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Cetina-Pérez L, Luvián-Morales J, Delgadillo-González M, Castro-Eguiluz D, Galicia-Carmona T, Rely K, Vaca González R, Lugo-Martínez G, García-Barrientos N, Nateras A. Sociodemographic characteristics and their association with survival in women with cervical cancer. BMC Cancer 2024; 24:161. [PMID: 38302893 PMCID: PMC10832171 DOI: 10.1186/s12885-024-11909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND In 2020, the highest incidence and mortality from cervical cancer (CC) were detected in low and middle-income countries. CC remains a health problem for women living in them. In Mexico, CC ranks second in cancer incidence and mortality in women. The main characteristics of this population are low income, low educational level, and inadequate medical coverage. The present study characterized the Mexican population by CC, and the sociodemographic variables that impacted overall survival (OS) were identified. METHODS A retrospective study that included a cohort of patients with a confirmed diagnosis of CC at the Instituto Nacional de Cancerologia between 2003 and 2016. Information was collected on sociodemographic variables related to the disease and OS. RESULTS Four thousand six hundred thirty-one patients were included. The median age was 51 years, 78.5% were unemployed, 44.4% lived in a rural/suburban area, 50.8% had a partner when collecting this information, and 74.3% were classified as having low socioeconomic status. Age, living in a rural/suburban area, more advanced stages of the disease, and not receiving cancer treatment were associated with lower OS. CONCLUSION CC continues to affect mainly women with minimal resources, low educational levels, and living in marginalized areas. These characteristics influence the OS. Prevention and timely detection programs, education, and training focused on this population and with broader coverage are required to identify patients with CC at earlier stages.
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Affiliation(s)
- Lucely Cetina-Pérez
- Department of Clinical Research, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Sección XVI, 14080, Mexico City, Tlalpan, Mexico.
| | | | | | - Denisse Castro-Eguiluz
- Department of Clinical Research, Investigador por México, Consejo Nacional de Humanidades, Ciencia y Tecnología (CONAHCyT, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Kely Rely
- International Healthcare Consultant - CEAHealth Tech, Mexico City, Mexico
| | - Rita Vaca González
- Department of Social Work, Instituto Nacional de Cancerología, Mexico City, Mexico
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Saldaña-Rodríguez P, Bahena-Román M, Delgado-Romero K, Madrid-Marina V, Torres-Poveda K. Prevalence and Risk Factors for High-Risk Human Papillomavirus Infection and Cervical Disorders: Baseline Findings From an Human Papillomavirus Cohort Study. Cancer Control 2023; 30:10732748231202925. [PMID: 37751562 PMCID: PMC10524074 DOI: 10.1177/10732748231202925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/23/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND A persistent infection by high-risk human papillomavirus (HR-HPV) is a prerequisite for the development of cervical neoplasms; however, most studies have focused on risk factors associated with HPV-16 and HPV-18 only. OBJECTIVES We assessed the association of risk factors with the prevalence of HPV-16, HPV-18, and non-16/18 HR-HPV infection and with the occurrence of cervical lesions in the baseline of a cohort study of HPV persistence in a Mexican population. METHODS Cross-sectional study within the baseline of a 5-year dynamic cohort study of HR-HPV persistence in women with an abnormal cytology study result from 2015 to 2021. HPV DNA was detected using the Anyplex II HPV 28 kit. Data on lifestyle, sociodemographic, and reproductive factors were assessed using bivariate and multivariate analyses to determine the association of risk factors with HR-HPV infection status and histopathologic diagnosis. RESULTS A total of 373 women were included in the study. The overall prevalence of HR-HPV infection was 69.97%. The most prevalent HR-HPV genotypes, including single and multiple infections, were HPV-53 (13.4%), HPV-16 (11.8%), HPV-58 (10.9%), HPV-31 (10.9%), and HPV-66 (10.7%). We found 90 multiple HR-HPV infection patterns, all of them with α-6 and -9 species. Significant associations of multiple HPV-16 and non-16/18 HR-HPV infections were found with marital status, number of lifetime sexual partners, and smoking history. The most prevalent genotype in CIN1 and CIN2 patients was HPV-16. No association was found between biological plausibility risk factors and cervical lesions. CONCLUSIONS The risk factors for non-16/18 HR-HPV multiple infections are no different than those linked to HPV-16 multiple infections.
