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Lepine C, Leboulanger N, Badoual C. Juvenile onset recurrent respiratory papillomatosis: What do we know in 2024 ? Tumour Virus Res 2024; 17:200281. [PMID: 38685530 PMCID: PMC11088349 DOI: 10.1016/j.tvr.2024.200281] [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: 02/29/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
Juvenile onset recurrent respiratory papillomatosis is a lifelong benign squamous lesion associated with HPV infection, particularly HPV6 and HPV11 genotypes. These lesions are rare, but can lead to laryngeal obturations, which can cause disabling dyspnea, or transform into squamous cell carcinoma. The aim here is to provide an epidemiological, biological and clinical overview of this pathology, particularly in children, in order to understand the issues at stake in terms of research and the development of medical and therapeutic management tools.
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Affiliation(s)
- Charles Lepine
- Pathology Department, CHU de Nantes, F-44000 Nantes, France; Nantes University, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Nicolas Leboulanger
- Otolaryngology - Head and Necker Surgery Department, Necker Enfants Malades University Hospital, 149 Rue de Sèvres 75015 Paris, France; Université Paris Cité, France
| | - Cécile Badoual
- Université Paris Cité, France; Pathology Department, European George Pompidou Hospital, APHP, 20 Rue Leblanc 75015 Paris, France.
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2
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Pu J, Zeng Z, Liu X, Zhong Y, Peng X. The clinical characteristics of 1894 cases of upper respiratory papillomatosis: A single-center retrospective analysis. Am J Otolaryngol 2024; 45:104373. [PMID: 38838480 DOI: 10.1016/j.amjoto.2024.104373] [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: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND With advancements in medicine and economy, it would be expected that there will be changes in the clinical characteristics of upper respiratory papillomatosis. The aim of this study was to examine the current clinical characteristics of upper respiratory papillomatosis, as there are no recent data in the literature. METHODS The medical records of 1894 patients with upper respiratory papillomatosis were retrospectively reviewed. Data extracted included clinical features, laryngoscopy images, and surgical procedure data. RESULTS The upper frequency of upper respiratory papillomatosis in the oropharynx was 69.1 %, and in the larynx was held 28.9 %. The overall postoperative relapse rate was 2.4 %. The relapse rate of laryngeal papillomatosis was 6.5 %. Approximately 2.6 % of cases were in children. All postoperative recurrences in children were laryngeal, and the recurrence rate was 30.4 %. CONCLUSION The oropharynx has the highest frequency of upper respiratory papillomatosis. The larynx, however, has the highest rate of postoperative recurrence. Compared to adults, children are more likely to experience a postoperative recurrence.
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Affiliation(s)
- Jiahui Pu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Zichun Zeng
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Xiong Liu
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Yanlan Zhong
- The Department of Rheumatology, Guangzhou Women and Children's Medical Centre, Guangzhou, 510623, Guangdong, China.
| | - Xiaohong Peng
- Department of Otolaryngology-Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China.
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Chen L, Hu H, Pan Y, Lu Y, Zhao M, Zhao Y, Wang L, Liu K, Yu Z. The role of HPV11 E7 in modulating STING-dependent interferon β response in recurrent respiratory papillomatosis. J Virol 2024; 98:e0192523. [PMID: 38624230 PMCID: PMC11092327 DOI: 10.1128/jvi.01925-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is a rare benign tumor caused mainly by the infection of the respiratory tract epithelial cells by the human papillomavirus (HPV) type 6/11. However, the specific mechanisms underlying the inhibition of the host's innate immune response by HPV remain unclear. For this purpose, we employed single-cell RNA sequencing to analyze the states of various immune cells in RRP samples post-HPV infection and utilized a cellular model of HPV infection to elucidate the mechanisms by which HPV evades the innate immune system in RRP. The results revealed distinct immune cell heterogeneity in RRP and demonstrated that HPV11 E7 can inhibit the phosphorylation of the stimulator of interferon genes protein, thereby circumventing the body's antiviral response. In vitro co-culture experiments demonstrated that stimulation of macrophages to produce interferon-beta induced the death of HPV-infected epithelial cells, also reducing HPV viral levels. In summary, our study preliminarily identifies the potential mechanisms by which HPV evades the host's antiviral immune response, as well as the latent antiviral functions exhibited by activated macrophages. This research serves as an initial exploration of antiviral immune evasion in RRP, laying a solid foundation for investigating immunotherapeutic approaches for the disease.IMPORTANCESurgical tumor reduction is the most common treatment for recurrent respiratory papillomatosis (RRP). One of the characteristics of RRP is its persistent recurrence, and multiple surgeries are usually required to control the symptoms. Recently, some adjuvant therapies have shown effectiveness, but none of them can completely clear human papillomavirus (HPV) infection, and thus, a localized antiviral immune response is significant for disease control; after all, HPV infection is limited to the epithelium. Inhibition of interferon-beta (IFN-β) secretion by HPV11 E7 viral proteins in epithelial cells by affecting stimulator of interferon genes phosphorylation may account for the persistence of low-risk HPV replication in the RRP. Moreover, suppression of the IFN-I pathway in RRP cell types might provide clues regarding the hyporeactive function of local immune cells. However, activation of macrophage groups to produce IFN-β can still destroy HPV-infected cells.
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Affiliation(s)
- Lijuan Chen
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Huiying Hu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Yufei Pan
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Yuanyuan Lu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Mengyuan Zhao
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Yun Zhao
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Lixin Wang
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Kai Liu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
| | - Zhenkun Yu
- Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Medical Key Laboratory of Laryngopharynx-Head and Neck Oncology, Nanjing, Jiangsu, China
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Lian D, Tang Q, Wu L, Liao X. Using targeted second-generation sequencing technique to guide clinical diagnosis and the effect of medication on the therapeutic effect and prognosis of respiratory tract infection in children: An observational study. Medicine (Baltimore) 2024; 103:e37757. [PMID: 38701307 PMCID: PMC11062728 DOI: 10.1097/md.0000000000037757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/08/2024] [Indexed: 05/05/2024] Open
Abstract
To explore the effect of targeted second-generation sequencing technique to guide clinical diagnosis and medication on the therapeutic effect and prognosis of respiratory tract infection (RTI) in children. During January 2021 to June 2022, 320 children with RTI cured were selected in our hospital as the object of this retrospective study. The control group accepted empirical broad-spectrum antibacterial therapy and the observation group accepted targeted second-generation sequencing technique to guide diagnosis and medication. The therapeutic effect, improvement time of clinical symptom index, laboratory-related index, level of inflammatory factors, incidence of complications, and parents' treatment satisfaction were compared. The observation group was considerably more efficacious (91.25%) versus the controlled group (72.50%). The duration of enhancement of fever, nasal congestion, tonsillar congestion, and cough symptoms was shorter in the observation group (P < .05). Serum levels of iron, IgA, IgG as well as IgM were substantially elevated in the observation group. The levels of IL-4 and IL-10 were markedly reduced in the observation group after treatment. The prevalence of complications was considerably below that of the comparison group (21.25%) in the observation group (8.75%). Parental satisfaction with therapy was markedly higher in the observation group (92.50%) than in the control group (66.25%). The application of targeted second-generation sequencing technology to guide clinical diagnosis and drug use can elevate the RTIs efficacy and prognosis in childhood. Targeted second-generation sequencing can achieve precise treatment, reduce drug resistance of drug-resistant strains, and improve the efficacy. It has high promotion and application value.
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Affiliation(s)
- Di Lian
- Respiratory Ward, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350005, Fujian, China
| | - Qiuyu Tang
- Respiratory Ward, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350005, Fujian, China
| | - Ling Wu
- Infection Diseases Ward, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350005, Fujian, China
| | - Xing Liao
- Infection Diseases Ward, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350005, Fujian, China
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5
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Erickson EL, Freeman TE, Sun S, Koch B, Allen DZ, Sethia R, deSilva B, Matrka L. Recurrent respiratory papillomatosis disease course in immunosuppressed populations. J Laryngol Otol 2024; 138:576-580. [PMID: 37877153 DOI: 10.1017/s0022215123001470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Recurrent respiratory papillomatosis is a benign manifestation of human papillomavirus types 6 and 11 in the respiratory tract. Disease is recurrent, and factors predicting these recurrences and severity of disease are incompletely characterised. This retrospective cohort study examined the relationship of immunosuppression with recurrent respiratory papillomatosis morbidity. METHODS A retrospective cohort of 97 adult patients with recurrent respiratory papillomatosis treated at a tertiary referral centre from 2005 to 2020 was conducted. Measures assessed included inter-surgical interval, Voice Handicap Index ('VHI-10') and anatomical Derkay scores. RESULTS Bivariate analyses comparing average inter-surgical interval, Voice Handicap Index and Derkay scores in immunosuppressed and healthy patients were insignificant. When controlling for diabetes mellitus and comparing immunosuppressed to healthy patients, inter-surgical interval and Voice Handicap Index change were insignificant (p = 0.458 and p = 0.465, respectively). CONCLUSION Recurrent respiratory papillomatosis morbidity for immunosuppressed patients did not significantly differ from that of immunocompetent patients.
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Affiliation(s)
| | | | - Shuai Sun
- Ohio State University Department of Public Health, Columbus, OH, USA
| | - Brandon Koch
- Ohio State University Department of Public Health, Columbus, OH, USA
| | - David Z Allen
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rishabh Sethia
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brad deSilva
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura Matrka
- Ohio State University Wexner Medical Center, Columbus, OH, USA
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Qu X, Xiao Y, Ma L, Wang J. Distribution Characteristics of Juvenile-Onset Recurrent Respiratory Papillomatosis at First-Time Surgery. EAR, NOSE & THROAT JOURNAL 2024; 103:NP289-NP293. [PMID: 34702097 DOI: 10.1177/01455613211049845] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The lesion distribution of juvenile-onset recurrent respiratory papillomatosis (JORRP) during first-time surgery has been rarely reported. The purpose of this study was to describe the anatomical distribution of papilloma across 25 Derkay sites during initial surgery and to assess the impact of the lesion distribution on disease severity. METHODS Surgical videos and medical records of 106 patients with JORRP (27 aggressive and 79 nonaggressive cases) were retrospectively reviewed. Lesion locations were recorded using Derkay anatomical sites. Logistic regression was used to analyze the effect of the lesion distribution on disease severity. RESULTS Among the 106 patients, the true vocal cords (90.6% left, 84.0% right) were the most frequently involved site, followed by the false vocal cords (39.6% left, 35.8% right) and the anterior commissure (26.4%). Two patients (1.9%) had tracheal involvement. Patients with false vocal cord involvement (odds ratio [OR] = 3.425, 95% confidence interval [CI] [1.285, 9.132], P = .014) and a younger age at diagnosis (OR = .698, 95% CI [.539, .905], P = .007) were more likely to require more than 4 procedures in the year following first-time surgery. CONCLUSIONS Lesions were most common on the true vocal cords. False vocal cord involvement and a younger age at diagnosis were risk factors for disease severity.
