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King RE, Bilger A, Rademacher J, Lambert PF, Thibeault SL. Preclinical Models of Laryngeal Papillomavirus Infection: A Scoping Review. Laryngoscope 2023; 133:3256-3268. [PMID: 37227124 PMCID: PMC10674042 DOI: 10.1002/lary.30762] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Laryngeal human papillomavirus (HPV) infection causes recurrent respiratory papillomatosis (RRP) and accounts for up to 25% of laryngeal cancers. Lack of satisfactory preclinical models is one reason that treatments for these diseases are limited. We sought to assess the literature describing preclinical models of laryngeal papillomavirus infection. DATA SOURCES PubMed, Web of Science, and Scopus were searched from the inception of database through October 2022. REVIEW METHODS Studies searched were screened by two investigators. Eligible studies were peer-reviewed, published in English, presented original data, and described attempted models of laryngeal papillomavirus infection. Data examined included type of papillomavirus, infection model, and results including success rate, disease phenotype, and viral retention. RESULTS After screening 440 citations and 138 full-text studies, 77 studies published between 1923 and 2022 were included. Models used low-risk HPV or RRP (n = 51 studies), high-risk HPV or laryngeal cancer (n = 16), both low- and high-risk HPV (n = 1), and animal papillomaviruses (n = 9). For RRP, 2D and 3D cell culture models and xenografts retained disease phenotypes and HPV DNA in the short term. Two laryngeal cancer cell lines were consistently HPV-positive in multiple studies. Animal laryngeal infections with animal papillomaviruses resulted in disease and long-term retention of viral DNA. CONCLUSIONS Laryngeal papillomavirus infection models have been researched for 100 years and primarily involve low-risk HPV. Most models lose viral DNA after a short duration. Future work is needed to model persistent and recurrent diseases, consistent with RRP and HPV-positive laryngeal cancer. LEVEL OF EVIDENCE NA Laryngoscope, 133:3256-3268, 2023.
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Affiliation(s)
- Renee E King
- McArdle Laboratory for Cancer Research, Department of Oncology, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Andrea Bilger
- McArdle Laboratory for Cancer Research, Department of Oncology, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Josef Rademacher
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Paul F Lambert
- McArdle Laboratory for Cancer Research, Department of Oncology, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Susan L Thibeault
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
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2
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Solarz P, Bodnar M, Czech J, Mackiewicz-Nartowicz H, Sinkiewicz A, Szylberg Ł, Borowczak J, Rutkiewicz P, Zwierz A, Burduk P. Assessment of immunomodulation and regulation of cell cycle in epithelium and stroma after Cidofovir injection in patients with recurrent respiratory papillomatosis-Pilot study. J Med Virol 2023; 95:e28303. [PMID: 36369954 DOI: 10.1002/jmv.28303] [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: 09/02/2022] [Revised: 10/22/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022]
Abstract
Recurrent respiratory papillomatosis is strictly connected with human papillomavirus (HPV) infection of the epithelium of the upper respiratory tract. The main treatment of lesions located in the larynx or lower pharynx includes microsurgical excision by using a CO2 laser. To decrease the amount of surgical procedures gain in importance combined therapy with antiviral agents. The aim of this study was to investigate the effect of the intralesional application of Cidofovir on the tissue of laryngeal papillomas. We have shown that simultaneous microsurgery with adjuvant therapy of Cidofovir reduces chronic inflammation (by measuring the expression of CD4 and CD8 in tissue samples), cell proliferation, and regulates the cell cycle of HPV-infected cells by reducing the expression of p53 and p63 proteins. In addition, this strategy reduces the multiple surgical procedures and regrowth of the pathology.
