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Pai SI, Wasserman I, Ji YD, Gilman M, Hung YP, Faquin WC, Mino-Kenudson M, Muniappan A. Pulmonary manifestations of chronic HPV infection in patients with recurrent respiratory papillomatosis. THE LANCET. RESPIRATORY MEDICINE 2022; 10:997-1008. [PMID: 35863360 PMCID: PMC10634185 DOI: 10.1016/s2213-2600(22)00008-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 10/17/2022]
Abstract
Human papillomavirus (HPV) types 6 and 11 can infect the squamous epithelium of the respiratory tract. Up to 8·9% of patients with HPV-associated recurrent respiratory papillomatosis (RRP) have pulmonary involvement. Pulmonary manifestations of HPV infection are associated with considerable morbidity, in part because treatment options and management guidelines are lacking. Patients with pulmonary RRP have a 32-times increased lifetime risk of malignant transformation compared with the overall RRP population. We review the clinical and radiographic presentation, pathological features, and genetics of pulmonary RRP, and we provide management algorithms based on our clinical experience with this complex patient population. In patients with suspected pulmonary involvement, tissue-sparing procedures to address growing lesions might be warranted given the chronicity and multifocality of the disease over a patient's lifetime. However, malignant transformation of pulmonary lesion(s) warrants standard-of-care treatment for primary lung squamous cell carcinoma. Large cohort studies are needed to understand the clinical course of pulmonary RRP and to identify molecular markers of increased risk of malignant transformation in order to develop guidelines for optimal and standardised surveillance and treatment.
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Affiliation(s)
- Sara I Pai
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Isaac Wasserman
- Harvard Medical School, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
| | - Yisi D Ji
- Harvard Medical School, Boston, MA, USA
| | - Matthew Gilman
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Ashok Muniappan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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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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Abstract
Hoarseness is a common problem, typically of transient nature. When hoarseness does not resolve, or when it is associated with concerning symptoms, it is important to consider a wide differential and refer to an otolaryngologist. This article discusses the physiology of the voice and possible causes of dysphonia, and explores when it warrants further work-up by ENT. A discussion of diagnostic techniques and the myriad of tools to treat hoarseness follows. Additionally, the role of reflux in dysphonia is examined with a critical eye to aid in accurate assessment of the patient's complaint.
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Affiliation(s)
- Hayley Born
- Sean Parker Institute for the Voice at Weill Cornell Medicine, New York, NY, USA; Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, 240 East 59th Street, New York, NY, USA. https://twitter.com/drhayleyborn
| | - Anaïs Rameau
- Sean Parker Institute for the Voice at Weill Cornell Medicine, New York, NY, USA; Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, 240 East 59th Street, New York, NY, USA.
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Donne AJ, Kinshuck A. Pharmacotherapy for recurrent respiratory papillomatosis (RRP): a treatment update. Expert Opin Pharmacother 2021; 22:1901-1908. [PMID: 34080517 DOI: 10.1080/14656566.2021.1935870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Recurrent respiratory papillomatosis is a rare human papillomavirus (HPV)-induced condition where warts grow within the airway and especially the larynx to effect voice and restrict breathing.Areas covered: A PubMed search using the following search terms was performed: respiratory papillomatosis and cidofovir, alpha-interferon, bevacizumab, PD1, and HPV vaccines. Surgery remains the mainstay of treatment. There has been a change in options available for adjuvant therapies with systemic bevacizumab and the potential benefits of prophylactic HPV vaccine. Despite efforts to identify a drug therapy to control RRP, no therapy yet remains which is predictable and effective in all. The current status of therapeutic vaccines and immunotherapy is discussed.Expert opinion: The current adjuvant therapies do offer a reasonable expectation of control but the effect for the individual is unpredictable despite the therapies being based on good science. The current therapies would allow an escalating treatment strategy to be formulated, however a single therapy is unlikely to be curative. Multi-center trials are required such that adequate numbers to show an effect are achieved.
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Affiliation(s)
- Adam J Donne
- Consultant Paediatric Otolaryngologist, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Andy Kinshuck
- Consultant in Otolaryngology/Head & Neck Surgery, Aintree University Hospital, Liverpool, UK
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Lépine C, Klein P, Voron T, Mandavit M, Berrebi D, Outh-Gauer S, Péré H, Tournier L, Pagès F, Tartour E, Le Meur T, Berlemont S, Teissier N, Carlevan M, Leboulanger N, Galmiche L, Badoual C. Histological Severity Risk Factors Identification in Juvenile-Onset Recurrent Respiratory Papillomatosis: How Immunohistochemistry and AI Algorithms Can Help? Front Oncol 2021; 11:596499. [PMID: 33763347 PMCID: PMC7982831 DOI: 10.3389/fonc.2021.596499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/12/2021] [Indexed: 11/23/2022] Open
Abstract
Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a condition characterized by the repeated growth of benign exophytic papilloma in the respiratory tract. The course of the disease remains unpredictable: some children experience minor symptoms, while others require multiple interventions due to florid growth. Our study aimed to identify histologic severity risk factors in patients with JoRRP. Forty-eight children from two French pediatric centers were included retrospectively. Criteria for a severe disease were: annual rate of surgical endoscopy ≥ 5, spread to the lung, carcinomatous transformation or death. We conducted a multi-stage study with image analysis. First, with Hematoxylin and eosin (HE) digital slides of papilloma, we searched for morphological patterns associated with a severe JoRRP using a deep-learning algorithm. Then, immunohistochemistry with antibody against p53 and p63 was performed on sections of FFPE samples of laryngeal papilloma obtained between 2008 and 2018. Immunostainings were quantified according to the staining intensity through two automated workflows: one using machine learning, the other using deep learning. Twenty-four patients had severe disease. For the HE analysis, no significative results were obtained with cross-validation. For immunostaining with anti-p63 antibody, we found similar results between the two image analysis methods. Using machine learning, we found 23.98% of stained nuclei for medium intensity for mild JoRRP vs. 36.1% for severe JoRRP (p = 0.041); and for medium and strong intensity together, 24.14% for mild JoRRP vs. 36.9% for severe JoRRP (p = 0.048). Using deep learning, we found 58.32% for mild JoRRP vs. 67.45% for severe JoRRP (p = 0.045) for medium and strong intensity together. Regarding p53, we did not find any significant difference in the number of nuclei stained between the two groups of patients. In conclusion, we highlighted that immunochemistry with the anti-p63 antibody is a potential biomarker to predict the severity of the JoRRP.
