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Piontek T, Harmel C, Pawlita M, Carow K, Schröter J, Runnebaum IB, Dürst M, Graw F, Waterboer T. Post-treatment human papillomavirus antibody kinetics in cervical cancer patients. Philos Trans R Soc Lond B Biol Sci 2020; 374:20180295. [PMID: 30955486 DOI: 10.1098/rstb.2018.0295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Antibodies to the E6 and E7 oncoproteins of high-risk human papillomavirus (HPV) types are strongly associated with HPV-driven cancer, while antibodies against the capsid protein L1 are considered cumulative exposure markers. To test the hypothesis that L1 antibody levels are stable over time, whereas E6 and E7 levels undergo decay after cervical cancer (CxCa) treatment, we performed multiplex serology for HPV16 and 18 antigens E6, E7 and L1 in a post-treatment study of 184 patients with invasive CxCa that were characterized with a median follow-up time of 725 days, and 2-12 sera per patient. Antibody titers significantly decreased within the first six months for HPV16 E6 and E7 but not L1, and stabilized for the following 12 months on a high level, with few patients showing seroreversion. Of 67 patients seropositive for HPV16 E6 at diagnosis, 28 (41.8%) showed a decrease in antibody titers of at least 50% within the first 18 months. Similarly, of 50 HPV16 E7 seropositives, 33 (66.0%) showed decreasing antibody levels, whereas antibody decay was less frequent for HPV16 L1 (12 of 47, 25.5%). Using a power-law mathematical model to characterize antibody decay kinetics, the mean (±s.e.) durations to a 50% reduction in antibody titers within individual patients were estimated to be 56.9 (±26.1) and 56.3 (±19.0) days for HPV16 E6 and E7, respectively. In summary, HPV16 E6 and E7 antibodies undergo a slow but significant decrease in antibody titers within the first 6-18 months following CxCa treatment. However, larger studies are needed to confirm the utility of serology for prediction of disease progression and time to relapse based on antibody decay kinetics. This article is part of the theme issue 'Silent cancer agents: multi-disciplinary modelling of human DNA oncoviruses'.
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Affiliation(s)
- Till Piontek
- 1 Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ) , Im Neuenheimer Feld 242, 69120 Heidelberg , Germany
| | - Christoph Harmel
- 1 Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ) , Im Neuenheimer Feld 242, 69120 Heidelberg , Germany
| | - Michael Pawlita
- 1 Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ) , Im Neuenheimer Feld 242, 69120 Heidelberg , Germany
| | - Katrin Carow
- 2 Department of Gynaecology, Jena University Hospital , Am Klinikum 1, Haus F2, 07747 Jena , Germany
| | - Juliane Schröter
- 1 Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ) , Im Neuenheimer Feld 242, 69120 Heidelberg , Germany
| | - Ingo B Runnebaum
- 2 Department of Gynaecology, Jena University Hospital , Am Klinikum 1, Haus F2, 07747 Jena , Germany
| | - Matthias Dürst
- 2 Department of Gynaecology, Jena University Hospital , Am Klinikum 1, Haus F2, 07747 Jena , Germany
| | - Frederik Graw
- 3 Center for Modelling and Simulation in the Biosciences, BioQuant-Center, Heidelberg University , Im Neuenheimer Feld 267, 69120 Heidelberg , Germany
| | - Tim Waterboer
- 1 Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ) , Im Neuenheimer Feld 242, 69120 Heidelberg , Germany
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2
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Simonidesova S, Hamsikova E, Ludvikova V, Klozar J, Vencalek O, Tachezy R. Prognostic value of posttreatment HPV-specific antibodies in patients with oropharyngeal tumors. J Surg Oncol 2019; 120:117-124. [PMID: 30986340 DOI: 10.1002/jso.25473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/15/2019] [Accepted: 03/27/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The presence of human papillomavirus (HPV)-specific antibodies in patients with head and neck cancer at enrollment has prognostic significance. In cervical carcinoma patients, the decrease of HPV E6/E7-specific antibodies appears to be associated with a better prognosis. METHODS This prospective study with follow-up focused on the persistence and prognostic value of antibodies specific for HR HPV-derived VLPs and HPV16 E6/E7 oncoproteins in patients with oropharyngeal cancers. In this study, we analyzed sera of 93 patients taken a year after the end of treatment and sera from 58 of these patients taken up to 14 years after treatment. RESULTS The level of HPV-specific antibodies decreased on the 1-year follow-up and the decrease during the long follow-up was statistically significant. For HPV16 E7 antibodies the decrease was steeper in nonrecurrent patients. While the level of antibodies at enrollment was not predictive of recurrences, the decrease of HPV16 E6 antibodies at 1-year follow up was associated with better overall as well as disease-specific survival of patients. CONCLUSIONS The data suggest that the pretreatment level of HPV-specific antibodies is not predictive of the occurrence of recurrences but the decrease HPV16 E6 antibodies on the 1-year follow-up is predictive of better survival of HN patients.
