Novel human papilloma virus (HPV) genotypes in children with recurrent respiratory papillomatosis

Genomic diversity of HPV6 and HPV11 in recurrent respiratory papillomatosis: Association with malignant transformation in the lungs and clinical outcomes

Recurrent respiratory papillomatosis (RRP) is a rare, proliferative disease caused by human papillomavirus 6 (HPV6) and HPV11. RRP can occasionally spread and undergo malignant transformation. We analysed samples across time for five RRP patients with malignant transformation and four with highly recurrent, non-malignant RRP by applying high-throughput sequencing. Patients with malignant transformation were infected by HPV11_A1/A2, while most non-malignant cases were associated with HPV6. Transient multiple infections with HPV6 and HPV11 were found in two patients, and resolved later to single infections. Viral genome loads were homogeneous across groups (median = 78 viral genomes per human genome). Within-patient, we did not observe differences between the viral sequences in the papillomatous lesions and in the malignant tissue. Genetic analysis of the NLRP1 gene revealed no known mutations linked to idiopathic RRP, though some novel variants merit to be explored in larger cohorts. HPV11 infections appear associated with RRP malignant transformation in young patients. Multiple infections can occur in RRP, but within-patient viral diversity is minimal for a given genotype. Our results confirm the importance of viral genotype in disease prognosis and are consistent with growing evidence of HPV11 infections to be differentially associated with RRP malignant transformation in young patients.

Paediatric Virology and innovation in medical education: An interview with Dr Ioannis N. Mammas, Consultant Paediatrician on the island of Euboea (Greece) and Coordinator of the Paediatric Virology Study Group

Born in Chalkida in Greece, Dr Ioannis N. Mammas, Consultant Paediatrician on the island of Euboea, studied Medicine at the University of Crete School of Medicine, where he received his MD in 2002 and his PhD in Clinical Virology in 2006. He was trained in Paediatrics and Neonatology in Merseyside (UK), attending the 'Alder Hey' Children's Hospital's specialty training (ST) rotation programme and in Athens (Greece) at the 'Penteli' Children's Hospital and the 'MAKKA' Paediatric Infectious Diseases (PID) Unit of the 'Aghia Sophia' Children's Hospital. On October 10th, 2015, he presented the Paediatric Virology subspecialty's proposal, which up-to-date has attracted the critical interest of several international experts in the scientific fields of Neonatology, Paediatrics, PID and Virology and has been evaluated as a unique project of innovation in medical education. According to Dr Mammas, Paediatrics is the specialty, which daily provides the opportunity to support with responsibility the children's smile, the hope of life and future. He highlights the significant role of the Paediatric Virology Study Group (PVSG), a paediatric think tank, which was established by a group of paediatric trainees and young paediatricians in 2007 and since then has been involved with enthusiasm in the perspectives of Paediatric Virology in medical education. Dr Mammas strongly believes that in the future, Paediatric Virology subspecialists will have a strategically principal role, both clinical and academic, at the fight against viral infections in childhood. This aim will be supported by the newly founded Institute of Paediatric Virology (IPV), the first scientific initiative in the world committed to medical education on neonatal and paediatric viral infections.

Clinical Virology research and medical education in Greece: An interview with Demetrios A. Spandidos, Professor of Clinical Virology at the University of Crete in Greece

Professor Demetrios A. Spandidos, Professor Emeritus of Clinical Virology at the University of Crete School of Medicine in Crete, Greece, is a pioneer in world research in Virology, Oncology and medical education. He has been the first Professor of Clinical Virology at the University of Crete School of Medicine, the only School of Medicine with a separate Department of Clinical Virology in Greece. According to Professor Spandidos, the understanding of the interactions of viruses with human host cells is what enables the development of new vaccines and new therapies against a wide range of diseases in humans, including cancer. Over the past two decades, the expansion of new knowledge, treatments, prevention and management options and the emerging needs on neonatal and paediatric viral infections have made the role of future paediatric virologists more than necessary. For this reason, he strongly believes that Paediatric Virology should be recognized as a new paediatric subspecialty. Professor Spandidos declares that medical education is a continuous sequence from undergraduate to postgraduate/specialty/subspecialty medical training and continuing learning. He also supports the concept that the future of medical education represents the future of Medicine.

The paediatric story of human papillomavirus (Review)

Human papillomavirus (HPV) is composed of a particularly heterogeneous family of DNA viruses, which has gained much attention in recent years due to the discoveries of Professor Harald zur Hausen, who first identified a connection between HPV and cervical cancer. Professor Harald zur Hausen, the 'Father of HPV Virology', was the recipient of the 2008 Nobel Prize. HPV can be transmitted through physical contact via autoinoculation or fomites, sexual contact, as well as vertically from the HPV-positive mother to her newborn, causing subclinical or clinical infections. In infancy and childhood, HPV-associated clinical infections include skin warts, genital warts and juvenile recurrent respiratory papillomatosis, while cervical squamous intraepithelial lesions have also been reported among adolescent girls. To date, several research teams, worldwide, have extensively investigated HPV from the paediatric point of view. This primitive effort has been performed before the recent great expansion of paediatric HPV research due to the vaccination programmes against HPV, which were introduced into clinical practice in 2006. In this review article, we present a brief overview of paediatric HPV research after the first report in 1978 involving children in the research of HPV until the time point of this great expansion. In the future, it is expected that further unresolved issues will be addressed and clarified, as the paediatric story of HPV remains a challenging research target.