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Affiliation(s)
- Paweł Solarz
- Department of Otolaryngology, Laryngological Oncology and Maxillofacial Surgery, University Hospital No. 2, Bydgoszcz, Poland
| | - Magdalena Bodnar
- Department of Perinatology, Gynaecology and Gynaecologic Oncology, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz, Bydgoszcz, Poland.,Chair of Pathology, University Hospital No. 2 im. Dr. Jan Biziel in Bydgoszcz, Bydgoszcz, Poland
| | - Joanna Czech
- Department of Otolaryngology, Laryngological Oncology and Maxillofacial Surgery, University Hospital No. 2, Bydgoszcz, Poland
| | - Hanna Mackiewicz-Nartowicz
- Department of Otolaryngology, Laryngological Oncology and Maxillofacial Surgery, University Hospital No. 2, Bydgoszcz, Poland.,Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz, Bydgoszcz, Poland
| | - Anna Sinkiewicz
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz, Bydgoszcz, Poland
| | - Łukasz Szylberg
- Department of Perinatology, Gynaecology and Gynaecologic Oncology, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz, Bydgoszcz, Poland.,Chair of Pathology, University Hospital No. 2 im. Dr. Jan Biziel in Bydgoszcz, Bydgoszcz, Poland.,Department of Tumor Pathology and Pathomorphology, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Jędrzej Borowczak
- Department of Perinatology, Gynaecology and Gynaecologic Oncology, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz, Bydgoszcz, Poland
| | - Paula Rutkiewicz
- Chair of Pathology, University Hospital No. 2 im. Dr. Jan Biziel in Bydgoszcz, Bydgoszcz, Poland
| | - Aleksander Zwierz
- Department of Otolaryngology, Laryngological Oncology and Maxillofacial Surgery, University Hospital No. 2, Bydgoszcz, Poland.,Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz, Bydgoszcz, Poland
| | - Paweł Burduk
- Department of Otolaryngology, Laryngological Oncology and Maxillofacial Surgery, University Hospital No. 2, Bydgoszcz, Poland.,Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz, Bydgoszcz, Poland
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Liu S, Wang J, Shao J. Safety of different surgical modalities for recurrent respiratory papillomatosis resection: A systematic review and meta-analysis. Clin Otolaryngol 2022; 48:403-413. [PMID: 36536541 DOI: 10.1111/coa.14023] [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: 05/23/2022] [Revised: 09/16/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Currently, the most common surgical modalities used for recurrent respiratory papillomatosis (RRP) resection are microdebrider, carbon dioxide (CO2 ) laser and potassium-titanyl-phosphate (KTP) laser. However, complication rates vary among different surgical modalities and have been controversial in different studies. OBJECTIVE OF REVIEW This study systematically reviews the available studies which reported intra-operative and post-operative complications, aiming to compare the safety of microdebrider, CO2 laser and KTP laser. TYPE OF REVIEW Meta-analysis. SEARCH STRATEGY Seven electronic databases (PubMed/MEDLINE, EMBASE[Ovid], Scopus, Cochrane Library and Web of Science) were searched from inception through 28 April 2022. Randomised controlled, prospective or retrospective observational studies that recorded the complications of three different surgical modalities for RRP resection were included in the meta-analysis. EVALUATION METHOD Outcomes of interest were intra-operative and post-operative complications, and complication rate was calculated to evaluate the safety of surgical methods. RESULTS Twenty different studies were included in quantitative synthesis. Only one study compared outcomes of those three kinds of treatment modalities simultaneously, two studies compared microdebrider and CO2 laser, and the remaining studies focussed on only one of three treatments. The weighted average complication rate for microdebrider was 0.03 (95% confidence interval [CI] 0.00-0.21), n = 6, for CO2 laser treatment was 0.16 (95% CI 0.09-0.25), n = 14 and for KTP laser treatment was 0.04 (95% CI 0.00-0.14), n = 4. CONCLUSION The limited evidence demonstrated that CO2 lasers in the surgical treatment of RRP may lead to more surgical complications, and microdebrider and KTP lasers may be safer. However, the heterogeneous data limit any strong comparison of outcomes of different treatment of laryngeal papillomas. Future randomised controlled trials that directly compare the safety of different surgical modalities are needed.
