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Hedlund Lindberg J, Widgren A, Ivansson E, Gustavsson I, Stålberg K, Gyllensten U, Sundfeldt K, Bergquist J, Enroth S. Toward ovarian cancer screening with protein biomarkers using dried, self-sampled cervico-vaginal fluid. iScience 2024; 27:109001. [PMID: 38352226 PMCID: PMC10863317 DOI: 10.1016/j.isci.2024.109001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/24/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
Early detection is key for increased survival in ovarian cancer, but no general screening program exists today due to lack of biomarkers and overall cost versus benefit over traditional clinical methods. Here, we used dried cervico-vaginal fluid (CVF) as sampling matrix coupled with mass spectrometry for detection of protein biomarkers. We find that self-collected CVF on paper cards yields robust results and is suitable for high-throughput proteomics. Artificial intelligence-based methods were used to identify an 11-protein panel that separates cases from controls. In validation data, the panel achieved a sensitivity of 0.97 (95% CI 0.91-1.00) at a specificity of 0.67 (0.40-0.87). Analyses of samples collected prior to development of symptoms indicate that the panel is informative also of future risk of disease. Dried CVF is used in cervical cancer screening, and our results opens the possibility for a screening program also for ovarian cancer, based on self-collected CVF samples.
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Affiliation(s)
- Julia Hedlund Lindberg
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden
| | - Anna Widgren
- Analytical Chemistry, Department of Chemistry-Biomedical Center, Uppsala University, SE-75237 Uppsala, Sweden
| | - Emma Ivansson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden
| | - Karin Stålberg
- Department of Women’s and Children’s Health, Uppsala University, SE-75185 Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden
| | - Karin Sundfeldt
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, SE-41685 Gothenburg, Sweden
| | - Jonas Bergquist
- Analytical Chemistry, Department of Chemistry-Biomedical Center, Uppsala University, SE-75237 Uppsala, Sweden
| | - Stefan Enroth
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden
- Swedish Collegium for Advanced Study, Thunbergsvägen 2, SE-752 38 Uppsala, Sweden
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2
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Hermansson RS, Olovsson M, Gustavsson I, Gyllensten U, Lindkvist O, Lindberg JH, Lillsunde-Larsson G, Lindström AK. Incidence of oncogenic HPV and HPV-related dysplasia five years after a negative HPV test by self-sampling in elderly women. Infect Agent Cancer 2022; 17:42. [PMID: 35922825 PMCID: PMC9351123 DOI: 10.1186/s13027-022-00453-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 07/26/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Cervical cancer prevention for older women can be challenging since there are no specific guidelines for this group. This study aimed to determine the incidence of oncogenic HPV and HPV-related dysplasia in elderly women 5 years after being HPV negative. METHODS Invited women participated five years earlier in a study where self-sampling for HPV testing was applied, at this time, they were all HPV negative. The women were now, five years later invited to perform self-sampling for HPV testing. Women with a positive result performed a repeat HPV test. Those with a positive repeat HPV test were examined by colposcopy, biopsy and cytology. RESULTS Of the 804 invited women, 634 (76.9%) agreed to participate in the study and a self-sampling kit was sent to them. Of these, 99.6% (632/634) sent a sample to the HPV laboratory. The participation rate in each age group was 93.3% at age 65, 74.0% at age 70, 80.7% at age 75 and 64.6% at age 80. Overall 18 women (2.8%, 95% CI 3.2 to 6.0) were HPV positive in the first test and 8 (1.3%, 95% CI 0.6 to 2.6) in the second test. Sampling for the second test was done on average 5.4 months after the first test. Fifty per cent (4/8) of the women with a positive repeat test had dysplasia in histology. CONCLUSION The incidence of HPV in previously HPV-negative elderly women was low. Among women who were HPV positive in a repeat test, there was a high prevalence of low grade dysplasia.
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Affiliation(s)
- Ruth S Hermansson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - Olga Lindkvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Gabriella Lillsunde-Larsson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,School of Health Sciences, Örebro University, Örebro, Sweden
| | - Annika K Lindström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Ohlsson AC, Li Y, Gustavsson I, Hofling K, Wahle U, Österlind C, Iwarsson J. Voice Therapy Outcome: A Comparison Between Imitation Model Voice Therapy and Verbal Instructions Model Voice Therapy. J Voice 2022:S0892-1997(22)00019-4. [PMID: 35227553 DOI: 10.1016/j.jvoice.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/18/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim was to compare voice outcomes over time in patients treated with Imitation Model voice therapy and Verbal Instructions Model voice therapy. METHODS A prospective clinical trial was performed with 56 consecutive patients diagnosed with a primary or secondary functional voice disorder. Thirty-one patients were included for voice therapy following the Imitation Model and 25 patients for the Verbal Instructions Model. Assessments included a self-rated Voice Handicap Index, self-perceived hoarseness and vocal fatigue, perceptual voice evaluation by a Speech Language Pathologist, and maximum Voice Range Profiles. All assessments were completed before therapy, at end of therapy, at six-months posttherapy follow-up and 12-months posttherapy follow-up. For maximum Voice Range Profiles group differences were also compared for effects from end-of-treatment to follow-up assessments. Linear mixed models were used for analysis. RESULTS Comparison between treatment groups showed significantly larger long-term improvement from the baseline, for verbal instructions model as compared to imitation model for Voice Handicap Index total, and also the physical and emotional subscales, while there was no difference between groups for the functional subscale. Also, voice quality improved more after verbal instructions model, as compared to imitation model, at end of therapy. Results from self-rated hoarseness and vocal fatigue showed no difference between groups. There was no difference between treatment groups in the change of maximum Voice Range Profile from end-of-treatment to follow-up assessments. CONCLUSIONS The study showed that both Imitation Model voice therapy and Verbal Instructions Model voice therapy improved voice function. Compared to Imitation Model, the Verbal Instructions model showed larger long-term effect on physical and emotional aspects of voice function in everyday life. The two approaches for voice therapy might have different impacts on patients' learning.
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Affiliation(s)
- Ann-Christine Ohlsson
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Ying Li
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Inger Gustavsson
- Department of Speech Language Pathology, ENT Clinic, Hospital of South of Älvsborg, Borås, Sweden
| | - Kerstin Hofling
- Department of Speech Language Pathology, Hospital of Skaraborg (SkaS) Lidköping, Lidköping, Sweden
| | - Ulrika Wahle
- Department of Logopedics and Phoniatrics, ENT Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Claes Österlind
- Department of Speech Language Pathology, NU- healthcare, Trollhättan, Sweden
| | - Jenny Iwarsson
- Department of Scandinavian Studies and Linguistics, Audiologopedics, Copenhagen University, Copenhagen S, Denmark
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Gutiérrez AL, Lindberg JH, Shevchenko G, Gustavsson I, Bergquist J, Gyllensten U, Enroth S. Identification of Candidate Protein Biomarkers for CIN2+ Lesions from Self-Sampled, Dried Cervico-Vaginal Fluid Using LC-MS/MS. Cancers (Basel) 2021; 13:cancers13112592. [PMID: 34070587 PMCID: PMC8198222 DOI: 10.3390/cancers13112592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/15/2021] [Accepted: 05/22/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Cervical cancer is the fourth most common cancer among women worldwide, and screening programs increase its detection rate and survivability. The molecular screening of the presence of human papilloma viruses (HPV) as alternatives to physical examinations offers cost-efficient solutions and can be performed on self-collected samples. A persistent infection with HPV is necessary (but not sufficient) to develop cancer, and additional biomarkers are needed to increase the precision. Here, we have analysed protein biomarkers found in self-collected dried cervico–vaginal fluid (CVF) from both controls and women with cervical cancer pre-stages. Our conclusion is that protein biomarkers can be robustly detected from dried CVF and that these can aid in the detection of cervical cancer pre-stages. Abstract Molecular screening programs for cervical cancer detect the presence of human papilloma virus (HPV) in cell material or vaginal fluids. Persistent infection with high-risk HPV is a necessary pre-requisite, but the majority of infections do not lead to pathological states. Additional biomarkers are needed to increase the specificity of the molecular tests. Here, we have investigated the possibility of detecting protein biomarkers using mass spectrometry from dried self-sampled cervico–vaginal fluid deposited on FTA cards. We found significant intra-individual correlations (p < 2.2 × 10−16), although heterogenous protein profiles were obtained between individuals. Out of 3699 proteins found in total, 169 were detected in at least 95% of the samples. Using a discovery/replication design, 18 proteins were found to be significant in the discovery cohort, with higher values in those cases compared to controls. All of these were found to also have higher levels among the cases in the replication cohort, with one protein (DEAD-Box Helicase) remaining statistically significant. Finally, a predictive 7-protein multivariate model was developed with a sensitivity and specificity of 0.90 and 0.55, respectively. Our results demonstrate that robust measurements of protein biomarkers can be obtained from self-sampled dried CVF and that these could be used to predict cervical cancer pre-stages.
