1
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Lobato-Martinez E, Muriel-Serrano J, García-Payá E, Gonzalez-de-la-Aleja P, Garcia-Sevila R, Navarro-de-Miguel M, Marco-de-la-Calle F, Ramos-Rincon JM, Sanchez-Martinez R. Association of Human Leukocyte Antigen Alleles with COVID-19 Severity and Mortality in a Spanish Population. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1392. [PMID: 39336433 PMCID: PMC11434301 DOI: 10.3390/medicina60091392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/12/2024] [Accepted: 08/23/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: The aim of the following cross-sectional study is to determine the association between human leukocyte antigen (HLA) alleles and outcomes in patients presenting to the emergency department (ED) with SARS-CoV-2 infection. Methods and Materials: Genotyping was made using the Axiom Human Genotyping SARS-CoV-2 Research Array. Statistical analysis was made with Fisher's exact test and multivariable logistic regression, adjusted for sex, age and clinical variables. Results: Of 190 patients, 11.1% were discharged from the ED; 57.9% were admitted to the COVID-19 ward, without intensive care unit (ICU) admission; 15.3% survived an ICU admission; and 15.8% died. After multivariable analysis, two HLA alleles protected against hospital admission (HLA-C*05:01, adjusted odds ratio [aOR] 0.2, 95% confidence interval [CI] 0.055-0.731; and HLA-DQB1*02:02, aOR 0.046, CI 0.002-0.871) and one was associated with higher risk for ICU admission or death (HLA-DQA1*05:01, aOR 2.517, CI 1.086-5.833). Conclusions: In this population, HLA-C*05:01 and HLA-DQB1*02:02 are associated with a protective effect against hospital admission and HLA-DQA1*05:01 is associated with higher risk of ICU admission or death in the multivariable analysis. This may help stratify risk in COVID-19 patients.
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Affiliation(s)
- Ester Lobato-Martinez
- Internal Medicine Department, Dr. Balmis Universitary General Hospital, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Centro de Diagnóstico, Edif Gris, Planta 5ª, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
| | - Javier Muriel-Serrano
- Alicante Institute for Health and Biomedical Research (ISABIAL), Centro de Diagnóstico, Edif Gris, Planta 5ª, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
| | - Elena García-Payá
- Alicante Institute for Health and Biomedical Research (ISABIAL), Centro de Diagnóstico, Edif Gris, Planta 5ª, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
- Clinical Analysis Department, Dr. Balmis Universitary General Hospital, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
| | - Pilar Gonzalez-de-la-Aleja
- Alicante Institute for Health and Biomedical Research (ISABIAL), Centro de Diagnóstico, Edif Gris, Planta 5ª, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
- Infectious Diseases Unit, Dr. Balmis Universitary General Hospital, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
| | - Raquel Garcia-Sevila
- Alicante Institute for Health and Biomedical Research (ISABIAL), Centro de Diagnóstico, Edif Gris, Planta 5ª, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
- Pneumology Department, Dr. Balmis Universitary General Hospital, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
| | - Mercedes Navarro-de-Miguel
- Alicante Institute for Health and Biomedical Research (ISABIAL), Centro de Diagnóstico, Edif Gris, Planta 5ª, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
- Clinical Analysis Department, Dr. Balmis Universitary General Hospital, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
| | - Francisco Marco-de-la-Calle
- Alicante Institute for Health and Biomedical Research (ISABIAL), Centro de Diagnóstico, Edif Gris, Planta 5ª, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
- Immunology Department, Dr. Balmis Universitary General Hospital, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
| | - Jose-Manuel Ramos-Rincon
- Internal Medicine Department, Dr. Balmis Universitary General Hospital, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Centro de Diagnóstico, Edif Gris, Planta 5ª, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
- Clinical Medicine Department, Miguel Hernández University, N-332, 87, 03550 Alicante, Spain
| | - Rosario Sanchez-Martinez
- Internal Medicine Department, Dr. Balmis Universitary General Hospital, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Centro de Diagnóstico, Edif Gris, Planta 5ª, Avenida Pintor Baeza, 12, 03010 Alicante, Spain
- Clinical Medicine Department, Miguel Hernández University, N-332, 87, 03550 Alicante, Spain
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2
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Zheng M, Arora N, Chambers T, O'Dell K, Johns MM. Comparison of Treatment for Recurrent Respiratory Papillomatosis at a Public County Versus Private Academic Hospital. J Voice 2024; 38:945-950. [PMID: 35197218 DOI: 10.1016/j.jvoice.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare patient, disease and treatment characteristics of patients treated for recurrent respiratory papillomatosis (RRP) at a public county versus a private hospital. METHODS A retrospective cohort study was conducted of adult patients undergoing treatment for RRP at a tertiary-care academic center (TAC, n = 48) versus public safety net hospital (PSNH, n = 14), both staffed by the same Otolaryngology providers. RESULTS There was no difference between cohorts in age, gender, medical comorbidities, history of juvenile-onset presentation, or history of prior treatment at a different institution. PSNH patients were more likely to be Hispanic/Latino, primarily speak Spanish, have public or no insurance, and reside in a zip code with lower median income compared with TAC patients. Despite living significantly closer to the hospital, PSNH patients were more likely than TAC patients to present with respiratory symptoms (50% versus 20.8%, P = 0.04), and exhibit more than one involved laryngeal subsite at their first surgical intervention (78.6% versus 27.1%, P = 0.001). They also had high rates of referral for otolaryngologic care via the emergency department (42.9%) rather than outpatient specialty referral (35.7%) and were more likely than TAC patients to require urgent intervention (21.4% versus 2.1%, P = 0.03). There was no difference in time interval from first clinic visit to procedure date or total number of treatments. CONCLUSIONS PSNH patients present with more severe and symptomatic RRP disease compared with TAC patients. This finding may be related to sociodemographic disparities leading to poorer access in care.
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Affiliation(s)
- Melissa Zheng
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Nikhil Arora
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Tamara Chambers
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California.
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3
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Ponduri A, Azmy MC, Axler E, Lin J, Schwartz R, Chirilă M, Dikkers FG, Yang CJ, Mehta V, Gangar M. The Efficacy of Human Papillomavirus Vaccination as an Adjuvant Therapy in Recurrent Respiratory Papillomatosis. Laryngoscope 2023; 133:2046-2054. [PMID: 36651338 PMCID: PMC10859188 DOI: 10.1002/lary.30560] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To characterize the efficacy of human papillomavirus (HPV) vaccination as an adjuvant therapy in recurrent respiratory papillomatosis (RRP). DATA SOURCES PubMed, Embase, Cochrane, Google Scholar, ClinicalTrials.gov, and Web of Science databases were queried for articles published before April 2021. REVIEW METHODS All retrieved studies (n = 870) were independently analyzed by two reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement using predefined inclusion and exclusion criteria. 13 studies met inclusion criteria. A random-effects meta-analysis was performed to study intersurgical interval (ISI) and number of surgical procedures per year before and after vaccination. RESULTS The systematic review included 13 studies, comprising 243 patients. All studies utilized the Gardasil® quadrivalent vaccine, and one study (Yiu et al. 2019) utilized both the quadrivalent and Gardasil® 9-valent vaccines. Our meta-analysis included 62 patients with ISI data across 4 studies, and 111 patients with data on the number of surgical procedures per month across 7 studies. The mean number of surgical procedures decreased by 4.43 per year after vaccination (95% CI, -7.48 to -1.37). Mean ISI increased after vaccination, with a mean difference of 15.73 months (95% CI, 1.46-29.99). Two studies reported on HPV sero-conversion, with HPV seropositivity of 100% prior to vaccination and 25.93% after vaccination. CONCLUSION The addition of HPV vaccination was associated with an increase in time between surgeries and reduction in the number of surgical procedures required. HPV vaccination may be a beneficial adjuvant treatment for RRP. LEVEL OF EVIDENCE NA Laryngoscope, 133:2046-2054, 2023.
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Affiliation(s)
- Anusha Ponduri
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Monica C Azmy
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Eden Axler
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan Lin
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Magdalena Chirilă
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Frederik G Dikkers
- Department of Otorhinolaryngology/Head and Neck Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Christina J Yang
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Vikas Mehta
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Mona Gangar
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
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4
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Soloperto D, Gazzini S, Cerullo R. Molecular Mechanisms of Carcinogenesis in Pediatric Airways Tumors. Int J Mol Sci 2023; 24:ijms24032195. [PMID: 36768522 PMCID: PMC9916405 DOI: 10.3390/ijms24032195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
Primary tumors of the airways in the pediatric population are very rare entities. For this reason, little is known about the pathogenesis of these neoplasms. Understanding the biology has different practical implications: for example, it could help in the differential diagnosis, have a prognostic significance, or may lead to the development of a targeted therapy. The aim of this article is to present the current knowledge about pediatric airways tumors, focusing on the molecular mechanisms that cause the onset and progression of these neoplasms. After a brief introduction of epidemiology and clinical presentation, the tumorigenesis of the most frequent pediatric airways tumors will be described: Juvenile-onset recurrent respiratory papillomatosis (JORRP), Subglottic Hemangiona (SH), Rhabdomyosarcoma (RMS), and Mucoepidermoid carcinoma (MEC).
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5
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Israr M, Lam F, DeVoti J, Mace EM, Papayannakos C, Abramson A, Steinberg BM, Bonagura VR. PGE 2 expression by HPV6/11-induced respiratory papillomas blocks NK cell activation in patients with recurrent respiratory papillomatosis. Eur J Immunol 2023; 53:e2250036. [PMID: 36608264 DOI: 10.1002/eji.202250036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/12/2022] [Accepted: 01/05/2023] [Indexed: 01/07/2023]
Abstract
Recurrent respiratory papillomatosis (RRP), a rare chronic disease caused primarily by human papillomavirus types 6 and 11, consists of repeated growth of premalignant papillomas in the airway. RRP is characterized by multiple abnormalities in innate and adaptive immunity. Natural killer (NK) cells play important roles in immune surveillance and are part of the innate immune responses that help prevent tumor growth. We identified that papillomas lack classical class I MHC and retain nonclassical class I MHC expression. Moreover, in this study, we have identified and characterized the mechanism that blocks NK cell targeting of papilloma cells. Here, we show for the first time that the PGE2 secreted by papilloma cells directly inhibits NK cells activation/degranulation principally through the PGE2 receptor EP2, and to a lesser extent through EP4 signaling. Thus, papilloma cells have a potent mechanism to block NK cell function that likely supports papilloma cell growth.
