Oral Papillomatosis: Its Relation with Human Papilloma Virus Infection and Local Immunity—An Update

Nanoemulsion and nanoemulgel-based carriers as advanced delivery tools for the treatment of oral diseases

Oral diseases rank among the most widespread ailments worldwide posing significant global health and economic challenges affecting around 3.5 billion people, impacting the quality of life for affected individuals. Dental caries, periodontal disease, bacterial and fungal infections, tooth loss and oral malignancies are among the most prevalent global clinical disorders contributing to oral health burden. Traditional treatments for oral diseases often face challenges such as poor drug bioavailability, breakdown of medication in saliva, inconsistent antibiotic levels at the site of periodontal infection as well as higher side effects. However, the emergence of nanoemulgel (NEG) as an innovative drug delivery system offers promising solutions where NEG combines the advantages of both nanoemulsions (NEs) and hydrogels providing improved drug solubility, stability, and targeted delivery. Due to their minuscule size and ability to control drug release, NEGs hold promise for improving treatment of oral diseases, where versatility of these delivery systems makes them suitable for various applications, including topical delivery in dentistry. This review concisely outlines the anatomy of the oral environment and investigates the therapeutic potential of NE-based gels in oral disorder treatment. It thoroughly examines the challenges of drug delivery in the oral cavity and proposes strategies to improve therapeutic efficacy, drawing attention to previous research reports for comparison. Through comprehensive analysis, the review highlights the promising role of NEGs as a novel therapeutic approach for oral health management via research advancements and their clinical translation. Additionally, it provides valuable insights into future research directions and development opportunities in this area.

Recurrent respiratory papillomatosis: role of bevacizumab and HPV vaccination. A literature review with case presentations

BACKGROUND

Recurrent respiratory papillomatosis (RRP) is a condition caused by human papilloma virus (HPV) infection. Curative treatments aren't identifiable, and conservative surgery is often the best option to preserve respiratory functions. To date monoclonal antibodies are considered to be a treatment choice with both good efficacy and safety profile.

MATERIALS AND METHODS

A web-based search of MEDLINE/PubMed library from 2000 to 2024 of English-language papers was performed to identify articles by using "respiratory or laryngeal papillomatosis" and "HPV respiratory infection, papillomatosis treatment, papillomatosis vaccine immunization, papillomatosis systemic treatment". Furthermore, a manual screening of references from original articles was done to identify additional studies. We selected 34 articles.

RESULTS

Since 2009, the systemic administration of Bevacizumab has been used to treat RRP not responding to surgical treatment. The efficacy of an anti-VEGF monoclonal antibody in RRP lesions can be related to their vascular nature. The major concern is the rebound papilloma growth within the cessation of treatment. An interesting solution could be the concomitant use of immunotherapy to both reduce the burden of residual disease and activate the immune system against the HPV-infected cells.

CONCLUSIONS

Bevacizumab has a safe profile with a short-term local eradication of HPV. Further prospective research with long-term follow-up is needed to better define its safety and results against the disease recurrence. Considering the role of the anti-HPV vaccine, both, in the prophylaxis of the infection and in the adjuvant setting, the actual data underline the need for evaluation of its therapeutic efficacy for the management of RRP.

An exploration of the natural and acquired immunological mechanisms to high-risk human papillomavirus infection and unmasking immune escape in cervical cancer: A concise synopsis

The most common STD that triggers cervical cancer is the human papillomavirus. More than 20 types of human papillomavirus (HPV) can induce uterine cervical cancer. Almost all women acquire genital HPV infection soon after their first intercourse, with most of them clearing the virus within 3 years. An immune response is necessary to clear. The first responders to HPV infection are the innate immune system elements composed of macrophages, keratinocytes, natural killer cells, and natural killer T-lymphocytic (NKT) cells. Cytotoxic T lymphocytes (CTLs) comprise the second line of defense and kill HPV16-infected cells expressing various peptides derived from their transforming early viral oncoproteins, mainly E2•E6. Even though HPV can manage to trick away our immune systems, first of all, it is important to emphasize that HPV replication does not kill the host cells. It does not replicate viral antigens or cause inflammation. The HPV16 E6 and E7 genes suppress host cell type 1 interferons (IFNs), which are detectable after infection. The patient may have immunological tolerance; hence, there are no costimulatory signals from inflammatory cytokines like IFNs during antigen recognition. Evidence shows that HlA class I generations have been inhibited by HPV16 E5, which could protect this tumor cell from CTL attack. HPV16 E7 is responsible for initiating immunotolerance and increasing regulatory T cells (Treg) to repress immunological regression. Evasion from immune system protection plays a critical role in the outcome of persistent HPV infection and the development of cervical cancer. Vaccination against HPV16 and 18 during adolescence is the most effective method for preventing cervical cancer in women, considering the immunological processes involved.

