Epidemiology of Human Papilloma Virus (HPV) in Cervical Mucosa

The Burden of HPV-Related Hospitalizations: Analysis of Hospital Discharge Records from the Years 2015-2021 from a Southern Italian Region

(1) Background: The human papillomavirus (HPV) is the most common agent related to sexually transmitted infections in the general population. Its genotypes are classified into two main classes, high-risk genotypes and low-risk genotypes, according to their capacity to induce cancers. The low-risk class (types 6 and 11) is associated with anogenital and genital lesions. The high-risk class is responsible for up to 4.5% of all new cancer cases yearly. The aim of this study was to evaluate the incidence of HPV-related hospitalizations and its trend in a southern Italian region for the years 2015-2021. (2) Methods: This was a retrospective study performed in the Abruzzo region, Italy. All admissions for the period 2015-2021 were extracted from the hospital discharge record (HDR). (3) Results: During the study period (2015-2021), a total of 5492 hospitalizations attributable to HPV infection occurred in the Abruzzo region, Italy. A significant number of admissions were related to cervical cancer (3386 cases) and genital warts (638 cases). The trend declined for all diagnoses except for penile cancer admissions. Considering the first year of the pandemic (year 2020), a decrease in the standardized incidence of the majority of the diseases considered was reported, particularly among cases of cervical cancer. (4) Conclusions: HPV-related hospitalizations decreased in Abruzzo during study period. These results could be useful to LHAs and policy-makers in improving vaccination coverage and screening adherence.

Human papillomavirus infection, cervical cancer and the less explored role of trace elements

Cervical cancer is an aggressive type of cancer affecting women worldwide. Many affected individuals rely on smear tests for the diagnosis, surgery, chemotherapy, or radiation for their treatment. However, due to a broad set of undesired results and side-effects associated with the existing protocols, the search for better diagnostic and therapeutic interventions is a never-ending pursuit. In the purview, the bio-concentration of trace elements (copper, selenium, zinc, iron, arsenic, manganese, and cadmium) is seen to fluctuate during the occurrence of cervical cancer and its progression from pre-cancerous to metastatic nature. Thus, during the occurrence of cervical cancer, the detection of trace elements and their supplementation will prove to be highly advantageous in developing diagnostic tools and therapeutics, respectively. This review provides a detailed overview of cervical cancer, its encouragement by human papillomavirus infections, the mechanism of pathology, and resistance. Majorly, the review emphasizes the less explored role of trace elements, their contribution to the growth and inhibition of cervical cancer. Numerous clinical trials have been listed, thereby providing a comprehensive reference to the exploration of trace elements in the management of cervical cancer.

Evaluation of the Burden of HPV-Related Hospitalizations as a Useful Tool to Increase Awareness: 2007-2017 Data from the Sicilian Hospital Discharge Records

In light of the implementation of human papillomavirus (HPV) prevention strategies, epidemiological studies in different geographical areas are required in order to assess the impact of HPV-related diseases. The purpose of the present study was to describe the burden of HPV-related hospitalizations in Sicily. A retrospective observational study estimated 43,531 hospitalizations attributable to HPV from 2007 to 2017. During the observed period, there was a decrease for all HPV-related conditions with a higher reduction, among neoplasms, for cervical cancer (annual percent change (APC) = −9.9%, p < 0.001). The median age for cervical cancer was 45 years old, with an increasing value from 43 to 47 years (p < 0.001). The age classes with greater decreases in hospital admissions for invasive cancers were women aged 35 years or more (APC range from −5.5 to −9.86) and 25–34 years old (APC = −11.87, p < 0.001) for women with cervical carcinoma in situ. After ten years for vaccine introduction and sixteen years for cervical cancer screening availability, a relatively large decrease in hospital admissions for cervical cancer and other HPV-related diseases in Sicily was observed. Some clinical characteristics of hospitalization, such as increasing age, are suggestive clues for the impact of preventive strategies, but further research is needed to confirm this relationship.