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Affiliation(s)
- Simona Simonidesova
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic.,Department of Immunology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Eva Hamsikova
- Department of Immunology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Viera Ludvikova
- Department of Immunology, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Jan Klozar
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Ondrej Vencalek
- Department of Mathematical Analysis and Applications of Mathematics, Faculty of Science of the Palacky University in Olomouc, Olomouc, Czech Republic
| | - Ruth Tachezy
- Department of Genetics and Microbiology, Faculty of Science, Charles University, BIOCEV, Průmyslová, Vestec, Czech Republic
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Mirghani H, Lang Kuhs KA, Waterboer T. Biomarkers for early identification of recurrences in HPV-driven oropharyngeal cancer. Oral Oncol 2018; 82:108-114. [PMID: 29909884 DOI: 10.1016/j.oraloncology.2018.05.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/04/2018] [Accepted: 05/17/2018] [Indexed: 11/17/2022]
Abstract
One of the major concerns in oncology lies in the ability to detect recurrences at their earliest stage to increase the likelihood of cure following second line, or salvage, therapy. Although human papillomavirus (HPV)-driven oropharyngeal cancers have a good prognosis, 20-25% of patients will recur within 5 years of treatment and a significant portion will die from their disease. In recent years, great effort has been put toward evaluating the potential clinical utility of HPV-related biomarkers for early diagnosis of recurrent disease. Indeed, following completion of treatment, detection of HPV-DNA in oral rinses or blood and serologic assays against HPV oncoproteins could be helpful to track residual disease or recurrence. Several recent studies have reported promising findings, thus potentially paving the way for the use of biomarkers in the management of HPV-OPC. In this review, we evaluate and discuss the current knowledge on this topic and provide some directions for future research.
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Affiliation(s)
- Haitham Mirghani
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif, France.
| | - Krystle A Lang Kuhs
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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4
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Hanna GJ, Sridharan V, Margalit DN, La Follette SK, Chau NG, Rabinowits G, Lorch JH, Haddad RI, Tishler RB, Anderson KS, Schoenfeld JD. Salivary and serum HPV antibody levels before and after definitive treatment in patients with oropharyngeal squamous cell carcinoma. Cancer Biomark 2017; 19:129-136. [DOI: 10.3233/cbm-160071] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Glenn J. Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Danielle N. Margalit
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA, USA
| | - Stephanie K. La Follette
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA, USA
| | - Nicole G. Chau
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Jochen H. Lorch
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Robert I. Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Roy B. Tishler
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA, USA
| | - Karen S. Anderson
- School of Life Sciences, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Jonathan D. Schoenfeld
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA, USA
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5
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Mirghani H, Jung AC, Fakhry C. Primary, secondary and tertiary prevention of human papillomavirus-driven head and neck cancers. Eur J Cancer 2017; 78:105-115. [PMID: 28437708 DOI: 10.1016/j.ejca.2017.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 01/03/2023]
Abstract
Human papillomavirus (HPV)-driven oropharyngeal cancers (OPCs) represent an increasing proportion of head and neck cancers that could become, in the next few decades, a public health problem in certain western countries. This significant epidemiological change strongly calls for preventive measures. Prophylactic HPV vaccination and screening programmes for early identification and treatment of premalignant lesions are currently being used to reduce the incidence of uterine cervical cancer, which is the paradigm of HPV-driven malignancy. These strategies have proven to be efficient as the incidence of cervical cancer has dramatically dropped since the 1960s in most countries where they are properly applied. The success of cervical cancer prevention encourages the development of similar approaches to prevent HPV-driven OPCs. However, a number of important limitations impede their application to HPV-driven OPCs, and the development of innovative and specific strategies dedicated to this disease are urgently needed. This article provides an overview on primary, secondary and tertiary prevention of HPV-driven OPC and discusses some directions for future research.