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Affiliation(s)
- Siwei Liu
- Department of Otolaryngology, Eye&ENT Hospital, Fudan University, Shanghai, China
| | - Jiaqi Wang
- Department of Otolaryngology, Eye&ENT Hospital, Fudan University, Shanghai, China
| | - Jun Shao
- Department of Otolaryngology, Eye&ENT Hospital, Fudan University, Shanghai, China
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Systematic review of the use of human papillomavirus vaccine as adjuvant therapy for juvenile-onset recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2022; 162:111314. [PMID: 36116179 DOI: 10.1016/j.ijporl.2022.111314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Juvenile-onset RRP (JoRRP) is considered a rare disease with high morbidity and healthcare costs. The management of RRP has received much scientific attention in recent years and several treatment methodologies have been explored, including therapeutic use of HPV vaccine. There has been increasing interest in the off-label use of the vaccine in virus-induced disease processes such as RRP, due to its immunomodulatory effect and activating role on the innate and adaptive immune system. This review explores the efficacy of the HPV vaccination as a therapeutic tool in the pediatric population. METHODS The review of the English literature included three electronic databases, PubMed, SCOPUS, and Cochrane, without publication date restrictions. Studies and reports identified by the database search were reviewed and assessed by two independent reviewers. RESULTS The literature searches identified 768 unique citations, from which 204 duplicates were removed (n = 564). A total of 547 articles were excluded as they did not meet our inclusion criteria. A total of 12 studies (3 experimental studies, 3 case series, 6 case reports) that met the inclusion criteria and reported one or more of the outcomes of interest were included for our review. The assessment of the outcome measures evaluated (number of surgeries during the follow-up period, ISI, SPM, Derkay or severity scores, and remission status) revealed that eight out of 12 studies included in the review showed varying degrees of potential benefits from the administration of the vaccine as a treatment modality compared to surgical interventions and/or concurrent adjuvant therapies alone. CONCLUSION We conclude that while the therapeutic use of HPV vaccination has shown promise for some JoRRP patients, it overall remains uncertain with the currently available data. There is a need for a prospective multi-centric trial with a larger sample size to fully characterize the potential use of the vaccine in the management of JoRRP.
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A Novel In Vivo Model of Laryngeal Papillomavirus-Associated Disease Using Mus musculus Papillomavirus. Viruses 2022; 14:v14051000. [PMID: 35632742 PMCID: PMC9147793 DOI: 10.3390/v14051000] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/01/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
Recurrent respiratory papillomatosis (RRP), caused by laryngeal infection with low-risk human papillomaviruses, has devastating effects on vocal communication and quality of life. Factors in RRP onset, other than viral presence in the airway, are poorly understood. RRP research has been stalled by limited preclinical models. The only known papillomavirus able to infect laboratory mice, Mus musculus papillomavirus (MmuPV1), induces disease in a variety of tissues. We hypothesized that MmuPV1 could infect the larynx as a foundation for a preclinical model of RRP. We further hypothesized that epithelial injury would enhance the ability of MmuPV1 to cause laryngeal disease, because injury is a potential factor in RRP and promotes MmuPV1 infection in other tissues. In this report, we infected larynges of NOD scid gamma mice with MmuPV1 with and without vocal fold abrasion and measured infection and disease pathogenesis over 12 weeks. Laryngeal disease incidence and severity increased earlier in mice that underwent injury in addition to infection. However, laryngeal disease emerged in all infected mice by week 12, with or without injury. Secondary laryngeal infections and disease arose in nude mice after MmuPV1 skin infections, confirming that experimentally induced injury is dispensable for laryngeal MmuPV1 infection and disease in immunocompromised mice. Unlike RRP, lesions were relatively flat dysplasias and they could progress to cancer. Similar to RRP, MmuPV1 transcript was detected in all laryngeal disease and in clinically normal larynges. MmuPV1 capsid protein was largely absent from the larynx, but productive infection arose in a case of squamous metaplasia at the level of the cricoid cartilage. Similar to RRP, disease spread beyond the larynx to the trachea and bronchi. This first report of laryngeal MmuPV1 infection provides a foundation for a preclinical model of RRP.