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Affiliation(s)
- Mohd Israr
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Fung Lam
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - James DeVoti
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Emily M Mace
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia Medical Center, NY, USA
| | | | - Allan Abramson
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Bettie M Steinberg
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Vincent R Bonagura
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
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6
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Chandran A, Verma H, Quadri JA. Trace Elements Levels in Serum of Patients with Recurrent Respiratory Papillomatosis. Indian J Otolaryngol Head Neck Surg 2022; 74:5037-5043. [PMID: 36742793 PMCID: PMC9895157 DOI: 10.1007/s12070-021-02676-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is a chronic airway disease characterized by unpredictable recurrences and relapses. Our study aimed to identify the role of trace elements, a proven risk factor for various malignancies, in the development of papilloma and to correlate their serum levels with various disease parameters. 32 RRP patients with 20 age-matched controls were recruited in the study. Analysis of serum trace elements was performed by atomic absorption spectrophotometry in whole blood samples from cases and controls. The serum levels of trace elements were correlated with age of onset, history of previous surgeries, tracheostomy status, Derkay's score, and presence of dysplasia. Among the 32 cases there were 18 males and 14 females with a mean age of 20.85 years (range: 3-60 years). The mean serum levels of Thallium, Zinc, and Gallium were higher among cases compared to their controls whereas the levels of Arsenic, Copper, Cobalt, Selenium, Cadmium, and Lead were higher in control subjects compared to RRP patients. There was a statistically significant correlation of serum level of Cobalt with more than 3 surgeries per year (p = 0.02), Gallium and Thallium with Derkay's score of more than 20 (p = 0.04 and 0.05) and Lead, Arsenic and Gallium with presence tissue dysplasia (p = 0.05, 0.04 and 0.04). Our study had shown a variable association of trace elements in RRP patients. The usefulness of these values need to be completely elucidated and our study calls for future investigations to identify the casual association of various trace elements in the pathogenesis of RRP.
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Affiliation(s)
- Aswin Chandran
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Hitesh Verma
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Javed Ahsan Quadri
- Department of Clinical Ecotoxicology (Diagnostic and Research) Facility, All India Institute of Medical Sciences, New Delhi, India
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7
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Li SL, Wang W, Zhao J, Zhang FZ, Zhang J, Ni X. A review of the risk factors associated with juvenile-onset recurrent respiratory papillomatosis: genetic, immune and clinical aspects. World J Pediatr 2022; 18:75-82. [PMID: 35072893 DOI: 10.1007/s12519-021-00496-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is one of the most common benign lesions of hyperplastic respiratory epithelial tissue in children and is predominantly caused by human papillomaviruses (HPVs) 6 and 11. The clinical course of the disease is variable, and some patients even develop a malignancy. The purpose of this review was to summarize the related factors affecting the disease course in patients with JoRRP. DATA SOURCES We used databases, including PubMed and Google Scholar, to search for publications on factors associated with the genetic, immune, and clinical aspects of JoRRP. The most relevant articles to the scope of this review were chosen for analysis. RESULTS Mother-to-child transmission is the most important mode of disease transmission; other factors, such as immune condition or genetic susceptibility, may be important determinants of JoRRP occurrence. Genetically, the presence of DRB1*0301 and HPV 6/11 E6/E7 is associated with a more severe disease. Immunewise, patients have an enhanced T helper 2-like response. In addition, regulatory T cells are enriched in tumors and may become one of the effective prognostic indicators. For clinical characteristics, patients infected with HPV-11 have more aggressive disease. However, compared with HPV type, age at first onset is a more important factor related to the aggressiveness of JoRRP. Furthermore, socioeconomic status may also affect the course. CONCLUSIONS Genetic, immune, and some clinical factors have been noted to play an important role in the course of JoRRP. Exploring definite influencing factors will be an important direction of research in the future.
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Affiliation(s)
- Shi-Lan Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
| | - Wei Wang
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
| | - Jing Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
| | - Feng-Zhen Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
| | - Jie Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China.
| | - Xin Ni
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China.
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8
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Syrjänen S, Syrjänen K. HPV-Associated Benign Squamous Cell Papillomas in the Upper Aero-Digestive Tract and Their Malignant Potential. Viruses 2021; 13:v13081624. [PMID: 34452488 PMCID: PMC8402864 DOI: 10.3390/v13081624] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/18/2022] Open
Abstract
Squamous cell papilloma (SCP) in the upper aero-digestive tract is a rare disease entity with bimodal age presentation both at childhood and in adults. It originates from stratified squamous and/or respiratory epithelium. Traditionally, SCPs have been linked to chemical or mechanical irritation but, since the 1980s, they have also been associated with human papillomavirus (HPV) infection. Approximately 30% of the head and neck SCPs are associated with HPV infection, with this association being highest for laryngeal papillomas (76–94%), followed by oral (27–48%), sinonasal (25–40%), and oropharyngeal papillomas (6–7%). There is, however, a wide variation in HPV prevalence, the highest being in esophageal SCPs (11–57%). HPV6 and HPV11 are the two main HPV genotypes present, but these are also high-risk HPVs as they are infrequently detected. Some 20% of the oral and oropharyngeal papillomas also contain cutaneous HPV genotypes. Despite their benign morphology, some SCPs tend to recur and even undergo malignant transformation. The highest malignant potential is associated with sinonasal inverted papillomas (7–11%). This review discusses the evidence regarding HPV etiology of benign SCPs in the upper aero-digestive tract and their HPV-related malignant transformation. In addition, studies on HPV exposure at an early age are discussed, as are the animal models shedding light on HPV transmission, viral latency, and its reactivation.
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Affiliation(s)
- Stina Syrjänen
- Department of Oral Pathology and Oral Radiology, Institute of Dentistry, Faculty of Medicine, University of Turku, 20520 Turku, Finland
- Department of Pathology, Turku University Hospital, 20521 Turku, Finland
- Correspondence:
| | - Kari Syrjänen
- Department of Clinical Research, Biohit Oyj, 00880 Helsinki, Finland;
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9
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Abstract
This article aims to educate readers on adjuvant therapies for recurrent respiratory papillomatosis (RRP). Although antivirals are injected locally into papillomas as an adjuvant treatment, new biologics targeting vascular endothelial growth factor or induction of human papillomavirus (HPV)-specific immunity are gaining traction with demonstration of clinical benefit and mechanism of action in retrospective case series and prospective clinical trials. The future of RRP treatment, alone or in combination with surgery, lies in the careful clinical study of vascular and immune targeting agents that balance the risk of adverse events with the chance for elimination of HPV-infected cells.
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Affiliation(s)
- Clint T Allen
- Section on Translational Tumor Immunology, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Building 10, Room 7N240C, Bethesda, MD 20892, USA.
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10
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Lépine C, Klein P, Voron T, Mandavit M, Berrebi D, Outh-Gauer S, Péré H, Tournier L, Pagès F, Tartour E, Le Meur T, Berlemont S, Teissier N, Carlevan M, Leboulanger N, Galmiche L, Badoual C. Histological Severity Risk Factors Identification in Juvenile-Onset Recurrent Respiratory Papillomatosis: How Immunohistochemistry and AI Algorithms Can Help? Front Oncol 2021; 11:596499. [PMID: 33763347 PMCID: PMC7982831 DOI: 10.3389/fonc.2021.596499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/12/2021] [Indexed: 11/23/2022] Open
Abstract
Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a condition characterized by the repeated growth of benign exophytic papilloma in the respiratory tract. The course of the disease remains unpredictable: some children experience minor symptoms, while others require multiple interventions due to florid growth. Our study aimed to identify histologic severity risk factors in patients with JoRRP. Forty-eight children from two French pediatric centers were included retrospectively. Criteria for a severe disease were: annual rate of surgical endoscopy ≥ 5, spread to the lung, carcinomatous transformation or death. We conducted a multi-stage study with image analysis. First, with Hematoxylin and eosin (HE) digital slides of papilloma, we searched for morphological patterns associated with a severe JoRRP using a deep-learning algorithm. Then, immunohistochemistry with antibody against p53 and p63 was performed on sections of FFPE samples of laryngeal papilloma obtained between 2008 and 2018. Immunostainings were quantified according to the staining intensity through two automated workflows: one using machine learning, the other using deep learning. Twenty-four patients had severe disease. For the HE analysis, no significative results were obtained with cross-validation. For immunostaining with anti-p63 antibody, we found similar results between the two image analysis methods. Using machine learning, we found 23.98% of stained nuclei for medium intensity for mild JoRRP vs. 36.1% for severe JoRRP (p = 0.041); and for medium and strong intensity together, 24.14% for mild JoRRP vs. 36.9% for severe JoRRP (p = 0.048). Using deep learning, we found 58.32% for mild JoRRP vs. 67.45% for severe JoRRP (p = 0.045) for medium and strong intensity together. Regarding p53, we did not find any significant difference in the number of nuclei stained between the two groups of patients. In conclusion, we highlighted that immunochemistry with the anti-p63 antibody is a potential biomarker to predict the severity of the JoRRP.
