HPV testing in first-void urine provides sensitivity for CIN2+ detection comparable with a smear taken by a clinician or a brush-based self-sample: cross-sectional data from a triage population

OBJECTIVE

To compare the sensitivity of high-risk human papillomavirus (hrHPV) and genotype detection in self-collected urine samples in the morning (U1), and later on (U2), brush-based self-samples (SS), and clinician-taken smears (CTS) for detecting cervical intraepithelial neoplasia grade 2+ (CIN2+) in a colposcopic referral population.

DESIGN

Cross-sectional single-centre study.

SETTING

A colposcopy clinic in Spain.

POPULATION

A cohort of 113 women referred for colposcopy after an abnormal Pap smear.

METHODS

Women undergoing colposcopy with biopsy for abnormal Pap smears were sent a device (Colli-Pee™, Novosanis, Wijnegem, Belgium) to collect U1 on the morning of colposcopy. U2, CTS, and SS (Evalyn brush™, Rovers Medical Devices B.V., Oss, the Netherlands) were also analysed. All samples were tested for HPV DNA using the analytically sensitive SPF10-DEIA-LiPA25 assay and the clinically validated GP5+/6+-EIA-LMNX.

MAIN OUTCOME MEASURES

Histologically confirmed CIN2+ and hrHPV positivity for 14 high-risk HPV types.

RESULTS

Samples from 91 patients were analysed. All CIN3 cases (n = 6) tested positive for hrHPV in CTS, SS, U1, and U2 with both HPV assays. Sensitivity for CIN2+ with the SPF10 system was 100, 100, 95, and 100%, respectively. With the GP5+/6+ assay, sensitivity was 95% in all sample types. The sensitivities and specificities for both tests on each of the sample types did not significantly differ. There was 10-14% discordance on hrHPV genotype.

CONCLUSIONS

CIN2+ detection using HPV testing of U1 shows a sensitivity similar to that of CTS or brush-based SS, and is convenient. There was substantial to almost excellent agreement between all samples on genotype with both hrHPV assays. There was no advantage in testing U1 compared with U2 samples.

TWEETABLE ABSTRACT

Similar CIN2+ sensitivity for HPV testing in first-void urine, physician-taken smear and brush-based self-sample.

The 40-kDa Fc gamma receptor (FcRII) on human neutrophils is essential for the IgG-induced respiratory burst and IgG-induced phagocytosis

Neutrophils express two types of receptor for the Fc region of IgG, FcRII and FcRIII. Per neutrophil, 10,000 to 20,000 molecules of FcRII (40 kDa) and 100,000 to 200,000 molecules of FcRIII (50 to 80 kDa) are expressed. Via these receptors, neutrophils bind IgG complexes that contain more than one IgG molecule. This binding activates functional processes, such as the respiratory burst and phagocytosis. We studied the contribution of FcRII and FcRIII in the activation of these processes, using well-defined complexes (both large and small) in combination with mAb against FcRII and FcRIII. Small (dimeric) IgG complexes appeared to bind via FcRIII. However, binding to FcRIII alone, when FcRII is blocked by an anti-FcRII mAb, did not induce a respiratory burst. Induction of the respiratory burst by a large immune complex, such as Staphylococcus aureus Wood opsonized with IgG antibodies, was mediated by binding to FcRII, because it was blocked by an anti-FcRII mAb but not by an anti-FcRIII mAb. This indicates that these IgG-opsonized bacteria can cross-link FcRII and activate the cells without the need to adhere to the FcRIII. The respiratory burst induced by IgG-latex was not inhibited by an anti-FcRII mAb, because the avidity for FcRII of IgG-latex, a particle of the same size as a Staphylococcus but with a two to three times higher IgG content, is increased by its simultaneous binding to FcRIII. This enhanced avidity results in removal of anti-FcRII mAb from the FcRII by IgG-latex. This increased avidity of large complexes for FcRII, created by concurrent binding to FcRIII, is not necessary for activation of human neutrophils, because neutrophils from patients with paroxysmal nocturnal hemoglobinuria, with about 10% of the normal FcRIII expression, showed a normal metabolic response upon addition of IgG-latex. Phagocytosis of IgG-opsonized 14C-labeled S. aureus Wood was inhibited equally well by anti-FcRII mAb and by anti-FcRII in combination with anti-FcRIII mAb. Thus, FcRII is not only essential for the IgG-induced activation of the NADPH oxidase system, but also for the IgG-induced phagocytosis.

The 40-kDa Fc gamma receptor (FcRII) on human neutrophils is essential for the IgG-induced respiratory burst and IgG-induced phagocytosis

Neutrophils express two types of receptor for the Fc region of IgG, FcRII and FcRIII. Per neutrophil, 10,000 to 20,000 molecules of FcRII (40 kDa) and 100,000 to 200,000 molecules of FcRIII (50 to 80 kDa) are expressed. Via these receptors, neutrophils bind IgG complexes that contain more than one IgG molecule. This binding activates functional processes, such as the respiratory burst and phagocytosis. We studied the contribution of FcRII and FcRIII in the activation of these processes, using well-defined complexes (both large and small) in combination with mAb against FcRII and FcRIII. Small (dimeric) IgG complexes appeared to bind via FcRIII. However, binding to FcRIII alone, when FcRII is blocked by an anti-FcRII mAb, did not induce a respiratory burst. Induction of the respiratory burst by a large immune complex, such as Staphylococcus aureus Wood opsonized with IgG antibodies, was mediated by binding to FcRII, because it was blocked by an anti-FcRII mAb but not by an anti-FcRIII mAb. This indicates that these IgG-opsonized bacteria can cross-link FcRII and activate the cells without the need to adhere to the FcRIII. The respiratory burst induced by IgG-latex was not inhibited by an anti-FcRII mAb, because the avidity for FcRII of IgG-latex, a particle of the same size as a Staphylococcus but with a two to three times higher IgG content, is increased by its simultaneous binding to FcRIII. This enhanced avidity results in removal of anti-FcRII mAb from the FcRII by IgG-latex. This increased avidity of large complexes for FcRII, created by concurrent binding to FcRIII, is not necessary for activation of human neutrophils, because neutrophils from patients with paroxysmal nocturnal hemoglobinuria, with about 10% of the normal FcRIII expression, showed a normal metabolic response upon addition of IgG-latex. Phagocytosis of IgG-opsonized 14C-labeled S. aureus Wood was inhibited equally well by anti-FcRII mAb and by anti-FcRII in combination with anti-FcRIII mAb. Thus, FcRII is not only essential for the IgG-induced activation of the NADPH oxidase system, but also for the IgG-induced phagocytosis.