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Affiliation(s)
- Haïtham Mirghani
- Department of Otolaryngology - Head and Neck Surgery, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif, France.
| | - Alain C Jung
- Laboratoire de Biologie Tumorale, EA 3430 Université de Strasbourg, CLCC Paul Strauss, Strasbourg, France
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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6
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Fakhry C, Qualliotine JR, Zhang Z, Agrawal N, Gaykalova DA, Bishop JA, Subramaniam RM, Koch WM, Chung CH, Eisele DW, Califano J, Viscidi RP. Serum Antibodies to HPV16 Early Proteins Warrant Investigation as Potential Biomarkers for Risk Stratification and Recurrence of HPV-Associated Oropharyngeal Cancer. Cancer Prev Res (Phila) 2015; 9:135-41. [PMID: 26701665 DOI: 10.1158/1940-6207.capr-15-0299] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/24/2015] [Indexed: 01/30/2023]
Abstract
Human papillomavirus (HPV) is responsible for increasing incidence of oropharyngeal cancer. At present, there are no biomarkers in the surveillance algorithm for HPV-positive oropharyngeal cancer (HPV-OPC). HPV16 E6 antibody precedes oropharyngeal cancer diagnosis. If HPV16 E6 indeed precedes primary diagnosis, it is similarly expected to precede disease recurrence and may have a potential role as a biomarker for surveillance of HPV-OPC. To determine whether HPV antibody titers have a potential role as early markers of disease recurrence or prognosis, a retrospective pilot study was designed to determine whether HPV16 early antibody titers E6, E7, E1, and E2 decrease after treatment of HPV16-positive OPC. Trends in pretreatment, early (≤6 months after treatment), and late posttreatment (>6 months after treatment) HPV16 antibody titers were examined. There were 43, 34, and 52 subjects with serum samples available for pretreatment, early, and late posttreatment intervals. Mean pretreatment antibody levels were higher than posttreatment antibody levels. Average antibody levels decreased significantly over time for E6 (Ptrend = 0.001) and E7 (Ptrend < 0.001). Six disease recurrences were observed during the follow-up period (median, 4.4 years). In univariate analysis, a log-unit increase in pretreatment E6 titer was significantly associated with increased risk of disease recurrence (HR, 5.42; 95% CI, 1.1-25.7; P = 0.03). Therefore, levels of antibodies to HPV16 early oncoproteins decline after therapy. Higher E6 titers at diagnosis are associated with significant increases in the risk of recurrence. These data support the prospective evaluation of HPV16 antibodies as markers of surveillance and for risk stratification at diagnosis.
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Affiliation(s)
- Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Jesse R Qualliotine
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zhe Zhang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nishant Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daria A Gaykalova
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin A Bishop
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rathan M Subramaniam
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wayne M Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine H Chung
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Califano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Raphael P Viscidi
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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7
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Human papillomavirus E7 serology and association with p16 immunohistochemistry in squamous cell carcinoma of the head and neck. Exp Mol Pathol 2015; 99:335-40. [DOI: 10.1016/j.yexmp.2015.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 06/22/2015] [Indexed: 12/14/2022]
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8
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Koslabova E, Hamsikova E, Salakova M, Klozar J, Foltynova E, Salkova E, Rotnaglova E, Ludvikova V, Tachezy R. Markers of HPV infection and survival in patients with head and neck tumors. Int J Cancer 2013; 133:1832-9. [DOI: 10.1002/ijc.28194] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 03/21/2013] [Indexed: 11/06/2022]
Affiliation(s)
| | - Eva Hamsikova
- Department of Experimental Virology; Institute of Hematology and Blood Transfusion; Prague; Czech Republic
| | - Martina Salakova
- Department of Experimental Virology; Institute of Hematology and Blood Transfusion; Prague; Czech Republic
| | - Jan Klozar
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine; Charles University in Prague; Motol University Hospital; Prague; Czech Republic
| | | | - Eva Salkova
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine; Charles University in Prague; Prague; Czech Republic
