Genetic immunization is a potentially useful strategy to prevent or treat hepatitis B virus (HBV) infection. We have previously shown that HBV envelope proteins are highly immunogenic using this technique. The large envelope protein (LHBs), however, induced significantly weaker humoral and cellular immune responses when compared with the middle envelope protein (MHBs). We studied the effect of co-immunizations with cytokine DNA expression constructs encoding for interleukin (IL)-2 and (GM-CSF) on the immunogenicity of LHBs at the B-and T-cell level. Co-immunizations of mice with plasmids encoding for MHBs and IL-2 or GM-CSF increased anti-HBs responses, helper T-cell proliferative activity, and cytotoxic T lymphocyte (CTL) killing. In contrast, co-immunizations of plasmids encoding for LHBs and IL-2 or GM-CSF had no effect on humoral and cellular immune responses. LHBs did not inhibit the production or secretion of IL-2 and GM-CSF. In addition, IL-2, tumor necrosis factor alfa (TNF-␣), and interferon gamma (IFN-␥) had no suppressive effect on HBV envelope protein expression in vitro. Based on these data, MHBs, but not LHBs, genetic immunization can be augmented by IL-2 or GM-CSF cytokines. (HEPATOLOGY 1998;28:202-210.)Hepatitis B virus (HBV) is a noncytopathic, hepatotropic virus infecting more than 350 million individuals worldwide. 1 Hepatitis B is a leading cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. 2 The cellular immune response to HBV is thought to be responsible for viral clearance and pathogenesis of liver disease. In acutely infected patients who successfully clear the virus the CD4ϩ and CD8ϩ T-cell response to HBV is vigorous, polyclonal, and multispecific. [3][4][5][6][7][8][9][10] The T cells typically secrete type-1 antiviral cytokines, such as interferon gamma (IFN-␥) and tumor necrosis factor alfa (TNF-␣), upon antigen stimulation. By contrast, in chronically infected patients, the T-cell response is relatively weak and is antigenetically more restricted, except during acute exacerbations of chronic disease or after spontaneous or IFN-␣ induced viral clearance. [11][12][13] The cytokine profile of the intrahepatic HBVspecific T cells is variable in chronically infected individuals. The observation of spontaneous HBV clearance in some chronically infected individuals implies that the suboptimal cellular immune response may be reversible; therefore, strategies designed to boost the HBV-specific T-cell immune response, to alter the balance between the cytopathic and the regulatory components of the response, or to mimic the regulatory functions of the T-cell response in the liver may be able to terminate persistent infection.In this regard, genetic immunization offers the potential advantage of inducing cellular and humoral immune responses against conserved viral epitopes because this approach uses DNA expression plasmids, instead of proteins, for vaccination. This technique involves the transfer of a viral gene into muscle cells and antigen presenting cells by a plasmid vec...