Association between Periodontal Disease and Oral Benign, Potentially Malignant, Malignant, and Chronic Immune-Mediated Disorders: A Clinical Study

Background: Periodontal disease is an inflammatory, chronic, and multifactorial disease. The objective of this study is to analyze the association between periodontal disease and some disorders such as papillomas (benign lesions), lichen planus (a chronic immune-mediated disorder), leukoplakia (potentially malignant lesions), and oral cancer (malignant lesions). Methods: For this study, 42 patients were recruited whose supragingival and subgingival plaque was qualitatively analyzed using a phase-contrast microscope, which allowed for the detection of compatible bacterial flora (immobile and composed mainly of cocci) indicative of periodontal health and incompatible bacterial flora (mobile and composed mainly of spirochetes) indicative of periodontal pathology. Patients with incompatible bacterial flora were then subjected to a laser-assisted periodontal treatment with irrigation with hydrogen peroxide within the periodontal pockets (a non-surgical laser-assisted periodontal protocol which is referred to as dye-free photodynamic therapy). Results: Based on the 42 patients recruited, there was no association between oral cavity lesions and periodontal pathogenic bacteria. Four of them were found to have incompatible bacterial flora. Indeed, it was found that almost all the patients had been previously instructed in the proper techniques of home oral hygiene, and more than half of them reported that they carried out periodic check-ups by a dental hygienist. Of the four patients with signs and symptoms of periodontitis, two stated a willingness to undergo the non-surgical laser-assisted periodontal protocol and showed improvements in periodontal indices such as CAL, PPD, and BoP. Conclusions: hygienists and dentists are determining factors in the prevention of periodontal disease and for the maintenance of good oral health.

Lactoferrin: A Promising Therapeutic Molecule against Human Papillomavirus

Lactoferrin is a multifunctional glycoprotein naturally found in mammalian secretions, predominantly in colostrum and milk. As a key component of dairy foods, lactoferrin enhances viral protection and boosts human health, owing to its fundamental properties including antiviral, anti-inflammatory, and immune-modulatory effects. Importantly, the antiviral effect of lactoferrin has been shown against a range of viruses causing serious infections and threatening human health. One of the viruses that lactoferrin exerts significant antiviral effects on is the human papillomavirus (HPV), which is the most prevalent transmitted infection affecting a myriad of people around the world. Lactoferrin has a high potential to inhibit HPV via different mechanisms, including direct binding to viral envelope proteins or their cell receptors, thereby hindering viral entry and immune stimulation by triggering the release of some immune-related molecules through the body, such as lymphocytes. Along with HPV, lactoferrin also can inhibit a range of viruses including coronaviruses and hepatitis viruses in the same manner. Here, we overview the current knowledge of lactoferrin and its effects on HPV and other viral infections.

Oral medicine considerations for the older patient

With the proportion of the world population aged over 60 years expected to nearly double to 22% by 2050, health care professionals are faced with the challenge of ensuring they are ready to address this demographic shift. As people age, they are more likely to develop comorbidities which have implications for their oral health. The effects of polypharmacy used to address these underlying health problems can also influence the oral health of older-aged patients. From a clinician's perspective, an awareness of the variety of conditions associated with old age, such as oral-mucosal disease, swellings and manifestations of underlying health conditions, are required to ensure appropriate referral, investigation and management, both in primary and secondary care settings. This article aims to provide the practitioner with an overview of orofacial and oral mucosal conditions commonly encountered with the older patient.

Analysis of Parents' Attitudes and Knowledge toward Immunization and How These Factors Influence Their Decisions to Vaccinate Their Children against Human Papilloma Virus (HPV)