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Affiliation(s)
- Paula Saldaña-Rodríguez
- Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Margarita Bahena-Román
- Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Karina Delgado-Romero
- Centro de Atención para la Salud de la Mujer (CAPASAM) (Center for Women's Health), Health Services of the State of Morelos, Cuernavaca, Mexico
| | - Vicente Madrid-Marina
- Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Kirvis Torres-Poveda
- Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Consejo Nacional de Humanidades Ciencias y Tecnologías (CONAHCYT), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
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Reyes-Vallejo T, Conde-Rodríguez I, Serna-Villalobos J, Ramírez-Díaz I, Pérez-Villalobos G, Delgado-López G, Vázquez-Zamora VJ, Gutierrez-Quiroz CT, Ávila-Jiménez L, García-Carrancá A, Martínez-Acosta L, Santos-López G, Reyes-Leyva J, Vallejo-Ruiz V. Response to Article "Serum Levels of Galectin-9 are Increased in Cervical Cancer Patients and are Higher in Advanced Clinical Stages" [Response to Letter]. Onco Targets Ther 2022; 15:1543-1544. [PMID: 36579183 PMCID: PMC9792111 DOI: 10.2147/ott.s399119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Tania Reyes-Vallejo
- Departamento de Ciencias Químico-Biológicas, Universidad de las Américas Puebla, Puebla, México
| | - Ileana Conde-Rodríguez
- Posgrado en Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | | | - Ivonne Ramírez-Díaz
- Posgrado en Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | | | - Guadalupe Delgado-López
- Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Atlixco, Puebla, México
| | | | | | - Laura Ávila-Jiménez
- Organo de Operación Administrativa Desconcentrada Estatal Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México
| | - Alejandro García-Carrancá
- Universidad Nacional Autónoma de México Instituto Nacional de Cancerología, Ciudad de México, México
| | - Liliana Martínez-Acosta
- Hospital General de Zona No. 5, Instituto Mexicano del Seguro Social, Metepec, Puebla, México
| | - Gerardo Santos-López
- Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Atlixco, Puebla, México
| | - Julio Reyes-Leyva
- Facultad de Ciencias Químicas, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Verónica Vallejo-Ruiz
- Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Atlixco, Puebla, México,Correspondence: Verónica Vallejo-Ruiz, Km 4.5 Carretera Federal Atlixco-Metepec, Atlixco, Puebla, Z.C. 74360, Mexico, Tel +52 24 44 440 122, Email ;
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4
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Piña-Sánchez P. Human Papillomavirus: Challenges and Opportunities for the Control of Cervical Cancer. Arch Med Res 2022; 53:753-769. [PMID: 36462952 DOI: 10.1016/j.arcmed.2022.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
Viruses are the most abundant and genetically diverse entities on the planet, infect all life forms and have evolved with their hosts. To date, 263 viral species have been identified that infect humans, of which only seven are considered type I oncogenic. Human papillomavirus (HPV) is the main virus associated with cancer and is responsible for practically all cases of cervical carcinoma. Screening tests for early detection have been available since the 1960s. Undoubtedly, the entailment between knowledge of HPV biology and the natural history of cervical cancer has contributed to the significant advances that have been made for its prevention since the 21st century, with the development of prophylactic vaccines and improved screening strategies. Therefore, it is possible to eradicate invasive cervical cancer as a worldwide public health problem, as proposed by the WHO with the 90-70-90 initiative based on vaccination coverage, screening, and treatment, respectively. In addition, the emerging knowledge of viral biology generates opportunities that will contribute to strengthening prevention and treatment strategies in HPV-associated neoplasms.