| | | | - Viera Ludvikova
- Department of Experimental Virology; Institute of Hematology and Blood Transfusion; Prague; Czech Republic
| | - Ruth Tachezy
- Department of Experimental Virology; Institute of Hematology and Blood Transfusion; Prague; Czech Republic
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9
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Rubenstein LM, Smith EM, Pawlita M, Haugen TH, Hamšíková E, Turek LP. Human papillomavirus serologic follow-up response and relationship to survival in head and neck cancer: a case-comparison study. Infect Agent Cancer 2011; 6:9. [PMID: 21740566 PMCID: PMC3160883 DOI: 10.1186/1750-9378-6-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 07/08/2011] [Indexed: 11/10/2022] Open
Abstract
Background Human papillomavirus high risk (HPV-HR) type 16 is a significant risk factor for head and neck cancers (HNC) independent of tobacco and alcohol. The purpose of this study was to determine whether antibody levels to the HPV-16 oncoproteins E6 and E7 measured in sera collected at baseline (BL) prior to treatment and at two post-treatment follow-up (FU) visits were associated with HNC risk factors or prognosis. Methods Presence of antibodies to HPV-16 E6 and E7 was evaluated in 109 newly diagnosed HNC cases with BL and FU blood samples, using the enzyme-linked immunosorbent assay (ELISA). Results HPV-16 E6 and/or E7 seropositive HNC cases were associated with higher risk in younger patients (≤ 55 years), more sexual partners (≥ 10), oropharyngeal cancer, worse stage at diagnosis, poorer grade, and nodal involvement. Between BL and FU (median = 8.3 months), there were decreased antibody levels for seropositive E6 (73% vs. 27%, p = 0.02) and seropositive E7 patients (65% vs. 35%, p = 0.09) with 5% of BL E6 and 35% of BL E7 seropositive patients converting to negative status at FU. Overall mortality (OM) was significantly worse among BL E6 seronegative patients than among BL seropositive patients (40.2% vs.13.6%, p = 0.01). There were no disease specific (DS) deaths among BL E6 seropositive vs. 24% in BL E6 seronegative patients (p = 0.01). BL E7 seronegative patients also had higher mortality than BL seropositive patients (OM: 38.2% vs. 20.0%, p = 0.04; DS: 22.5% vs. 5.6%, p = 0.07). Conclusion These findings are the first to follow post-treatment OD levels of HPV-16 E6 and E7 in HNC and suggest that these HPV antibodies may be potential prognostic markers of survival in HNC patients.
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Affiliation(s)
- Linda M Rubenstein
- Department of Epidemiology College of Public Health, University of Iowa, Iowa City, IA 52242, USA.
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10
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Rotnáglová E, Tachezy R, Saláková M, Procházka B, Košl'abová E, Veselá E, Ludvíková V, Hamšíková E, Klozar J. HPV involvement in tonsillar cancer: prognostic significance and clinically relevant markers. Int J Cancer 2011; 129:101-10. [PMID: 21190188 DOI: 10.1002/ijc.25889] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 11/19/2010] [Indexed: 12/12/2022]
Abstract
The association of high-risk human papillomaviruses (HR HPVs) with tonsillar cancer (TC) has been documented. Because patients with HPV-associated tumors show better survival rates, modification of their treatment regimen is being considered. It is therefore crucial to find markers for the identification of patients whose tumors are linked to viral infection. A cohort of 109 patients with primary TC was screened for HPV DNA presence in the tumor tissues and HPV-specific antibodies in sera. Data regarding risk factors and clinical parameters were collected. Forty-five specimens were analyzed for the expression of viral E6 and E2-region mRNA, and the p16 and p53 protein expression status was assessed by immunohistochemistry. The overall prevalence of HPV DNA in TC tissues was 65.1%. Ninety-three percent of HR HPV DNA-positive samples expressed E6*I mRNA. E2-region mRNA expression was detected in 36% of positive samples, which implies that the virus is integrated in 64% of HPV DNA/RNA-positive tumors. p16 overexpression and the presence of antibodies specific to HPV16 E6/E7 oncoproteins correlated well with HPV DNA and RNA presence. The disease-specific survival rate of patients with HPV DNA-positive tumors was significantly higher than that of HPV DNA-negative patients. In addition to providing further evidence of the involvement of HPV infection in the etiopathogenesis of a proportion of TC cases, our study demonstrates that p16 immunostaining and anti-E6/E7 antibodies as surrogate markers of HPV involvement represent specific, sensitive and clinically accessible assays for the identification of TC patients who have a considerably better prognosis.