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Affiliation(s)
- Charles Lépine
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Pathology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | | | | | | | | | - Sophie Outh-Gauer
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Pathology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Hélène Péré
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Virology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Louis Tournier
- Department of Pathology, Hôpital Robert Debré, APHP, Paris, France
| | - Franck Pagès
- Department of Immunology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Eric Tartour
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Immunology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | | | | | - Natacha Teissier
- Department of Pediatric ENT Surgery, Hôpital Robert Debré, APHP, Paris, France
| | - Mathilde Carlevan
- Department of Pediatric ENT Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Nicolas Leboulanger
- Department of Pediatric ENT Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Louise Galmiche
- Department of Pathology, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Cécile Badoual
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Pathology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
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11
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Lépine C, Voron T, Berrebi D, Mandavit M, Nervo M, Outh-Gauer S, Péré H, Tournier L, Teissier N, Tartour E, Leboulanger N, Galmiche L, Badoual C. Juvenile-Onset Recurrent Respiratory Papillomatosis Aggressiveness: In Situ Study of the Level of Transcription of HPV E6 and E7. Cancers (Basel) 2020; 12:cancers12102836. [PMID: 33019611 PMCID: PMC7601884 DOI: 10.3390/cancers12102836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a condition related to HPV 6 and 11 infection which is characterized by the repeated growth of benign exophytic papilloma in the respiratory tract of children. Disease progression is unpredictable leading sometimes to airway compromise and death. The aim of this study was to explore p16INK4a and expression of the RNA of HPV genes E6 and E7 with a chromogenic in situ hybridization (CISH) as biomarkers of JoRRP aggressiveness on a bicentric cohort of forty-eight children. CISH was scored semi-quantitatively as high (2+ score) and low (1+ score) levels of transcription of E6 and E7. Patients with a 2+ score had a more aggressive disease compared to those with a 1+ score. These data are a first step towards the use of biomarkers predictive of disease severity in JoRRP, this could improve the disease management, for example, by implementing adjuvant treatment at the early stages. Abstract Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a condition related to HPV 6 and 11 infection which is characterized by the repeated growth of benign exophytic papilloma in the respiratory tract. Disease progression is unpredictable: some children experience minor symptoms, while others require multiple interventions due to florid growth. The aim of this study was to explore the biomarkers of JoRRP severity on a bicentric cohort of forty-eight children. We performed a CISH on the most recent sample of papilloma with a probe targeting the mRNA of the E6 and E7 genes of HPV 6 and 11 and an immunostaining with p16INK4a antibody. For each patient HPV RNA CISH staining was assessed semi-quantitatively to define two scores: 1+, defined as a low staining extent, and 2+, defined as a high staining extent. This series contained 19 patients with a score of 1+ and 29 with a score of 2+. Patients with a score of 2+ had a median of surgical excision (SE) per year that was twice that of patients with a score of 1+ (respectively 6.1 versus 2.8, p = 0.036). We found similar results with the median number of SE the first year. Regarding p16INK4a, all patients were negative. To conclude, HPV RNA CISH might be a biomarker which is predictive of disease aggressiveness in JoRRP, and might help in patient care management.
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Affiliation(s)
- Charles Lépine
- Department of Pathology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France; (C.L.); (M.N.); (S.O.-G.)
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Thibault Voron
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Dominique Berrebi
- Department of Pathology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France; (D.B.); (L.T.)
| | - Marion Mandavit
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Marine Nervo
- Department of Pathology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France; (C.L.); (M.N.); (S.O.-G.)
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Sophie Outh-Gauer
- Department of Pathology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France; (C.L.); (M.N.); (S.O.-G.)
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Hélène Péré
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
- Department of Virology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France
| | - Louis Tournier
- Department of Pathology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France; (D.B.); (L.T.)
| | - Natacha Teissier
- Department of Pediatric ENT Surgery, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France;
| | - Eric Tartour
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
- Department of Immunology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France
| | - Nicolas Leboulanger
- Department of Pediatric ENT Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France;
| | - Louise Galmiche
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France;
| | - Cécile Badoual
- Department of Pathology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France; (C.L.); (M.N.); (S.O.-G.)
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
- Correspondence: ; Tel.: +33-156-093-888
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12
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Israr M, DeVoti JA, Lam F, Abramson AL, Steinberg BM, Bonagura VR. Altered Monocyte and Langerhans Cell Innate Immunity in Patients With Recurrent Respiratory Papillomatosis (RRP). Front Immunol 2020; 11:336. [PMID: 32210959 PMCID: PMC7076114 DOI: 10.3389/fimmu.2020.00336] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/11/2020] [Indexed: 12/24/2022] Open
Abstract
The micromilieu within respiratory papillomas supports persistent human papillomavirus (HPV) infection and disease recurrence in patients with recurrent respiratory papillomatosis (RRP). These patients show polarized (TH2-/Treg) adaptive immunity in papillomas and blood, enriched immature Langerhans cell (iLC) numbers, and overexpression of cyclooxygenase-2/prostaglandin E2 (PGE2) in the upper airway. Blood monocyte-derived, and tissue-derived iLCs from RRP patients and controls were now studied to more fully understand innate immune dysregulation in RRP. Patients' monocytes generated fewer iLCs than controls, due to a reduced fraction of classical monocytes that generated most but not all the iLCs. Prostaglandin E2, which was elevated in RRP plasma, reduced monocyte-iLC differentiation from controls to the levels of RRP patients, but had no effect on subsequent iLC maturation. Cytokine/chemokine responses by iLCs from papillomas, foreskin, and abdominal skin differed significantly. Freshly derived tissue iLCs expressed low CCL-1 and high CCL-20 mRNAs and were unresponsive to IL-36γ stimulation. Papilloma iLCs uniquely expressed IL-36γ at baseline and expressed CCL1 when cultured overnight outside their immunosuppressive microenvironment without additional stimulation. We conclude that monocyte/iLC innate immunity is impaired in RRP, in part due to increased PGE2 exposure in vivo. The immunosuppressive papilloma microenvironment likely alters iLC responses, and vice versa, supporting TH2-like/Treg HPV-specific adaptive immunity in RRP.
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Affiliation(s)
- Mohd Israr
- Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - James A DeVoti
- Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Fung Lam
- Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Allan L Abramson
- Department of Otolaryngology, Long Island Jewish Medical Center, Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States
| | - Bettie M Steinberg
- Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Manhasset, NY, United States.,Department of Otolaryngology, Long Island Jewish Medical Center, Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States
| | - Vincent R Bonagura
- Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Manhasset, NY, United States.,Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States
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13
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Ivancic R, Iqbal H, deSilva B, Pan Q, Matrka L. Immunological tolerance of low-risk HPV in recurrent respiratory papillomatosis. Clin Exp Immunol 2019; 199:131-142. [PMID: 31628850 DOI: 10.1111/cei.13387] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 12/12/2022] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is characterized by benign exophytic lesions of the respiratory tract caused by the human papillomavirus (HPV), in particular low-risk HPV6 and HPV11. Aggressiveness varies greatly among patients. Surgical excision is the current standard of care for RRP, with adjuvant therapy used when surgery cannot control disease recurrence. Numerous adjuvant therapies have been used to control RRP with some success, but none are curative. Current literature supports a polarization of the adaptive immune response to a T helper type 2 (Th2)-like or T regulatory phenotype, driven by a complex interplay between innate immunity, adaptive immunity and HPV6/11 proteins. Additionally, certain immunogenetic polymorphisms can predispose individuals to an HPV6/11-tolerant microenvironment. As a result, immunomodulatory efforts are being made to restore the host immune system to a more balanced T cell phenotype and clear viral infection. Literature has shown exciting evidence for the role of HPV vaccination with Gardasil or Gardasil-9 as both primary prevention, by decreasing incidence through childhood vaccinations, and secondary prevention, by treating active RRP disease. Multi-institution randomized clinical trials are needed to better assess their efficacy as treatment for active disease. Interestingly, a DNA vaccine has recently shown in-vitro success in generating a more robust CD8+ T cell response. Furthermore, clinical trials for programmed death 1 (PD-1) inhibitors are under investigation for RRP management. Molecular insights into RRP, in particular the interplay between RRP and the immune system, are needed to advance our understanding of this disease and may lead to the identification of immunomodulatory agents to better manage RRP.
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Affiliation(s)
- R Ivancic
- College of Medicine, The Ohio State University, OH, USA
| | - H Iqbal
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - B deSilva
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Q Pan
- Case Comprehensive Cancer Center, Cleveland, OH
| | - L Matrka
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
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14
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Age at diagnosis, but not HPV type, is strongly associated with clinical course in recurrent respiratory papillomatosis. PLoS One 2019; 14:e0216697. [PMID: 31194767 PMCID: PMC6563955 DOI: 10.1371/journal.pone.0216697] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 04/28/2019] [Indexed: 02/07/2023] Open
Abstract
Background Recurrent Respiratory Papillomatosis (RRP) is a rare disease characterized by the growth of papillomas in the airway and especially the larynx. The clinical course is highly variable among individuals and there is poor understanding of the factors that drive an aggressive vs an indolent course. Methods A convenience cohort of 339 affected subjects with papillomas positive for only HPV6 or HPV11 and clinical course data available for 1 year or more, from a large multicenter international study were included. Exploratory data analysis was conducted followed by inferential analyses with frequentist and Bayesian statistics. Results We examined 339 subjects: 82% were diagnosed prior to the age of 18 years, 65% were infected with HPV6, and 69% had an aggressive clinical course. When comparing age at diagnosis with clinical course, the probability of aggressiveness is high for children under five years of age then drops rapidly. For patients diagnosed after the age of 10 years, an indolent course is more common. After accounting for confounding between HPV11 and young age, HPV type was minimally associated with aggressiveness. Fast and Frugal Trees (FFTs) were utilized to determine which algorithms yield the highest accuracy to classify patients as having an indolent or aggressive clinical course and consistently created a branch for diagnostic age at ~5 years old. There was no reliable strong association between clinical course and socioeconomic or parental factors. Conclusion In the largest cohort of its type, we have identified a critical age at diagnosis which demarcates a more aggressive from less aggressive clinical course.