Background and objectives: Vaccination hesitancy is a growing problem associated with decreasing chances for the elimination of vaccine-preventable diseases through immunization. This research was conducted to learn about parents' attitudes toward vaccination, particularly against HPV, in the context of their beliefs and fears regarding immunization and the impact of these views on their children's vaccination decisions. An additional goal was to determine what views or convictions most often lead to the phenomenon of delaying or refusing vaccinations, especially HPV vaccines, in the surveyed community. Materials and Methods: An online questionnaire was conducted in which parents marked how they vaccinated their children with mandatory vaccinations and whether they took the opportunity to protect their children with additional vaccinations, including HPV and COVID-19. Respondents also marked the extent to which they agreed with the statements, regarding the safety of vaccinations, doubts about them, as well as popular anti-vaccine myths. Results: A total of 250 questionnaires were collected with data on the immunization of 425 children. Associations between specific beliefs and vaccine abstention were established. The most motivating factor for vaccination against HPV was the parent's awareness that the virus HP is the cause of cancer. The most inhibiting factor was respondent's compliance with the opinion that HPV vaccines can affect the child's sexual activity. Conclusions: The results indicate that information campaigns are needed, especially focusing on vaccine safety and the regularity and transparency of monitoring adverse effects. The obtained results will be used to create educational interventions against vaccination hesitancy more adapted to local conditions.

Screening for High-Risk Oral Human Papillomavirus (HPV31, HPV33, HPV35) in a Multi-Racial Pediatric and Adult Clinic Patient Population

Many human papillomavirus (HPV) strains induce cancer in the cervix and the oral cavity. Although high-risk strains including HPV16 and HPV18 are commonly known, additional high-risk strains including HPV31, HPV33, and HPV35 may also induce carcinogenesis, and much less is known about their prevalence. Using an approved protocol, samples from a salivary biorepository were screened to find pediatric and adult samples from a multi-ethnic, university-based patient clinic population. A total of N = 86 samples from the saliva biorepository met the quality and concentration standards and were screened for high-risk HPV. qPCR screening of adult samples revealed n = 10/45 or 22% were HPV31- or HPV33-positive. In addition, a total of n = 9/41 or 21.9% of pediatric samples were either HPV31- or HPV33-positive (or both). No samples harbored HPV35. Most samples were derived from patients within the recommended vaccination or catch-up age range (age 9-45 years). These results demonstrated that a significant percentage of patients harbor additional high-risk HPV strains within the oral cavity, including HPV31 and HPV33. These data support oral healthcare provider recommendations for the newer nine-valent vaccine, which includes both HPV31 and HPV33.

Involvement of TLR9 in priming the immune response in oral papillomatosis induced by low-risk HPV

Oral papillomatosis represents a benign lesion of the oral mucosa often induced by human papillomavirus (HPV) or having a non-infection local or general etiology. HPVs are very well adapted and efficient viruses able to produce changes in the immune system, endowed with the ability to replicate in the keratinocytes and to remain silent. The natural evolution of HPV infection is different, depending on the efficiency of the innate immune system. The purpose of this study was to explore Toll-like receptor 9 (TLR9) immunohistochemical expression in low-risk (LR)-HPV oral infection and its ability to facilitate an efficient immune response by activating the macrophages, which serve as main antigen-presenting cells. Samples of two groups of oral mucosae - LR-HPV-positive and HPV-negative - were processed for immunohistochemistry technique and incubated with antibody against TLR9 and cluster of differentiation 68 (CD68). Image analysis and morphometry were conducted to assess the intensity of TLR9 immune signal in the epithelium and the number of macrophages labeled by CD68. We found a statistically significant difference between macrophage count for the subjects in HPV-positive and HPV-negative groups; thought no significant differences of TLR9 immune signal was noted, which demonstrates a diminished immune response in HPV-positive group, probably influencing the time of lesion's clearance.

Unveiling the Human Gastrointestinal Tract Microbiome: The Past, Present, and Future of Metagenomics

Over 10¹⁴ symbiotic microorganisms are present in a healthy human body and are responsible for the synthesis of vital vitamins and amino acids, mediating cellular pathways and supporting immunity. However, the deregulation of microbial dynamics can provoke diverse human diseases such as diabetes, human cancers, cardiovascular diseases, and neurological disorders. The human gastrointestinal tract constitutes a hospitable environment in which a plethora of microbes, including diverse species of archaea, bacteria, fungi, and microeukaryotes as well as viruses, inhabit. In particular, the gut microbiome is the largest microbiome community in the human body and has drawn for decades the attention of scientists for its significance in medical microbiology. Revolutions in sequencing techniques, including 16S rRNA and ITS amplicon sequencing and whole genome sequencing, facilitate the detection of microbiomes and have opened new vistas in the study of human microbiota. Especially, the flourishing fields of metagenomics and metatranscriptomics aim to detect all genomes and transcriptomes that are retrieved from environmental and human samples. The present review highlights the complexity of the gastrointestinal tract microbiome and deciphers its implication not only in cellular homeostasis but also in human diseases. Finally, a thorough description of the widely used microbiome detection methods is discussed.