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Affiliation(s)
- Eliška Rotnáglová
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University in Prague, Motol University Hospital, Prague, Czech Republic
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11
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Evidence for vertical transmission of HPV from mothers to infants. Infect Dis Obstet Gynecol 2010; 2010:326369. [PMID: 20300545 PMCID: PMC2838362 DOI: 10.1155/2010/326369] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 11/02/2009] [Accepted: 02/10/2010] [Indexed: 11/17/2022] Open
Abstract
Few large studies have evaluated concordance based on a broad spectrum of human papillomavirus (HPV) types in oral and genital specimens of mothers and their recently born infants. This information is important in determining whether HPV vaccines administered prior to pregnancy may be useful for preventing vertical transmission. HPV DNA was positive in 30% of mothers and 1.5% of newborns. Maternal/newborn concordance (HPV+/+ or HPV−/−) was 71%. Among HPV DNA+ mothers, only 3% of their infants were DNA+ and only 1 pair had the same HPV type. Among HPV− women, 0.8% of infants were HPV+. HPV DNA detected in hospitalized newborns reflects current infection transmitted to infants during pregnancy or delivery. None of the mother/baby HPV DNA+ concordance pairs detected viral types found in HPV vaccines suggesting that vaccination prior to pregnancy is unlikely to be efficacious in preventing vertical transmission.
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12
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Tachezy R, Klozar J, Rubenstein L, Smith E, Saláková M, Smahelová J, Ludvíková V, Rotnáglová E, Kodet R, Hamsíková E. Demographic and risk factors in patients with head and neck tumors. J Med Virol 2009; 81:878-87. [PMID: 19319944 DOI: 10.1002/jmv.21470] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The association between human papillomavirus (HPV) infection and the development of head and neck cancer has been documented recently. In this study on 86 head and neck cancer patients and 124 controls, data regarding demographics, behavioral risk factors, and risks related to HPV exposure were collected. HPV detection was carried out using polymerase chain reaction in the tumors and in oral exfoliated cells, and HPV typing by a reverse line blot assay specific for 37 HPV types. Sera were tested by an enzyme-linked immunosorbent assay specific for HPV proteins. Head and neck cancer cases report significantly more oral-anal contact (P = 0.02) and tobacco and alcohol use than controls (P = 0.001; P = 0.02, respectively). High-risk HPV DNA was detected in 43% of oral washings of cases and 4% of controls (P < 0.0001). The association between the presence of high-risk HPV DNA in oral exfoliated cells and in tumor tissues was statistically significant (adjusted P < 0.0001). The prevalence of HPV-specific antibodies was significantly higher in cases than in controls (adjusted P < 0.0001). These results provide epidemiological and immunological evidence for HR HPV as a strong risk factor (OR = 44.3, P < 0.0001) for head and neck cancer, even after controlling for age, tobacco and alcohol use. The detection of high-risk HPV DNA in oral exfoliated cells and HPV-specific antibodies in serum can be considered as clinically relevant surrogate markers for the presence of a HPV-associated head and neck cancer, with a high sensitivity (83%) and specificity (88%).
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Affiliation(s)
- Ruth Tachezy
- Department of Experimental Virology, Institute of Haematology and Blood Transfusion, Prague, Czech Republic.