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Affiliation(s)
- Patricia Piña-Sánchez
- Laboratorio Molecular de Oncología, Unidad de Investigación Oncológica, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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5
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Pedroza-Gonzalez A, Reyes-Reali J, Campos-Solorzano M, Blancas-Diaz EM, Tomas-Morales JA, Hernandez-Aparicio AA, Montes de Oca-Samperio D, Garrido E, Garcia-Romo GS, Mendez-Catala CF, Alvarez Ortiz P, Sánchez Ramos J, Mendoza-Ramos MI, Saucedo-Campos AD, Pozo-Molina G. Human papillomavirus infection and seroprevalence among female university students in Mexico. Hum Vaccin Immunother 2022; 18:2028514. [PMID: 35103580 PMCID: PMC8993084 DOI: 10.1080/21645515.2022.2028514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Human papillomavirus (HPV) is one of the most common causes of sexually transmitted diseases, and the main etiology of cervical cancer. This study was aimed to assess type-specific cervical HPV prevalence and their association with HPV-specific antibodies in a cohort of female university students. HPV genotyping was performed by amplifying and sequencing a fragment of the L1 protein. A BLAST search was performed to identify HPV types. HPV-specific IgG antibodies were measured by ELISA in serum samples. A total of 129 women participated, with an average age of 21.75 years. The prevalence of vaginal HPV infection was 74.42%. The most predominant high-risk HPV types were 18 (13.95%), 31 (10.85%), and 16 (9.3%). We found that early age at coitarche and a higher number of sexual partners were significantly associated with a high prevalence of HPV infection. In addition to sexual behavior, we observed that the presence of serum-specific IgG antibodies against HPV can impact the prevalence of the virus. Seropositivity to HPV-16 and HPV-18 was associated with a lower prevalence of HPV-16, but not for other HPV types. Of note, there was a lower proportion of HPV-specific seropositivity in women who had the presence of the same HPV type in a cervical specimen, suggesting an immunoregulatory mechanism associated with the viral infection. In conclusion, the prevalence of HPV in university women was higher than expected and it was associated with early age of sexual debut, an increasing number of sexual partners, and a low proportion of HPV seropositivity.
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Affiliation(s)
- Alexander Pedroza-Gonzalez
- Laboratorio de Inmunología, Unidad de Morfología y Función. Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | - Julia Reyes-Reali
- Laboratorio de Inmunología, Unidad de Morfología y Función. Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | - Maricela Campos-Solorzano
- Clínica Universitaria de Salud Integral, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | - Eloy Moises Blancas-Diaz
- Laboratorio de Genética y Oncología Molecular, Laboratorio 5, Edificio A4, Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | - Janik Adriana Tomas-Morales
- Laboratorio de Inmunología, Unidad de Morfología y Función. Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | - Aldo Aram Hernandez-Aparicio
- Laboratorio de Inmunología, Unidad de Morfología y Función. Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | - Daniel Montes de Oca-Samperio
- Laboratorio de Genética y Oncología Molecular, Laboratorio 5, Edificio A4, Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | - Efrain Garrido
- Departamento de Genética y Biología Molecular, CINVESTAV-IPN, Ciudad de México, México
| | - Gina Stella Garcia-Romo
- Laboratorio de Inmunología, Unidad de Morfología y Función. Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | - Claudia Fabiola Mendez-Catala
- Laboratorio de Genética y Oncología Molecular, Laboratorio 5, Edificio A4, Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México.,División de Investigación y Posgrado, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | | | - Janet Sánchez Ramos
- Laboratorio de Genética y Oncología Molecular, Laboratorio 5, Edificio A4, Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | - Maria Isabel Mendoza-Ramos
- Laboratorio de Inmunología, Unidad de Morfología y Función. Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | - Alberto Daniel Saucedo-Campos
- Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | - Glustein Pozo-Molina
- Laboratorio de Genética y Oncología Molecular, Laboratorio 5, Edificio A4, Carrera de Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
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6
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Ortiz-Gutiérrez F, Sánchez-Minutti L, Martínez-Herrera JF, Torres-Escobar ID, Pezzat-Said EB, Márquez-Domínguez L, Grandes-Blanco AI. Identification of Genetic Variants of Human Papillomavirus in a Group of Mexican HIV/AIDS Patients and Their Possible Association with Cervical Cancer. Pol J Microbiol 2022; 70:501-509. [PMID: 35003280 PMCID: PMC8702602 DOI: 10.33073/pjm-2021-047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/16/2021] [Indexed: 12/17/2022] Open
Abstract
Infections caused by the human immunodeficiency virus (HIV) and human papillomavirus (HPV) cause thousands of deaths worldwide each year. So far, there has been no consensus on whether there is a direct relationship between the incidence of neoplasms and the immunosuppression caused by HIV that could help understand if coinfection increases the likelihood of cervical cancer. The objective of the study was to identify the presence of genetic variants of HPV in a group of HIV-positive women and their possible association with cervical cancer. Cervical samples were taken from HIV-positive patients for cytological analysis to identify the HPV genotype by polymerase chain reaction (PCR) and sequencing. The most prevalent L1 capsid protein mutations in the HPV genotype were analyzed in silico. Various types of HPV were identified, both high-risk (HR) and low-risk (LR). The most prevalent genotype was HPV51. Analysis of the L1 gene sequences of HPV51 isolates showed nucleotide variations. Of the samples analyzed in Puebla, Mexico, HPV51 had the highest incidence (17.5%, 7/40). Different mutations, which could be used as population markers, were detected in this area, and they have not been reported in the L1 databases for HPV51 in Mexico. Genotypes 6, 14, 86, 87, 89, and 91, not detected or reported in samples from patients with HPV in Mexico, were also identified. Data from the population analyzed suggest no direct relationship between HIV immunosuppression and cervical cancer, regardless of the high- or low-risk HPV genotype. Furthermore, it is possible to develop regional population markers for the detection of HPV based on the mutations that occur in the sequence of nucleotides analyzed.