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Affiliation(s)
- Xiaoli Qu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Xiao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lijing Ma
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jun Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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So RJ, Hidalgo Lopez JC, Ballestas SA, Klein AM, Steuer C, Shin DM, Abousaud M, Teng Y, Saba NF, Tkaczuk AT, Schaefer ES, Seiwert TY, McClellan K, Best SR. Efficacy of Systemic Bevacizumab for Recurrent Respiratory Papillomatosis with Pulmonary Involvement. Laryngoscope 2024; 134:577-581. [PMID: 37470254 DOI: 10.1002/lary.30893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES Pulmonary papillomatosis is a rare but severe manifestation of recurrent respiratory papillomatosis (RRP). Efficacy data of systemic bevacizumab for pulmonary RRP are limited. This study's objective was to characterize disease response of pulmonary RRP to systemic bevacizumab. METHODS A retrospective review was performed to identify patients with pulmonary RRP seen at three medical institutions. Clinical symptoms, CT findings, and disease response were compared before and after initiation of systemic bevacizumab therapy. Disease response was categorized as complete response, partial response, stabilization, or progression for each subsite involved by papilloma. RESULTS Of the 12 pulmonary RRP patients treated with systemic bevacizumab, 4 (33.3%) were male, and 11 (91.7%) were juvenile-onset RRP patients. All presented with laryngeal, tracheal, and pulmonary RRP. The median (range) age at first bevacizumab infusion was 48.1 (19.5-70.2) years. Progression to pulmonary malignancy was identified in 3 (25.0%) patients, 2 before initiation of and 1 after complete cessation of bevacizumab therapy. Clinical symptoms such as dyspnea (75.0% vs. 25.0%; p = 0.01) and dysphagia and/or odynophagia (33.3 vs. 0.0%; p = 0.03) were significantly decreased following bevacizumab therapy. Compared with pre-treatment baseline, 9 (75.0%) patients experienced a stable-to-partial response in the lungs to systemic bevacizumab, and 10 (83.3%) experienced partial-to-complete responses in the larynx and trachea. CONCLUSION Systemic bevacizumab is effective in stabilizing progression in even the most severe cases of RRP, with both a dramatic reduction in laryngeal and tracheal disease as well as a stable-to-partial response of pulmonary involvement in a majority of patients. LEVEL OF EVIDENCE 4 Laryngoscope, 134:577-581, 2024.
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Affiliation(s)
- Raymond J So
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Julio C Hidalgo Lopez
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Samir A Ballestas
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Adam M Klein
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Conor Steuer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, U.S.A
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, U.S.A
| | - Marin Abousaud
- Department of Pharmaceutical Sciences, Emory University, Atlanta, Georgia, U.S.A
| | - Yong Teng
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, U.S.A
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, U.S.A
| | - Andrew T Tkaczuk
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, U.S.A
| | | | - Tanguy Y Seiwert
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Kim McClellan
- Recurrent Respiratory Papillomatosis Foundation, Lawrenceville, New Jersey, U.S.A
| | - Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Boland JM. What's new in benign lung tumours? Histopathology 2024; 84:124-135. [PMID: 37691383 DOI: 10.1111/his.15037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Abstract
While lung cancer is one of the most common malignancies routinely encountered by pathologists, benign pulmonary neoplasms are quite rare. However, it is important for pathologists to be familiar with the typical diagnostic features of benign lung tumors to avoid confusing them with malignant morphological mimics. There have also been intriguing discoveries in the genetics of benign pulmonary neoplasms in the past decade. This review will cover several of the most common benign lung tumors, including the diagnostic categories of pulmonary adenomas, bronchial papillomas, and benign mesenchymal tumors, with discussion of the current classification, differential diagnosis, and current knowledge regarding genetic drivers.
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Schindele A, Al-Sabtti S, Olofsson K. Human papilloma virus (HPV) vaccination is associated with reduced number of surgical treatments, an observational study on recurrent respiratory papillomatosis in Northern Sweden. Acta Otolaryngol 2024; 144:71-75. [PMID: 38484282 DOI: 10.1080/00016489.2024.2316264] [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: 11/21/2023] [Accepted: 02/05/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Recurrent respiratory papillomatosis (RRP) is a wart-like lesion mainly affecting the larynx, caused by human papillomavirus (HPV) genotypes 6 and 11. The disease affects both children and adults, and there is no cure. Surgery is the current symptom-relieving treatment; however, HPV vaccination is used as an adjuvant treatment. AIMS AND OBJECTIVES The aims were to study effects of HPV vaccination in RRP cases and to compare juvenile-onset to adult-onset disease and high treatment frequency (TF) to low TF cases. MATERIAL AND METHODS Medical records of RRP patients were studied from May 2006 to January 2023. Eighty-five RRP cases, tested for HPV genotypes with PapilloCheck®, were included. Vaccination- onset- and treatment analysis were performed. RESULTS Twelve percent of the cases were vaccinated. The number of surgeries decreased from 2.0 to 0.8/year after HPV vaccination. Most cases had an adult-onset and less than one treatment per year. Juvenile-onset cases had a higher vaccination treatment ratio compared to adult-onset. CONCLUSIONS HPV vaccination was associated with a lower number of treatments per year, supporting the use of vaccination as an adjuvant treatment. SIGNIFICANCE Vaccination as adjuvant treatment to surgery may lead to increased quality of life for RRP patients and saved healthcare resources.
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Affiliation(s)
- Alexandra Schindele
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Östersund, Sweden
| | - Semma Al-Sabtti
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Katarina Olofsson
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden
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Freeman T, Erickson E, Koch B, Young T, Allen D, Kim B, deSilva B, Matrka L. Smoking and Carcinoma Trends in Recurrent Respiratory Papillomatosis Patients. Ann Otol Rhinol Laryngol 2023; 132:1380-1385. [PMID: 36879422 DOI: 10.1177/00034894231158459] [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] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Recurrent respiratory papillomatosis (RRP) is a chronic disease of the upper respiratory tract caused by human papillomavirus types 6 and 11. The disease course is characteristically unpredictable, ranging from spontaneous remission to aggressive, recurrent disease. Thus, management is often challenging and requires unique approaches tailored to each individual patient. While recent literature has described risk factors for more aggressive disease, few sources have investigated the impact of smoking on RRP disease course and risk for malignant transformation. METHODS A retrospective chart review was conducted for adult RRP patients evaluated at an academic tertiary care center between 2005 and 2020. A total of 188 patients were identified. Demographic and clinical data were collected, including smoking and alcohol history, HPV subtype, history of dysplasia and/or carcinoma, voice handicap index scores, Derkay scores, debulkings (in office and operating room), and days to papilloma recurrence. RESULTS Malignant degeneration in RRP occurred in 16.3% of smokers and 3.6% of nonsmokers. Smokers who developed carcinoma had less debulkings per years of evaluation than those not developing carcinoma (0.21 vs 0.92, P = .004). Additionally, patients that either presented with or developed carcinoma during their course had a higher pack-year smoking history (18.0 vs 12.21, P = .0002). No difference in days to recurrence or inter-surgical interval was demonstrated between smokers and nonsmokers. CONCLUSIONS The report demonstrates that smoking can increase the risk of malignant transformation in RRP patients.
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Affiliation(s)
- Taylor Freeman
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ericka Erickson
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Brandon Koch
- Department of Public Health, The Ohio State University, Columbus, OH, USA
| | - Tyler Young
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - David Allen
- University of Texas Houston Health Science Center, Houston, TX, USA
| | - Brandon Kim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brad deSilva
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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11
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Mau T, Amin MR, Belafsky PC, Best SR, Friedman AD, Klein AM, Lott DG, Paniello RC, Pransky SM, Saba NF, Howard T, Dallas M, Patel A, Morrow MP, Skolnik JM. Interim Results of a Phase 1/2 Open-Label Study of INO-3107 for HPV-6 and/or HPV-11-Associated Recurrent Respiratory Papillomatosis. Laryngoscope 2023; 133:3087-3093. [PMID: 37204106 DOI: 10.1002/lary.30749] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To evaluate the safety, immunogenicity, and efficacy of INO-3107, a DNA immunotherapy designed to elicit targeted T-cell responses against human papillomavirus (HPV) types 6 and 11, in adult patients with recurrent respiratory papillomatosis (RRP; NCT04398433). METHODS Eligible patients required ≥2 surgical interventions for RRP in the year preceding dosing. INO-3107 was administered by intramuscular (IM) injection followed by electroporation (EP) on weeks 0, 3, 6, and 9. Patients underwent surgical debulking within 14 days prior to first dose, with office laryngoscopy and staging at screening and weeks 6, 11, 26, and 52. Primary endpoint was safety and tolerability, as assessed by treatment-emergent adverse events (TEAEs). Secondary endpoints included frequency of surgical interventions post-INO-3107 and cellular immune responses. RESULTS An initial cohort of 21 patients was enrolled between October 2020 and August 2021. Fifteen (71.4%) patients had ≥1 TEAE; 11 (52.4%) were Grade 1, and 3 (14.3%) were Grade 3 (none treatment related). The most frequently reported TEAE was injection site or procedural pain (n = 8; 38.1%). Sixteen (76.2%) patients had fewer surgical interventions in the year following INO-3107 administration, with a median decrease of 3 interventions versus the preceding year. The RRP severity score, modified by Pransky, showed improvement from baseline to week 52. INO-3107 induced durable cellular responses against HPV-6 and HPV-11, with an increase in activated CD4 and CD8 T cells and CD8 cells with lytic potential. CONCLUSION The data suggest that INO-3107 administered by IM/EP is tolerable and immunogenic and provides clinical benefit to adults with RRP. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3087-3093, 2023.