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13
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Smith EM, Rubenstein LM, Ritchie JM, Lee JH, Haugen TH, Hamsikova E, Turek LP. Does pretreatment seropositivity to human papillomavirus have prognostic significance for head and neck cancers? Cancer Epidemiol Biomarkers Prev 2008; 17:2087-96. [PMID: 18708401 DOI: 10.1158/1055-9965.epi-08-0054] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is a risk factor for head and neck cancers (HNC), yet HPV-associated tumors have better prognosis than HPV-negative tumors. METHODS We evaluated whether pretreatment presence of antibodies to HPV capsids [virus-like particles (VLP)] or to HPV-16 oncoproteins E6 and E7 was a predictor of HPV-positive HNC and clinical outcomes. Sera from 156 HNC patients were tested for antibodies to HPV-16-derived antigens using ELISA. HPV-16 in tumors was evaluated by PCR and DNA sequencing. RESULTS HPV-16 antibodies were found in 33% with HPV-16 VLP, 21% with HPV-16 E6, and 21% with E7. HPV-16 was detected in 26% of tumors. There was a strong correlation between detection of HPV-16 tumor DNA and antibodies to HPV-16 E6 or E7 (kappa = 0.7) but not to HPV-16 VLP (kappa = 0.4). Multivariate analyses showed significantly better disease-specific survival in seropositive HPV-16 VLP [hazard ratio (HR), 0.4; 95% confidence interval (95% CI), 0.1-0.9], HPV-16 E6 (HR, 0.1; 95% CI, 0.02-0.5), and HPV-16 E7 (HR, 0.3; 95% CI, 0.1-0.9) cases. Less disease recurrence occurred among those with antibodies to both E6 and E7 compared with those negative to both (P = 0.003). There was better disease-specific survival in patients who were E6 positive at baseline and remained positive at follow-up compared with individuals who were E6 negative at both time points (P = 0.03; kappa = 0.9). CONCLUSIONS The presence of antibodies to HPV-16 E6 and E7 is associated with HPV in tumor cells and with better clinical outcomes. These findings suggest that the presence of E6/E7 antibodies before treatment is predictive of better clinical outcomes and that they may serve as biomarkers for selecting targeted therapeutic modalities developed for HPV-associated tumors.
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Affiliation(s)
- Elaine M Smith
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA.
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14
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Giorgi C, Di Bonito P, Grasso F, Mochi S, Accardi L, Donà MG, Branca M, Costa S, Mariani L, Agarossi A, Ciotti M, Syrjänen K. Clinical and epidemiological correlates of antibody response to human papillomaviruses (HPVs) as measured by a novel ELISA based on denatured recombinant HPV16 late (L) and early (E) antigens. Infect Agent Cancer 2008; 3:9. [PMID: 18582363 PMCID: PMC2474580 DOI: 10.1186/1750-9378-3-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 06/26/2008] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND At present, seroreactivity is not a valuable parameter for diagnosis of Human Papillomavirus (HPV) infection but, it is potentially valuable as marker of viral exposure in elucidating the natural history of this infection. More data are needed to asses the clinical relevance of serological response to HPV. OBJECTIVES The objective was to assess the clinical and epidemiological correlates of HPV-seroreactivity in a cohort of HIV-negative and HIV-positive women. METHODS Seroreactivity of 96 women, evaluated in an ELISA test based on denatured HPV16 late (L) and early (E) antigens, was correlated with their clinical and epidemiological data previously collected for a multi-centre Italian study, HPV-PathogenISS study. RESULTS No significant correlation was found between HPV DNA detection and seroreactivity. Women, current smokers showed significantly less seroreactivity to L antigens as compared with the non-smokers. HIV-positive women showed significantly less (66.7%) antibody response as compared with HIV-negative women (89.3%), with particularly impaired response to L antigens. Women, HIV-positive and current smokers, showed by far the lowest seroprevalence (33.3%) as compared to 75.9% among all other women (OR = 0.158; 95%CI 0.036-0.695, p = 0.014; Fisher's exact test). Importantly, this association did not loose its significance when controlled for confounding from age (continuous variable) in multivariate analysis or using Mantel-Haenszel test for age-groups. CONCLUSION It is tempting to speculate that HIV-positive current smokers comprise a special high-risk group, with highly impaired immunological response that could prevent eradication of persistent HPV infections and thus contribute to development of CIN3/CC.