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Welschmeyer A, Berke GS. An updated review of the epidemiological factors associated with recurrent respiratory papillomatosis. Laryngoscope Investig Otolaryngol 2021; 6:226-233. [PMID: 33869755 PMCID: PMC8035934 DOI: 10.1002/lio2.521] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/15/2020] [Accepted: 01/04/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To identify studies evaluating the epidemiology of recurrent respiratory papillomatosis (RRP), including patient demographics, human papillomavirus (HPV) immunology, clinical course, surgical and medical treatments, and psychosocial factors. METHODS A systematic literature search through PubMed was performed to identify studies evaluating the epidemiological factors associated with RRP. All studies were screened through a priori selection criteria using the titles and abstracts. RESULTS A total of 208 studies were identified, of which 54 met eligibility criteria and were included in the review. CONCLUSIONS RRP is a rare disease most commonly caused by HPV 6 and 11. It is characterized by recurring benign papillomatous lesions in the respiratory tract, particularly the larynx. Existing evidence about disease risk factors is limited but includes both maternal HPV infection and patient smoking and sexual behaviors. Disease management involves a combination of routine surgical and medical treatment. Surgical techniques include CO2-laser, sharp dissection, coblation, microdebridement, and photoangiolytic laser. Medical treatments which have been found to facilitate disease control off-label include interferon-alpha (IFN-α), indole-3-carbinol, acyclovir, bevacizumab, retinoids, and the Gardasil and mumps vaccines. Many patients suffer from additional psychosocial challenges related to their diagnosis. Current disease knowledge remains limited, and more robust controlled trials about risk factors, medical therapies, and surgical options are needed. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | - Gerald S. Berke
- Department of Head and Neck SurgeryRonald Reagan UCLA Medical CenterLos AngelesCaliforniaUSA
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Khan M, Naidu TK. Risk factors associated with severe recurrent respiratory papillomatosis. S Afr J Infect Dis 2019; 34:69. [PMID: 34485449 PMCID: PMC8378090 DOI: 10.4102/sajid.v34i1.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 07/24/2019] [Indexed: 11/02/2022] Open
Abstract
Background Objectives Methods Results Conclusion
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Affiliation(s)
- Muddaseer Khan
- Department of Otorhinolaryngology (ENT), Nelson R Mandela School of Medicine, University of KwaZulu- Natal, Durban, South Africa
- Department of Otorhinolaryngology (ENT), General Justice Gizenga Mpanza (GJGM) Regional Hospital, Durban, South Africa
| | - Tesuven K. Naidu
- Department of Otorhinolaryngology, Bay of Plenty District Health Board Tauranga Hospital, Tauranga, New Zealand
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8
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Katsenos S, Nikolopoulou M. Pharyngeal Papilloma: a Rare Non-Pulmonary Cause of Hemoptysis. ACTA MEDICA (HRADEC KRÁLOVÉ) 2019; 61:158-161. [PMID: 30664450 DOI: 10.14712/18059694.2018.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The most common benign neoplasm of the pharynx is papilloma. It is characterized by bulging brittle lesions, which are pedicled or sessile, whitish-grey or pinkish colour. Progressive hoarseness is the main clinical feature. When the papillomata spread throughout the tracheobronchial tree symptoms such as chronic cough, stridor, dyspnea or acute respiratory distress are mostly present. Hemoptysis as a presenting symptom is exceptionally rare in patients with pharyngeal papillomatosis. Herein, we report a case of pharyngeal papillomatosis in which hemoptysis was the primary clinical manifestation. The clinical and therapeutic aspects of the disease are briefly discussed.
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Affiliation(s)
- Stamatis Katsenos
- Department of Pneumonology, Army General Hospital of Athens, Athens, Greece.
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9
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Yiu Y, Fayson S, Smith H, Matrka L. Implementation of Routine HPV Vaccination in the Management of Recurrent Respiratory Papillomatosis. Ann Otol Rhinol Laryngol 2018; 128:309-315. [PMID: 30595025 DOI: 10.1177/0003489418821695] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES: To investigate vaccine compliance and clinical outcomes after implementation of an initiative to provide the human papillomavirus (HPV) vaccine to all patients with recurrent respiratory papillomatosis (RRP). METHODS: A retrospective review was performed of all adult patients treated for RRP from 2012 to 2017. Rates of HPV vaccination were evaluated before and after December 2015, when a program was established to increase compliance by educating patients and providing financial assistance toward vaccine administration. Paired sample analyses were conducted to compare intersurgical intervals (ISIs) and number of procedures per year pre- and post-vaccination. RESULTS: Fourteen patients with RRP completed the HPV vaccine series, with 11 patients undergoing vaccination after the initiative began. The pre-initiative vaccination rate of all patients with RRP was 9.7%; post-initiative rates improved to 43.8% ( P = .004; odds ratio, 7.26). Of vaccinated patients, there were significant differences between mean pre-vaccine ISI (3.5 months) and post-vaccine ISI (12.8 months; P = .0021), as well as between number of surgical procedures performed per year before and after vaccination (2.7 vs 0.81; P = .014). After vaccination, 5 patients demonstrated no evidence of papilloma regrowth for >12 months. CONCLUSIONS: Initiatives focused on patient education and financial support can successfully boost HPV vaccination rates in an RRP patient cohort. Our research mirrors prior findings that HPV vaccination is correlated with an increase in time between procedures and a decrease in number of procedures needed per year-factors that can dramatically reduce the disease burden on patients coping with RRP.