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Affiliation(s)
- Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, Voice Center, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, U.S.A
| | - Peter C Belafsky
- Department of Otolaryngology/Head and Neck Surgery, Davis School of Medicine, University of California, Sacramento, California, U.S.A
| | - Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Aaron D Friedman
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, U.S.A
| | - Adam M Klein
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - David G Lott
- Division of Laryngology, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Randal C Paniello
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Seth M Pransky
- Pediatric Specialty Partners of San Diego, San Diego, California, U.S.A
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute, Emory University, Atlanta, Georgia, U.S.A
| | - Tamara Howard
- Inovio Pharmaceuticals, Plymouth Meeting, Plymouth, Pennsylvania, U.S.A
| | - Michael Dallas
- Inovio Pharmaceuticals, Plymouth Meeting, Plymouth, Pennsylvania, U.S.A
| | - Aditya Patel
- Inovio Pharmaceuticals, Plymouth Meeting, Plymouth, Pennsylvania, U.S.A
| | - Matthew P Morrow
- Inovio Pharmaceuticals, Plymouth Meeting, Plymouth, Pennsylvania, U.S.A
| | - Jeffrey M Skolnik
- Inovio Pharmaceuticals, Plymouth Meeting, Plymouth, Pennsylvania, U.S.A
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12
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Hseu AF, Spencer GP, Jo S, Kawai K, Nuss RC. Pediatric Dysphonia: When to Refer. Clin Pediatr (Phila) 2023; 62:1261-1268. [PMID: 36856137 DOI: 10.1177/00099228231157957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The reported prevalence of voice disorders in the pediatric population varies widely between studies, ranging from 3.9% to 23%. Despite this, not all children with dysphonia are referred to a voice specialist for further evaluation. The objective of this study is to examine the relationship between dysphonia history, voice assessment, and laryngeal findings to help guide referrals of dysphonic children. A retrospective review was conducted of pediatric patients at a tertiary voice clinic between January 2014 and December 2017. Data including dates of presentation, demographics, co-morbidities, presenting symptoms, laryngeal exam findings, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores, and Pediatric Voice Handicap Index (pVHI) scores were collected and analyzed. Of 475 patients initially identified, 459 met inclusion criteria and were reviewed. In all, 272 (59.3%) were male and 187 (40.7%) were female. Mean age at first presentation was 8.6 years old (range: 2-18). Males were more likely to present at a younger age than females. CAPE-V data were available for 439 patients, and pVHI data were available for 109 patients. The mean CAPE-V Overall Severity score was 38.2. The mean total pVHI score was 25.4. Males had higher CAPE-V Overall Severity (40.0 vs. 35.4), Roughness (32.2 vs. 27.6), and Strain scores (37.2 vs. 32.4) than females. Patient pVHI scores did not differ by gender. In all, 283 patients self-reported a length of symptoms prior to evaluation. Children with a longer duration of symptoms prior to evaluation had higher CAPE-V Overall Severity scores. Diagnoses of vocal fold movement impairment and benign vocal fold lesions that were not nodules were associated with higher average CAPE-V Overall Severity scores. Overall, 310 patients (67.5%) were recommended intervention for their dysphonia. These patients had higher CAPE-V Overall Severity scores than those who were solely recommended observation (42.8 vs. 28.0). Males were more likely than females to present with dysphonia and presented with more severe perceptual dysphonia scores on average. The length of symptoms and certain diagnoses correlated with higher CAPE-V Scores. Referrals to a pediatric voice clinic should be considered in patients with a dysphonia history lasting greater than 3 months and in patients with more severe symptoms.
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Affiliation(s)
- Anne F Hseu
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Grant P Spencer
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Stacy Jo
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Roger C Nuss
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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13
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Hu H, Jiang H, Zhu Z, Yin H, Liu K, Chen L, Zhao M, Yu Z. Analysis of the anatomical distribution of HPV genotypes in head and neck squamous papillomas. PLoS One 2023; 18:e0290004. [PMID: 37566623 PMCID: PMC10420351 DOI: 10.1371/journal.pone.0290004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Squamous papillomas (SPs) of the head and neck are usually benign lesions associated with human papilloma virus (HPV) infection. However, the reported HPV detection rates vary widely, especially with respect to anatomical distribution. The etiology of SPs in the head and neck remains unclear; analyzing HPV genotypes of SPs based on anatomical sites could assist in clarifying the pathogenesis of SPs in the head and neck. Therefore, the aim of this study was to review the prevalence, subtypes, and anatomical distribution of HPV in head and neck SPs at a hospital in China; we also investigated whether p16, a marker of HPV infection in oropharyngeal carcinoma, could serve as a surrogate marker for HPV in head and neck SPs. The presence of HPV DNA of 23 types (5 low-risk HPV and 18 high-risk HPV types) was detected via real-time PCR. p16 immunohistochemistry was performed using SP sections. Age, sex, anatomical location, and HPV subtype were recorded for each case. In total, 105 SPs were identified, including 47 in the larynx, 42 in the pharynx, 6 in the external auditory canal (EAC), 5 in the oral cavity, and 5 in the nasal cavity. HPV was found in 57 (54.3%) cases, with the highest positivity rate in the larynx (46/47; 97.9%). Only 5/42 (11.9%) patients showed HPV positivity in the pharynx. HPV incidence was highly dependent on the anatomical site. SPs in the larynx and EAC were more likely to carry HPV than those in other anatomical sites. High-risk HPV infections were rarely associated with SPs in the head and neck region. The sensitivity and specificity of p16 immunohistochemistry for HPV infection were 88% and 96%, respectively. There may be an association between p16 and HPV infection in head and neck SPs, but further studies are needed to validate this assertion.
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Affiliation(s)
- Huiying Hu
- School of Medicine, Southeast University, Nanjing, China
- Department of Otolaryngology Head and Neck Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Huanyu Jiang
- School of Medicine, Southeast University, Nanjing, China
| | - Zhenwen Zhu
- Department of Otolaryngology Head and Neck Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Honglin Yin
- Department of Pathology, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Liu
- Department of Otolaryngology Head and Neck Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Lijuan Chen
- Department of Otolaryngology Head and Neck Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Mengyuan Zhao
- Department of Otolaryngology Head and Neck Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Zhenkun Yu
- School of Medicine, Southeast University, Nanjing, China
- Department of Otolaryngology Head and Neck Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
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14
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Collette F, Lawson G, Hassid S, Delahaut G, Bachy V, Van Der Vorst S, Faugeras L, Gilliaux Q, D'Hondt L. Aggressive recurrent respiratory papillomatosis: A series of five consecutive patients successfully treated with adjuvant intravenous bevacizumab. A single Belgian academic center experience. Head Neck 2023; 45:1071-1079. [PMID: 36840929 DOI: 10.1002/hed.27300] [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: 07/21/2022] [Revised: 12/22/2022] [Accepted: 01/23/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Recurrent respiratory papillomatosis (RRP) is a currently incurable benign neoplasm caused by human papilloma virus (HPV) infection. It usually reduces voice, respiratory, and general quality of life, and is sometimes life-threatening. Patients usually need repeated operations. The use of adjuvant bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor A, has been described in several case reports, with a good efficacy and safety profile. METHODS We report the cases of five patients with aggressive RRP who were treated with adjuvant systemic bevacizumab in a single Belgian tertiary center. RESULTS A complete response was achieved in four patients after a median of 4.5 months, and a partial response in one. In all cases, the number of surgeries was drastically reduced, and quality of life improved. Toxicity was easily managed. CONCLUSIONS Systemic bevacizumab seems to be an effective and safe adjuvant treatment for aggressive RRP.
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Affiliation(s)
- Fanny Collette
- Department of Oncology, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Georges Lawson
- Department of ENT and Head and Neck Surgery, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Samantha Hassid
- Department of ENT and Head and Neck Surgery, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Gilles Delahaut
- Department of ENT and Head and Neck Surgery, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Vincent Bachy
- Department of ENT and Head and Neck Surgery, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Sébastien Van Der Vorst
- Department of ENT and Head and Neck Surgery, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Laurence Faugeras
- Department of Oncology, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Quentin Gilliaux
- Department of Oncology, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Lionel D'Hondt
- Department of Oncology, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
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15
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Ding D, Yin G, Guo W, Huang Z. Analysis of lesion location and disease characteristics of pharyngeal and laryngeal papilloma in adult. Eur Arch Otorhinolaryngol 2023; 280:289-295. [PMID: 35939058 DOI: 10.1007/s00405-022-07575-5] [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: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Papilloma is a common benign epithelial tumor of the respiratory tract in adults. Its histological structure and immune environment vary from site to site. This study investigated the disease characteristics and prognostic differences of papillomas at various primary locations. METHODS Clinical data was collected from patients with adult glossal root and hypopharyngeal papilloma admitted to our tertiary referral center between January 2010 and December 2020, and compared with patients with laryngeal papilloma. Differences in age, sex, smoking, alcohol consumption, single or multiple lesions, surgical methods, immunohistochemical indexes, Ki-67 and p16, were analyzed in patients with different primary papilloma sites. RESULTS A total of 84 cases of glossal root papilloma, 51 cases of hypopharyngeal papilloma, and 51 cases of laryngeal papilloma were included. Differential analysis between groups showed that there were statistically significant differences in age, sex, smoking, single and multiple lesions, and surgical methods in the different primary sites. Ki-67 expression in laryngeal papilloma was higher than that in glossal root and hypopharyngeal papilloma. There was no significant difference in p16 expression in the three groups. In terms of prognosis, laryngeal papilloma is more likely to relapse than glossal root or hypopharyngeal papilloma, and the recurrence time is shorter. CONCLUSIONS As the largest clinical study of papilloma in different primary locations, this study found that the clinical characteristics and postoperative recurrence of papilloma of the glossal root and hypopharynx differ from those of papilloma of the larynx. This finding supports the current clinical experience in treating papillomas in different locations and facilitates the development of clinical treatment plans.
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Affiliation(s)
- Dong Ding
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Room 501, No. 8 Chongwenmennei Street, Dongcheng District, Beijing, China
| | - Gaofei Yin
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Room 501, No. 8 Chongwenmennei Street, Dongcheng District, Beijing, China
| | - Wei Guo
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Room 501, No. 8 Chongwenmennei Street, Dongcheng District, Beijing, China
| | - Zhigang Huang
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Room 501, No. 8 Chongwenmennei Street, Dongcheng District, Beijing, China.
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16
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Aggarwal K, Kumar R, Kumari J, Kumar A, Jat KR, Kabra SK, Bhalla AS, Kumar R. Experience with Systemic Bevacizumab in Advanced Juvenile Recurrent Respiratory Papillomatosis. Indian J Otolaryngol Head Neck Surg 2022; 74:5117-5121. [PMID: 36742877 PMCID: PMC9895530 DOI: 10.1007/s12070-021-02783-7] [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: 06/03/2021] [Accepted: 07/25/2021] [Indexed: 02/07/2023] Open
Abstract
Vascular Endothelial Growth Factor has been demonstrated in squamous papillomas of Recurrent Respiratory Papillomatosis patients. This case series aimed at studying the feasibility and efficacy of systemic use of VEGF inhibitor Bevacizumab in advanced Juvenile Onset Recurrent Respiratory Papillomatosis (JORRP) patients. Three pediatric patients with advanced RRP were included in this study. A detailed bronchoscopic and radiological follow-up is presented. All patients responded well to the treatment. We conclude that systemic Bevacizumab can be tried as a feasible and rational adjuvant treatment in advanced JORRP patients.