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Affiliation(s)
- Ariadna Lara Gutiérrez
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden; (A.L.G.); (J.H.L.); (I.G.); (U.G.)
| | - Julia Hedlund Lindberg
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden; (A.L.G.); (J.H.L.); (I.G.); (U.G.)
| | - Ganna Shevchenko
- Analytical Chemistry, Department of Chemistry-Biomedical Center, Uppsala University, SE-75237 Uppsala, Sweden; (G.S.); (J.B.)
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden; (A.L.G.); (J.H.L.); (I.G.); (U.G.)
| | - Jonas Bergquist
- Analytical Chemistry, Department of Chemistry-Biomedical Center, Uppsala University, SE-75237 Uppsala, Sweden; (G.S.); (J.B.)
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden; (A.L.G.); (J.H.L.); (I.G.); (U.G.)
| | - Stefan Enroth
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, SE-75108 Uppsala, Sweden; (A.L.G.); (J.H.L.); (I.G.); (U.G.)
- Correspondence: ; Tel.: +46-(0)-18-471-0000
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Aarnio R, Isacson I, Sanner K, Gustavsson I, Gyllensten U, Olovsson M. Comparison of vaginal self-sampling and cervical sampling by medical professionals for the detection of HPV and CIN2+: A randomized study. Int J Cancer 2021; 148:3051-3059. [PMID: 33497465 DOI: 10.1002/ijc.33482] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 12/07/2020] [Accepted: 01/11/2021] [Indexed: 11/06/2022]
Abstract
Primary screening with human papillomavirus (HPV) test is more effective in reducing cervical cancer incidence than cytology and it also offers the opportunity to self-sample. We conducted a randomized study to compare vaginal self-sampling with cervical sampling by medical professionals for HPV testing concerning prevalence of HPV and detection of cervical intraepithelial neoplasia (CIN) of grade 2 or worse (CIN2+) or grade 3 or worse (CIN3+) in primary screening. In total, 11 951 women aged 30-60 years were randomized into two groups, 5961 for self-sampling (SS arm) and 5990 for sampling by medical professionals (SMP arm). Sampling was performed with a RoversViba-brush in the SS arm and a cytobrush in the SMP arm. All samples were applied to an indicating FTA elute card and analyzed for HPV using a clinically validated real-time PCR test (hpVIR). All HPV-positive women performed repeated sampling about 6 months later using the same procedure as used initially. All HPV-positive women in the second sampling were referred to colposcopy. The prevalence of HPV in the first test did not differ between the SS arm (6.8%, 167/2466) and the SMP arm (7.8%, 118/1519) (P = .255). The prevalence of CIN2+ per 1000 screened women was 17 (43/2466 × 1000) (95%CI 13-24) in the SS arm and 21 (32/1519 × 1000) (95%CI 15-30) in the SMP arm. For CIN3+, the prevalence per 1000 screened women was 14 (35/2466 × 1000) (95%CI 10-20) in the SS arm and 15 (23/1519 × 1000) (95%CI 10-23) in the SMP arm. In conclusion, self-sampling and sampling by medical professionals showed the same prevalence of HPV and detection rate of CIN2+ and CIN3+ in histology.
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Affiliation(s)
- Riina Aarnio
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Isabella Isacson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Karin Sanner
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, Uppsala, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Stark CR, Gustavsson I, Horal P, Kotopouli M, Gyllensten U, Hirsch JM. Brush Samples of Oral Lesions to FTA Elute Card for High-risk Human Papilloma Virus Diagnosis. Anticancer Res 2021; 41:269-277. [PMID: 33419821 DOI: 10.21873/anticanres.14773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/23/2020] [Indexed: 11/10/2022]
Abstract
AIM To investigate the level of agreement between three non-invasive methods for hrHPV diagnosis in oral and oropharyngeal squamous cell carcinoma (OSCC, OPSCC) and in oral mucosal lesions. MATERIALS AND METHODS For hrHPV DNA FTA Elute card™ and Anyplex II HPV28™ were used and for hrHPV mRNA PreTect SEE™ in tumour patients (n=60), non-tumour lesions (n=51), immunosuppression or previous hrHPV-infection (n=32). RESULTS The level of agreement between the DNA-methods was 82.2% (k=0.54, p=0.001). Pair-wise comparison for the FTA Elute card were close to the reference (AUC=0.83, 95% CI=0.73-0.90). hrHPV mRNA was diagnosed in 50% of the tumours, with an agreement level of 58.3%, compared to Anyplex II (k=0.17, p=0.04). The hrHPV positivity in oral lesions was 3.9% for immunosuppression and for previous HPV infection 9.4%. CONCLUSION The FTA card is reliable for hrHPV DNA diagnosis while mRNA gives an insight into viral activity and correlates with severity of the lesion.
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Affiliation(s)
- Christina Runow Stark
- Department of Research & Development, Folktandvården Stockholms län AB, Stockholm, Sweden; .,Department of Surgical Sciences, Oral & Maxillofacial Surgery, Medical Faculty, Uppsala University, Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics and Pathology, Medical Genetics and Genomics, Uppsala University, Uppsala, Sweden
| | - Peter Horal
- Department of Clinical Virology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Kotopouli
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Solna, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics and Pathology, Medical Genetics and Genomics, Uppsala University, Uppsala, Sweden
| | - Jan-MichaÉl Hirsch
- Department of Research & Development, Folktandvården Stockholms län AB, Stockholm, Sweden.,Department of Surgical Sciences, Oral & Maxillofacial Surgery, Medical Faculty, Uppsala University, Uppsala, Sweden
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Taku O, Meiring TL, Gustavsson I, Phohlo K, Garcia-Jardon M, Mbulawa ZZA, Businge CB, Gyllensten U, Williamson AL. Acceptability of self- collection for human papillomavirus detection in the Eastern Cape, South Africa. PLoS One 2020; 15:e0241781. [PMID: 33170891 PMCID: PMC7654756 DOI: 10.1371/journal.pone.0241781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022] Open
Abstract
Human papillomavirus (HPV) testing on vaginal self-collected and cervical clinician-collected specimens shows comparable performance. Self-sampling on FTA cards is suitable for women residing in rural settings or not attending regular screening and increases participation rate in the cervical cancer screening programme. We aimed to investigate and compare high-risk (HR)-HPV prevalence in clinician-collected and self-collected genital specimens as well as two different HPV tests on the clinician collected samples. A total of 737 women were recruited from two sites, a community health clinic (n = 413) and a referral clinic (n = 324) in the Eastern Cape Province. Cervical clinician-collected (FTA cards and Digene transport medium) and vaginal self-collected specimens were tested for HR-HPV using the hpVIR assay (FTA cards) and Hybrid Capture-2 (Digene transport medium). There was no significant difference in HR-HPV positivity between clinician-collected and self-collected specimens among women from the community-based clinic (26.4% vs 27.9%, p = 0.601) or the referral clinic (83.6% vs 79.9%, p = 0.222). HPV16, HPV35, and HPV33/52/58 group were the most frequently detected genotypes at both study sites. Self-sampling for HPV testing received a high positive response of acceptance (77.2% in the community-based clinic and 83.0% in referral clinic). The overall agreement between hpVIR assay and HC-2 was 87.7% (k = 0.754). The study found good agreement between clinician-collected and self-collected genital specimens. Self-collection can have a positive impact on a cervical screening program in South Africa by increasing coverage of women in rural areas, in particular those unable to visit the clinics and women attending clinics where cytology-based programs are not functioning effectively.