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Affiliation(s)
- Colomba Giorgi
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Paola Di Bonito
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Felicia Grasso
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Stefania Mochi
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Luisa Accardi
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Maria Gabriella Donà
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Margherita Branca
- Unità Citoistopatologia, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italy
| | - Silvano Costa
- Dipartimento di Ginecologia e Ostetricia, Ospedale S. Orsola Malpighi, Bologna, Italy
| | - Luciano Mariani
- Clinica Ostetrica e Ginecologica, IFO, Istituto Regina Elena, Roma, Italy
| | - Alberto Agarossi
- Istituto Scienze Biomediche, Ospedale Luigi Sacco, Milano, Italy
| | - Marco Ciotti
- Laboratory of Clinical Microbiology and Virology, Policlinico of Tor Vergata University, Rome, Italy
| | - Kari Syrjänen
- Department of Oncology and Radiotherapy, Turku University Hospital, FIN-20521 Turku, Finland
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15
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Tachezy R, Mikysková I, Ludvíková V, Rob L, Kucera T, Slavík V, Beková A, Robová H, Pluta M, Hamsíková E. Longitudinal study of patients after surgical treatment for cervical lesions: detection of HPV DNA and prevalence of HPV-specific antibodies. Eur J Clin Microbiol Infect Dis 2006; 25:492-500. [PMID: 16896828 DOI: 10.1007/s10096-006-0172-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The principal aims of this study were to test whether persistence of human papillomavirus (HPV) DNA is predictive of recurrent disease in women after surgical treatment for cervical lesions, to distinguish between persistent and newly acquired HPV infection, and to observe the effect of surgical treatment on levels of HPV-specific antibodies. A group of 198 patients surgically treated for low-grade and high-grade squamous intraepithelial lesions and 35 age-matched controls were monitored for 18 months at 6-month intervals. The presence of HPV DNA in cervical smears was detected by means of consensus polymerase chain reaction, and serum levels of HPV-specific antibodies to HPV types 16, 18, 31, 33, and 45 were measured. In ten patients positive for HPV type 16 in consecutive samples, the HPV 16 variants were identified using a polymerase chain reaction specific for the long control region. Data regarding demographics, risk factors for cervical cancer, and risks related to HPV exposure were collected through a patient questionnaire. Subjects persistently positive for HPV DNA were more likely to present with cytological and/or colposcopical abnormalities. A higher reactivity to HPV-specific antibodies was observed in these women at the 18-month follow-up visit. All ten patients with HPV 16 infection detected in consecutive samples showed persistence of either the same prototype or the same variant during the follow-up period. Risky sexual behavior and smoking were more common in patients than in controls. Persistent HPV infection as demonstrated by both HPV DNA detection and antibody detection appears to be a risk factor for the recurrence of pathological findings in women after surgery. An individually based approach to surgical treatment is an important factor in the outcome of disease at follow-up.
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Affiliation(s)
- R Tachezy
- Department of Experimental Virology, Institute of Hematology and Blood Transfusion, U Nemocnice 1, 12820 Prague 2, Czech Republic.
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16
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Ravaggi A, Romani C, Pasinetti B, Tassi RA, Bignotti E, Bandiera E, Odicino FE, Ragnoli M, Donzelli C, Falchetti M, Calza S, Santin AD, Pecorelli S. Correlation between serological immune response analyzed by a new ELISA for HPV-16/18 E7 oncoprotein and clinical characteristics of cervical cancer patients. Arch Virol 2006; 151:1899-916. [PMID: 16732494 DOI: 10.1007/s00705-006-0787-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Accepted: 04/18/2006] [Indexed: 10/24/2022]
Abstract
Human papillomaviruses (HPVs), particularly HPV-16/18, are linked to cervical cancer development. Full-length, recombinant HPV-16/18 E7 oncoproteins were used in a new streptavidin-biotin capture ELISA method to investigate anti-HPV E7 antibody prevalence in serum. Sera from 99 healthy women, 70 cervical cancer patients, and 30 patients with cervical pre-invasive neoplasia were analyzed. Anti-HPV-16/18 E7 positivity was found in 53% of cervical cancer patients, in 40% with cervical pre-invasive neoplasia, and in 8% of healthy women. Serum samples from 12 cervical cancer patients were obtained at different time intervals during the treatment. Eleven out of 12 showed a correspondence between HPV-E7 antibody levels (decreasing versus increasing) and the type of response (clinically complete or partial response versus progression or stable disease) at each serological evaluation. Five patients with recurrent HPV-16/18-positive cervical carcinoma were analyzed before and after vaccination with HPV-16/18 E7-pulsed autologous dendritic cells; anti-HPV-16/18 E7 positivity was found in 3 out of 5 women. In conclusion, this assay could potentially be used as an adjunctive tool to monitor the type of response to treatment and possibly to detect antibody induction in cervical cancer patients after vaccination, as a potential marker to evaluate its efficacy.