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Affiliation(s)
- Karan Aggarwal
- Department of Otorhinolaryngology and Head & Neck Surgery, Dr BR Ambedkar State Institute of Medical Sciences, Mohali, Punjab India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Kumari
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Kana Ram Jat
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - S. K. Kabra
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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17
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Muacevic A, Adler JR, Gomes J, Xará S. Recurrent Respiratory Papillomatosis Presenting as Worsening Dyspnea in an HIV-infected Patient. Cureus 2022; 14:e32908. [PMID: 36699756 PMCID: PMC9870301 DOI: 10.7759/cureus.32908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/25/2022] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is a rare manifestation of human papillomavirus (HPV) infection. It is characterized by relapsing bulky papillomas in the respiratory tract, which are usually benign in nature. We describe a challenging case of RRP in an HIV-infected patient with extensive pulmonary disease, presenting with worsening dyspnea. The interaction between HPV with HIV as a coinfection is still not completely understood, particularly the role of HIV-associated immunosuppression in RRP. Our main goal is to raise awareness of this clinical entity and to promote further studies on its management, particularly in specific populations such as HIV-infected individuals. A brief review of the theme is also presented.
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18
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Tatineni S, Warren Z, Applebaum MA, Baroody FM. Systemic Bevacizumab for Severe Recurrent Respiratory Papillomatosis. Case Rep Oncol Med 2022; 2022:2767996. [PMID: 36483909 PMCID: PMC9726241 DOI: 10.1155/2022/2767996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/20/2022] [Accepted: 11/10/2022] [Indexed: 07/21/2023] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is the most common benign pediatric laryngeal neoplasm. Various adjuvant medical therapies have failed to reliably decrease surgical frequency in this challenging airway disease. Recently, systemic bevacizumab has shown promise in advanced, treatment-resistant papillomatosis. We describe the use of systemic bevacizumab in two children with severe RRP unresponsive to other therapies. Voice and breathing improved dramatically in both patients with minimal side effects. Both patients have not required surgery in 24 months and 16 months, respectively. Systemic bevacizumab is a promising long-term treatment for severe RRP, with oncology playing an important role in patient care.
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Affiliation(s)
- Swetha Tatineni
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Zachary Warren
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, Illinois, USA
| | - Mark A Applebaum
- Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
| | - Fuad M Baroody
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
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19
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Yeung V, Sackstein P, Grant NN, Krochmal R, Gandhi N, Aggarwal C, Halmos B, Reuss JE, Liu SV, Kim C. Use of Erdafitinib in FGFR3-Mutated Recurrent Respiratory Papillomatosis. JCO Precis Oncol 2022; 6:e2200435. [DOI: 10.1200/po.22.00435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Vincent Yeung
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Paul Sackstein
- Department of Internal Medicine, Georgetown University, Washington, DC
| | | | - Rebecca Krochmal
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Georgetown University, Washington, DC
| | | | - Charu Aggarwal
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Balazs Halmos
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Joshua E. Reuss
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Stephen V. Liu
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Chul Kim
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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20
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Rimoli CF, Hamerschmidt R, Filho EDDM, Santos VM, Mangia LRL, Carvalho B. Tumor risk markers in recurrent respiratory papillomatosis. Braz J Otorhinolaryngol 2022; 89:285-291. [PMID: 36319567 PMCID: PMC10071536 DOI: 10.1016/j.bjorl.2022.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This study aims to investigate the pattern of immunoexpression of proteins p16, p53 and Ki-67 in RRP, as well as to evaluate its influence on the number of surgeries that patients have undergone to date and to analyze the benefit of immunohistochemistry in this disease. METHODS Clinical-demographic data and tumor samples were obtained from 33 patients with RRP. The expression of proteins p16, p53 and Ki-67 was analyzed by immunohistochemical method. RESULTS Most patients had already undergone more than one surgery. The p16 marker was negative in 24.2% of the cases, with little positivity in 27.3% of the cases, moderate in 36.4% and intense in 12.1%. The p53 marker was positive in all cases, with little immunoexpression in 39.4% of cases, moderate in 36.4% and intense in 24.2%. The Ki-67 marker showed nuclear positivity in all lesions, although in varying degrees, with a mean proliferative index ± SD (standard deviation) of 51.7 ± 26. CONCLUSIONS The papillomatous lesions had varying degrees of immunoexpression of proteins p16, p53 and Ki-67, but no specific immunohistochemical pattern was observed. It was found, with statistical difference, that the number of surgeries was higher in cases with greater intensity of p53 expression, without correlation with the other markers. The benefit of immunohistochemistry in recurrent respiratory papillomatosis may lie in the prognostic assessment. However, further studies are needed to evaluate the use of this technique for this purpose. LEVEL OF EVIDENCE 4.
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21
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Kumar SA, O’Meara C, Paulus F, Wise L, Havas T. Synchronous sinonasal and respiratory papilloma: could long-term positive pressure ventilation be the cause? A rare case report. J Surg Case Rep 2022; 2022:rjac302. [PMID: 35774475 PMCID: PMC9238302 DOI: 10.1093/jscr/rjac302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/01/2022] [Indexed: 11/14/2022] Open
Abstract
This case report describes a rare presentation of synchronous pathologies—sinonasal inverted papilloma (SIP) and recurrent respiratory papillomatosis (RRP)—in a 47-year-old man using continuous positive airway pressure (CPAP) ventilation for progressive obstructive sleep apnoea. As far as we know, this is the first case of concurrent SIP and RRP disease described in the literature. The patient initially presented for management of chronic rhinosinusitis symptoms. He was found to have an extensive nasal lesion on flexible nasendoscopy, for which surgical management was recommended. However, during anaesthetic induction, he obstructed unexpectedly and was found to have an occlusive supraglottic lesion that required expedient ENT airway management. Diagnosis was made clinically and was supported with histopathology of excised tissue. Management involved multiple staged procedures for excision of sinonasal and glottic lesions and regular follow-up and imaging.
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Affiliation(s)
- Shivani Angelique Kumar
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group , Sydney, NSW , Australia
- Department of Otolaryngology, Prince of Wales Hospital , Sydney, NSW , Australia
- Faculty of Medicine, University of New South Wales , Sydney, NSW , Australia
| | - Connor O’Meara
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group , Sydney, NSW , Australia
- Department of Otolaryngology, Prince of Wales Hospital , Sydney, NSW , Australia
| | - Felik Paulus
- NSW Health Pathology, Prince of Wales Hospital , Sydney, NSW , Australia
| | - Laura Wise
- NSW Health Pathology, Prince of Wales Hospital , Sydney, NSW , Australia
| | - Thomas Havas
- Prince of Wales Hospital Otolaryngology Head and Neck Research Group , Sydney, NSW , Australia
- Department of Otolaryngology, Prince of Wales Hospital , Sydney, NSW , Australia
- Faculty of Medicine, University of New South Wales , Sydney, NSW , Australia
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22
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Mazur A, Koziorowska K, Dynarowicz K, Aebisher D, Bartusik-Aebisher D. Photodynamic Therapy for Treatment of Disease in Children—A Review of the Literature. CHILDREN 2022; 9:children9050695. [PMID: 35626872 PMCID: PMC9140108 DOI: 10.3390/children9050695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022]
Abstract
Photodynamic therapy is a mode of treatment whereby local irradiation of an administered photosensitizer with light of a specific wavelength generates cytotoxic reactive oxygen species. Despite the upward trend in the popularity of this method in adults, it is not yet commonly used in the treatment of children. Due to certain limitations, underdeveloped treatment regimens and potential side effects, the use of photodynamic therapy in the pediatric population is still in the initial phases of evaluation in clinical trials. Method: This study is a review of articles in English from the databases PubMed and Web of Science retrieved by applying the search term “photodynamic therapy in children” from 2000–2020. Results: Based on the literature review, we analyze selected pediatric clinical cases in which photodynamic therapy was used for treatment in children. Examples of photodynamic therapy for treatment of dermatological diseases, diseases of the mucosa of the upper respiratory tract, halitosis, eye diseases and brain tumors are described. The paper describes the effectiveness of anti-cancer photodynamic therapy, including its use in antibacterial therapy. Conclusions: The results of the analysis suggest the potential of photodynamic therapy for the treatment of various diseases in children.
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Affiliation(s)
- Anna Mazur
- Students Biochemistry Science Club URCell, Medical College of the University of Rzeszów, 35-959 Rzeszów, Poland;
| | - Katarzyna Koziorowska
- Students English Division Science Club, Medical College of the University of Rzeszów, 35-959 Rzeszów, Poland;
| | - Klaudia Dynarowicz
- Centre for Innovative Research in Medical and Natural Sciences, Medical College of the University of Rzeszów, 35-310 Rzeszów, Poland;
| | - David Aebisher
- Department of Photomedicine and Physical Chemistry, Medical College of the University of Rzeszów, 35-959 Rzeszów, Poland;
| | - Dorota Bartusik-Aebisher
- Department of Biochemistry and General Chemistry, Medical College of the University of Rzeszów, 35-959 Rzeszów, Poland
- Correspondence:
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23
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Immunological Aspects of Human Papilloma Virus-Related Cancers Always Says, “I Am like a Box of Complexity, You Never Know What You Are Gonna Get”. Vaccines (Basel) 2022; 10:vaccines10050731. [PMID: 35632488 PMCID: PMC9144219 DOI: 10.3390/vaccines10050731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
The human papillomavirus (HPV) can cause different cancers in both men and women. The virus interferes with functions of the cervix, vulva, vagina, anus in the anogenital area, breast, and head and neck cancer due to the local lesions. The tumors lead to death if not treated as a result of distant metastasis to internal organs and brain. Moreover, HPV attenuates the immune system during chronic infection and releases viral antigens into the tumor microenvironment. The tumors know how difficult is to win the battle with a strong united army of immune cells that are equipped with cytokines and enzymes. They confuse the immune cells with secreting viral antigens. The immune system is equipped with cytokines, a complement system, antibodies, and other secretory proteins to overcome the foreign invaders and viral antigens. However, the majority of the time, tumors win the battle without having all the equipment of the immune cells. Thus, in this review, we describe the recent progression in cellular and humoral immunity studies during the progression of HPV-related cancers. First of all, we describe the role of B, plasmoid cells, and B regulatory cells (Breg) in their functions in the tumor microenvironment. Then, different subtypes of T cells such as T CD8, CD4, T regulatory (Treg) cells were studied in recently published papers. Furthermore, NK cells and their role in tumor progression and prevention were studied. Finally, we indicate the breakthroughs in immunotherapy techniques for HPV-related cancers.