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Affiliation(s)
- Ongeziwe Taku
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Tracy L. Meiring
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Keletso Phohlo
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Mirta Garcia-Jardon
- Department of Pathology at Walter Sisulu University and National Health Laboratory Service, Mthatha, South Africa
| | - Zizipho Z. A. Mbulawa
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- Department of Laboratory Medicine and Pathology, National Health Laboratory Service Nelson Mandela Academic Hospital and Walter Sisulu University, Mthatha, Eastern Cape, South Africa
- Medical Virology, National Health Laboratory Service, Nelson Mandela Academic Hospital, Mthatha, South Africa
| | - Charles B. Businge
- Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Mthatha, South Africa
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Anna-Lise Williamson
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- * E-mail:
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8
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Berggrund M, Gustavsson I, Aarnio R, Lindberg JH, Sanner K, Wikström I, Enroth S, Bunikis I, Olovsson M, Gyllensten U. Temporal changes in the vaginal microbiota in self-samples and its association with persistent HPV16 infection and CIN2. Virol J 2020; 17:147. [PMID: 33028395 PMCID: PMC7541248 DOI: 10.1186/s12985-020-01420-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Background The vaginal microbiota has been reported to be associated with HPV infection and cervical cancer. This study was performed to compare the vaginal microbiota at two timepoints in women performing self-sampling and had a persistent or transient HPV16 infection. The women were tested for 12 high-risk HPV (hrHPV) types but only women with single type (HPV16) were included to reduce confounding variables. Methods In total 96 women were included in this study. Of these, 26 were single positive for HPV16 in the baseline test and HPV negative in the follow-up test and 38 were single positive for HPV16 in both tests and diagnosed with CIN2+ in histology. In addition, 32 women that were negative for all 12 HPV tested were included. The samples of vaginal fluid were analyzed with the Ion 16S™ Metagenomics Kit and Ion 16S™ metagenomics module within the Ion Reporter™ software. Results K-means clustering resulted in two Lactobacillus-dominated groups, one with Lactobacillus sp. and the other specifically with Lactobacillus iners. The two remaining clusters were dominated by a mixed non-Lactobacillus microbiota. HPV negative women had lower prevalence (28%) of the non-Lactobacill dominant cluster in the baseline test, as compared to women with HPV16 infection (42%) (p value = 0.0173). Transition between clusters were more frequent in women with persistent HPV16 infection (34%) as compared in women who cleared the HPV16 infection (19%) (p value = 0.036). Conclusions The vaginal microbiota showed a higher rate of transitioning between bacterial profiles in women with persistent HPV16 infection as compared to women with transient infection. This indicate an instability in the microenvironment in women with persistent HPV infection and development of CIN2+.
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Affiliation(s)
- Malin Berggrund
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Riina Aarnio
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Julia Hedlund Lindberg
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Karin Sanner
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Ingrid Wikström
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Stefan Enroth
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Ignas Bunikis
- Uppsala Genome Center, Science for Life Laboratory, Department of Immunology, Genetics, and Pathology, Uppsala University, BMC, Box 815, 752 37, Uppsala, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory (SciLifeLab) Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden.
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9
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Aarnio R, Östensson E, Olovsson M, Gustavsson I, Gyllensten U. Cost-effectiveness analysis of repeated self-sampling for HPV testing in primary cervical screening: a randomized study. BMC Cancer 2020; 20:645. [PMID: 32660432 PMCID: PMC7359275 DOI: 10.1186/s12885-020-07085-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/17/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) testing is recommended in primary cervical screening to improve cancer prevention. An advantage of HPV testing is that it can be performed on self-samples, which could increase population coverage and result in a more efficient strategy to identify women at risk of developing cervical cancer. Our objective was to assess whether repeated self-sampling for HPV testing is cost-effective in comparison with Pap smear cytology for detection of cervical intraepithelial neoplasia grade 2 or more (CIN2+) in increasing participation rate in primary cervical screening. METHODS A cost-effectiveness analysis (CEA) was performed on data from a previously published randomized clinical study including 36,390 women aged 30-49 years. Participants were randomized either to perform repeated self-sampling of vaginal fluid for HPV testing (n = 17,997, HPV self-sampling arm) or to midwife-collected Pap smears for cytological analysis (n = 18,393, Pap smear arm). RESULTS Self-sampling for HPV testing led to 1633 more screened women and 107 more histologically diagnosed CIN2+ at a lower cost vs. midwife-collected Pap smears (€ 229,446 vs. € 782,772). CONCLUSIONS This study resulted in that repeated self-sampling for HPV testing increased participation and detection of CIN2+ at a lower cost than midwife-collected Pap smears in primary cervical screening. Offering women a home-based self-sampling may therefore be a more cost-effective alternative than clinic-based screening. TRIAL REGISTRATION Not registered since this trial is a secondary analysis of an earlier published study (Gustavsson et al., British journal of cancer. 118:896-904, 2018).
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Affiliation(s)
- Riina Aarnio
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden.
| | - Ellinor Östensson
- Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 65, Stockholm, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, SciLifeLab Uppsala, Uppsala University, Box 815, 75108, Uppsala, Sweden
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Cui T, Enroth S, Ameur A, Gustavsson I, Lindquist D, Gyllensten U. Invasive cervical tumors with high and low HPV titer represent molecular subgroups with different disease etiology. Carcinogenesis 2019; 40:269-278. [PMID: 30596972 DOI: 10.1093/carcin/bgy183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 11/13/2022] Open
Abstract
Invasive cervical cancer (ICC) with very low titer of high-risk human papillomavirus (HPV) has worse clinical outcome than cases with high titer, indicating a difference in molecular etiology. Fresh-frozen ICC tumors (n = 49) were classified into high- and low-HPV-titer cases using real-time PCR-based HPV genotyping. The mutation spectra were studied using the AmpliSeq Comprehensive Cancer Panel and the expression profiles using total RNA sequencing, and the results were validated using the AmpliSeq Transcriptome assay. HPV DNA genotyping and RNA sequencing showed that 16.6% of ICC tumors contained very low levels of HPV DNA and HPV transcripts. Tumors with low HPV levels had more mutations with a high allele frequency and fewer mutations with low allele frequency relative to tumors with high HPV titer. A number of genes showed significant expression differences between HPV titer groups, including genes with somatic mutations. Gene ontology and pathway analyses implicated the enrichment of genes involved in DNA replication, cell cycle control and extracellular matrix in tumors with low HPV titer. The results indicate that in low titer tumors, HPVs act as trigger of cancer development whereas somatic mutations are clonally selected and become drivers of the tumor development process. In contrast, in tumors with high HPV titer the expression of HPV oncoproteins plays a major role in tumor development and the many low frequency somatic mutations represent passengers. This putative subdivision of invasive cervical tumors may explain the higher radiosensitivity of ICC tumors with high HPV titer and thereby have consequences for clinical management.