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Affiliation(s)
- Charles Lépine
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Pathology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | | | | | | | | | - Sophie Outh-Gauer
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Pathology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Hélène Péré
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Virology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Louis Tournier
- Department of Pathology, Hôpital Robert Debré, APHP, Paris, France
| | - Franck Pagès
- Department of Immunology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Eric Tartour
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Immunology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | | | | | - Natacha Teissier
- Department of Pediatric ENT Surgery, Hôpital Robert Debré, APHP, Paris, France
| | - Mathilde Carlevan
- Department of Pediatric ENT Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Nicolas Leboulanger
- Department of Pediatric ENT Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Louise Galmiche
- Department of Pathology, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Cécile Badoual
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Pathology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
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Lépine C, Voron T, Berrebi D, Mandavit M, Nervo M, Outh-Gauer S, Péré H, Tournier L, Teissier N, Tartour E, Leboulanger N, Galmiche L, Badoual C. Juvenile-Onset Recurrent Respiratory Papillomatosis Aggressiveness: In Situ Study of the Level of Transcription of HPV E6 and E7. Cancers (Basel) 2020; 12:cancers12102836. [PMID: 33019611 PMCID: PMC7601884 DOI: 10.3390/cancers12102836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a condition related to HPV 6 and 11 infection which is characterized by the repeated growth of benign exophytic papilloma in the respiratory tract of children. Disease progression is unpredictable leading sometimes to airway compromise and death. The aim of this study was to explore p16INK4a and expression of the RNA of HPV genes E6 and E7 with a chromogenic in situ hybridization (CISH) as biomarkers of JoRRP aggressiveness on a bicentric cohort of forty-eight children. CISH was scored semi-quantitatively as high (2+ score) and low (1+ score) levels of transcription of E6 and E7. Patients with a 2+ score had a more aggressive disease compared to those with a 1+ score. These data are a first step towards the use of biomarkers predictive of disease severity in JoRRP, this could improve the disease management, for example, by implementing adjuvant treatment at the early stages. Abstract Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a condition related to HPV 6 and 11 infection which is characterized by the repeated growth of benign exophytic papilloma in the respiratory tract. Disease progression is unpredictable: some children experience minor symptoms, while others require multiple interventions due to florid growth. The aim of this study was to explore the biomarkers of JoRRP severity on a bicentric cohort of forty-eight children. We performed a CISH on the most recent sample of papilloma with a probe targeting the mRNA of the E6 and E7 genes of HPV 6 and 11 and an immunostaining with p16INK4a antibody. For each patient HPV RNA CISH staining was assessed semi-quantitatively to define two scores: 1+, defined as a low staining extent, and 2+, defined as a high staining extent. This series contained 19 patients with a score of 1+ and 29 with a score of 2+. Patients with a score of 2+ had a median of surgical excision (SE) per year that was twice that of patients with a score of 1+ (respectively 6.1 versus 2.8, p = 0.036). We found similar results with the median number of SE the first year. Regarding p16INK4a, all patients were negative. To conclude, HPV RNA CISH might be a biomarker which is predictive of disease aggressiveness in JoRRP, and might help in patient care management.
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Affiliation(s)
- Charles Lépine
- Department of Pathology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France; (C.L.); (M.N.); (S.O.-G.)
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Thibault Voron
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Dominique Berrebi
- Department of Pathology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France; (D.B.); (L.T.)
| | - Marion Mandavit
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Marine Nervo
- Department of Pathology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France; (C.L.); (M.N.); (S.O.-G.)
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Sophie Outh-Gauer
- Department of Pathology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France; (C.L.); (M.N.); (S.O.-G.)
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Hélène Péré
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
- Department of Virology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France
| | - Louis Tournier
- Department of Pathology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France; (D.B.); (L.T.)
| | - Natacha Teissier
- Department of Pediatric ENT Surgery, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France;
| | - Eric Tartour
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
- Department of Immunology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France
| | - Nicolas Leboulanger
- Department of Pediatric ENT Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France;
| | - Louise Galmiche
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France;
| | - Cécile Badoual
- Department of Pathology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France; (C.L.); (M.N.); (S.O.-G.)
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
- Correspondence: ; Tel.: +33-156-093-888
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