The role of Nuclear Factor-kappa B signaling in human cervical cancer

Background The Nuclear Factor kappaB (NF-kB) family consists of transcription factors that play a complex and essential role in the regulation of immune responses and inflammation. NF-kB has recently generated considerable interest as it has been implicated in human cancer initiation, progression and resistance to treatment. In the present comprehensive review the different aspects of NF-kB signaling in the carcinogenesis of cancer of the uterine cervix are discussed. NF-kB functions as part of a network, which determines the pattern of its effects on the expression of several other genes (such as crosstalks with reactive oxygen species, p53, STAT3 and miRNAS) and thus its function. Activation of NF-kB triggered by a HPV infection is playing an important role in the innate and adaptive immune response of the host. The virus induces down regulation of NF-kB to liquidate the inhibitory activity for its replication triggered by the immune system leading a status of persistant HPV infection. During the progression to high grade intraepithelial neoplasia and cervical cancer NF-KB becomes constitutionally activated again. Mutations in NF-kB genes are rare in solid tumors but mutations of upstream signaling molecules such as RAS, EGFR, PGF, HER2 have been implicated in elevated NF-kB signaling. NF-kB can stimulate transcription of proliferation regulating genes (eg. cyclin D1 and c-myc), genes involved in metastasis, VEGF dependent angiogenesis and cell immortality by telomerase. NF-kB activation can also induce the expression of activation-induced cytodine deaminase (AID) and the APOBEC proteins, providing a mechanistic link between the NF-kB pathway and mutagenic characteristic of cervical cancer. Inhibition of NF-kB has the potential to be used to reverse resistance to radiotherapy and systemic anti-cancer medication, but currently no clinicaly active NF-kB targeting strategies are available.

Disparity in rates of HPV infection and cervical cancer in underserved US populations

There is a higher rate of HPV infection and cervical cancer incidence and mortality in underserved US population who reside in Appalachian mountain region compared to Northern Plains. Social and behavioral factors such as smoking and alcohol consumption are for such a high incidence. However, by and large, the reasons for these discrepancies lie in the reluctance of the underserved population to adopt preventive measures such as prophylactic Human papilloma virus (HPV) vaccines and Pap smear screening that have significantly reduced the incidence and mortality rate of cervical cancer in Caucasian women. Thus, it is clear that drastic change in social behavior and implementation of preventive measures is required to effectively reduce the incidence and mortality from cervical cancer in this underserved population.

In silico pathway analysis in cervical carcinoma reveals potential new targets for treatment

An in silico pathway analysis was performed in order to improve current knowledge on the molecular drivers of cervical cancer and detect potential targets for treatment. Three publicly available Affymetrix gene expression data-sets (GSE5787, GSE7803, GSE9750) were retrieved, vouching for a total of 9 cervical cancer cell lines (CCCLs), 39 normal cervical samples, 7 CIN3 samples and 111 cervical cancer samples (CCSs). Predication analysis of microarrays was performed in the Affymetrix sets to identify cervical cancer biomarkers. To select cancer cell-specific genes the CCSs were compared to the CCCLs. Validated genes were submitted to a gene set enrichment analysis (GSEA) and Expression2Kinases (E2K). In the CCSs a total of 1,547 probe sets were identified that were overexpressed (FDR < 0.1). Comparing to CCCLs 560 probe sets (481 unique genes) had a cancer cell-specific expression profile, and 315 of these genes (65%) were validated. GSEA identified 5 cancer hallmarks enriched in CCSs (P < 0.01 and FDR < 0.25) showing that deregulation of the cell cycle is a major component of cervical cancer biology. E2K identified a protein-protein interaction (PPI) network of 162 nodes (including 20 drugable kinases) and 1626 edges. This PPI-network consists of 5 signaling modules associated with MYC signaling (Module 1), cell cycle deregulation (Module 2), TGFβ-signaling (Module 3), MAPK signaling (Module 4) and chromatin modeling (Module 5). Potential targets for treatment which could be identified were CDK1, CDK2, ABL1, ATM, AKT1, MAPK1, MAPK3 among others. The present study identified important driver pathways in cervical carcinogenesis which should be assessed for their potential therapeutic drugability.