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Affiliation(s)
- Yin Yiu
- 1 Department of Otolaryngology - Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shannon Fayson
- 1 Department of Otolaryngology - Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Holly Smith
- 1 Department of Otolaryngology - Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura Matrka
- 1 Department of Otolaryngology - Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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10
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Egorov VI, Mustafaev DM, Kochneva AO. [Papillomatosis of the larynx in children: the current state of the problem]. Vestn Otorinolaringol 2018; 83:84-90. [PMID: 30412184 DOI: 10.17116/otorino20188305184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is the authors have considered variants of modern methods of medical and surgical treatment of laryngeal papillomatosis in children in the review, based on the etiology of the disease. The analysis of the effectiveness of new methods of combined treatment with the use of modern technologies, taking into account their advantages and disadvantages. The possible prospects for further study problems and develop new methods of adjuvant therapy.
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Affiliation(s)
- V I Egorov
- The State Budgetary Healthcare Institution of Moscow Area Moscow's Regional Research Clinical Institute M.F. Vladimirskiy, Moscow, Russia
| | - D M Mustafaev
- The State Budgetary Healthcare Institution of Moscow Area Moscow's Regional Research Clinical Institute M.F. Vladimirskiy, Moscow, Russia
| | - A O Kochneva
- The State Budgetary Healthcare Institution of Moscow Area Moscow's Regional Research Clinical Institute M.F. Vladimirskiy, Moscow, Russia
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Teng SE, Dion GR, Sin DN, Hiwatashi N, Benedict PA, Amin MR, Branski RC. Imiquimod Injection to Rabbit Vocal Folds: A Preliminary, Preclinical Investigation. Otolaryngol Head Neck Surg 2017; 156:702-705. [PMID: 28171734 DOI: 10.1177/0194599816689585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Given the recalcitrant nature of recurrent respiratory papillomatosis, targeted therapies to reduce disease burden are fundamental to improved patient care paradigms. We seek to demonstrate the safety of imiquimod injection into vocal fold mucosa by evaluating the degree of laryngeal edema, histopathologic changes to vocal fold structure, and serologic interferon α (IFNα) levels following injection. Study Design Preclinical. Setting Academic institution. Subjects and Methods Six New Zealand White rabbits underwent unilateral injection of 100 µg of sterile imiquimod (1 µg/µL), with 100 µL of normal saline injected into the contralateral vocal fold. Direct laryngoscopy was performed on days 3, 7, and 30 following injection. Larynges from 3 rabbits were harvested on postinjection day 7 for histologic analysis. The remaining 3 rabbit larynges were harvested on day 30. Serial serum samples were drawn for IFNα quantification via immunoassay. Results No signs of respiratory distress were observed at any point. Vocal fold appearance was not clinically divergent between imiquimod and control conditions via serial direct laryngoscopic evaluation. No inflammatory lesions or scarring were identified following injection. Histology showed no signs of acute inflammatory processes or changes in the control or imiquimod injection groups. Serum IFNα increased at days 3 and 7 following imiquimod injection ( P < .0001 and P = .0368, respectively), before returning to baseline by day 14. Conclusions Vocal fold imiquimod injection did not result in notable morbidity in this preclinical model. However, serum IFNα concentrations increased transiently. These data are critical to advance the therapeutic utility of this compound, particularly in the setting of recurrent respiratory papillomatosis.
