to viral load (
4,
5) and is significantly reduced or even disappears when patients are successfully treated (
5,
30). In spite of the fact that genotype 3a showed very high-sustained virological response (SVR) for interferon treatment, HCV burden is rising in Pakistan. This might be linked to higher steatosis in infected patients, which results in lower SVR. Hepatic steatosis could be a result of viral, host genetic and dietary factors. Management of steatosis should be considered when treating HCV patients with standard interferon treatment.