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24
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Pogoda L, Ziylan F, Smeeing DPJ, Dikkers FG, Rinkel RNPM. Bevacizumab as treatment option for recurrent respiratory papillomatosis: a systematic review. Eur Arch Otorhinolaryngol 2022; 279:4229-4240. [PMID: 35462578 PMCID: PMC9363326 DOI: 10.1007/s00405-022-07388-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/02/2022] [Indexed: 11/28/2022]
Abstract
Purpose To this day, there is no cure for recurrent respiratory papillomatosis (RRP). Multiple surgical procedures are performed to achieve symptom relief and prevention of airway obstruction. A promising drug for RRP is the vascular endothelial growth factor (VEGF) binding antibody bevacizumab. This chemotherapeutic agent has an angiogenesis-inhibiting effect which inhibits tumor growth. The objective of this review was to investigate the efficacy of bevacizumab as treatment option for RRP, and to explore the difference of its effects between intralesional and systemic treatment. Methods A systematic search was conducted in Cochrane, PubMed, and Embase. Articles were included if bevacizumab treatment was given intralesionally and/or systemically. The methodological quality of the studies was assessed using the CAse REport (CARE) guidelines. Results Of 585 unique articles screened by title and abstract, 15 studies were included, yielding a total of 64 patients. In 95% of the patients treated with systemic bevacizumab, the post-bevacizumab surgical interval was considerably prolonged. More than half of them did not need any surgical intervention during mean follow-up of 21.6 months. Treatment with intralesional bevacizumab showed a lower efficacy: in 62% of the patients, the post-bevacizumab surgical interval (mean, 1.8 months follow-up) was extended when compared to the interval before the treatment. Conclusion Systemically and intralesionally administered bevacizumab are effective treatment options for severe RRP. A systemic administration might be the treatment of first choice. Further prospective research with long term follow-up is advocated to elucidate this important topic.
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Affiliation(s)
- Louis Pogoda
- Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Fuat Ziylan
- Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Diederik P J Smeeing
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Frederik G Dikkers
- Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Rico N P M Rinkel
- Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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25
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Valdivia Padilla A, Tellez-Garcia E, Grosu H. A Case of Recurrent Respiratory Papillomatosis With Lung Involvement and Malignant Transformation. Cureus 2022; 14:e24370. [PMID: 35619833 PMCID: PMC9126428 DOI: 10.7759/cureus.24370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/26/2022] Open
Abstract
Recurrent respiratory papillomatosis is a rare and complex progression of the disease due to the human papillomavirus (HPV). In this case report, we present the findings of a 53-year-old male who was diagnosed with obstructing respiratory papillomatosis of the trachea and underwent several procedures until the disease progressed to squamous cell carcinoma. Our objective with this case report is to contribute to a broader understanding of this disease by reporting a clinical case.
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26
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Wu X, Xiao Y, Guo D, Zhang Z, Liu M. Reduced NK Cell Cytotoxicity by Papillomatosis-Derived TGF-β Contributing to Low-Risk HPV Persistence in JORRP Patients. Front Immunol 2022; 13:849493. [PMID: 35350785 PMCID: PMC8957810 DOI: 10.3389/fimmu.2022.849493] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/11/2022] [Indexed: 12/19/2022] Open
Abstract
The role of natural killer (NK) cells in juvenile-onset recurrent respiratory papillomatosis (JORRP) patients remains elusive. In this study, we find increased NK cell percentage, particularly CD11b-CD27- (DN) subsets in peripheral blood of JORRP patients and associated with disease activity. RNA sequencing shows a downregulated "natural killer cell-mediated cytotoxicity" feature in JORRP tumors. We also find impaired cytotoxic capacity and lower expression of NK cell-activating receptors including NKp30 and NKp46. Higher transforming growth factor-beta 1 (TGF-β1) is found both in plasma and tumor tissues of JORRP, and anti-TGF-β1 antibody could restore NK cell cytolytic activity and upregulate NKp30 and NKG2D expression. Also, we find a significantly higher Chemokine receptor type 6 (CXCR6) on NK cells in tumors compared with that in peripheral blood. Finally, RT-PCR analysis show that both HPV6-E6-E7 and HPV11-E6-E7 overexpression leads to higher TGFB1 expression compared with control SNU-1076 cell line, and higher CXCR6 expression is detected on NK coculture with HPV11-E6-E7-overexpressing cells. In conclusion, we demonstrate that TGF-β1 by papillomatosis leads to decreased NK cell cytotoxicity through downregulating NK cell-activating receptors in JORRP patients.
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Affiliation(s)
- Xunyao Wu
- Clinical Biobank, Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Xiao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dan Guo
- Clinical Biobank, Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zixin Zhang
- Clinical Biobank, Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meiyu Liu
- Clinical Biobank, Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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27
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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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28
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Bertinazzi M, Gheit T, Polesel J, McKay-Chopin S, Cutrone C, Sari M, Sbaraglia M, Tos APD, Nicolai P, Tommasino M, Boscolo-Rizzo P. Clinical implications of alpha, beta, and gamma HPV infection in juvenile onset recurrent respiratory papillomatosis. Eur Arch Otorhinolaryngol 2022; 279:285-292. [PMID: 34453571 PMCID: PMC8738360 DOI: 10.1007/s00405-021-07040-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of our study was to evaluate the prevalence of different HPV genera-alpha, beta and gamma-in Juvenile onset Recurrent Respiratory Papillomatosis (JoRRP) and examine the association of type and genus-specific viral features with the clinical outcome of disease. METHODS This retrospective observational study included consecutive patients with JoRRP who were treated in a referral centre between October 2000 and October 2020. All patients underwent cold excision and laser vaporisation of papillomatous lesions. Samples were analysed for the presence of 120 viral genotypes (22 alpha-HPV, 46 beta-HPV, 52 gamma-HPV) using a highly sensitive multiplex genotyping assay. RESULTS Twenty patients with JoRRP, aged 0.3-11 years, were included, with a median follow-up of 13.5 years. All samples were HPV DNA positive: 20 (100%) for alpha-HPV DNA; 7 (35%) for beta-HPV DNA; 0 for gamma-HPV DNA. Three groups were defined according to the number of infections: seven cases (35%) with HPV mono-infection; ten cases (50%) with HPV double-infection; three cases (15%) with ≥ 3 HPV infections. At diagnosis, patients with ≥ 3 HPV infections reported higher median Derkay's score than those with mono-infection (21 vs 14, P = 0.018). Number of HPV infections was also associated with clinical outcomes, with an average of 0.5 surgical procedures/year in patients with mono-infection, 1.2 for double-infection, 2.6 for ≥ 3 infections (P = 0.006). CONCLUSION Despite the small sample size, these preliminary data support an association between the number of different alpha and beta HPV co-infections and the clinical severity of the disease.
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Affiliation(s)
- Martina Bertinazzi
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Tarik Gheit
- International Agency for Research On Cancer, Lyon, France
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro Di Riferimento Oncologico Di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Cesare Cutrone
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Marianna Sari
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Marta Sbaraglia
- Department of Medicine, Section of Pathology, University of Padova, Padova, Italy
| | - Angelo Paolo Dei Tos
- Department of Medicine, Section of Pathology, University of Padova, Padova, Italy
| | - Piero Nicolai
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy
| | | | - Paolo Boscolo-Rizzo
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy.
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
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29
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HPV and Recurrent Respiratory Papillomatosis: A Brief Review. Life (Basel) 2021; 11:life11111279. [PMID: 34833157 PMCID: PMC8618609 DOI: 10.3390/life11111279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/26/2022] Open
Abstract
Recurrent Respiratory Papillomatosis (RRP) is a rare but severe manifestation of human papillomavirus (HPV). As our knowledge about HPV infections has expanded, it has become possible to understand the course of RRP disease and unravel plausible efficient methods to manage the disease. However, the surge in reports on HPV has not been accompanied by a similar increase in research about RRP specifically. In this paper, we review the clinical manifestation and typical presentation of the illness. In addition, the pathogenesis and progression of the disease are described. On the other hand, we discuss the types of treatments currently available and future treatment strategies. The role of vaccination in both the prevention and treatment of RRP will also be reviewed. We believe this review is essential to update the general knowledge on RRP with the latest information available to date to enhance our understanding of RRP and its management.
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30
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Transcriptomic landscape of gene expression profiles and pathways in JORRP tumor tissues and HPV6/11 E6-E7-overexpressing HNSCC cell lines. J Virol 2021; 96:e0134221. [PMID: 34669519 DOI: 10.1128/jvi.01342-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Juvenile-onset recurrent respiratory papillomatosis (JORRP) is the most common benign laryngeal neoplasm in children and is considered to be primarily caused by human papillomavirus (HPV) types 6 and 11. In the present study, we performed RNA sequencing (RNA-seq) of 8 tumors and 4 adjacent nontumor tissues to explore the transcriptional profiles of JORRP tumors. A total of 1151 upregulated genes involved in the IL-17 signaling pathway and 1620 downregulated genes involved in dysregulated inflammatory responses were reported. Immunohistochemistry (IHC) assays confirmed the upregulation of IL-17C in JORRP tumors compared with paired adjacent nontumor tissues. Real-time PCR (RT-PCR) assays showed positive correlations between CXCL1 and CXCL8 and the Derkay Clinic Score of JORRP patients. We further overexpressed the HPV6 or HPV11 E6 and E7 oncogenes in SNU-1076 head and neck squamous cell carcinoma (HNSCC) cell lines and carried out RNA-seq. We found that HPV6-E6-E7 gene overexpression resulted in only 16 upregulated genes and 1 downregulated gene; however, HPV11-E6-E7 gene overexpression resulted in 1776 upregulated genes and 461 downregulated genes compared with the control cell lines. The DEGs of HPV11-E6-E7 gene overexpression were positively enriched in the DNA replication-related terms by Gene Ontology (GO) analysis and the IL-17 signaling pathway by Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. Taken together, our present findings revealed IL-17 signaling pathway-related gene profiles that might contribute to disease pathogenesis and that the HPV11 E6 and E7 oncogenes promote disease progression by enhancing tumor growth and activating the IL-17 signaling pathway in JORRP patients. Importance JORRP is primarily caused by HPV 6 and HPV11 infection, however, the gene signatures of tumor are less understood currently. In the present study, we performed RNA-sequencing and found up-regulated genes associated with "IL-17 signaling pathway" and down-regulated genes associated with inflammatory-related pathways. Further RNA-sequencing was performed in HPV6-E6-E7 or HPV11-E6-E7 over-expressing SNU-1076 HNSCC cells lines to explore the potential pathogenic molecular mechanisms of HPV virus. We found HPV11-E6-E7 over-expression resulted in gene expressions related to DNA replication and IL-17 signaling pathway. Our results suggested enriched IL-17 signaling pathway resulted from HPV11 infection might contribute to JORRP pathogenesis.