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Affiliation(s)
- Stephanie E Teng
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, New York University, New York, New York, USA
| | - Gregory R Dion
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, New York University, New York, New York, USA
| | - Danielle N Sin
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, New York University, New York, New York, USA
| | - Nao Hiwatashi
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, New York University, New York, New York, USA
| | - Peter A Benedict
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, New York University, New York, New York, USA
| | - Milan R Amin
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, New York University, New York, New York, USA
| | - Ryan C Branski
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, New York University, New York, New York, USA
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12
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Sullivan C, Curtis S, Mouzakes J. Therapeutic use of the HPV vaccine in Recurrent Respiratory Papillomatosis: A case report. Int J Pediatr Otorhinolaryngol 2017; 93:103-106. [PMID: 28109479 DOI: 10.1016/j.ijporl.2016.12.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/22/2016] [Accepted: 12/24/2016] [Indexed: 11/30/2022]
Abstract
Recurrent Respiratory Papillomatosis (RRP) is a condition characterized by recurring squamous papillomas in the aerodigestive tract due to Human Papilloma Virus (HPV) infection. Treatment includes surgical debridement of the lesions often with adjuvant therapy. A newer adjuvant agent being tested is the HPV vaccine. The case report includes a child with RRP who underwent 10 surgeries in a year with an average inter-surgical interval (ISI) of 46 days. The patient then received the scheduled regimen of 3 doses of 9 valent HPV vaccine. Since beginning the vaccination, her average ISI increased to 113 days and as of writing of this paper only 1 surgery in the last 340 days. It is theorized that the increase in humoral response to the virus can slow the course of the disease, lengthen the ISI, and decrease morbidity. The results of this case report lends evidence to the use of the HPV vaccine as a therapeutic adjuvant therapy for RRP.
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Affiliation(s)
| | - Stuart Curtis
- Division of Otolaryngology and Head-Neck Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA
| | - Jason Mouzakes
- Division of Otolaryngology and Head-Neck Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA
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13
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Bowen AJ, Bryson PC. OR Management of Recurrent Respiratory Papilloma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0117-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Hermann JS, Weckx LY, Monteiro Nürmberger J, Santos Junior GFD, Campos Pignatari AC, Nagata Pignatari SS. Effectiveness of the human papillomavirus (types 6, 11, 16, and 18) vaccine in the treatment of children with recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2016; 83:94-8. [PMID: 26968061 DOI: 10.1016/j.ijporl.2016.01.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/16/2016] [Accepted: 01/27/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether the quadrivalent human papillomavirus (HPV) (types 6, 11, 16, and 18) vaccine influences the clinical course of juvenile-onset recurrent respiratory papillomatosis (RRP) when administered to a group of patients with this condition. METHODS Uncontrolled intervention study of patients with juvenile-onset RRP examined at the Pediatric Otorhinolaryngology Clinic, Federal University of São Paulo, where nine patients between the ages of nine and 17 received three doses of the prophylactic quadrivalent HPV vaccine (Gardasil(®)) and were followed for one year. Disease staging, intervals between relapses, intervals between surgeries, and the number of surgeries during the year prior to vaccination and during the first year after vaccination were compared. RESULTS Eight patients were infected with HPV-6 and one with HPV-11. There were no statistically significant differences in the clinical scores (p=0.083), anatomical scores (p=0.257), intervals between relapses (p=0.062), intervals between surgeries (p=0.357), or the numbers of surgeries (p=0.180) when the years before and after vaccination were compared. All patients had relapses following vaccination. CONCLUSION Patients with juvenile-onset RRP experienced a similar clinical course in the year after versus the year before vaccination with Gardasil(®).
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Affiliation(s)
- Juliana Sato Hermann
- Discipline of Pediatric Otorhinolaryngology, Federal University of São Paulo, Brazil.
| | - Lily Yin Weckx
- Department of Pediatrics, Federal University of São Paulo, Brazil
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HPV Type 6 and 18 Coinfection in a Case of Adult-Onset Laryngeal Papillomatosis: Immunization with Gardasil. Case Rep Otolaryngol 2015; 2015:916023. [PMID: 26783482 PMCID: PMC4691470 DOI: 10.1155/2015/916023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 11/17/2022] Open
Abstract
Laryngeal papillomatosis (LP) is a rare human papillomavirus (HPV) related disease that often requires multiple surgical interventions and residual impairment of voice is almost inevitable. We report the case of a patient with adult onset recurrent LP, showing moderate dysplasia and coinfection with HPV types 6 and 18. The tetravalent HPV vaccine Gardasil was prescribed off label, with the aim of triggering an immunogenic response and consequently reducing the probability of further recurrences. The patient was followed for 9 months with no sign of relapse of his LP. The postexposure use of the anti-HPV vaccine could represent a promising therapeutic agent in established LP. Unfortunately, the potential efficacy of this new therapeutic option in this situation has been suggested only by isolated case reports. Further controlled studies, with a longer follow-up and a larger sample size, are needed to assess efficacy of Gardasil in LP.