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15
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Ivancic R, Iqbal H, deSilva B, Pan Q, Matrka L. Current and future management of recurrent respiratory papillomatosis. Laryngoscope Investig Otolaryngol 2018; 3:22-34. [PMID: 29492465 PMCID: PMC5824106 DOI: 10.1002/lio2.132] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/17/2017] [Accepted: 11/11/2017] [Indexed: 01/01/2023] Open
Abstract
Objectives Recurrent respiratory papillomatosis (RRP) is a chronic disease of the respiratory tract that occurs in both children and adults. It is caused by the human papillomavirus (HPV), in particular low‐risk HPV6 and HPV11, and aggressiveness varies among patients. RRP remains a chronic disease that is difficult to manage. This review provides perspectives on current and future management of RRP. Results The current standard of care is surgical excision, with adjuvant therapies as needed. Surgical management of RRP has evolved with the introduction of microdebriders and photoangiolytic lasers; the latter can now be used in the office setting. Numerous adjuvant pharmacologic therapies have been utilized with some success. Also, exciting preliminary data show that HPV vaccines may prolong the time to recurrence in the RRP population. There is also optimism that wide‐spread HPV vaccination could reduce RRP incidence indirectly by preventing vertical HPV transmission to newborns. Conclusion To date, the biology of RRP is not well understood, although it has been noted to become more aggressive in the setting of immune suppression. Additional research is needed to better understand immune system dysfunction in RRP such that immunomodulatory approaches may be developed for RRP management. Level of Evidence 4
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Affiliation(s)
- Ryan Ivancic
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center Columbus Ohio U.S.A
| | - Hassan Iqbal
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center Columbus Ohio U.S.A
| | - Brad deSilva
- Department of Otolaryngology-Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Quintin Pan
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center Columbus Ohio U.S.A.,Department of Otolaryngology-Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio U.S.A
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio U.S.A
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16
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Perdana RF, Herawati S, Suroso B, Aksono EB. NO ASSOCIATION OF RECURRENT RESPIRATORY PAPILLOMATOSIS AGGRESSIVENESS AND HUMAN PAPILLOMAVIRUS TYPE 6 AND 11. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2017. [DOI: 10.20473/ijtid.v6i5.3705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recurrent Respiratory Papillomatosis (RRP) is the most common benign neoplasm of the larynx among children as a result of HPV infection mainly type 6 and 11. RRP is still considered as serious problem since papilloma in the airway can cause hoarseness and obstruction which later described as aggressive and non aggressive types. Patients underwent multiple surgeries to keep airway patency and in order to communicate vocally. Previous studies reported that HPV-11 was associated with a more aggressive disease course. This study aim is to determine the association of RRP aggressiveness with HPV-6 and 11. Papilloma specimens were taken from patients who underwent surgical treatment of RRP patients and subjected HPV typing. All 17 patients with completed data and epidemiologic questionaires were defined for their staging to disease severity. Informations in the database were analyzed to identity statistically significant relationship with HPV type and knowing the HPV type is to predict the disease course. 17 patients RRP (12 males and 5 females) with age at onset 3,15 + 2,28 years and age at diagnosis 3,81 + 2,51 years. Surgery was performed 2,71 ± 1,16 times per year and 9 patients treated more than 3 surgeries per year. 10 patients had distal papilloma and 11 patients had tracheotomy. Agrressive disease was show found in 14 patients among 17 patients. HPV-11 was detected in 10 patients, HPV-6 was detected in 7 patients. According to the statisitcal analysis (Chi square test), there is no relationship between HPV type and disease aggressiveness. HPV-6 and 11 are not the only cause that affect the aggressiveness of Recurrent Respiratory Papillomatosis.
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17
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Zhao J, Wang G, Wang G, Wang H, Wang S, Tai J, Tang L, Gui J, Zhang J, Ni X. HLA-DRB1 and HLA-DQB1 alleles in Chinese Han patients with Juvenile-Onset recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2017; 102:119-122. [PMID: 29106857 DOI: 10.1016/j.ijporl.2017.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/06/2017] [Accepted: 04/10/2017] [Indexed: 11/25/2022]
Abstract
Juvenile-Onset recurrent respiratory papillomatosis (JORRP) is a rare benign neoplasm of the respiratory mucosa caused by human papilloma virus. Previous studies on the possible associations between HLA alleles and JORRP have shown various results in different ethnic groups. The present study aims to investigate the association between JORRP and HLA class II DRB1and DQB1 alleles in Chinese Han children. We found that the frequencies of HLA-DRB1*03:01 (pc = 0.0378, OR = 4.8) and HLA-DQB1*02:01 (pc = 0.021, OR = 4.8) alleles were significantly higher in patients with JORRP than in controls. In addition, HLA-DRB1*03:01 allele significantly correlated with aggressive JORRP (r = 0.467, p = 0.009). This was the first study on the HLA alleles in Chinese Han patients with JORRP. Future studies are required to further elucidate the correlation of HLA class II alleles and susceptibility to JORRP.
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Affiliation(s)
- Jing Zhao
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China; Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Guoliang Wang
- Key Laboratory of Major Diseases in Children by Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Guixiang Wang
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China; Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Hua Wang
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China; Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Shengcai Wang
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China; Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Jun Tai
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China; Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Lixing Tang
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China; Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Jingang Gui
- Key Laboratory of Major Diseases in Children by Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Jie Zhang
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China; Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China.
| | - Xin Ni
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China; Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China.
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18
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Pahari S, Chatterjee D, Negi S, Kaur J, Singh B, Agrewala JN. Morbid Sequences Suggest Molecular Mimicry between Microbial Peptides and Self-Antigens: A Possibility of Inciting Autoimmunity. Front Microbiol 2017; 8:1938. [PMID: 29062305 PMCID: PMC5640720 DOI: 10.3389/fmicb.2017.01938] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/21/2017] [Indexed: 12/11/2022] Open
Abstract
Understanding etiology of autoimmune diseases has been a great challenge for designing drugs and vaccines. The pathophysiology of many autoimmune diseases may be attributed to molecular mimicry provoked by microbes. Molecular mimicry hypothesizes that a sequence homology between foreign and self-peptides leads to cross-activation of autoreactive T cells. Different microbial proteins are implicated in various autoimmune diseases, including multiple sclerosis, human type 1 diabetes, primary biliary cirrhosis and rheumatoid arthritis. It may be imperative to identify the microbial epitopes that initiate the activation of autoreactive T cells. Consequently, in the present study, we employed immunoinformatics tools to delineate homologous antigenic regions between microbes and human proteins at not only the sequence level but at the structural level too. Interestingly, many cross-reactive MHC class II binding epitopes were detected from an array of microbes. Further, these peptides possess a potential to skew immune response toward Th1-like patterns. The present study divulges many microbial target proteins, their putative MHC-binding epitopes, and predicted structures to establish the fact that both sequence and structure are two important aspects for understanding the relationship between molecular mimicry and autoimmune diseases. Such findings may enable us in designing potential immunotherapies to tolerize autoreactive T cells.
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Affiliation(s)
- Susanta Pahari
- Immunology Laboratory, CSIR-Institute of Microbial Technology, Chandigarh, India.,Department of Biotechnology, Panjab University, Chandigarh, India
| | - Deepyan Chatterjee
- Immunology Laboratory, CSIR-Institute of Microbial Technology, Chandigarh, India
| | - Shikha Negi
- Immunology Laboratory, CSIR-Institute of Microbial Technology, Chandigarh, India
| | - Jagdeep Kaur
- Department of Biotechnology, Panjab University, Chandigarh, India
| | - Balvinder Singh
- Immunology Laboratory, CSIR-Institute of Microbial Technology, Chandigarh, India
| | - Javed N Agrewala
- Immunology Laboratory, CSIR-Institute of Microbial Technology, Chandigarh, India
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19
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Kwon TK, Chung EJ, Lee N, Roh EY, Song EY. Associations of FoxP3 gene polymorphisms with severe recurrent respiratory papillomatosis in Korean patients. J Otolaryngol Head Neck Surg 2017; 46:21. [PMID: 28298239 PMCID: PMC5353865 DOI: 10.1186/s40463-017-0197-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/13/2017] [Indexed: 11/29/2022] Open
Abstract
Background FoxP3 is the most dependable marker for regulatory T cells which play a major role in immune tolerance. Foxp3 gene polymorphisms were associated with various autoimmune diseases and clearance of viral infections. We studied the association of Foxp3 polymorphisms in severe RRP patients. Methods A total of 30 Korean severe RRP patients and 195 healthy controls were enrolled. Foxp3 polymorphisms (rs5902434 del/ATT, rs3761548 C/A, rs3761549 C/T, and rs2232365 G/A) were determined by PCR and sequencing. Results Genotype frequencies (GF) of rs5902434 ATT/ATT and rs2232365 GG were significantly decreased in female RRP patients than controls (0.0% vs 23.0%, p = 0.039, OR = 9.4 for both). Conclusions We showed that Foxp3 polymorphism of rs5902434 and rs2232365 could be an important protective factor in the susceptibility of severe RRP in female Koreans. Further studies on larger number of patients and other ethnic groups are needed to clarify the association.
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Affiliation(s)
- Tack-Kyun Kwon
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun Jae Chung
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Nuri Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Eun Youn Roh
- Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Eun Young Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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20
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Epidemiology of Low-Risk Human Papillomavirus. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0112-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Kolesnikova OM. [The association of the severe clinical course of respiratory papillomatosis with certain HLA-DQ alleles]. Vestn Otorinolaringol 2016; 81:31-33. [PMID: 27500575 DOI: 10.17116/otorino201681431-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We undertook the analysis of genetic polymorphism of the HLADQA1 and DQB1 genes in the patients presenting with recurrent respiratory papillomatosis (n=21) with the use of the multiprimer polymerase chain reaction. The results of the study give evidence that the identification of DQ 2.5 and DQ 7.5 haplotypes encoded by the DQA1 *0501, DQB1 *0201, DQA1 *0505, and DQB1 *0301 alleles as well as the carriage of type 16 human papilloma virus (HPV) in combination with these haplotypes in the patients with recurrent respiratory papillomatosis can be used for the prognostication of the severity of this disease.
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Affiliation(s)
- O M Kolesnikova
- Department of Otorhinolaryngology, I.P. Pavlov Saint-Petersburg First State Medical University, Russian Ministry of Health, Saint-Petersburg, Russia, 197022
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22
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Abstract
Human Papillomaviruses (HPVs) 6 and 11 are part of a large family of small DNA viruses, some of which are commensal. Although much of the population can contain or clear infection with these viruses, there is a subset of individuals who develop persistent infection that can cause significant morbidity and on occasion mortality. Depending on the site of infection, patients chronically infected with these viruses develop either recurrent, and on occasion, severe genital warts or recurrent respiratory papillomas that can obstruct the upper airway. The HPV-induced diseases described are likely the result of a complex and localized immune suppressive milieu that is characteristic of patients with persistent HPV infection. We review data that documents impaired Langerhans cell responses and maturation, describes the polarized adaptive T-cell immune responses made to these viruses, and the expression of class select II MHC and KIR genes that associate with severe HPV6 and 11 induced disease. Finally, we review evidence that documents the polarization of functional TH2 and T-regulatory T-cells in tissues persistently infected with HPV6 and 11, and we review evidence that there is suppression of natural killer cell function. Together, these altered innate and adaptive immune responses contribute to the cellular and humoral microenvironment that supports HPV 6 and 11-induced disease.