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Affiliation(s)
- Tao Cui
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Stefan Enroth
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Adam Ameur
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - David Lindquist
- Department of Radiation Sciences, Umeå University Hospital, Umeå, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
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11
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Berggrund M, Gustavsson I, Aarnio R, Hedlund-Lindberg J, Sanner K, Wikström I, Enroth S, Olovsson M, Gyllensten U. HPV viral load in self-collected vaginal fluid samples as predictor for presence of cervical intraepithelial neoplasia. Virol J 2019; 16:146. [PMID: 31771594 PMCID: PMC6880361 DOI: 10.1186/s12985-019-1253-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022] Open
Abstract
Objective This study was performed to evaluate the use of high-risk HPV (hrHPV) viral load in screening tests for cervical cancer to predict persistent infection and presence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Methods We followed women between 30 and 60 years of age who performed self-sampling of vaginal fluid and subsequently a hrHPV test. Women who were hrHPV positive in their screening test repeated the hrHPV test 3–6 months later and were included in the present study. Results Our results show that women with a persistent HPV16 infection had higher HPV viral load in their primary screening test than women with transient infections (p = 5.33e-03). This was also true for sum of viral load for all hrHPV types in the primary screening test (p = 3.88e-07). 48% of women with persistent HPV16 infection and CIN2+ had an increase in HPV16 titer in the follow-up test, as compared to only 20% of women with persistent infection but without CIN2+ lesions. For the sum of all hrHPV types, 41% of women with persistent infection and CIN2+ had an increase in titer as compared to 26% of women without CIN2 + . Conclusions The results show that hrHPV viral load in the primary screening HPV test is associated with the presence of CIN2+ and could be used in triaging hrHPV positive women for different follow-up strategies or recall times. Serial testing of hrHPV viral load has the potential to distinguish women with CIN2+ lesions from women with persistent infection but without CIN2+ lesions.
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Affiliation(s)
- Malin Berggrund
- Science for Life Laboratory (SciLifeLab), Department of Immunology, Genetics, and Pathology, Biomedical Center, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Inger Gustavsson
- Science for Life Laboratory (SciLifeLab), Department of Immunology, Genetics, and Pathology, Biomedical Center, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Riina Aarnio
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Julia Hedlund-Lindberg
- Science for Life Laboratory (SciLifeLab), Department of Immunology, Genetics, and Pathology, Biomedical Center, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Karin Sanner
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Ingrid Wikström
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Stefan Enroth
- Science for Life Laboratory (SciLifeLab), Department of Immunology, Genetics, and Pathology, Biomedical Center, Uppsala University, Box 815, 75108, Uppsala, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, 75185, Uppsala, Sweden
| | - Ulf Gyllensten
- Science for Life Laboratory (SciLifeLab), Department of Immunology, Genetics, and Pathology, Biomedical Center, Uppsala University, Box 815, 75108, Uppsala, Sweden.
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Gustavsson I, Aarnio R, Myrnäs M, Hedlund-Lindberg J, Taku O, Meiring T, Wikström I, Enroth S, Williamson AL, Olovsson M, Gyllensten U. Clinical validation of the HPVIR high-risk HPV test on cervical samples according to the international guidelines for human papillomavirus DNA test requirements for cervical cancer screening. Virol J 2019; 16:107. [PMID: 31438976 PMCID: PMC6704622 DOI: 10.1186/s12985-019-1216-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/14/2019] [Indexed: 12/18/2022] Open
Abstract
Background The indicating FTA card is a dry medium used for collection of cervical samples. HPVIR is a multiplex real-time PCR test that detects 12 high-risk human papillomavirus types (hrHPV) and provides single genotype information for HPV16, − 31, − 35, − 39, − 51, − 56, and − 59 and pooled type information for HPV18/45 and HPV33/52/58. The aim of this study was to evaluate whether a strategy with cervical samples collected on the FTA card and subsequently analysed with the HPVIR test complies with the criteria of the international guidelines for a clinically validated method for cervical screening. Methods We performed a non-inferiority test comparing the clinical sensitivity and specificity of the candidate test (FTA card and HPVIR) with a clinically validated reference test (Cobas® HPV test) based on liquid-based cytology (LBC) samples. Two clinical samples (LBC and FTA) were collected from 896 participants in population-based screening. For evaluation of the specificity we used 799 women without ≥ CIN2, and for clinical sensitivity we used 67 women with histologically confirmed ≥ CIN2. The reproducibility was studied by performing inter- and intra-laboratory tests of 558 additional clinical samples. Results The clinical sensitivity and specificity for samples collected on the FTA card and analysed using the HPVIR test were non-inferior to samples analysed with the Cobas® HPV test based on LBC samples (non-inferiority test score, p = 1.0 × 10− 2 and p = 1.89 × 10− 9, respectively). Adequate agreement of > 87% was seen in both the intra- and inter-laboratory comparisons. Conclusions Samples collected on the indicating FTA card and analysed with HPVIR test fulfil the requirements of the international guidelines and can therefore be used in primary cervical cancer screening.
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Affiliation(s)
- Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Box 815, SE-75108, Uppsala, Sweden
| | - Riina Aarnio
- Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Mattias Myrnäs
- Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Julia Hedlund-Lindberg
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Box 815, SE-75108, Uppsala, Sweden
| | - Ongeziwe Taku
- Division of Medical Virology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Tracy Meiring
- Division of Medical Virology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Ingrid Wikström
- Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Stefan Enroth
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Box 815, SE-75108, Uppsala, Sweden
| | - Anna-Lise Williamson
- Division of Medical Virology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Box 815, SE-75108, Uppsala, Sweden.
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13
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Aarnio R, Wikström I, Gustavsson I, Gyllensten U, Olovsson M. Diagnostic excision of the cervix in women over 40 years with human papilloma virus persistency and normal cytology. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100042. [PMID: 31404426 PMCID: PMC6687369 DOI: 10.1016/j.eurox.2019.100042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/16/2019] [Accepted: 05/06/2019] [Indexed: 12/20/2022] Open
Abstract
Objective Persistent infection with human papillomavirus (HPV) is recognized as the main risk factor of cervical cancer. Investigation via cytology and colposcopy have lower sensitivity than HPV testing in the diagnosis of high-grade cervical intraepithelial neoplasia (CIN2+). Despite normal cytology and colposcopy findings women with persistent HPV infection have an increased risk of CIN2+. The aim of the study was to evaluate the proportion of histologically confirmed CIN2+ in women with persistent HPV infection and normal Pap smears. Study design From April 2013 until March 2016 we prospectively recruited 91 women over 40 years with persistent HPV infection without any abnormalities in cytology. Of these, 40 women attended a gynecological examination including an HPV test, Pap smear, endocervical cytology, colposcopy with biopsies and diagnostic loop electrosurgical excision procedure (LEEP). Biopsy and LEEP samples were subjected to histological examination Results CIN2+ was verified by histological examination of the LEEP sample in 6/40 (15%) of the women. All the cytological samples were normal and none of the biopsies confirmed CIN2+. Only 19/40 women still had a persistent HPV infection at the study visit. None of the 21/40 women who had cleared their HPV infection at the study visit had CIN2+ in histology of the LEEP sample. Conclusions A persistent HPV infection needs to be monitored despite normal Pap smears, since 6/40 (15%) women older than 40 years, was revealed to have an undiagnosed CIN2+ when LEEP was performed. Counseling women regarding the risk of cervical cancer and the expected effect of an eventual LEEP can help them to make an optimal informed choice.