Genomic diversity of low-risk human papillomavirus genotypes HPV 40, HPV 42, HPV 43, and HPV 44

In order to investigate the genomic diversity of low-risk human papillomavirus (HPV) genotypes, a total of 108 isolates of HPV 40, HPV 42, HPV 43, or HPV 44, obtained from anal swabs or tissue specimens of patients with anogenital warts, and cervical swabs of women with cervical intraepithelial neoplasia of different grades, were analyzed. The characterization of genomic variants was established by sequencing one third of the viral genome and analysis of three different genomic regions: L1, LCR, and E6. Maximum variant divergence accounted for 0.4-1.1% of the investigated genomic segments. Several novel, potentially important nucleotide substitutions, deletions, and insertions are described. Altogether, among 14 HPV 40 isolates, a total of nine different genomic variants were identified, composed of eight L1, five LCR, and four E6 genomic variants. Among 49 HPV 42 isolates, a total of 30 genomic variants were identified, composed of 20 L1, 18 LCR, and four E6 genomic variants. Among 10 HPV 43 isolates, distributed into two major genomic variant lineages with clearly defined nucleotide signatures, three genomic variants were identified, composed of three L1, two LCR, and two E6 genomic variants. Among 35 HPV 44 isolates, a total of eight HPV 44 and 11 subtype HPV 44 genomic variants were identified, composed of 13 L1, 14 LCR, and 6 E6 genomic variants. A similar level of genomic diversity of HPV 44 and its subtype was identified in our geographic region as has been reported previously on isolates collected worldwide.

The ‘Trojan horse’ oncogenic strategy of HPVs in childhood

HPVs are considered to be the principal cause of cervical cancer worldwide. During the last decade, their possible oncogenic involvement has also been proposed in a substantial proportion of nongenital cancers, such as breast and lung cancer. The presence of high-risk HPVs in the neonatal oral mucosa supports the transmission of HPVs from the mother to her newborn. This review presents current evidence that supports the perinatal transmission of high-risk HPVs and suggests that this may be the initial step of the oncogenic strategy of high-risk HPVs in humans. The hypothesis that children are a unique reservoir of silent high-risk HPVs, analogously to the Trojan horse, should be investigated further.

Laboratory-developed L1 sequencing and type-specific, real-time polymerase chain reaction for the detection and typing of human papillomaviruses in formalin-fixed, paraffin-embedded tissues

CONTEXT

The detection and typing of high-risk and low-risk human papillomavirus (HPV) in archival formalin-fixed, paraffin-embedded tissues by nucleic acid amplification testing is an important adjunct to immunohistochemical staining in evaluation of squamous cell proliferations of the oropharynx, larynx, and anal canal.

OBJECTIVE

To evaluate semiautomated, xylene-free extraction from formalin-fixed, paraffin-embedded tissues combined with laboratory-developed HPV L1 sequencing and type-specific HPV 6, 11, 16, and 18 real-time polymerase chain reaction for identification and typing of HPV in the clinical laboratory.

DESIGN

We evaluated the adequacy of extraction using β-globin amplification and compared L1 sequencing and real-time polymerase chain reaction methods for typing accuracy using 68 formalin-fixed, paraffin-embedded tissues, including 56 anorectal biopsy or surgical resection specimens and 12 laryngeal papilloma specimens from patients with recurrent respiratory papillomatosis.

RESULTS

Adequate DNA was obtained from 68 of 68 specimens analyzed and all were HPV positive. In 47 cases where L1 sequencing demonstrated that the predominant HPV type was 6, 11, 16, or 18, type-specific, real-time polymerase chain reaction provided concordant results. Sequencing revealed additional low-risk (HPV 40) and high-risk HPV types (HPV 31, 33, 56, and 58) in anorectal specimens, whereas HPV 6 or 11 were the types found in laryngeal papillomas.

CONCLUSION

Both L1 sequencing and type-specific, real-time polymerase chain reaction are suitable methods for routine HPV testing of formalin-fixed, paraffin-embedded tissues in a clinical laboratory setting.

Detection of human papillomavirus in bronchoalveolar lavage samples in immunocompetent children

BACKGROUND

Human papillomavirus (HPV) has been detected in lungs of adults and has been proposed to play a role in lung carcinogenesis. However, no data are currently available on the incidence of HPV in the lower respiratory tract of children.

PURPOSE

To determine the prevalence of HPV deoxyribonucleic acid (DNA) in bronchoalveolar lavage (BAL) samples were obtained from asymptomatic immunocompetent children.

METHODS

A total of 71 children between 2 and 12 years of age were prospectively enrolled. Detection of HPV DNA and HPV typing were performed using polymerase chain reaction-based techniques.

RESULTS

Of the 71 BAL samples, HPV DNA was detected in 6 children. Coinfection with HPV 16, 18, and 31 was detected in 2 children, while 4 children were positive for non-"high-risk" HPVs.

CONCLUSIONS

This preliminary case-control study indicates the presence of HPV DNA in BAL samples in children. The possible presence of HPV in the lower respiratory tract of children requires further investigation to elucidate the actual epidemiologic condition, the potential modes of its transmission, and its possible causative relationship in lung carcinogenesis in adulthood.