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31
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Meites E, Stone L, Amiling R, Singh V, Unger ER, Derkay CS, Markowitz LE. Significant Declines in Juvenile-onset Recurrent Respiratory Papillomatosis Following Human Papillomavirus (HPV) Vaccine Introduction in the United States. Clin Infect Dis 2021; 73:885-890. [PMID: 33621333 PMCID: PMC8380742 DOI: 10.1093/cid/ciab171] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Juvenile-onset recurrent respiratory papillomatosis (JORRP) is a rare and serious disease caused by human papillomavirus (HPV) presumably acquired during vaginal delivery. HPV vaccination of females through age 26 years, recommended in the United States since 2006, can prevent HPV transmission. We assessed trends in JORRP cases before and after HPV vaccine introduction in the United States. METHODS Case-patients were identified from 26 pediatric otolaryngology centers in 23 U.S. states. Demographics and clinical history were abstracted from medical records. Case-patients were grouped by year of birth, and birth-cohort incidences were calculated using number of births from either national or state-level natality data from the 23 states. We calculated incidence rate ratios (IRR) and 95% confidence intervals (CI) in 2-year intervals. RESULTS We identified 576 U.S. JORRP case-patients born in 2004-2013. Median age at diagnosis was 3.4 years (interquartile range: 1.9, 5.5). Number of identified JORRP case-patients declined from a baseline of 165 born in 2004-2005 to 36 born in 2012-2013. Incidence of JORRP per 100 000 births using national data declined from 2.0 cases in 2004-2005 to 0.5 cases in 2012-2013 (IRR = 0.2, 95% CI = .1-.4); incidence using state-level data declined from 2.9 cases in 2004-2005 to 0.7 cases in 2012-2013 (IRR = 0.2, 95% CI = .1-.4). CONCLUSIONS Over a decade, numbers of JORRP case-patients and incidences declined significantly. Incidences calculated using national denominator data are likely underestimates; those calculated using state-level denominator data could be overestimates. These declines are most likely due to HPV vaccination. Increasing vaccination uptake could lead to elimination of this HPV-related disease.
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Affiliation(s)
- Elissa Meites
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Stone
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Raiza Amiling
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Vidisha Singh
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
- Pediatric Otolaryngology, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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32
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Enrique OH, Eloy SH, Adrian TP, Perla V. Systemic bevacizumab as adjuvant therapy for recurrent respiratory papillomatosis in children: A series of three pediatric cases and literature review. Am J Otolaryngol 2021; 42:103126. [PMID: 34175693 DOI: 10.1016/j.amjoto.2021.103126] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/13/2021] [Indexed: 11/16/2022]
Abstract
Recurrent respiratory papillomatosis (RRP), a viral disease caused by human papillomavirus (HPV), is the most common benign neoplasm of the larynx among children and the second most frequent cause of infantile hoarseness. The course of the disease is variable; some patients experience spontaneous remission, while others may develop an aggressive respiratory compromise. Especially juvenile-onset RRP cases experience shorter intervals between surgical interventions and thus more surgeries overall, causing high rates of depression and voice-related quality of life. Various local adjuvant therapies have been studied with mixed efficacy and some early potential but have failed to show consistent effect across large cohorts of patients. Bevacizumab, a recombinant monoclonal antibody that inhibits VEGF, has shown efficacy in patients with rapid regrowth of papillomas with severe airway compromise, and/or distal multisite spread of disease. We present three juvenile-onset RRP cases successfully managed with systemically administered bevacizumab.
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Affiliation(s)
- Ortiz H Enrique
- Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.
| | - Sanchez H Eloy
- Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | - Trujillo P Adrian
- Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | - Villamor Perla
- Centro Hospitalario Serena del Mar. Cartagena, Colombia.
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33
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Carvalho AMAS, Brito DSD, Cunha APA, Monteiro PDM, Ferreira MB, Assis DSFRD, Bentivi JO, Andrade MSD, Vidal FCB, Salgado Filho N. Recurrent respiratory papillomatosis: clinical characteristics and viral genotyping in a Brazilian population. Rev Inst Med Trop Sao Paulo 2021; 63:e63. [PMID: 34406288 PMCID: PMC8376275 DOI: 10.1590/s1678-9946202163063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 11/22/2022] Open
Abstract
This study presents 25 cases of recurrent respiratory papillomatosis (RRP) that occurred in Sao Luis, Maranhao State, Northeast region, Brazil, between January 2007 and December 2018. Sociodemographic and clinical profile of patients as well as human papillomavirus (HPV) infection status were evaluated. Clinical and histopathological data were collected from the patients' medical records. For the HPV infection analysis, DNA was extracted and subjected to amplification by a nested polymerase chain reaction. Viral genotyping was performed by automated sequencing. The median age of patients was 12.40 ± 12.6. years, and the juvenile form of the disease (68%) was the predominant form of disease. Female participants were predominant (60%), and they were from cities located in the interior of the State (60%). The most common clinical manifestation was dysphonia; recurrence was observed in most cases (56%), and tracheostomy was necessary in seven patients (26.9%). When comparing the RRP forms, patients in the juvenile-RRP group had higher recurrence rates and need of tracheostomy than those in the adult-RRP group. The viral genotyping analysis revealed that 47.8% of patients had low-risk HPVs, whereas 13.1% had high-risk HPVs, and in 39.1% of patients the viral genotype was not obtained. HPV-6 was the most prevalent type and Juvenile-RRP was more prevalent in our population. HPV was present at a high rate, and HPV-6 was the predominant genotype. This study serves as the basis for further studies to be conducted in the Brazilian population. Our findings aid the better understanding of RRP, possibly suggesting some prognostic factors associated with the disease aggressiveness.
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Affiliation(s)
| | | | - Ana Paula Almeida Cunha
- Universidade Federal do Maranhão, Pós-Graduação em Saúde do Adulto, São Luís, Maranhão, Brazil
| | | | | | | | | | - Marcelo Souza de Andrade
- Universidade Federal do Maranhão, Pós-Graduação em Saúde do Adulto, São Luís, Maranhão, Brazil.,Universidade Federal do Maranhão, Departamento de Fisiologia, São Luís, Maranhão, Brazil
| | - Flávia Castello Branco Vidal
- Universidade Federal do Maranhão, Pós-Graduação em Saúde do Adulto, São Luís, Maranhão, Brazil.,Universidade Federal do Maranhão, Departamento de Farmácia, São Luís, Maranhão, Brazil.,Universidade Federal do Maranhão, Departamento de Morfologia, São Luís, Maranhão, Brazil
| | - Natalino Salgado Filho
- Universidade Federal do Maranhão, Pós-Graduação em Saúde do Adulto, São Luís, Maranhão, Brazil.,Universidade Federal do Maranhão, Departamento de Medicina I, São Luís, Maranhão, Brazil
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34
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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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35
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Amiling R, Meites E, Querec TD, Stone L, Singh V, Unger ER, Derkay CS, Markowitz LE. Juvenile-Onset Recurrent Respiratory Papillomatosis in the United States, Epidemiology and HPV Types-2015-2020. J Pediatric Infect Dis Soc 2021; 10:774-781. [PMID: 34145881 PMCID: PMC8446313 DOI: 10.1093/jpids/piab016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/02/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Juvenile-onset recurrent respiratory papillomatosis (JORRP) is a rare disease characterized by the growth of papillomas in the respiratory tract. In the United States, JORRP is not a nationally notifiable condition and current data are limited. METHODS Children with JORRP aged <18 years were enrolled from 26 pediatric otolaryngology centers in 23 US states from January 2015 through August 2020. Demographic, birth information, and maternal vaccination history were collected from a parent/guardian. Clinical history was abstracted from medical records. Papilloma biopsies were tested for 28 human papillomavirus (HPV) types. Mothers who delivered in 2006 or later were considered age-eligible for HPV vaccination if aged ≤26 years in 2006. We described characteristics of enrolled children and their birth mothers and analyzed disease severity by diagnosis age and HPV type using multiple logistic regression. RESULTS Among 215 children with JORRP, 88.8% were delivered vaginally; 64.2% were firstborn. Among 190 mothers, the median delivery age was 22 years. Among 114 (60.0%) age-eligible for HPV vaccination, 16 (14.0%) were vaccinated, 1 (0.9%) before delivery. Among 162 specimens tested, 157 (96.9%) had detectable HPV; all 157 had a vaccine-preventable type. Disease severity was associated with younger diagnosis age and HPV 11; adjusted analyses found only younger diagnosis age significant (adjusted odds ratio: 6.1; 95% confidence interval: 2.9, 12.8). CONCLUSIONS Children with JORRP were commonly firstborn and delivered vaginally to young mothers; most of the mothers reported no HPV vaccination before delivery. Vaccine-preventable HPV was identified in all specimens with detectable HPV. Increasing preexposure HPV vaccination could substantially reduce or eliminate JORRP in the United States.
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Affiliation(s)
- Raiza Amiling
- Division of Viral Diseases, National Center for immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Synergy America, Inc., Duluth, Georgia, USA
| | - Elissa Meites
- Division of Viral Diseases, National Center for immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Troy D. Querec
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Stone
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Vidisha Singh
- Division of Viral Diseases, National Center for immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth R. Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Craig S. Derkay
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA,Pediatric Otolaryngology, Children’s Hospital of the King’s Daughters, Norfolk, Virginia, USA
| | - Lauri E. Markowitz
- Division of Viral Diseases, National Center for immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Gluvajić D, Šereg-Bahar M, Jerin A, Janša R, Hočevar-Boltežar I. The Impact of Laryngopharyngeal Reflux on Occurrence and Clinical Course of Recurrent Respiratory Papillomatosis. Laryngoscope 2021; 132:619-625. [PMID: 34338331 DOI: 10.1002/lary.29793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES/HYPOTHESIS Laryngopharyngeal reflux (LPR) has been proposed both as a trigger for recurrent respiratory papillomatosis (RRP) onset and as a factor favoring an aggressive clinical course. STUDY DESIGN In this prospective study, 106 participants were recruited within a period of 24 months at the Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana. METHODS This study compared a group of RRP patients (N = 36) with a group of LPR patients (N = 28) and a group of healthy participants (N = 42) based on Reflux Symptom Index (RSI), Reflux Finding Scores (RFS), and saliva analyses (pH, pepsin concentration, bile acid concentration, and pepsin enzymatic activity). RESULTS The RRP group compared to the LPR group showed a statistically significant difference only in RSI and RFS scores, while the RRP group compared to healthy controls showed significantly higher values in all tested parameters (RSI score, RFS, saliva pH, pepsin concentration, bile acids concentration, pepsin enzymatic activity). CONCLUSIONS LPR is common in RRP patients and significantly more prevalent compared to healthy controls. Our results show that saliva analyses are a better office-based tool than RSI questionnaires and RFS scores for diagnosing LPR in RRP patients. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2021.