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Affiliation(s)
- Riina Aarnio
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden
- Corresponding author at: Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Ingrid Wikström
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics and Pathology, Biomedical Center, SciLifeLab Uppsala, Box 815, Uppsala University, SE-75108 Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics and Pathology, Biomedical Center, SciLifeLab Uppsala, Box 815, Uppsala University, SE-75108 Uppsala, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden
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14
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Gustavsson I, Aarnio R, Berggrund M, Hedlund-Lindberg J, Sanner K, Wikström I, Enroth S, Olovsson M, Gyllensten U. Randomised study of HPV prevalence and detection of CIN2+ in vaginal self-sampling compared to cervical specimens collected by medical personnel. Int J Cancer 2018; 144:89-97. [PMID: 29943822 DOI: 10.1002/ijc.31637] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/17/2018] [Accepted: 05/30/2018] [Indexed: 12/27/2022]
Abstract
We conducted a randomised study to compare vaginal self-sampling with assisted sampling by medical personnel on the cervix for HPV testing in primary screening. The first aim was to determine if the HPV prevalence is independent of sampling location (vagina versus cervix) and the person performing the sampling. The second aim was to evaluate if the two sampling strategies differed in the detection rate of CIN2+. In total, 19,523 women were randomised into two groups, with 9926 invited to perform self-sampling (SS arm) using the Rover VIBA-brush and 9597 offered assisted sampling using the cytobrush (AS arm). All samples were applied to the indicating FTA elute card and analysed for high-risk HPV using the hpVIR real-time PCR assay. The outcome for the first aim was HPV prevalence and for the second aim the number of CIN2+ based on histology. In the SS arm, 52.7% of invited women participated in the study, as compared to 34.2% in the AS arm. All samples contained sufficient amount of nuclear DNA for a valid HPV result, with vaginal samples having a higher DNA amount than cervical samples (p < 4.62 × 10-11 ). HPV prevalence was 4.6% in the SS arm and 4.1% in the AS arm (p = 5.5 × 10-2 ), and the distribution of HPV types similar between arms. There was no difference in the prevalence of CIN2+ per 1000 women screened between arms (p = 0.86). The results show that vaginal self-sampling is an equivalent alternative to sampling by medical personnel for HPV typing and identification of CIN2+.
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Affiliation(s)
- Inger Gustavsson
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Riina Aarnio
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Malin Berggrund
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Julia Hedlund-Lindberg
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Karin Sanner
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ingrid Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Stefan Enroth
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics, and Pathology, Biomedical Center, Science for Life Laboratory Uppsala, Uppsala University, Uppsala, Sweden
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Ohlsson AC, Dotevall H, Gustavsson I, Hofling K, Wahle U, Österlind C. Voice Therapy Outcome-A Randomized Clinical Trial Comparing Individual Voice Therapy, Therapy in Group, and Controls Without Therapy. J Voice 2018; 34:303.e17-303.e26. [PMID: 30344071 DOI: 10.1016/j.jvoice.2018.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/24/2018] [Accepted: 08/31/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A stumbling-block in voice therapy is how the patient will be able to apply the new voice technique in everyday life. Possibly this generalization process could be facilitated by giving voice therapy in group because of the natural forum for training voice-to-speech early in communication between the patients in a group setting. The aim of the study was to compare treatment results from individual voice therapy and voice therapy in group, at several time points and in comparison to patients with no voice therapy. METHODS A randomized treatment study was performed with 77 consecutive patients diagnosed with a functional voice disorder. Thirty-one patients were randomized to individual and group therapy, respectively, and 15 patients to no therapy. The assessments included standardized voice recording and registration of voice range profile (VRP), answering Voice handicap index (VHI) and visual analogue scales for self-hoarseness and self-vocal fatigue, and perceptual voice evaluation by speech-language pathologist. The assessments were performed before, direct after therapy, and three months later in all groups. The 2 therapy groups were also assessed 12 months after therapy. RESULTS All VHI scores as well as the self-ratings of hoarseness and vocal fatigue, and the perceptual evaluation of voice quality and maximum VRP improved significantly in both therapy groups 3 months after treatment and at 12 months follow-up. There were no significant changes in the control group, with the exception of decreased self-rated hoarseness and increased maximum VRP. Comparisons between treatment groups showed significant larger improvement after group therapy for VHI physical subscale at 12 months, as well as significant lower VHI total score at all measurement sessions and lower subscale scores at 12 months. There were no differences between treatment groups in self-hoarseness or self-vocal fatigue and no difference in perceptual voice quality or VRP. Comparison between controls and treatment groups showed significant larger change in treatment groups from baseline to three months in VHI total and to end of therapy in functional subscale. Treatment groups also showed significant lower scores than controls at each measurement session, for VHI total and physical subscale as well as lower degree of perceptual aberration of voice quality and vocal fatigue, at three months follow-up. CONCLUSIONS This study shows long-term improvement from behavioral voice therapy, particularly in a group setting. The results indicate the importance of early transfer-to-speech and late posttherapy test to capture whether the goal of voice therapy was fulfilled or not for the patients.
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Affiliation(s)
- Ann-Christine Ohlsson
- Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Hans Dotevall
- Department of Logopedics and Phoniatrics, ENT Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inger Gustavsson
- Department of Speech Language Pathology, ENT Clinic, Hospital of South of Älvsborg, Borås, Sweden
| | - Kerstin Hofling
- Department of Speech Language Pathology, Hospital of Lidköping, Lidköping, Sweden
| | - Ulrika Wahle
- Department of Logopedics and Phoniatrics, ENT Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Claes Österlind
- Department of Speech Language Pathology, NU- Healthcare, Trollhättan, Sweden
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Berggrund M, Ekman D, Gustavsson I, Sundfeldt K, Olovsson M, Enroth S, Gyllensten U. Protein Detection Using the Multiplexed Proximity Extension Assay (PEA) from Plasma and Vaginal Fluid Applied to the Indicating FTA Elute Micro Card™. J Circ Biomark 2016; 5:9. [PMID: 28936257 PMCID: PMC5548362 DOI: 10.5772/64000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/28/2016] [Indexed: 01/20/2023] Open
Abstract
The indicating FTA elute micro card™ has been developed to collect and stabilize the nucleic acid in biological samples and is widely used in human and veterinary medicine and other disciplines. This card is not recommended for protein analyses, since surface treatment may denature proteins. We studied the ability to analyse proteins in human plasma and vaginal fluid as applied to the indicating FTA elute micro card™ using the sensitive proximity extension assay (PEA). Among 92 proteins in the Proseek Multiplex Oncology Iv2 panel, 87 were above the limit of detection (LOD) in liquid plasma and 56 among 92 above LOD in plasma applied to FTA cards. Washing and protein elution protocols were compared to identify an optimal method. Liquid-based cytology samples showed a lower number of proteins above LOD than FTA cards with vaginal fluid samples applied. Our results demonstrate that samples applied to the indicating FTA elute micro card™ are amendable to protein analyses, given that a sensitive protein detection assay is used. The results imply that biological samples applied to FTA cards can be used for DNA, RNA and protein detection.