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DeVoti J, Hatam L, Lucs A, Afzal A, Abramson A, Steinberg B, Bonagura V. Decreased Langerhans cell responses to IL-36γ: altered innate immunity in patients with recurrent respiratory papillomatosis. Mol Med 2014; 20:372-80. [PMID: 24950037 DOI: 10.2119/molmed.2014.00098] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/12/2014] [Indexed: 01/09/2023] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is a rare, chronic disease caused by human papillomaviruses (HPVs) types 6 and 11 that is characterized by the polarization of adaptive immune responses that support persistent HPV infection. Respiratory papillomas express elevated mRNA levels of IL-36γ, a proinflammatory cytokine in comparison to autologous clinically normal laryngeal tissues; however there is no evidence of inflammation in these lesions. Consistent with this, respiratory papillomas do not contain TH1-like CD4(+) T-cells or cytotoxic CD8(+) T-cells, but instead contain a predominance of TH2-like and T regulatory cells (Tregs). In addition, papillomas also are infiltrated with immature Langerhans cells (iLCs). In this study, we show that papilloma cells express IL-36γ protein, and that human keratinocytes transduced with HPV11 have reduced IL-36γ secretion. We now provide the first evidence that peripheral blood-derived iLCs respond to IL-36γ by expressing inflammatory cytokines and chemokines. When stimulated with IL-36γ, iLCs from patients with RRP had lower expression levels of the TH2-like chemokine CCL-20 as compared with controls. Patients' iLCs also had decreased steady state levels of CCL-1, which is a proinflammatory chemokine. Moreover, CCL-1 levels in iLCs inversely correlated with the severity of RRP. The combined decrease of TH1- and a TH2-like chemokines by iLCs from patients could have consequences in the priming of IFN-γ expression by CD8(+) T-cells. Taken together, our results suggest that, in RRP, there is a defect in the proinflammatory innate immune responses made by iLCs in response to IL-36γ. The consequence of this defect may lead to persistent HPV infection by failing to support an effective HPV-specific, TH1-like and/or Tc1-like adaptive response, thus resulting in the predominant TH2-like and/or Treg micromilieu present in papillomas.
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Affiliation(s)
- James DeVoti
- Feinstein Institute for Medical Research, Manhasset, New York, United States of America Division of Allergy and Immunology, Department of Pediatrics, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York, United States of America
| | - Lynda Hatam
- Feinstein Institute for Medical Research, Manhasset, New York, United States of America Division of Allergy and Immunology, Department of Pediatrics, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York, United States of America
| | - Alexandra Lucs
- Feinstein Institute for Medical Research, Manhasset, New York, United States of America Department of Otolaryngology, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York, United States of America
| | - Ali Afzal
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, United States of America
| | - Allan Abramson
- Feinstein Institute for Medical Research, Manhasset, New York, United States of America Department of Otolaryngology, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York, United States of America
| | - Bettie Steinberg
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, United States of America Department of Otolaryngology, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York, United States of America
| | - Vincent Bonagura
- Feinstein Institute for Medical Research, Manhasset, New York, United States of America Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, United States of America Division of Allergy and Immunology, Department of Pediatrics, Hofstra North Shore-LIJ School of Medicine, Great Neck, New York, United States of America
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Ruiz R, Achlatis S, Verma A, Born H, Kapadia F, Fang Y, Pitman M, Sulica L, Branski RC, Amin MR. Risk factors for adult-onset recurrent respiratory papillomatosis. Laryngoscope 2014; 124:2338-44. [PMID: 24764146 DOI: 10.1002/lary.24730] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 04/10/2014] [Accepted: 04/17/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate risk factors strongly associated with adult-onset recurrent respiratory papillomatosis (AO-RRP). STUDY DESIGN Prospective, age- and sex-matched, case control. METHODS Patients with AO-RRP and controls completed a computer-based, 89-item questionnaire across three academic institutions. RESULTS Forty-eight AO-RRP patients were compared to 73 controls; 43 of the 48 AO-RRP patients were male (89.5%). The difference in the median number of lifetime sexual partners between AO-RRP (15) and controls (10) was significant (P = 0.0387). Additionally, an increased number of lifetime sexual partners (≥ 26) was associated with AO-RRP. No significant difference for the number of lifetime oral sex partners was observed between groups. Increased comorbidity, as quantified by the Charlson Comorbidity Index, was observed in patients with AO-RRP. AO-RRP and control groups were similar across many other variables, including birth history, smoking history, alcohol use, drug use, education, income, and the Short Form Health Survey scores. CONCLUSIONS AO-RRP was not associated with previously proposed risk factors for juvenile-onset RRP and may be associated with an increased number of lifetime sexual partners.
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Affiliation(s)
- Ryan Ruiz
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York, New York, U.S.A
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Niyibizi J, Rodier C, Wassef M, Trottier H. Risk factors for the development and severity of juvenile-onset recurrent respiratory papillomatosis: a systematic review. Int J Pediatr Otorhinolaryngol 2014; 78:186-97. [PMID: 24367938 DOI: 10.1016/j.ijporl.2013.11.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a rare yet aggressive disease caused by human papillomavirus (HPV). Although many newborns are likely exposed to HPV, few develop JoRRP and the clinical course of the disease varies from one child to another. This systematic review seeks to provide an up-to-date understanding of the risk factors for acquisition and severity. METHODS We conducted a comprehensive literature search in EMBASE, MEDLINE and EBMR databases using various combinations of keywords related to JoRRP etiology, risk factors and severity. We also searched Google Scholar and the reference lists of eligible studies. Our search was limited to original studies published in French or English between 1995 and July 2012 and to patients under 20 years of age. RESULTS Of 1362 citations, we retrieved 102 articles and found 14 additional studies. We retained 32 studies meeting inclusion criteria. All were observational and together included 2296 JoRRP cases. Risk factors could be classified mainly as maternal and birth history, viral genotype, and host factors. A history of genital warts during pregnancy and delivery was strongly linked to the development of JoRRP. Depending on ethnicity, specific human leukocyte antigen class II alleles and immune response factors were important determinants of JoRRP acquisition and severity. HPV-11 genotype and younger age at onset of JoRRP were important predictors of severity. CONCLUSIONS Genetic and immunological profiles underlying the acquisition and clinical course are not readily modifiable. Thus, preventing condylomas in women of childbearing age could reduce the burden of this life-threatening disease.
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Affiliation(s)
- Joseph Niyibizi
- Department of Social and Preventive Medicine, University of Montreal, Public Health School 7101, Avenue du Parc, 3rd Floor, Montreal, Quebec H3N 1X9, Canada; Sainte Justine Hospital (CHU Sainte-Justine), 3175 Chemin de la Côte Ste-Catherine, Room A-830, Montreal, Quebec H3T 1C5, Canada
| | - Caroline Rodier
- Department of Social and Preventive Medicine, University of Montreal, Public Health School 7101, Avenue du Parc, 3rd Floor, Montreal, Quebec H3N 1X9, Canada; Merck Canada Inc., 16711 Route Transcanadienne, Kirkland, Quebec H9H 3L1, Canada
| | - Maggy Wassef
- Sainte Justine Hospital (CHU Sainte-Justine), 3175 Chemin de la Côte Ste-Catherine, Room A-830, Montreal, Quebec H3T 1C5, Canada
| | - Helen Trottier
- Department of Social and Preventive Medicine, University of Montreal, Public Health School 7101, Avenue du Parc, 3rd Floor, Montreal, Quebec H3N 1X9, Canada; Sainte Justine Hospital (CHU Sainte-Justine), 3175 Chemin de la Côte Ste-Catherine, Room A-830, Montreal, Quebec H3T 1C5, Canada.
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Rodier C, Lapointe A, Coutlée F, Mayrand MH, Dal Soglio D, Roger M, Trottier H. Juvenile respiratory papillomatosis: risk factors for severity. J Med Virol 2013; 85:1447-58. [PMID: 23765781 DOI: 10.1002/jmv.23615] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/10/2022]
Abstract
Juvenile recurrent respiratory papillomatosis is caused mainly by human papillomavirus genotypes 6 or 11, acquired at birth or during pregnancy from an infected mother. Recurrent respiratory papillomatosis is characterized by recurring warts growing most commonly in the larynx. Multiple surgical procedures and the risk of airway obstruction contribute to the devastating impact of this disease. Some children will go into remission after a few surgeries whereas others will require repeated interventions over several years. Further understanding of the risk factors associated with severity may contribute to tailored treatments. A retrospective study of cases diagnosed between January 1995 and December 2008 was conducted to study determinants of severe forms of juvenile recurrent respiratory papillomatosis. Demographic and clinical variables were abstracted from children's medical charts and mothers' delivery charts. Viral factors (HPV genotyping and viral load) were studied from archived biopsies. Specific HLA class II alleles and killer-cell immunoglobulin-like receptors genes were tested from saliva samples. Logistic regression was performed to identify risk factors for severity. Overall, 31 pediatric cases of recurrent respiratory papillomatosis were identified. The only significant factor associated with severe forms of recurrent respiratory papillomatosis was the maternal history of condylomas during pregnancy (OR: 12.05 [P=0.05]). The analysis failed to identify risk factors that could be used clinically to identify recurrent respiratory papillomatosis cases likely to take a severe course. Although too early to determine, vaccination against the HPV types involved most commonly in recurrent respiratory papillomatosis may provide the best hope to prevent severe forms of this disease.
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Affiliation(s)
- Caroline Rodier
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec, Canada
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Song EY, Shin S, Park KU, Park MH, Sung MW, Kim KH, Kwon TK. Associations of HLA-DRB1 and -DQB1 alleles with severe recurrent respiratory papillomatosis in Korean patients. Hum Immunol 2013; 74:961-4. [DOI: 10.1016/j.humimm.2013.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 01/29/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
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Hatam LJ, Devoti JA, Rosenthal DW, Lam F, Abramson AL, Steinberg BM, Bonagura VR. Immune suppression in premalignant respiratory papillomas: enriched functional CD4+Foxp3+ regulatory T cells and PD-1/PD-L1/L2 expression. Clin Cancer Res 2012; 18:1925-35. [PMID: 22322668 DOI: 10.1158/1078-0432.ccr-11-2941] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Respiratory papillomas, caused by human papillomaviruses types 6 and 11 (HPV6/11), are premalignant lesions with potential for malignant conversion. The cytokine and chemokine micromilieu of papillomas is T(H)2-like with a marked absence of IFN-γ expression. To illuminate why patients with recurrent respiratory papillomatosis (RRP) fail to effectively control their disease, we further investigated the suppressive cellular microenvironment in papillomas. EXPERIMENTAL DESIGN CD4(+)CD25(+)CD127(low/-)Foxp3(+) regulatory T cells (Treg) and CD4(+)CD25(-)CD127(low/-)Foxp3(-) T cells within papillomas were characterized and isolated. Their suppressor function was measured by inhibition of peripheral blood mononuclear cell (PBMC) proliferation. Expression of PD-1, CD69, and Helios was identified on these T cells. PD-L1, PD-L2, CCL17, and CCL22 mRNA was also identified in papillomas by quantitative PCR. RESULTS Functional Tregs were markedly enriched in papillomas and strongly inhibited anti-CD3 and anti-CD28 antibody activated PBMC proliferation. The natural Treg marker Helios was reduced on Tregs from papillomas, indicating that the majority of Tregs in papillomas are adaptive. The majority of the papilloma-derived CD4(+) T cells expressed the CD4(+)CD25(-)CD127(low/-)Foxp3(-)PD1(+)CD69(+) phenotype and failed to suppress PBMC proliferation, suggesting that they are chronically activated and exhausted. The Treg-attracting chemokine CCL22 was equally expressed by all laryngeal tissues examined. However, CCL17 was robustly expressed by papillomas compared with unaffected laryngeal tissues from RRP patients and individuals without RRP. PD-L1 was elevated in papillomas compared with control laryngeal tissues. CONCLUSIONS Papilloma CD4(+) T cells are enriched with functional Tregs, and the adaptive Helios(-) Treg fraction was increased within the T(H)2-like papilloma micromilieu. CD4(+)CD25(-)CD127(low/-)Foxp3(-) T-cells failed to suppress PBMC proliferation and may be exhausted. The PD-1/PDL-1 pathway may represent an additional immunosuppressive mechanism that contributes to defective HPV6/11 clearance in RRP.