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Affiliation(s)
- Daša Gluvajić
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Maja Šereg-Bahar
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Aleš Jerin
- Institute of Chemistry and Biochemistry, University Medical Centre, Ljubljana, Slovenia
| | - Rado Janša
- Clinical Department of Gastroenterology, University Medical Centre, Ljubljana, Slovenia
| | - Irena Hočevar-Boltežar
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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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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Nagy Z, Pethő Z, Kardos G, Major T, Szűcs A, Szarka K. Effect of E2 and long control region polymorphisms on disease severity in human papillomavirus type 11 mediated mucosal disease: Protein modelling and functional analysis. INFECTION GENETICS AND EVOLUTION 2021; 93:104948. [PMID: 34089910 DOI: 10.1016/j.meegid.2021.104948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/20/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
Interaction of the long control region (LCR) and the E2 protein of HPV11s was studied by in silico modelling and in vitro functional analysis. Genomes of HPV11s from fifteen (six known and nine novel) patients (two solitary papillomas, eleven respiratory papillomatoses of different severity, one condyloma acuminatum and one cervical atypia) were sequenced; E2 polymorphisms were analysed in silico by protein modelling. E2 and LCR variants were cloned into pcDNA3.1+ expression vector and into pALuc reporter vector, respectively, transfected to HEp2 cells alone or in different combinations and the luciferase activity was measured. In the E2, the ubiquitous polymorphism K308R caused stronger binding between the dimers but did not alter DNA binding; E2s with this polymorphism were significantly less efficient than the reference in promoting LCR activity. The unique polymorphism Q86K changed the negative surface charge of E2 (Q86) to positive (K86). The unique polymorphisms S245F and N247T in the hinge region disrupt a probable phosphorylation site in a RXXS motif targeted by protein kinase A and B, but do not affect directly the amino acids critical to nuclear transport. Both unique patterns partly restored the LCR activating potential disrupted by K308R. A unique E2/E4 ORF with a 58-bp deletion leading to a frameshift and an early stop codon resulted in a practically nonfunctional E2, and was associated with a papillomatosis with dysplasia. When testing existing LCR-E2 combinations, LCR with intrinsically lower enhancer capacity was only marginally activated by its E2 (R308 and the deletion mutant), and did not significantly exceed the activity of the reference LCR without E2. Combined with more potent LCRs associated with more severe disease, the activity was significantly higher, but still significantly lower than LCRs with reference E2. In summary, LCR-E2 interaction determined by their polymorphisms may explain, at least partly, differences in disease severity.
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Affiliation(s)
- Zsófia Nagy
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Nagyerdei krt.98, H-4032 Debrecen, Hungary
| | - Zoltán Pethő
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, Nagyerdei krt.98, H-4032 Debrecen, Hungary; Institute of Physiology II, University Muenster, Robert-Koch-Str. 27B, 48147 Münster, Germany
| | - Gábor Kardos
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Nagyerdei krt.98, H-4032 Debrecen, Hungary
| | - Tamás Major
- Otorhinolaryngology and Head-Neck Surgery Division, Kenézy Gyula Teaching Hospital, University of Debrecen, Bartók Béla út 2-26, H-4031 Debrecen, Hungary
| | - Attila Szűcs
- Otorhinolaryngology and Head and Neck Surgery Clinic, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, H-4032 Debrecen, Hungary
| | - Krisztina Szarka
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Nagyerdei krt.98, H-4032 Debrecen, Hungary.
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Sichero L, Ferreira S, López RVM, Mello BP, Costa V, El-Achkar VNR, Carlos R, Ribeiro-Silva A, Pignatari S, Kaminagakura E, Villa LL. Prevalence of human papillomavirus 6 and 11 variants in recurrent respiratory papillomatosis. J Med Virol 2021; 93:3835-3840. [PMID: 32910471 DOI: 10.1002/jmv.26503] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 11/11/2022]
Abstract
Human papillomavirus (HPV) types 6 and 11 are the etiological agents of recurrent respiratory papillomatosis (RRP). We examined the prevalence and distribution of HPVs 6 and 11 genetic variants in juvenile onset (JORRP) and adult onset (AORRP) laryngeal papillomas. Cases of JORRP and AORRP were collected, retrospectively. HPV detection and genotyping were accessed by polymerase chain reaction-sequencing in 67 RRP samples. Overall, the most prevalent HPV-6 variants were from B1 (55.8%) and B3 (27.9%) sublineages, whereas among HPV-11 positive samples A2 (62.5%) variants were predominant. A higher prevalence of HPV-6 B1 was observed in JORRP (83.3% B1 and 16.7% B3), compared with AORRP cases (58.3% B1 and 41.7% B3). HPV-11 A2 variants were more prevalent both in JORRP (57.2%) and in AORRP cases (70.0%). Nevertheless, with the exception that HPV-6 B1 were significantly less likely to recur, there was a lack of association between any particular HPVs 6 or 11 variant and clinicopathological features. Our data do not support an association between HPVs 6 and 11 variability and RRP.
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Affiliation(s)
- Laura Sichero
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Silvaneide Ferreira
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rossana V M López
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Barbara P Mello
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Victor Costa
- Department of Bioscience and Oral Diagnosis, São Paulo State University (UNESP), São Paulo, Brazil
| | - Vivian N R El-Achkar
- Department of Bioscience and Oral Diagnosis, São Paulo State University (UNESP), São Paulo, Brazil
| | - Román Carlos
- Centro Clínico de Cabeza y Cuello, Guatemala City, Guatemala
| | - Alfredo Ribeiro-Silva
- Department of Pathology and Forensic Medicine, Ribeirao Preto Medical School, Universidade de São Paulo, Ribeirao, Preto, Brazil
| | - Shirley Pignatari
- Department of Otorhinolaryngology and Head and Neck Surgery, Sao Paulo Federal University, Sao Paulo, Brazil
| | - Estela Kaminagakura
- Department of Bioscience and Oral Diagnosis, São Paulo State University (UNESP), São Paulo, Brazil
| | - Luisa L Villa
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
- Department of Otorhinolaryngology and Head and Neck Surgery, Sao Paulo Federal University, Sao Paulo, Brazil
- Department of Radiology and Oncology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Iravani K, Bakhshi F, Doostkam A, Malekmakan L, Tale M, Jafari P, Dowran R. Detection of human papillomavirus (HPV) DNA in benign laryngeal lesions and role of cigarette smoking as an inducing factor. Virusdisease 2021; 32:255-259. [PMID: 34350316 PMCID: PMC8324672 DOI: 10.1007/s13337-021-00661-y] [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: 10/06/2020] [Accepted: 01/26/2021] [Indexed: 11/28/2022] Open
Abstract
The association of human papillomavirus (HPV) in laryngeal malignancies is largely known. This study evaluated the association between HPV and benign laryngeal lesions and also the role of smoking and alcohol consumption in increasing the prevalence of HPV in such benign lesions. Seventy-eight specimens of benign laryngeal lesions including 26 polyps, 26 dysplasia, and 26 other lesions such as nodules and cysts were enrolled in this study. Polymerase chain reaction (PCR) technique was used to detect HPV DNA in the tissues. The role of smoking and alcohol consumption in the prevalence of HPV was also evaluated through appropriate statistical tests. This study showed that the prevalence of HPV in benign laryngeal lesions was not statistically significant. The Cohen's effect size for comparing polyps vs. other lesions was nearly 0.7, indicating that HPV prevalence in laryngeal polyps may be clinically meaningful. Another finding in our study is the role of smoking in increasing the HPV prevalence in laryngeal polyps (P = 0.034). In benign laryngeal polyps, HPV prevalence may be clinically important. Smoking acts as a co-factor to induce HPV infection in laryngeal polyps in our study.
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Affiliation(s)
- Kamyar Iravani
- Department of Otolaryngology, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fariba Bakhshi
- Department of Otolaryngology, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Doostkam
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Malekmakan
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masih Tale
- Department of Otolaryngology, Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Jafari
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Razieh Dowran
- Department of Bacteriology and Virology, Shiraz University of Medical Sciences, Shiraz, Iran
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HPV Strain Predicts Severity of Juvenile-Onset Recurrent Respiratory Papillomatosis with Implications for Disease Screening. Cancers (Basel) 2021; 13:cancers13112556. [PMID: 34070981 PMCID: PMC8197133 DOI: 10.3390/cancers13112556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is the most common benign neoplasm of the larynx in children, presenting with significant variation in clinical course and potential for progression to malignancy. Since JoRRP is driven by human papillomavirus (HPV), we evaluated viral factors in a prospective cohort to identify predictive factors of disease severity. Twenty children with JoRRP undergoing routine debridement of papillomas were recruited and followed for ≥1 year. Demographical features, clinical severity scores, and surgeries over time were tabulated. Biopsies were used to establish a tissue bank and primary cell cultures for HPV6 vs. HPV11 genotyping and evaluation of viral gene expression. We found that patients with HPV11+ disease had an earlier age at disease onset, higher frequency of surgeries, increased number of lifetime surgeries, and were more likely to progress to malignancy. However, the amplitude of viral E6/E7 gene expression did not account for increased disease severity in HPV11+ patients. Determination of HPV strain is not routinely performed in the standard of care for JoRRP patients; we demonstrate the utility and feasibility of HPV genotyping using RNA-ISH for screening of HPV11+ disease as a biomarker for disease severity and progression in JoRRP patients.
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Bai K, Allen C. How Enhancing Immunity to Low-Risk HPV Could Cure Recurrent Respiratory Papillomatosis. Laryngoscope 2021; 131:2041-2047. [PMID: 33720393 DOI: 10.1002/lary.29153] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/13/2020] [Accepted: 09/09/2020] [Indexed: 12/12/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) is currently treated with repeat surgical resection of papillomatous disease that does not address the fundamental underlying issue of chronic infection with low-risk human papillomavirus. Here, we review the biology and immunology of low-risk human papillomavirus (HPV) infections. Antiviral or antiangiogenic adjuvant treatments similarly address the papillomatous disease itself but do not activate HPV immunity. It is likely that only through immune-mediated clearance of low-risk HPV infection can patients with RRP be cured. In some patients, this occurs spontaneously. In others with more aggressive disease, adjuvant immunotherapy to activate immunity may be needed. Based on current understanding of antiviral immune responses, the only rational strategy to clear HPV-infected epithelial cells is through activation of the T-lymphocyte arm of the adaptive immune response. Translation of immunotherapies that are Food and Drug Administration-approved or under clinical study for cancer, such as immune checkpoint blockade or engineered therapeutic vaccines, may provide a path toward tolerable and efficacious adjuvant immunotherapy for RRP. LEVEL OF EVIDENCE: NA Laryngoscope, 131:2041-2047, 2021.