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Affiliation(s)
- Malin Berggrund
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Biomedical Center, Uppsala University, Uppsala, Sweden
| | - Daniel Ekman
- Olink Bioscience AB, Dag Hammarskjölds väg, Uppsala, Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Biomedical Center, Uppsala University, Uppsala, Sweden
| | - Karin Sundfeldt
- Department of Obstetrics and Gynecology, Institute for Clinical Sciences, Sahlgrenska Cancer Center, Gothenburg University, Gothenburg, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Stefan Enroth
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Biomedical Center, Uppsala University, Uppsala, Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Biomedical Center, Uppsala University, Uppsala, Sweden
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Andersson S, Mints M, Gyllensten U, Lindell M, Gustavsson I, Lambe M, Wilander E. Uneven distribution of human papillomavirus 16 in cervical carcinoma in situ and squamous cell carcinoma in older females: A retrospective database study. Oncol Lett 2014; 8:1528-1532. [PMID: 25202362 PMCID: PMC4156228 DOI: 10.3892/ol.2014.2347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 05/07/2014] [Indexed: 11/06/2022] Open
Abstract
Human papillomavirus (HPV) 16 is the dominant cofactor in cervical cancer development. The present report investigated the age-specific prevalence of HPV16 in cervical carcinoma in situ (CIS) in females attending organised cervical cancer screening. A retrospective observational study was performed based on individual data from two databases. A total of 162 females aged between 20 and 65 years from Uppsala County, Sweden with CIS and an HPV test conducted between 2010 and 2011, preceding or concomitant to CIS diagnosis, were included. Females with cervical squamous cell carcinoma (SCC; n=35) were used for comparison. In total, 96% (n=156) of females with CIS were positive for high-risk HPV; HPV16 was the most prevalent (44.5%), followed by HPV33/52/58 (19.5%), HPV31 (13.1%) and HPV18/45 (9.5%). HPV16 was most frequently detected in females with CIS aged between 20 and 29 years (73.6%) and least frequently detected in those aged between 50 and 65 years (33.3%), with a statistically significant age-specific difference (P=0.001). Among the HPV16-positive females, multiple infections were most frequent in the younger age groups. The prevalence of HPV16 in females with CIS decreased with age, whereas a high prevalence of HPV16 remained in females with SCC. These results may indicate that HPV16 has increased oncogenic potential in older females.
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Affiliation(s)
- Sonia Andersson
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute, Karolinska University Hospital Solna, Stockholm S-171 76, Sweden
| | - Miriam Mints
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institute, Karolinska University Hospital Solna, Stockholm S-171 76, Sweden
| | - Ulf Gyllensten
- Department of Genetics and Pathology, Uppsala University, Uppsala S-751 85, Sweden
| | - Monica Lindell
- Department of Genetics and Pathology, Uppsala University, Uppsala S-751 85, Sweden
| | - Inger Gustavsson
- Department of Genetics and Pathology, Uppsala University, Uppsala S-751 85, Sweden
| | - Mats Lambe
- Department of Genetics and Pathology, Uppsala University, Uppsala S-751 85, Sweden
| | - Erik Wilander
- Department of Clinical Pathology and Cytology, Uppsala University Hospital and Uppsala University, Uppsala S-751 85, Sweden ; Regional Oncologic Centre, Uppsala University Hospital and Uppsala University, Uppsala S-751 85, Sweden
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Mbulawa ZZA, Johnson LF, Marais DJ, Gustavsson I, Moodley JR, Coetzee D, Gyllensten U, Williamson AL. Increased alpha-9 human papillomavirus species viral load in human immunodeficiency virus positive women. BMC Infect Dis 2014; 14:51. [PMID: 24484380 PMCID: PMC3922074 DOI: 10.1186/1471-2334-14-51] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 01/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent high-risk (HR) human papillomavirus (HPV) infection and increased HR-HPV viral load are associated with the development of cancer. This study investigated the effect of human immunodeficiency virus (HIV) co-infection, HIV viral load and CD4 count on the HR-HPV viral load; and also investigated the predictors of cervical abnormalities. METHODS Participants were 292 HIV-negative and 258 HIV-positive women. HR-HPV viral loads in cervical cells were determined by the real-time polymerase chain reaction. RESULTS HIV-positive women had a significantly higher viral load for combined alpha-9 HPV species compared to HIV-negative women (median 3.9 copies per cell compared to 0.63 copies per cell, P = 0.022). This was not observed for individual HPV types. HIV-positive women with CD4 counts >350/μl had significantly lower viral loads for alpha-7 HPV species (median 0.12 copies per cell) than HIV-positive women with CD4 ≤350/μl (median 1.52 copies per cell, P = 0.008), but low CD4 count was not significantly associated with increased viral load for other HPV species. High viral loads for alpha-6, alpha-7 and alpha-9 HPV species were significant predictors of abnormal cytology in women. CONCLUSION HIV co-infection significantly increased the combined alpha-9 HPV viral load in women but not viral loads for individual HPV types. High HR-HPV viral load was associated with cervical abnormal cytology.
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Affiliation(s)
| | | | | | | | | | | | | | - Anna-Lise Williamson
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa.
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Östensson E, Hellström AC, Hellman K, Gustavsson I, Gyllensten U, Wilander E, Zethraeus N, Andersson S. Projected cost-effectiveness of repeat high-risk human papillomavirus testing using self-collected vaginal samples in the Swedish cervical cancer screening program. Acta Obstet Gynecol Scand 2013; 92:830-40. [DOI: 10.1111/aogs.12143] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/19/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Ellinor Östensson
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska University Hospital-Solna; Karolinska Institute; Stockholm; Sweden
| | - Ann-Cathrin Hellström
- Gynecological Oncology; Radiumhemmet; Department of Oncology; Karolinska Hospital and Institute in Solna; Stockholm; Sweden
| | - Kristina Hellman
- Gynecological Oncology; Radiumhemmet; Department of Oncology; Karolinska Hospital and Institute in Solna; Stockholm; Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics and Pathology; Rudbeck Laboratory; Uppsala University; Uppsala; Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics and Pathology; Rudbeck Laboratory; Uppsala University; Uppsala; Sweden
| | - Erik Wilander
- Department of Pathology and Cytology; Department of Women's and Children's Health; Uppsala University Hospital; Uppsala; Sweden
| | - Niklas Zethraeus
- Medical Management Center (MMC); Department of Learning, Informatics, Management and Ethics (LIME); Karolinska Institute; Stockholm; Sweden
| | - Sonia Andersson
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska University Hospital-Solna; Karolinska Institute; Stockholm; Sweden
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20
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Chen D, Juko-Pecirep I, Hammer J, Ivansson E, Enroth S, Gustavsson I, Feuk L, Magnusson PKE, McKay JD, Wilander E, Gyllensten U. Genome-wide association study of susceptibility loci for cervical cancer. J Natl Cancer Inst 2013; 105:624-33. [PMID: 23482656 DOI: 10.1093/jnci/djt051] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cervical carcinoma has a heritable genetic component, but the genetic basis of cervical cancer is still not well understood. METHODS We performed a genome-wide association study of 731 422 single nucleotide polymorphisms (SNPs) in 1075 cervical cancer case subjects and 4014 control subjects and replicated it in 1140 case subjects and 1058 control subjects. The association between top SNPs and cervical cancer was estimated by odds ratios (ORs) and 95% confidence intervals (CIs) with unconditional logistic regression. All statistical tests were two-sided. RESULTS Three independent loci in the major histocompatibility complex (MHC) region at 6p21.3 were associated with cervical cancer: the first is adjacent to the MHC class I polypeptide-related sequence A gene (MICA) (rs2516448; OR = 1.42, 95% CI = 1.31 to 1.54; P = 1.6×10(-18)); the second is between HLA-DRB1 and HLA-DQA1 (rs9272143; OR = 0.67, 95% CI = 0.62 to 0.72; P = 9.3×10(-24)); and the third is at HLA-DPB2 (rs3117027; OR=1.25, 95% CI = 1.15 to 1.35; P = 4.9×10(-8)). We also confirmed previously reported associations of B*0702 and DRB1*1501-DQB1*0602 with susceptibility to and DRB1*1301-DQA1*0103-DQB1*0603 with protection against cervical cancer. The three new loci are statistically independent of these specific human leukocyte antigen alleles/haplotypes. MICA encodes a membrane-bound protein that acts as a ligand for NKG2D to activate antitumor effects. The risk allele of rs2516448 is in perfect linkage disequilibrium with a frameshift mutation (A5.1) of MICA, which results in a truncated protein. Functional analysis shows that women carrying this mutation have lower levels of membrane-bound MICA. CONCLUSIONS Three novel loci in the MHC may affect susceptibility to cervical cancer in situ, including the MICA-A5.1 allele that may cause impaired immune activation and increased risk of tumor development.