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Kim HT, Baizhumanova AS. Is recurrent respiratory papillomatosis a manageable or curable disease? Laryngoscope 2015; 126:1359-64. [PMID: 26608928 DOI: 10.1002/lary.25795] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Recurrent respiratory papillomatosis (RRP) is a relatively rare disease with potentially devastating consequences for the patient. The purpose of this study was to evaluate the patterns of recurrence of RRP after surgery and determine the effectiveness of combined concurrent adjuvant therapy. METHODS A total of 86 patients were diagnosed with and operated on for RRP. The clinical characteristics of 29 of the 86 patients who had undergone operations at other hospitals and who were followed up for >2 years were evaluated retrospectively. A combined concurrent adjuvant therapy was performed with microlaryngeal surgery, 585-nm pulsed dye laser (PDL) application, and an intralesional cidofovir injection. To evaluate the recurrence pattern, the larynx was divided into 10 subsites, and patients were investigated for the frequency of recurrence at the subsites after the operation. RESULTS Twenty-nine subjects required a mean of 3.0 operations to achieve complete remission for 2 years. The most common subsites for recurrence were the anterior commissure, subglottis, and epiglottis according to increasing number of operations. The subsites of recurrence tended to be closely correlated with the laryngeal submucosal glandular density distribution. A complete en-bloc layer excision, including the submucosal glands, using cold instruments decreased the recurrence rate of RRP. Applying PDL minimized scarring and provided significant posttreatment voice-quality improvement. CONCLUSIONS The results of the recurrent pattern analysis suggest that a combined concurrent adjunctive treatment might be promising as a cure for RRP and restoration of vocal function after treatment. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1359-1364, 2016.
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Affiliation(s)
- Hyung-Tae Kim
- Yeson Voice Center, Institute of Performing Art Medicine, Seoul, South Korea
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Li J, Zhang TY, Tan LT, Wang SY, Chen YY, Tian JY, Da WY, He P, Zhao YM. Expression of human papillomavirus and prognosis of juvenile laryngeal papilloma. Int J Clin Exp Med 2015; 8:15521-15527. [PMID: 26629043 PMCID: PMC4658932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/03/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate the correlation between clinical behavior and expression of human papillomavirus (HPV) in patients with juvenile laryngeal papillomatosis, in an attempt to develop an effective molecular biological method to predict prognosis. We included 37 patients with juvenile laryngeal papillomatosis in the study group and 10 cases each of juvenile vocal cord polyps and juvenile normal laryngeal mucosa as the control group. We detected HPV by immunocytochemistry and in situ hybridization, identified the virus type, and measured HPV-DNA content using a computer-assisted, color pathological image-analysis system. Additionally, we conducted a retrospective study with regard to the patients' clinical history to evaluate the prognosis. The data of the 2 groups were compared and statistically analyzed, including a correlation with prognosis. In the study group, 67.3% (25/37) were positive for HPV-Ag by immunocytochemistry; whereas 53.2%, 45.8%, and 25.4% were positive for HPV6b-DNA, HPV11-DNA, and HPV6b+11-DNA, respectively, by in situ hybridization. HPV was not detected in the control group. There was a significant difference between two groups (P < 0.05). Compared to HPV11-DNA-positive cases, those that were positive for HPV6b-DNA and HPV6b+11-DNA showed lower results on average, for age at first diagnosis and self-relief, number of surgeries, and interval between surgeries. Our findings suggest that immunocytochemistry and in situ hybridization are useful methods to evaluate the prognosis of juvenile laryngeal papilloma (JLP) and that HPV6b-positivity can be used as an index to predict the development and outcome of JLP.