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Affiliation(s)
- Lynda J Hatam
- The Feinstein Institute for Medical Research, 350 Community Drive, Room 1239, Manhasset, NY 11030, USA
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James EA, DeVoti JA, Rosenthal DW, Hatam LJ, Steinberg BM, Abramson AL, Kwok WW, Bonagura VR. Papillomavirus-specific CD4+ T cells exhibit reduced STAT-5 signaling and altered cytokine profiles in patients with recurrent respiratory papillomatosis. THE JOURNAL OF IMMUNOLOGY 2011; 186:6633-40. [PMID: 21531896 DOI: 10.4049/jimmunol.1004181] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Recurrent respiratory papillomatosis (RRP) is caused by human papillomavirus type 6 (HPV-6) or HPV-11. Specific HLA-DR haplotypes DRB1*01:02 and DRB1*03:01 are associated with the development of RRP, disease severity, and Th2-like responses to HPV early proteins. Th1-like responses to HPV proteins have been shown to be protective in animal models. Therefore, we investigated the hypothesis that RRP patients have dysfunctional Th1-like, HPV-specific T cell responses. Using MHC class II tetramers, we identified immunogenic peptides within HPV-11 early proteins. Two distinct peptides (E6(113-132) and E2(1-20)) contained DRB1*01:02- or DRB1*03:01-restricted epitopes, respectively. An additional peptide (E2(281-300)) contained an epitope presented by both alleles. Peptide binding, tetramer, and proliferation assays identified minimal epitopes within these peptides. These epitopes elicited E2/E6-specific CD4(+) T cell responses in RRP patients and healthy control subjects, allowing the isolation of HPV-specific T cell lines using tetramers. The cytokine profiles and STAT signaling of these tetramer-positive T cells were measured to compare the polarization and responsiveness of HPV-specific T cells from patients with RRP and healthy subjects. HPV-specific IFN-γ secretion was substantially lower in T cells from RRP patients. HPV-specific IL-13 secretion was seen at modest levels in T cells from RRP patients and was absent in T cells from healthy control subjects. HPV-specific T cells from RRP patients exhibited reduced STAT-5 phosphorylation and reduced IL-2 secretion, suggesting anergy. Levels of STAT-5 phosphorylation and IFN-γ secretion could be improved through addition of IL-2 to HPV-specific T cell lines from RRP patients. Therapeutic vaccination or interventions aimed at restoring Th1-like cytokine responses to HPV proteins and reversing anergy could improve clinical outcomes for RRP patients.
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Affiliation(s)
- Eddie A James
- Benaroya Research Institute at Virginia Mason, Seattle, WA 98101, USA.
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Heller C, Weisser T, Mueller-Schickert A, Rufer E, Hoh A, Leonhardt RM, Knittler MR. Identification of key amino acid residues that determine the ability of high risk HPV16-E7 to dysregulate major histocompatibility complex class I expression. J Biol Chem 2011; 286:10983-97. [PMID: 21321113 DOI: 10.1074/jbc.m110.199190] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
High risk human Papillomavirus (HPV) types are the major causative agents of cervical cancer. Reduced expression of major histocompatibility complex class I (MHC I) on HPV-infected cells might be responsible for insufficient T cell response and contribute to HPV-associated malignancy. The viral gene product required for subversion of MHC I synthesis is the E7 oncoprotein. Although it has been suggested that high and low risk HPVs diverge in their ability to dysregulate MHC I expression, it is not known what sequence determinants of HPV-E7 are responsible for this important functional difference. To investigate this, we analyzed the capability to affect MHC I of a set of chimeric E7 variants containing sequence elements from either high risk HPV16 or low risk HPV11. HPV16-E7, but not HPV11-E7, causes significant diminution of mRNA synthesis and surface presentation of MHC I, which depend on histone deacetylase activity. Our experiments demonstrate that the C-terminal region within the zinc finger domain of HPV-E7 is responsible for the contrasting effects of HPV11- and HPV16-E7 on MHC I. By using different loss- and gain-of-function mutants of HPV11- and HPV16-E7, we identify for the first time a residue variation at position 88 that is highly critical for HPV16-E7-mediated suppression of MHC I. Furthermore, our studies suggest that residues at position 78, 80, and 88 build a minimal functional unit within HPV16-E7 required for binding and histone deacetylase recruitment to the MHC I promoter. Taken together, our data provide new insights into how high risk HPV16-E7 dysregulates MHC I for immune evasion.
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Affiliation(s)
- Corina Heller
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Immunology, Tuebingen, Germany
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The quality of life and health utility burden of recurrent respiratory papillomatosis in children. Otolaryngol Head Neck Surg 2010; 143:685-90. [DOI: 10.1016/j.otohns.2010.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 07/26/2010] [Accepted: 08/10/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE In this study we 1) measured the impact of juvenile-onset recurrent respiratory papillomatosis on health-related quality of life, voice-related quality of life, and family psychosocial well-being; and 2) compared these different measures, exploring their intercorrelation and their correlation with clinical disease severity. STUDY DESIGN Cross-sectional qualitative study. SETTING Tertiary academic pediatric hospital. SUBJECTS AND METHODS Twenty consecutive children with active juvenile-onset recurrent respiratory papillomatosis (JoRRP) were included. Standardized interviews were performed on parents and children with the use of four validated tools: the Health Utilities Index version 3; the Pediatric Voice-Related Quality of Life survey; the Impact on Family Scale; and a visual analogue health preference measure. Clinical disease severity and demographic data also were collected. RESULTS Subjects (13 male, 7 female) had a median age of 9.2 years, median age of JoRRP onset of 3.8 years, and averaged four procedures per year of disease. Mean health utility was 0.76 (95% confidence interval 0.68–0.84) on a scale of 0 (death) to 1 (perfect health). Marked impact on voice-related quality of life and family psychosocial health also was identified. Health burden correlated poorly with existing methods of severity scoring. CONCLUSION This is the first study to use validated measures of health utility, voice-related quality of life, and psychosocial impact. This information has public health implications, providing essential parameters for accurate modeling studies and cost-utility analysis of future interventions, including different human papilloma virus vaccination strategies.
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Bonagura VR, Hatam LJ, Rosenthal DW, de Voti JA, Lam F, Steinberg BM, Abramson AL. Recurrent respiratory papillomatosis: a complex defect in immune responsiveness to human papillomavirus-6 and -11. APMIS 2010; 118:455-70. [PMID: 20553528 DOI: 10.1111/j.1600-0463.2010.02617.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Recurrent respiratory papillomatosis (RRP) is a rare disease of the larynx caused by infection with human papillomaviruses (HPV) -6 or -11, associated with significant morbidity and on occasion mortality. Here we summarize our current understanding of the permissive adaptive and innate responses made by patients with RRP that support chronic HPV infection and prevent immune clearance of these viruses. Furthermore, we provide new evidence of T(H)2-like polarization in papillomas and blood of patients with RRP, restricted CD4 and CD8 Vbeta repertoires, the effect of HPV-11 early protein E6 on T-cell alloreactivity, enriched Langerhans cell presence in papillomas, and evidence that natural killer cells are dysfunctional in RRP. We review the immunogenetic mechanisms that regulate the dysfunctional responses made by patients with RRP in response to HPV infection of the upper airway. In addition, we are identifying T-cell epitopes on HPV-11 early proteins, in the context of human leukocyte antigen (HLA) class II alleles enriched in RRP that should help generate a therapeutic vaccine. Taken together, RRP is a complex, multigene disease manifesting as a tissue and HPV-specific, immune deficiency that prevents effective clearance and/or control of HPV-6 and -11 infection.
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Affiliation(s)
- Vincent R Bonagura
- Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY, USA.
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Peng S, Best SR, Hung CF, Loyo M, Lyford-Pike S, Flint PW, Tunkel DE, Saunders JR, Wu TC, Pai SI. Characterization of human papillomavirus type 11-specific immune responses in a preclinical model. Laryngoscope 2010; 120:504-10. [PMID: 20025042 DOI: 10.1002/lary.20745] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Human papillomavirus (HPV) types 6 and 11 are associated with recurrent respiratory papillomatosis (RRP). Although a prophylactic vaccine has been developed that protects against HPV infection, a therapeutic vaccine is still needed for those patients infected with and/or suffering from persistent disease. Therefore, we developed a novel, therapeutic DNA vaccine targeting HPV-11 and characterized the in vivo immunologic responses generated against HPV-11 E6 and E7 after DNA vaccination in a preclinical model. METHODS We generated a DNA vaccine that encodes the HPV-11 E6 and E7 genes in a pcDNA3 backbone plasmid. We then vaccinated C57BL/6 mice with the pcDNA3-HPV11-E6E7 DNA plasmid. Splenocytes were harvested from these vaccinated animals and were incubated with overlapping peptides spanning either the HPV-11 E6 or E7 protein. The frequency of interferon-gamma-releasing CD8(+) T cell responses was then analyzed by flow cytometry. RESULTS Vaccinated mice with the HPV11-E6E7 DNA generated strong CD8(+) T cell responses against the E6(aa44-51) peptide. We determined that the epitope is presented by the MHC class I H2-K(b) molecule. No significant E7 peptide-specific T cell responses were observed. CONCLUSIONS We developed a novel DNA vaccine that targets the E6 gene of HPV-11. Characterization of the immunologic responses elicited by this DNA vaccine reveals that the E6(aa44-51) peptide contains the most immunogenic region for the HPV-11 viral type. Knowledge of this specific T cell epitope and generation of a RRP preclinical model will allow for the development and evaluation of novel vaccine strategies targeting the RRP patient population.