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Affiliation(s)
- Dan Chen
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, 751 85 Uppsala, Sweden
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Marincevic-Zuniga Y, Gustavsson I, Gyllensten U. Multiply-primed rolling circle amplification of human papillomavirus using sequence-specific primers. Virology 2012; 432:57-62. [PMID: 22739442 DOI: 10.1016/j.virol.2012.05.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/15/2012] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
Abstract
Multiply-primed rolling circle amplification (RCA) is a suitable technique for amplification of circular templates and has been used to identify novel human papillomaviruses (HPV). In this study we develop an efficient RCA for whole genome amplification of HPV using HPV-specific primers in clinical samples and establish a protocol for whole genome sequencing using the Sanger method. Amplification of cloned HPV-genomes by RCA was compared using specific primers against random hexamers. Using HPV-specific primers increased the effectiveness on average 15.2 times and the enrichment of HPV relative to human gDNA on average 62.2 times, as compared to using random hexamer. RCA products were sequenced without need for cloning, even when using low-input amounts. The technique was successfully used on 4 patient samples from FTA cards, to generate whole HPV-genome sequences. Degenerated HPV-specific primers for RCA produce DNA of sufficient quality and quantity suitable for sequencing and other potential downstream analyses.
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Affiliation(s)
- Yanara Marincevic-Zuniga
- Department of Immunology, Genetics and Pathology, SciLife Lab Uppsala, Uppsala University, Uppsala, Sweden
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22
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Gyllensten U, Sanner K, Gustavsson I, Lindell M, Wikström I, Wilander E. Short-time repeat high-risk HPV testing by self-sampling for screening of cervical cancer. Br J Cancer 2011; 105:694-7. [PMID: 21811250 PMCID: PMC3188941 DOI: 10.1038/bjc.2011.277] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Testing for high-risk human papillomavirus (HPV) in primary screening for cervical cancer is considered more sensitive, but less specific, in comparison with Pap-smear cytology. Women with persistent HPV infections have a higher risk of developing cervical intraepithelial neoplasia 2+ (CIN2+) lesions. This study was performed to evaluate the gain in specificity for detection of histologically confirmed CIN2+ lesions achieved by short-time repeat testing for high-risk HPV in women aged 30-65 years, with the primary sample for HPV analysis taken by self-sampling. METHODS A total of 8000 women in Uppsala County, aged 30-65 years, who had not attended organised screening for 6 years or longer, were offered self-sampling of vaginal fluid at home and the samples sent for HPV typing. Of these, 8% (669) were not possible to contact or had performed hysterectomy. Women positive for high-risk HPV in the self-sampling test were invited for a follow-up HPV test and a cervical biopsy on average 3 months after the initial HPV test. RESULTS In all, 39% (2850/7331) of invited women chose to perform self-sampling of vaginal fluid at home. High-risk HPV infection was found in 6.6% (188) of the women. In all, 89% of the women testing HPV positive performed a follow-up examination, on average 2.7 months, after the first test and 59% of these women were HPV positive in the follow-up test. The prevalence of CIN2+ lesions in women with an initial HPV-positive test was 23% (95% CI 18-30%) and in women with two consecutive HPV-positive tests was 41% (95% CI 31-51%). In women with two positive HPV tests, the prevalence of CIN2+ lesions varied from 49% in women at age 30-39 years to 24% in women at age 50-65 years. Short-time repeat HPV testing increased the specificity for detection of CIN2+ lesions from about 94.2% to 97.8%. The most prevalent HPV types were HPV16 (32%), followed by HPV18/45 (19%) and HPV 33/52/58 (19%). CONCLUSION The short-time persistence of high-risk HPV infection in this age group was about 60%. Repeat testing for high-risk HPV using self-sampling of vaginal fluid can be used to increase the specificity in the screening for cervical cancer in women aged 30-65 years.
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Affiliation(s)
- U Gyllensten
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, SciLifeLab, Uppsala University Hospital, Uppsala, Sweden.
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Gustavsson I, Sanner K, Lindell M, Strand A, Olovsson M, Wikström I, Wilander E, Gyllensten U. Type-specific detection of high-risk human papillomavirus (HPV) in self-sampled cervicovaginal cells applied to FTA elute cartridge. J Clin Virol 2011; 51:255-8. [DOI: 10.1016/j.jcv.2011.05.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 04/18/2011] [Accepted: 05/03/2011] [Indexed: 11/29/2022]
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Nurkkala M, Wassén L, Nordström I, Gustavsson I, Slavica L, Josefsson A, Eriksson K. Conjugation of HPV16 E7 to cholera toxin enhances the HPV-specific T-cell recall responses to pulsed dendritic cells in vitro in women with cervical dysplasia. Vaccine 2010; 28:5828-36. [PMID: 20600477 DOI: 10.1016/j.vaccine.2010.06.068] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 05/31/2010] [Accepted: 06/22/2010] [Indexed: 11/30/2022]
Abstract
We have evaluated whether cholera toxin (CT) as a carrier/adjuvant can enhance human T-cell responses to a viral oncoprotein in vitro using dendritic cells (DCs) as antigen-presenting cells. Monocyte-derived DCs obtained from women with cervical dysplasia were pulsed with the HPV16 oncoprotein E7, either alone or conjugated to CT, and tested for their ability to induce antigen-specific activation of autologous T cells in vitro. CT-conjugation of E7 significantly improved the capacity of pulsed DCs to activate antigen-specific CD4+ T-cell proliferation and IFN-gamma secretion. The CT-E7-pulsed DCs also produced significantly more of the Th1-inducing cytokine IL-12 compared to DCs pulsed with E7 or CT alone. Furthermore, DCs pulsed with CT-conjugated HPV16 E7 caused a response in T cells from women with advanced disease (CIN III) as well as in T cells from women that were currently not infected with HPV16. These data show the potential of using CT-conjugated viral oncoproteins for DC-induced T-cell activation in humans.
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Affiliation(s)
- Merja Nurkkala
- Department of Rheumatology & Inflammation Research, University of Gothenburg, Göteborg, Sweden.