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Affiliation(s)
- Ke Bai
- Section on Translation Tumor Immunology, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, U.S.A
| | - Clint Allen
- Section on Translation Tumor Immunology, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, U.S.A
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44
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Hall SR, Thiriveedi M, Yandrapalli U, Zhang N, Lott DG. Sublesional Bevacizumab Injection for Recurrent Respiratory Papillomatosis: Evaluation of Utility in a Typical Clinical Practice. Ann Otol Rhinol Laryngol 2021; 130:1164-1170. [PMID: 33648353 DOI: 10.1177/0003489421998215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate the benefit of sublesional bevacizumab injection for recurrent respiratory papillomatosis (RRP) as used in a typical clinical practice. METHODS A retrospective review of patients with RRP treated between 2011 and 2016 was undertaken. All patients were treated with in-office potassium titanyl phosphate (KTP) laser photoablation. Sublesional bevacizumab injection was used based on joint patient-physician decision making. Papilloma burden was objectively measured on prior recordings by 2 blinded reviewers and described as vocal fold segments affected (VFSA) by papilloma. Each patient served as their own control by comparing times when bevacizumab was or was not used. Mixed model for longitudinal data was used to determine if the previous use of bevacizumab decreased the disease burden. RESULTS A total of 19 patients met inclusion criteria and all prior laryngoscopic exams were reviewed for VFSA as described above. The mean (SD) number of VFSA when bevacizumab was not used at the prior procedure was 15 (14) as compared to 8 (11) when bevacizumab was used. When adjusted for age, time from initial presentation and baseline disease burden, mixed model showed a decrease of 11 VFSA (95% CI 6.5, 15.5, P < .0001) when bevacizumab was used as compared to when bevacizumab was not used at the prior procedure. In mixed model analysis, there was not a significant association between bevacizumab dose used and VFSA at the subsequent visit (P = .8). CONCLUSION Using sublesional bevacizumab intermittently based on clinical findings appears to be effective in improving disease control. Papilloma burden is significantly decreased at the subsequent clinical follow-up following injection of sublesional bevacizumab. The beneficial effect of sublesional bevacizumab may be not be dose-dependent.
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Affiliation(s)
- Scott Ryan Hall
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, AZ, USA
| | - Mrudula Thiriveedi
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, AZ, USA
| | - Usha Yandrapalli
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, AZ, USA
| | - Nan Zhang
- Division of Health Science Research, Mayo Clinic, AZ, USA
| | - David G Lott
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, AZ, USA
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45
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Ruiz R, Zur KB. Recurrent Respiratory Papillomatosis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Evers G, Schliemann C, Beule A, Schmidt LH, Schulze AB, Kessler C, Hoffmann TK, Wiewrodt R, Groll AH, Bleckmann A, Rudack C, Berdel WE, Mohr M. Long-Term Follow-Up on Systemic Bevacizumab Treatment in Recurrent Respiratory Papillomatosis. Laryngoscope 2020; 131:E1926-E1933. [PMID: 33382105 DOI: 10.1002/lary.29351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/17/2020] [Accepted: 12/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Recurrent respiratory papillomatosis (RRP) is a primarily benign disease affecting the entire respiratory tract. Treatment is challenging and usually involves surgical interventions and adjuvant medications. Previously, promising results on systemic administration of bevacizumab have been reported. However, experience on long-term systemic use in patients with RRP is not yet available. Here, we present our long-term follow-up on RRP patients undergoing systemic bevacizumab treatment. STUDY DESIGN Case series. METHODS To describe experience on long-term systemic bevacizumab administration, we performed the underlying investigation. Clinical, radiological, and bronchoscopy data were collected. RESULTS To date, a total of n = 5 patients has been treated with systemic bevacizumab at Muenster University Hospital. With a median follow-up since first systemic bevacizumab administration of 95.5 months long-term follow-up is illustrated. Following bevacizumab treatment partial remission or very good partial remission were achieved in all patients. After papilloma recurrence/progression due to bevacizumab discontinuation, further response was documented in all patients in whom bevacizumab was started again. In one patient, bevacizumab was discontinued due to loss of efficacy. Lung cancer developed in one patient with pulmonary papillomatosis prior to bevacizumab administration whereas three patients suffered from malignant transformation during bevacizumab treatment. Systemic bevacizumab led to long-term reduction in surgical interventions in all patients. Except from mild proteinuria and hypertension in two patients therapy was well tolerated. CONCLUSIONS Systemic bevacizumab represents a promising long-term treatment option for aggressive forms of papillomatosis. Rate of malignant transformation under bevacizumab treatment, optimal treatment schedule, and influence on survival should be further evaluated in clinical trials. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1926-E1933, 2021.
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Affiliation(s)
- Georg Evers
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Achim Beule
- Department of Otolaryngology/Head and Neck Cancer, University Hospital Muenster, Muenster, Germany
| | - Lars-Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Arik B Schulze
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Christina Kessler
- Department of Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Thomas K Hoffmann
- Department of Otolaryngology/Head and Neck Cancer, University Hospital Ulm, Ulm, Germany
| | - Rainer Wiewrodt
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Andreas H Groll
- Department of Pediatric Hematology/Oncology, University Hospital Muenster, Muenster, Germany
| | - Annalen Bleckmann
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Claudia Rudack
- Department of Otolaryngology/Head and Neck Cancer, University Hospital Muenster, Muenster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
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Rojas-Lechuga MJ, Remacha J, González-Sánchez N, Grau JJ, Castillo P, Haag O, Vilaseca I. Juvenile recurrent respiratory papillomatosis treated with combined erlotinib and celecoxib: Initial report. Int J Pediatr Otorhinolaryngol 2020; 137:110194. [PMID: 32658799 DOI: 10.1016/j.ijporl.2020.110194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 11/18/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) is a chronic disease caused by human papillomavirus (HPV). RRP is a clinical challenge because of the high recurrence rate, poor surgery response, extension to tracheobronchial tree and because of the risk of malignancy in some cases. There is no consensus on which adjuvant therapy is better for those patients with highly recurrent course. Because papilloma cells overexpress the epidermal growth factor receptor (EGFR), together with an increased expression of COX-2 and prostaglandin E2, the combination of erlotinib and celecoxib seems plausible, and could be proposed for patients with poor response to previous lines of treatment.
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Affiliation(s)
| | - Joan Remacha
- Otorhinolaryngology Department Hospital Clinic, Barcelona, Spain
| | | | - Juan José Grau
- Medical Oncology Department, Hospital Clinic, Barcelona, Spain; IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Paola Castillo
- Pathology Department, Hospital Clinic, Barcelona, Spain; IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Oliver Haag
- Otorhinolaryngology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Isabel Vilaseca
- Otorhinolaryngology Department Hospital Clinic, Barcelona, Spain; IDIBAPS, University of Barcelona, Barcelona, Spain
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Nogueira RL, Küpper DS, do Bonfim CM, Aragon DC, Damico TA, Miura CS, Passos IM, Nogueira ML, Rahal P, Valera FCP. HPV genotype is a prognosticator for recurrence of respiratory papillomatosis in children. Clin Otolaryngol 2020; 46:181-188. [PMID: 32869523 DOI: 10.1111/coa.13640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/03/2020] [Accepted: 08/16/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to compare the prognosis according to age, genotype or human papillomavirus (HPV) variant in patients with recurrent respiratory papillomatosis (RRP). DESIGN Non-concurrent cohort. PARTICIPANTS Forty one patients with RRP. SETTING Tertiary referral hospital. MAIN OUTCOME MEASURES Disease severity was defined by the number of surgeries performed, and Derkay score at surgeries, obtained from medical records. HPV was detected and genotyped, and HPV-6 variants were also assessed. RESULTS Fifteen (36.58%) individuals belonged to the juvenile RRP group (JoRRP, less than 18 years), while 26 patients (63.41%) were allocated at the adult group (AoRRP, equal or more than 18 years). JoRRP patients needed, in average, a higher number of surgeries to control the disease than AoRRP patients (mean difference: 3.36). Also, JoRRP patients showed a higher Derkay score at each surgery (mean difference: 3.76). There was no significant difference in the number of surgeries when we compared patients infected with HPV-6 or HPV-11, neither in accordance to HPV-6 variants. Patients with HPV-11 presented a higher mean Derkay score at surgery than those with HPV-6 (mean difference: 4.39); when co-variated by age, we observed that this difference occurred only among JoRRP patients (mean difference: 6.15). CONCLUSIONS Age of onset of RRP has an important impact on number of surgeries to control disease. Patients with JoRRP and HPV-11 tend to present worse Derkay score at each surgery. HPV genotype among adults and HPV-6 variants had no impact on the outcome of the disease.
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Affiliation(s)
- Rodrigo L Nogueira
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Daniel S Küpper
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Caroline M do Bonfim
- Department of Biology, IBILCE, Institute of Bioscience, Language & Literature and Exact Science, University of São Paulo State (UNESP), Sao Jose do Rio Preto, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Thiago A Damico
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Carolina S Miura
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Ivna M Passos
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Maurício L Nogueira
- Laboratory of Research in Virology, School of Medicine of São José do Rio Preto, FAMERP, Sao Jose do Rio Preto, Brazil
| | - Paula Rahal
- Department of Biology, IBILCE, Institute of Bioscience, Language & Literature and Exact Science, University of São Paulo State (UNESP), Sao Jose do Rio Preto, Brazil
| | - Fabiana C P Valera
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
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Zeleník K, Komínek P, Staníková L, Formánek M. Local Bevacizumab Treatment of Juvenile-Onset Respiratory Papillomatosis Might Induce Multiple Tracheal Pyogenic Granulomas. Laryngoscope 2020; 131:E518-E520. [PMID: 32633817 PMCID: PMC7818179 DOI: 10.1002/lary.28928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/21/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Karol Zeleník
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Pavel Komínek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Lucia Staníková
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Martin Formánek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, Ostrava, Czech Republic
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Ballestas SA, Shelly S, Soriano RM, Klein A. Trends in recurrent respiratory papillomatosis treatment. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:109-120. [PMID: 32312478 DOI: 10.1016/j.otorri.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/23/2019] [Accepted: 11/08/2019] [Indexed: 11/27/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) consist of benign tumours along the airway caused by human papillomavirus infection. Papillomas may cause changes in phonation and obstruct the airway. The purpose of this study was to evaluate the different surgical and adjuvant therapies available for the treatment of this condition reported between 2014-2018. A PubMed search was performed for RRP treatment articles published between 2014 -2018. Forty articles that encompassed 1425 patients with RRP met the criteria. Of these, 24 articles evaluate the use of adjuvant therapies such as bevacizumab, human papillomavirus vaccine and cidofovir. There has been an increase in adjuvant therapy options for RRP in the literature in recent years. An awareness of these options highlights gaps and opportunities in the care of these patients, opens the door to new protocols to control disease and increase intersurgical intervals, and guides us towards new management paradigms in the future.
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Affiliation(s)
- Samir A Ballestas
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos
| | - Sandeep Shelly
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos
| | - Roberto M Soriano
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos
| | - Adam Klein
- Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello, Emory University School of Medicine, Atlanta, Estados Unidos.
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