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Affiliation(s)
- Shiwen Peng
- Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland 21287, USA
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Bonagura VR, Du Z, Ashouri E, Luo L, Hatam LJ, DeVoti JA, Rosenthal DW, Steinberg BM, Abramson AL, Gjertson DW, Reed EF, Rajalingam R. Activating killer cell immunoglobulin-like receptors 3DS1 and 2DS1 protect against developing the severe form of recurrent respiratory papillomatosis. Hum Immunol 2009; 71:212-9. [PMID: 19861144 DOI: 10.1016/j.humimm.2009.10.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 09/21/2009] [Accepted: 09/21/2009] [Indexed: 10/20/2022]
Abstract
The polymorphic killer cell immunoglobulin-like receptors (KIR) control natural killer (NK) cell response against viral infection and tumor transformation. Here we investigated if select KIR genes are associated with recurrent respiratory papillomatosis (RRP), a rare disease of the larynx and upper airway caused by human papillomaviruses (HPV)-6/11. DNA from 66 RRP patients and 195 healthy controls were characterized for KIR and HLA gene polymorphism. Patients lacking activating KIR genes 3DS1 and 2DS1 were more common in severe RRP compared with mild-moderate RRP (78.8% vs 48.5%, p = 0.019). Further, patients carrying any of the known susceptible HLA-DRB1/DQB1 alleles were more frequently negative for KIR3DS1 (p = 0.006), KIR2DS1 (p = 0.003) or KIR2DS5 (p = 0.004) compared with controls carrying any of these HLA allotypes. Nearly 80% of the patients with severe disease were missing the protective HLA-DQB1*0602 allele as well as both KIR3DS1 and KIR2DS1 genes. Phenotyping of papilloma-infiltrating mononuclear-cells revealed an elevated numbers of NK cells and CD57(+)CD4(+) T cells in KIR3DS1(-)KIR2DS1(-) patients compared with patients carrying either one or both of these KIRs. Our data suggest that NK cells expressing activating receptors KIR3DS1 and KIR2DS1 may be necessary to trigger an effective early immune response against HPV-infected targets to establish resistance to RRP development.
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Affiliation(s)
- Vincent R Bonagura
- Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030, USA.
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Abstract
Papillomas are rare tumors that originate from the mucosa. They may appear in the nose, paranasal sinuses, oral cavity, larynx, trachea, or the skin. Papillomas are mainly asymptomatic and are therefore mostly diagnosed coincidentally. In contrast, laryngeal papillomatosis may cause stridor, dyspnoea, and hoarseness. A viral cause of the disease seems likely, especially human papilloma virus. Mechanical irritation is also a possible reason when the nose, oral cavity, or oropharynx is affected. All papillomas, independent of their origin, may recur, and have the possibility of malignant degeneration in common. The therapy of choice is complete surgical excision. Regarding laryngeal papillomatosis, laser vaporisation or excision using the CO(2)laser is recommended. Because retreatments using conventional modalities are frequently necessary, especially in the case of laryngeal papillomatosis, adjuvant therapies are applied with the aim of reducing the recurrence rate and prolonging the interval between treatments.
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Nair A, Salman S, Cantor J, Marik P. A 56-year-old man with multiple airway procedures with fever, cough, and dyspnea. Chest 2009; 134:1332-1335. [PMID: 19059965 DOI: 10.1378/chest.07-2447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Abhilash Nair
- Department of Pulmonary and Critical Care, Thomas Jefferson University Hospital, Philadelphia, PA.
| | - Salam Salman
- Department of Pulmonary and Critical Care, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Joshua Cantor
- Department of Pulmonary and Critical Care, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Paul Marik
- Department of Pulmonary and Critical Care, Thomas Jefferson University Hospital, Philadelphia, PA
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DeVoti JA, Rosenthal DW, Wu R, Abramson AL, Steinberg BM, Bonagura VR. Immune dysregulation and tumor-associated gene changes in recurrent respiratory papillomatosis: a paired microarray analysis. Mol Med 2008; 14:608-17. [PMID: 18607510 DOI: 10.2119/2008-00060.devoti] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 06/30/2008] [Indexed: 12/31/2022] Open
Abstract
Recurrent respiratory papillomas (RRP) are benign airway tumors, caused primarily by human papillomaviruses (HPV) types 6 and 11. The disease is characterized by multiple recurrences after surgical removal, with limited effective therapy. To identify novel targets for future therapy, we established transcriptional profiles for actively growing papillomas compared with autologous, clinically normal, laryngeal epithelia (adjacent tissue). Total ribonucleic acid (RNA) from 12 papillomas and 12 adjacent tissues were analyzed by microarray, and the matched sets of tissues compared by paired t test, to identify differentially expressed genes in papilloma tissues while minimizing variations intrinsic to individual patients. Quantitative polymerase chain reaction (PCR) was used to confirm the relative expression levels for a subset of genes. Within the 109 differentially expressed transcripts whose expression varied at least three-fold were two large groups of genes with related functions. The first group consisted of 18 genes related to host defense, including both innate and adaptive immunity. The second group contained 37 genes that likely contribute to growth of papillomas as benign tumors, since the altered pattern of expression also had been reported previously in many cancers. Our results support our previous studies that document a systemic T(H)2-like adaptive immune response in RRP, and suggest that there is a role for altered innate immunity in RRP as well. We propose that HPV 6 and 11 infection establishes a tumorigenic microenvironment characterized by alteration of both innate inflammatory signals and adaptive immune responses that prevent effective T(H)1-like response, in conjunction with altered expression of numerous genes that regulate cellular growth and differentiation.
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Affiliation(s)
- James A DeVoti
- Feinstein Institute for Medical Research, Manhasset, New York, USA
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Madkan VK, Cook-Norris RH, Steadman MC, Arora A, Mendoza N, Tyring SK. The oncogenic potential of human papillomaviruses: a review on the role of host genetics and environmental cofactors. Br J Dermatol 2007; 157:228-41. [PMID: 17553059 DOI: 10.1111/j.1365-2133.2007.07961.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Human papillomaviruses (HPVs), with over 100 genotypes, are a very complex group of human pathogenic viruses. In most cases, HPV infection results in benign epithelial proliferations (verrucae). However, oncogenic types of HPV may induce malignant transformation in the presence of cofactors. For example, over 99% of all cervical cancers and a majority of vulval, vaginal, anal and penile cancers are the result of oncogenic HPV types. Such HPV types have been increasingly linked to other epithelial cancers involving the skin, larynx and oesophagus. Although viral infection is necessary for neoplastic transformation, evidence suggests that host and environmental cofactors are also required. Research investigating HPV oncogenesis is complex and quite extensive. The inability to produce mature HPV virions in animal models has been a major limitation in fully elucidating the oncogenic potential and role of associated cofactors in promoting malignant transformation in HPV-infected cells. We have reviewed the literature and provide a brief account of the current understanding of HPV oncogenesis, emphasizing the role of genetic susceptibility, immune response, and environmental and infectious cofactors.
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Affiliation(s)
- V K Madkan
- Center for Clinical Studies, Studies & Department of Dermatology, University of Texas Health Sciences Center, Houston, TX, USA.
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Comar M, Fabris A, Vatta S, Pelos G, Zocconi E, Campello C. HPV genotyping and HLA II analysis in a pedigree study of pediatric RRP: preliminary results. Int J Pediatr Otorhinolaryngol 2006; 70:1935-9. [PMID: 16920199 DOI: 10.1016/j.ijporl.2006.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Revised: 07/06/2006] [Accepted: 07/08/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This preliminary pedigree study aims at the evaluation of HPV infection and HLA class II alleles as predictive markers in pediatric RRP. METHODS We investigated for HPV genotyping and HLA class II polymorphisms all the components of family nucleus where we detected a child born to an HPV infected mother and suffering from RRP. RESULTS HPV 11 was detected both in the laryngeal biopsies of two of the three affected babies and in the cervical smear of their mothers. The third child was positive for HPV 6 while his mother harboured a double HPV 6-16 infection. In one family, the HLA-DQB1*0501 allele exerted its protective role. The HLA-DQB1*0301 allele, commonly associated to a high grade of cervical neoplasia and HPV infection, was present in homozygous in one mother and her child. The same allele was found, though in a heterozygous form, in the third patient too. CONCLUSION Our report is the first attempt to use the pedigree study for the evaluation of HLA class II alleles and HPV infection related to pediatric RRP. This approach could identify genetic markers that may influence disease predisposition and the severity of HPV infection.
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Affiliation(s)
- M Comar
- Department of Public Medicine Sciences, UCO Hygiene and Preventive Medicine, University of Trieste and IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34100 Trieste, Italy.
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Sisk J, Schweinfurth JM, Wang XT, Chong K. Presence of Human Papillomavirus DNA in Tonsillectomy Specimens. Laryngoscope 2006; 116:1372-4. [PMID: 16885738 DOI: 10.1097/01.mlg.0000225973.21736.bc] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this prospective case-control study were to study the prevalence of human papillomavirus (HPV) in tonsillectomy specimens from pediatric patients without recurrent respiratory papillomatosis (RRP), and to study methods of HPV detection. METHODS Fifty pediatric patients without known RRP undergoing tonsillectomy for hypertrophy or recurrent tonsillitis were enrolled in the study. After tonsillectomy, a 20-mg section was subjected to DNA extraction, and DNA content and purity were confirmed with spectrophotometry. Polymerase chain reaction (PCR) was performed using consensus primer pools PGMY 09/11 targeted at the L1 region. Amplification products were detected and analyzed with standard agarose gel electrophoresis. Positive samples were then subjected to reverse line blot assay to determine virus genotype. Laryngeal papilloma specimens of 15 patients obtained during routine debulking procedures were also analyzed and served as positive controls. RESULTS Of 50 tonsil samples tested, two were positive for HPV DNA after PCR and gel electrophoresis. One of these samples was confirmed with typing and tested positive for HPV 11. All 15 papilloma specimens were positive for DNA of HPV types 6 and/or 11. CONCLUSIONS In the current study, the prevalence of HPV DNA in tonsillar tissue of patients without RRP is 2%, whereas the incidence of this disease is 2 to 4 cases per 100,000 (0.004%). These findings are significantly different (P = .005 within a 95% confidence interval) suggesting that host factors in addition to infection play a role in pathogenesis of RRP. The molecular methods described in this study are well suited for detection of HPV in tonsillar tissue.