A Markov Decision Process Model for Cervical Cancer Screening Policies in Colombia

Cervical cancer is the second most common cancer in women around the world, and the human papillomavirus (HPV) is universally known as the necessary agent for developing this disease. Through early detection of abnormal cells and HPV virus types, cervical cancer incidents can be reduced and disease progression prevented. We propose a finite-horizon Markov decision process model to determine the optimal screening policies for cervical cancer prevention. The optimal decision is given in terms of when and what type of screening test to be performed on a patient based on her current diagnosis, age, HPV contraction risk, and screening test results. The cost function considers the tradeoff between the cost of prevention and treatment procedures and the risk of taking no action while taking into account a cost assigned to loss of life quality in each state. We apply the model to data collected from a representative sample of 1141 affiliates at a health care provider located in Bogotá, Colombia. To track the disease incidence more effectively and avoid higher cancer rates and future costs, the optimal policies recommend more frequent colposcopies and Pap tests for women with riskier profiles.

Poly (I:C) transfection induces mitochondrial-mediated apoptosis in cervical cancer

Polyinosinic acid:polycytidylic acid, known as poly (I:C), is an analogue of double‑stranded RNA, which exhibits direct antitumor effects against several types of cancer. The present study aimed to evaluate the role of poly (I:C) in the apoptosis of cervical cancer cells. The HeLa human cervical cancer cell line was used in the present study, and cell apoptosis was determined following poly (I:C) transfection. Furthermore, the mRNA levels of interferon (IFN)‑β, the production of reactive oxygen species (ROS), DNA damage, mitochondrial membrane potential (∆Ψm) and the release of cytochrome c, as well as caspase activation, were determined. The effect of IFN‑β on poly (I:C) transfection‑mediated apoptosis was also examined by IFN‑β knockdown. The results showed that poly (I:C) transfection markedly induced HeLa apoptosis, increased the protein levels of pro‑apoptotic B cell lymphoma‑2 (Bcl‑2)‑associated X protein (Bax) and BH3 interacting‑domain death agonist (Bid), and suppressed the protein expression levels of anti‑apoptotic Bcl‑2 and Survivin. However, poly (I:C) transfection increased the mRNA levels of IFN‑β, induced ROS production and increased the levels of phosphorylated γH2A.X, an indicator of DNA damage. In addition, poly (I:C) transfection decreased ∆Ψm, triggered the release of cytochrome c from the mitochondria to the cytosol, and induced caspase‑9 and ‑3 activation. IFN‑β knockdown decreased the poly (I:C)‑induced production of ROS and DNA damage, restored ∆Ψm and cytochrome c release, and suppressed caspase‑9 and ‑3 activation, thereby suppressing poly (I:C)‑mediated apoptosis in the HeLa cells. Together, the results of the present study demonstrated that poly (I:C) transfection induced IFN‑β, contributing to ROS production, DNA damage, and caspase‑9 and ‑3 activation in the HeLa cervical cancer cell line, leading to mitochondrial‑mediated apoptosis.