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Affiliation(s)
- Juan Li
- Department of Otolaryngology, Tongren Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghai 200336, China
| | - Tian-Yu Zhang
- Department of Otolaryngology, Eye Ear Nose & Throat Hospital of Fudan UniversityShanghai 200031, China
| | - Le-Tian Tan
- Department of Otolaryngology, Eye Ear Nose & Throat Hospital of Fudan UniversityShanghai 200031, China
| | - Shu-Yi Wang
- Department of Otolaryngology, Eye Ear Nose & Throat Hospital of Fudan UniversityShanghai 200031, China
| | - Yu-Ying Chen
- Institude of Biochemistry and Cell Biology of Medical College of Shanghai Jiaotong UniversityShanghai 200025, China
| | - Jie-Yan Tian
- Department of Otolaryngology, Eye Ear Nose & Throat Hospital of Fudan UniversityShanghai 200031, China
| | - Wen-Ying Da
- Department of Otolaryngology, Eye Ear Nose & Throat Hospital of Fudan UniversityShanghai 200031, China
| | - Ping He
- Department of Otolaryngology, Tongren Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghai 200336, China
| | - Ya-Ming Zhao
- Department of Otolaryngology, Tongren Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghai 200336, China
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Young DL, Moore MM, Halstead LA. The use of the quadrivalent human papillomavirus vaccine (gardasil) as adjuvant therapy in the treatment of recurrent respiratory papilloma. J Voice 2015; 29:223-9. [PMID: 25619468 DOI: 10.1016/j.jvoice.2014.08.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the effect of the quadrivalent human papillomavirus vaccine, Gardasil, on the disease course of patients with recurrent respiratory papillomatosis (RRP). METHODS A retrospective chart review of patients with RRP was conducted and 20 patients were selected who had received the Gardasil vaccine as part of their treatment. Efficacy was assessed by calculating the intersurgical interval (ISI) before and after receiving the vaccine, as well as number of complete and partial remissions. RESULTS Analysis of all patients found a significant increase in the ISI of 3.1 months (95% confidence interval [CI]: 1.02-5.19, P=0.0061). Male patients experienced an increase in the ISI of 4.2 months (95% CI: 1.6-6.7, P=0.0048). Female patients had a nonsignificant increase in ISI of 1.2 months (95% CI: 3.1-5.4, P=0.51). Eight patients (40%; six male and two female) experienced complete remission. Five patients (25%) overall (three male and two female) experienced partial remission. In total, complete or partial remission was achieved in a total of 13 (65%) patients (nine male and four female). CONCLUSIONS The Gardasil vaccine can modulate the severity of RRP and induce remission in some patients. The effect was much greater in males and in females in low estrogen states.
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Affiliation(s)
- David L Young
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Michael M Moore
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Lucinda A Halstead
- Department of Otolaryngology-Head & Neck Surgery, MUSC Evelyn Trammell Institute for Voice & Swallowing, Medical University of South Carolina, Charleston, South Carolina; Department of Pediatrics, MUSC Evelyn Trammell Institute for Voice & Swallowing, Medical University of South Carolina, Charleston, South Carolina.
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Longubuco CEG, dos Reis HLB, Cavalcante FS, de Pinho CRP, Oliveira NS, Nicol AF, Zamolyi RQ, Ferreira DDC. Dysphonia as a sign of HPV laryngeal infection: a case report. BMC Res Notes 2014; 7:898. [PMID: 25494907 PMCID: PMC4295475 DOI: 10.1186/1756-0500-7-898] [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: 09/21/2014] [Accepted: 11/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Voice dysfunction or dysphonia may be associated with several clinical conditions. Among these, laryngeal human papillomavirus (HPV)-induced lesions should be considered as a possible causative factor. We report a case of dysphonia in a patient presenting with an HPV laryngeal lesion. We also discuss the clinical features of the disease, its histopathological findings, and treatment and rigorous follow-up. CASE PRESENTATION We report a case of laryngeal papilloma in a 29-year-old, Afro-descendant, male patient with dysphonia. He was a non-smoker and was not a drug user. Videolaryngostroboscopy revealed signs suggestive of pharyngolaryngeal reflux. The right vocal fold presented with a papillomatous aspect in the posterior third, which underwent excision. Histopathological examination showed a nodular lesion of the right vocal fold, conclusive of squamous papilloma with absence of malignancy. CONCLUSION Patients presenting with persistent voice dysfunction or dysphonia should be investigated for possible laryngeal HPV infection. Diagnostic confirmation by HPV genotyping is important for follow-up of potential recurrence.
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