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Affiliation(s)
- Jamie Sisk
- Department of Otolaryngology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
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Koskinen WJ, Partanen J, Vaheri A, Aaltonen LM. HLA-DRB1, -DQB1 alleles in head and neck carcinoma patients. ACTA ACUST UNITED AC 2006; 67:237-40. [PMID: 16573562 DOI: 10.1111/j.1399-0039.2006.00558.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Certain HLA class II alleles have been reported to play a role in development or prevention of cervical carcinoma, an epithelial malignancy linked to human papillomavirus (HPV). In head and neck carcinomas, of which a subset is also HPV associated, the impact of HLA genes remains unknown. HLA-DRB1, -DQB1 alleles were determined in a comprehensive series of 162 head and neck carcinoma patients, for which 83 consecutive cadaveric organ donors of Finnish origin served as controls. DRB1*03 was associated with node-negative disease and DRB1*08 and 13 with small tumors; DRB1*04 was protective against disease relapse. Most alleles of borderline significance in this study act similarly in cervical carcinomas.
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Affiliation(s)
- W J Koskinen
- Department of Virology, Haartman Institute, University of Helsinki, Finland.
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Andrus JG, Shapshay SM. Contemporary Management of Laryngeal Papilloma in Adults and Children. Otolaryngol Clin North Am 2006; 39:135-58. [PMID: 16469660 DOI: 10.1016/j.otc.2005.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jennifer G Andrus
- Department of Otolaryngology - Head & Neck Surgery, Boston Medical Center, 88 East Newton Street, Suite D-610, Boston, MA 02118, USA.
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Korin YD, Lee C, Gjertson DW, Wilkinson AH, Pham TP, Danovitch GM, Gritsch HA, Reed EF. A novel flow assay for the detection of cytokine secreting alloreactive T cells: application to immune monitoring. Hum Immunol 2006; 66:1110-24. [PMID: 16571412 DOI: 10.1016/j.humimm.2005.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2005] [Accepted: 10/13/2005] [Indexed: 11/26/2022]
Abstract
The direct and indirect allorecognition pathways play an important role in graft rejection. We hypothesized that the presence of alloreactive memory T cells in the recipient's circulation increases the risk of rejection after transplantation. The objective of this study was to develop a noninvasive, immune monitoring tool that simultaneously measures donor-specific responses via both the direct and indirect recognition pathways. Our laboratory developed a whole blood flow cytometric cytokine secretion assay to identify interferon (IFN)-gamma secreting memory T cells in whole blood of renal transplant patients. The assay readily detected IFN-gamma producing CD3+ T cells in response to recall antigens tetanus toxoid, purified protein derivative, and alloantigens in whole blood from healthy controls. Analysis of sequential posttransplant blood samples from 19 renal allograft recipients showed that alloimmune responses were higher in transplant recipients who had undergone acute rejection than in those without acute rejection episodes. In addition, patients showing increased creatinine levels 3 months after transplantation were more likely to exhibit alloimmune responses than recipients with stable graft function. The flow cytokine secretion assay provides a reliable and simple method for identification of patients at risk of acute rejection and early graft dysfunction.
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Affiliation(s)
- Yael D Korin
- UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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Khanna D, Wu H, Park G, Gersuk V, Gold RH, Nepom GT, Wong WK, Sharp JT, Reed EF, Paulus HE, Tsao BP. Association of tumor necrosis factor α polymorphism, but not the shared epitope, with increased radiographic progression in a seropositive rheumatoid arthritis inception cohort. ACTA ACUST UNITED AC 2006; 54:1105-16. [PMID: 16572445 DOI: 10.1002/art.21750] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine whether the tumor necrosis factor alpha (TNFA) -308 guanine-to-adenosine polymorphism and/or the shared epitope (SE) is associated with radiographic damage in patients with early rheumatoid arthritis (RA). METHODS The cohort consisted of 189 patients with early seropositive RA (median 5.6 months since symptom onset) who had active disease, no previous disease-modifying antirheumatic drug treatment, and >or=2 sets of scored radiographs of the hands/wrists and forefeet. TNFA -308 polymorphism was analyzed by polymerase chain reaction pyrosequencing. The SE was defined as presence of any 1 of the following HLA-DRB1 alleles: *0101, *0102, *0401, *0404, *0405, *0408, *0410, *1001, *1402, or *1406. Radiographic progression was assessed by the total Sharp score. RESULTS Using a weighted least-squares regression analysis, patients with the -308 TNFA AA plus AG genotypes (n=49) had significantly higher rates of progression in erosion scores (median 0.84 versus 0.48 units/year), joint space narrowing (JSN) scores (0.42 versus 0.04), and total Sharp scores (1.70 versus 0.61) compared with patients with the TNFA GG genotype (n=140). Presence of the SE (n=137) was associated with significantly lower progression rates (per year) for total Sharp scores (median 0.9 versus 1.25 units/year) and JSN scores (0.04 versus 0.41), but not for erosion scores (0.50 versus 0.61) compared with patients without the SE (n=52). In a least-squares multiple linear regression model, the presence of the AA plus AG genotypes was associated with a significantly higher progression rate after adjusting for the presence of the SE, interaction between the SE and the AA plus AG genotypes, baseline log C-reactive protein level, Health Assessment Questionnaire Disability Index, total Sharp score, swollen joint count, and presence of osteophytes (osteoarthritis). There was a strong linkage disequilibrium between DRB1*0301 and TNFA polymorphism (D'=0.84, r2=0.45, P<0.001). CONCLUSION This study showed an association between the TNFA -308 polymorphism and progression of radiographic damage in patients with early seropositive RA. This association appeared to be independent of the SE, but might be dependent on other genetic variants in linkage disequilibrium with the -308 TNFA A allele and DRB1*0301. Further studies should be conducted to validate these results in both longitudinal observational cohorts and randomized clinical trials.
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Affiliation(s)
- Dinesh Khanna
- David Geffen School of Medicine at the University of California, Los Angeles, and the Veterans Affairs Medical Center, Cincinnati, Ohio 45267-0563, USA.
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Abstract
PURPOSE OF REVIEW Recurrent respiratory papillomatosis remains a serious disease and is commonly treated by otolaryngologists. The goals of this review are to update physicians on current understandings regarding viral pathogenesis, patient risks, and current trends in treatment strategies. RECENT FINDINGS Surgical debulking still remains the foundation of treatment; however, newer surgical approaches utilizing microdebriders are replacing laser ablation. Genetic studies have identified individuals with specific immune cell alleles to be at greater risk for persistent infection. Our understanding of the viral pathogenesis has increased by the identification of a viral mechanism to downregulate antigen expression in cells infected with human papillomavirus, thus possibly allowing decreased immune detection. Although the viral types responsible for recurrent respiratory papillomatosis have been identified, the mechanism by which they alter cellular growth has not been identified. Research studies investigating adjuvant medical therapies aimed at reducing required surgical therapy intervals and possibly helping cure the infection are being completed. A safe, effective adjuvant therapy is still currently not available. SUMMARY Improved surgical approaches have slightly enhanced patient care; however, more research is needed to understand how human papillomavirus causes disease so that these therapies can be developed.
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Affiliation(s)
- John H Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Szeps M, Dahlgren L, Aaltonen LM, Öhd J, Kanter-Lewenshon L, Dahlstrand H, Munck-Wikland E, Grandér D, Dalianis T. Human papillomavirus, viral load and proliferation rate in recurrent respiratory papillomatosis in response to alpha interferon treatment. J Gen Virol 2005; 86:1695-1702. [PMID: 15914847 DOI: 10.1099/vir.0.80849-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The aim of this study was to identify recurrent respiratory papillomatosis patients who may benefit from interferon (IFN)-alpha treatment and to determine the means of IFN-alpha action. The presence of human papillomavirus (HPV) and viral load and proliferation rate in pre-, ongoing and post-treatment respiratory papillomatosis biopsies were examined retrospectively in 25 patients, 18 of whom were IFN-alpha treated and seven of whom were IFN-alpha non-treated. Using PCR, HPV was found to be present in 20/25 respiratory papillomatosis patients and HPV type was determined for 18/25 patients (12 HPV6 and six HPV11). Eighteen of the patients were treated with IFN-alpha, 14 of whom were HPV positive (eight HPV6, five HPV11 and one undefined HPV). Response to IFN-alpha therapy was observed in 12 patients (7/8 HPV6, 3/5 HPV11, 1/1 undefined HPV and 1/4 HPV negative), while six patients (1/8 HPV6, 2/5 HPV11 and 3/4 HPV negative) did not respond to therapy. Viral load, determined by quantitative real-time PCR (between 0.03 and 533 HPV copies per cell), and proliferation rate, determined as the percentage of Ki-67-positive cells (between 8 and 54 %), were similar in IFN-alpha-treated and non-treated patients and were generally unaffected by IFN-alpha treatment. In summary, most (12/18) IFN-alpha-treated patients responded to therapy. Moreover, there was a tendency for patients with HPV6-positive (7/8) respiratory papillomatosis to respond more frequently to IFN-alpha therapy than patients with HPV11 (3/5) or HPV-negative (1/4) respiratory papillomatosis. Finally, the presence of HPV and viral load and proliferation in respiratory papillomatosis biopsies was similar in patients treated or not with IFN-alpha and were in general unaffected by IFN-alpha treatment.
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Affiliation(s)
- Michael Szeps
- Department of Oncology-Pathology, CancerCenterKarolinska, R8 : 01, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Liselotte Dahlgren
- Department of Oncology-Pathology, CancerCenterKarolinska, R8 : 01, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Leena-Maija Aaltonen
- Department of Oto-Rhino-Laryngology, Helsinki University Hospital, Helsinki, Finland
| | - John Öhd
- Department of Oncology-Pathology, CancerCenterKarolinska, R8 : 01, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Lena Kanter-Lewenshon
- Department of Oncology-Pathology, CancerCenterKarolinska, R8 : 01, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Hanna Dahlstrand
- Department of Oncology-Pathology, CancerCenterKarolinska, R8 : 01, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Eva Munck-Wikland
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, CancerCenterKarolinska, R8 : 01, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Dan Grandér
- Department of Oncology-Pathology, CancerCenterKarolinska, R8 : 01, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology-Pathology, CancerCenterKarolinska, R8 : 01, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden
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