Cervical cancer: A comprehensive approach towards extermination

Human Papilloma Virus (HPV) is one of the most common sexually transmitted pathogen, globally. Oncogenic types of HPV are the causative agents of many neoplastic diseases, including cervical cancer, which ranks as the most common cancer affecting females in developing countries. HPV infection of the cervical epithelium and the subsequent integration of viral DNA into the host genome are the major risk factors for cervical cancer. The scientific discovery of HPV as the causal agent of cervical cancer has led to the development of HPV-based diagnostic tools. Prophylactic vaccines, based on the oncogenic HPV type virus-like particles have been introduced in several developed countries as a preliminary preventive approach. Nevertheless, it remains a continuous threat to women in developing countries, where the prophylactic vaccines are unaffordable and organized screening programmes are lacking. This warrants implementation of prevention strategies that will reduce cervical cancer-related mortality. In this review, we have discussed molecular pathogenesis of HPV infection and the risk factors associated with it. The diagnosis, treatment and prevention strategies of HPV-related cervical cancer have also been discussed.

Carcinogenic ability quantification of human papilloma virus subtypes in eastern China

Human papilloma virus (HPV) infection is a precursor of cervical cancer. This study aimed to introduce a method to quantify the risk of cervical cancer resulting from infection by different HPV subtypes, to help guide patient treatment. Nucleic acid molecule flow-through hybridization and gene chip technology were used to test 6,510 non-cervical cancer healthy volunteers (≤CIN-I) and 204 cervical cancer patients (≥CIN-III) from Dongying City for 21 HPV subtypes (HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 6, 11, 42, 43, 44, 53, 66 and CP8304) in exfoliated cervical cells. The positive proportion of HPV subtypes was calculated, excluding or including patients with multiple subtype infections. The lower (L) and upper (H) limits of the carcinogenic risk score range were calculated, respectively. The values of carcinogenic index ± uncertainty in the carcinogenic ability (CI ± U) were also calculated. CI = (H + L)/2 represents the carcinogenic risk of the different subtypes, and U =(H - L)/2 represents the probability of each subtype being present in multiple infections. Infection rates were 15.87 and 96.57%, and HPV subtypes with high infection rates were HPV-16, 52, 58, 33, 18, and 31 and HPV-16, 31, 58, 18, 68, and 33 in the non-cervical cancer and cervical cancer groups, respectively. HPV subtypes with high risk of cervical cancer were HPV-31 (3.71 ± 0.68), 51 (2.65 ± 0.44), 18 (2.03 ± 0.43), 68 (1.76 ± 0.40), 58 (1.68 ± 0.49), and 16 (1.39 ± 0.33). We have provided a quantitative method for expressing HPV subtype carcinogenic risk.

Effect of Rac1 downregulation mediated by shRNA on the biological behaviour of human cervical cancer cells

OBJECTIVE

The function of Ras-related C3 botulinum toxin substrate1 (Rac1) in the progression of cervical cancer is unclear. This study used RNA interference technology to explore the involvement of Rac1 in the regulation of cervical cancer cells.

METHODS

A short hairpin (sh) RNA plasmid targeting Rac1 was constructed and transfected into HeLa cells. Rac1 mRNA and protein levels were investigated by reverse transcription-polymerase chain reaction and Western blot, respectively. Cell proliferation and cisplatin chemosensitivity were determined using the methyl thiazolyl tetrazolium assay. The Matrigel™ assay and flow cytometry were used to assess cell invasion and apoptosis, respectively. The concentration of matrix metalloproteinase (MMP)-2 in cell supernatants was detected by enzyme-linked immunosorbent assay.

RESULTS

Rac1 expression was significantly downregulated at the mRNA and protein levels in HeLa cells transfected with Rac1 shRNA, and the cell proliferation and invasion capability of cells was decreased. Rac1 downregulation was associated with a decrease in MMP-2 secretion, and increased cell chemosensitivity to cisplatin and cisplatin-induced apoptosis.

CONCLUSIONS

Rac1 may play an important role in cervical cancer progression and could be a potential target for anticancer therapy.

Overexpression of BMI-1 is associated with poor prognosis in cervical cancer

AIM

It has been reported that BMI-1, a gene transcription promoter overexpressed in various human cancers, is associated with poor survival. We investigated whether BMI-1 is a marker for cervical cancer by detecting the expression of BMI-1 in cervical cancer.