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Affiliation(s)
- A Ravaggi
- Division of Gynecologic Oncology, University of Brescia, Brescia, Italy
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17
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Parker TM, Smith EM, Ritchie JM, Haugen TH, Vonka V, Turek LP, Hamsikova E. Head and neck cancer associated with herpes simplex virus 1 and 2 and other risk factors. Oral Oncol 2006; 42:288-96. [PMID: 16324878 DOI: 10.1016/j.oraloncology.2005.08.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Accepted: 08/05/2005] [Indexed: 11/26/2022]
Abstract
We investigated whether herpes simplex viruses, HSV-1 and HSV-2, are cofactors of head and neck cancer (HNC) in association with tobacco, alcohol, or HPV-16 infection. The study included 164 HNC cases and 295 controls. Serologic tests were used to distinguish HSV-1 and HSV-2. Antibodies to anti-VLP HPV-16 and HPV-16 E6 and E7 were evaluated by ELISA. After adjusting for age, tobacco, alcohol use, and number of sexual partners, risk of cancer was not significantly increased in those with HSV-1 [adjusted odds ratio (OR)=0.7] or HSV-2 (OR=0.8) compared to HSV-negative patients. Although heavy use of tobacco, alcohol and HPV-16 infection was associated with an increased risk of HNC, the adjusted risk among those infected with HSV-1 or HSV-2 lowered the odds compared to those who were not infected. Heavy smokers (OR=1.7) and heavy drinkers infected with HSV-1 (OR=4.2) or HSV-2 (smokers: OR=1.6; drinkers: OR=3.2) had lower odds compared to seronegative HSV-1 heavy users (smokers: OR=2.5; drinkers: OR=5.5) or HSV-2 (smokers: OR=1.9; drinkers: OR=6.2). Those seropositive to HPV-16 E6 and/or E7 but not HSV-1 (OR=27.4) or HSV-2 (OR=18.0) had higher risk of HNC compared to those infected with HSV-1 (OR=16.7) or HSV-2 (not estimable). These findings suggest that seropositivity to HSV-1 and HSV-2, although not independent risk factors for HNC, may modify the risk of HNC associated with exposure to tobacco, alcohol, or HPV-HR.
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Affiliation(s)
- Tina M Parker
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
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18
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Kaku N, Kashima K, Daa T, Nakayama I, Yokoyama S. Herpes simplex infection in urothelial carcinoma. Virchows Arch 2004; 445:68-73. [PMID: 15156316 DOI: 10.1007/s00428-004-1019-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2004] [Accepted: 03/23/2004] [Indexed: 10/26/2022]
Abstract
Herpes simplex virus (HSV), a member of the Herpesviridae family, is a very common pathogen that can infect any site in the body. Urothelial carcinoma (UC) is a common malignancy of the urinary tract. The possibility of HSV infection in cases of UC has attracted little attention. In this study, we investigated the possible presence of HSV in UC and non-neoplastic urothelium. We examined the incidence of HSV infection in 100 samples of UC from 78 patients and 50 samples of non-neoplastic urothelium from 50 autopsy cases using immunohistochemical staining and amplification of DNA using polymerase chain reaction (PCR). Infection by HSV was detected in 39 of the 100 samples of UC (35 of 78 patients) using immunohistochemical staining and/or PCR analysis, in marked contrast with 1 of 50 samples of non-neoplastic urothelium. There was no significant relationship between infection by HSV and anatomical site, growth pattern or depth of invasion of UC, but the frequency of HSV infection was significantly higher in females than in males. Our findings indicate that UCs become infected with HSV much more easily than non-neoplastic urothelium.
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Affiliation(s)
- Naomi Kaku
- Department of Pathology, Faculty of Medicine, Oita University, Hasama-machi, 879-5593, Oita, Japan.
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