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Gustavsson I, Johansson I. Chromosome aberrations and their influence on the reproductive performance of domestic animals - a review. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1439-0388.1980.tb00925.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Gustavsson I, Gyllensten U, Lindell M, Wilander E. [Is the HPV test to supplement vaginal smears in menopausal women?]. Lakartidningen 2010; 107:528-529. [PMID: 20384066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Gustavsson I, Rendel J. A translocation in cattle and its association to polymorphisms in red cell antigens, transferrins and carbonic anhydrases. Hereditas 2009; 67:35-8. [PMID: 4218208 DOI: 10.1111/j.1601-5223.1971.tb02356.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Bergman H, Gustavsson I. Variable starch gel electrophoretic pattern of the enzyme 6-phosphogluconate dehydrogenase in a family of donkeys (Equus asinus L.). Hereditas 2009; 67:145-6. [PMID: 4680625 DOI: 10.1111/j.1601-5223.1971.tb02367.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Gustavsson I, Sundt CO. Karyotypes in five species of deer (Alces alces L., Capreolus capreolus L., Cervus elaphus L., Cervus nippon nippon Temm. and Dama dama L.). Hereditas 2009; 60:233-48. [PMID: 5721324 DOI: 10.1111/j.1601-5223.1968.tb02204.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Gustavsson I. Mitotic and meiotic chromosomes of the variable hare (Lepus timidus L.), the common hare (Lepus europaeus Pall.) and their hybrids. Hereditas 2009; 67:27-34. [PMID: 4680627 DOI: 10.1111/j.1601-5223.1971.tb02355.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Wallin A, Gustavsson I. Immunization with xenogeneic erythrocytes to increase the number of mitss for in vivo chromosome studies in the mammalian spleen. Hereditas 2009; 61:278-82. [PMID: 5399204 DOI: 10.1111/j.1601-5223.1969.tb01842.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Gustavsson I, Lindell M, Wilander E, Strand A, Gyllensten U. Use of FTA card for dry collection, transportation and storage of cervical cell specimen to detect high-risk HPV. J Clin Virol 2009; 46:112-6. [PMID: 19628427 DOI: 10.1016/j.jcv.2009.06.021] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 06/23/2009] [Accepted: 06/23/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND The FTA elute micro card, which enable the collection, transport, and archiving of DNA could be an attractive alternative to a liquid based collection system for detection of human papillomavirus (HPV). OBJECTIVES To develop a method based on the FTA elute micro card for dry collection of cervical epithelial cell samples, suitable for subsequent PCR-based HPV testing. STUDY DESIGN The method was evaluated by a comparison of the DNA collected by cytobrush and the regular FTA elute micro card from 50 cervical cell samples. The method was then used to estimate the DNA amount in 1040 samples applied to the indicating FTA elute micro card. RESULT The agreement in HPV positivity between the cytobrush and FTA samples (94%) was excellent (kappa=0.88, 95% CI 0.748-1). All the 1040 samples on the indicating FTA card had sufficient amounts of genomic DNA (>10 copies of a single copy gene) to be suitable for HPV typing. In 53 of the 1040 women the day in the menstrual cycle was noted, and the copy number during follicular phase day 9-13 was found to be statistically significantly lower than for the other three stages in the menstrual cycle (day 4-8, 14, >14) and during menopause. CONCLUSION The indicating FTA elute micro card represents a suitable medium for collection of cervical cell samples, although follow-up studies are needed to verify the detection of low frequency HPV types.
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Affiliation(s)
- Inger Gustavsson
- Department of Genetics and Pathology, Rudbeck Laboratory, University of Uppsala, Uppsala, Sweden.
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Gustavsson I, Juko-Pecirep I, Backlund I, Wilander E, Gyllensten U. Comparison between the Hybrid Capture 2 and the hpVIR real-time PCR for detection of human papillomavirus in women with ASCUS or low grade dysplasia. J Clin Virol 2009; 45:85-9. [PMID: 19451022 DOI: 10.1016/j.jcv.2009.04.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 03/26/2009] [Accepted: 04/20/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) testing is an important part of cervical carcinoma screening, and the most widely used assay for detection of HPV is Hybrid Capture 2 (HC2). OBJECTIVES We compare the HC2 with the real-time PCR hpVIR assay for detection of HPV in follow-up smears of 398 women diagnosed with atypical squamous cells of unknown significance (ASCUS) or low grade cervical intraepithelial neoplasia (CIN 1) in their initial smear. STUDY DESIGN The two assays target the same set of high-risk (HR) HPVs with exception of HPV68. hpVIR identify individual or groups of HPV types as well as their viral load, while HC2 identify HR HPVs without specification of type. RESULTS 34% (131/391) of the women were positive with HC2 and 45% (175/391) with hpVIR. 16% (63/391) were positive only with hpVIR and among those with cytology available 6% (3/52) had a CIN 2. The 3% (13/391) of women positive only with HC2 either contained low-risk HPVs or copy numbers below the cut-off for the hpVIR assay. CONCLUSION The hpVIR assay has a similar sensitivity and specificity as HC2, but hpVIR detect a higher frequency of high-risk HPV infections.
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Affiliation(s)
- Inger Gustavsson
- Department of Genetics and Pathology, Rudbeck Laboratory, University of Uppsala, Dag Hammarskjöldsväg 20, S-751 85 Uppsala, Sweden.
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Abstract
Fibroblasts from a pig with a spontaneous reciprocal translocation involving chromosome 7, were used to prepare a set of pig-mouse somatic cell hybrids. The isozyme analysis strongly indicated that in pigs, the NP (nucleoside phosphorylase) gene is located on the distal part of the long arm of chromosome 7, (q21----qter), while the MPI (mannose phosphate isomerase) gene is in the region q21----pter. This confirmed previously reported chromosomal assignment of these genes in pigs and that this synteny has been evolutionarily conserved in several different animal species.
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Affiliation(s)
- H Ryttman
- Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, Uppsala
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Ryttman H, Thebo P, Gustavsson I, Gahne B, Juneja RK. Further data on chromosomal assignments of pig enzyme loci LDHA, LDHB, MPI, PEPB and PGM1, using somatic cell hybrids. Anim Genet 2009; 17:323-33. [PMID: 2950811 DOI: 10.1111/j.1365-2052.1986.tb00725.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Clear interspecies differentiation between the chromosomes in pig-mouse somatic cell hybrids was achieved by using the THA-technique for the cytogenetic analysis. The assignments of LDHB and MPI to pig chromosomes nos 5 and 7 respectively, reported previously, were confirmed by analysis of 34 hybrid clones. The LDHA, PEPB and PGM1 genes were assigned to pig chromosomes nos 2, 5 and 6 respectively. Both LDHB and PEPB were indicated to be located on the long arm, except the most proximal part, of pig chromosome no. 5. The proposed synteny between LDHB and PEPB in pigs is in accordance with the synteny observed between these two loci in several other mammalian species.
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Gustavsson I, Hageltorn M, Zech L, Reiland S. Identification of the chromosomes in a centric fusion-fission polymorphic system of the pig (Sus scrofa L.). Hereditas 2009; 75:153-5. [PMID: 4778104 DOI: 10.1111/j.1601-5223.1973.tb01156.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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King WA, Linares T, Gustavsson I, Bane A. Presumptive translocation type trisomy in embryos sired by bulls heterozygous for the 1/29 translocation. Hereditas 2009; 92:167-9. [PMID: 7380659 DOI: 10.1111/j.1601-5223.1980.tb01690.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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King WA, Gustavsson I, Popescu CP, Linares T. Gametic products transmitted by rcp(13q--;14q+) translocation heterozygous pigs, and resulting embryonic loss. Hereditas 2009; 95:239-46. [PMID: 7309540 DOI: 10.1111/j.1601-5223.1981.tb01413.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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