METHODS

An immunohistochemistry (IHC) streptavidin-peroxidase technique was used to identify BMI-1 protein expression in 302 cervical cancer specimens. Reverse transcription polymerase chain reaction and Western blot were employed to measure BMI-1 mRNA and protein level. The correlation between BMI-1 expression and clinicopathological factors was analyzed.

RESULTS

Both BMI-1 mRNA and protein expression were evident in cervical carcinoma tissues. An intense positive rate of 55.3% (167/302) was observed by IHC. High BMI-1 expression was correlated with clinical stage, lymph node metastasis, vascular invasion and human papillomavirus (HPV) infection (P < 0.05), but there is insufficient evidence to confirm its value in tumor size, age, estrogen or progesterone receptor (P > 0.05). The BMI-1 protein level was positively correlated with the clinical stages of cervical carcinoma and a high BMI-1 expression was associated with poor prognosis (P < 0.05).

CONCLUSION

The high expression of BMI-1 in cervical cancer is related to tumor progression, lymph node metastasis and HPV infection, suggesting that cervical cancer with excessive BMI-1 expression possesses high metastases potential and that BMI-1 may be a promising biomarker for predicting metastasis in cervical cancer.

Oncogenic HPV infection resembling pseudocondyloma of vulvae: a descriptive study of 31 cases

OBJECTIVE

Report a special type of human papillomavirus infection resembling pseudocondyloma of vulvae. The characteristics of the clinical manifestation and subtypes of the HPV infection were studied.

METHODS

Thirty-one women with unprotected sex and genital warts resembling pseudocondyloma of vulvae were involved in this study. The clinical and histological manifestations were characterized. The genotypes of human papillomavirus were determined by a reverse hybridization of polymerase chain reaction (PCR) RESULTS: Thirteen HPV genotypes were detected from 31 cases. Of 13 genotypes, 3 were non-oncogenic and 10 were oncogenic. At least, one of oncogenic genotypes was detected from each patient. Among 31 cases, 10 were found with one genotype of the HPV infection, 14 with 2 genotypes of HPV and 7 with at least 3 genotypes. The most common genotype was genotype 16 that was detected from 15 of 31 samples (48%).

CONCLUSION

There is a special type of oncogenic HPV infection clinically resembling pseudocondyloma of vulvae. Some of the patients who were infected with this type of HPV infection may have been misdiagnosed as pseudocondyloma of vulvae in the past time.

[Epidemiology, characterization of genotypes of human papillomavirus in a population of women in Ouagadougou]

OBJECTIVES

This work was carried out in order to determine the prevalence of different HPV genotypes in a population of women attending gynecological consultation.

MATERIAL AND METHODS

From May to June 2010, cervical samples were obtained from 300 women attending gynecological consultation in two health centers in Ouagadougou. The strains of HPV genotyping was done using the technique of polymerase chain reaction (PCR) followed by reverse hybridization on nitrocellulose strips.

RESULTS

Among the 73 women(24.3%) infected with HPV, only 27.4% (20/73) of them were infected with a HPV low risk (BR), the 72.6% (53/73). Other women were infected with at least one high risk HPV (HR). By combining the HPV genotypes found without taking into account the number of infected women, we found a total of 84 HPV among whom we have high-risk HPV : HPV-50'S(26/84 or 31.0%), HPV-18 (12/84 or 14.3%), HPV-16 (9/84 or 10.7%), HPV-30'S (5/84 or 5.9%), HPV-HR (5/84 or 5.9%) and HPV-45 (3/84 or 3.6%) and low-risk HPV: HPV-6 (15/84 or 17.9%) and HPV-BR (9/84 or 10.7%). We have found no HPV-11.

DISCUSSION AND CONCLUSION

The prevalence of HPV found in our series is comparable to that found in the world. To complete this study, it would be necessary to investigate the prevalence of HPV found in cervical lesions in Burkina Faso.