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Affiliation(s)
- Felipe Ortiz-Gutiérrez
- Programa Institucional de Biomedicina Molecular, Escuela Nacional de Medicina y Homeopatía. Instituto Politécnico Nacional, CDMX, México
| | - Lilia Sánchez-Minutti
- Laboratorio de Procesos Biotecnológicos, Universidad Politécnica de Tlaxcala, Tlaxcala, México
| | - José F Martínez-Herrera
- Oncología Médica y Neoplasias de Torax y Medicina Interna Centro de Cáncer Hospital ABC, CDMX, México
| | | | | | - Luis Márquez-Domínguez
- Laboratorio de Biología Molecular y Virología, Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Metepec, Puebla, México
| | - Amado I Grandes-Blanco
- Facultad de Ciencias de la Salud, Licenciatura en Nutrición, Universidad Autónoma de Tlaxcala, Tlaxcala, México
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7
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Prevalence of HPV in Mexican Patients with Head and Neck Squamous Carcinoma and Identification of Potential Prognostic Biomarkers. Cancers (Basel) 2021; 13:cancers13225602. [PMID: 34830760 PMCID: PMC8616077 DOI: 10.3390/cancers13225602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Head and neck squamous cell carcinomas (HNSCC) are a heterogeneous group of neoplasms that show diverse clinical and biological characteristics associated with human papillomavirus (HPV). Biological and clinical characterization is essential to stratify patients based on prognostic and predictive factors. The biological features of HNSCC may change according to geography and population characteristics. Studies on the molecular biology of HNSCC in Mexico are scarce. In the present study, we analyzed 414 Mexican patients with HNSCC and determined the presence and genotype of HPV, p16 expression, and global gene expression profiles. Twenty-two percent of total cases were HPV+, and 32% were p16+. We identified genes associated with survival, such as SLIRP, KLF10, AREG, ACT1, and LIMA. In addition, CSF1R, MYC, and SRC genes were identified as potential therapeutic targets. This study offers information that may be relevant for our understanding of the biology of HNSCC and the development of therapeutic strategies. Abstract Head and neck squamous cell carcinomas (HNSCC) show a variety of biological and clinical characteristics that could depend on the association with the human papillomavirus (HPV). Biological and clinical characterization is essential to stratify patients based on prognostic and predictive factors. Reports on HNSCC are scarce in Mexico. Herein, we analyzed 414 Mexican patients with HNSCC, including oropharynx (OPSCC), larynx (LASCC), and oral cavity (OCSCC), and identified HPV DNA and p16 expression. Global gene expression profiles were analyzed in 25 HPV+/p16+ vs. HPV−/p16− cases. We found 32.3% p16+ and 22.3% HPV+ samples, HPV 16, 18, 39, 52, and 31 being the most frequent genotypes. For OPSCC, LASCC and OCSCC, 39.2, 14.7, and 9.6% were HPV+/p16+, respectively. High expression of SLIRP, KLF10, AREG, and LIMA was associated with poor survival; in contrast, high expression of MYB and SYCP2 correlated with better survival. In HPV+ cases, high expression of SLC25A39 and GJB2 was associated with poor survival. Likewise, EGFR, IL-1, IL-6, JAK-STAT, WNT, NOTCH, and ESR1 signaling pathways were downregulated in HPV+ cases. CSF1R, MYC, and SRC genes were identified as key hubs and therapeutic targets. Our study offers information regarding the molecular and clinical characteristics of HNSCC in Mexican patients.
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Torres-Rojas FI, Mendoza-Catalán MA, Alarcón-Romero LDC, Parra-Rojas I, Paredes-Solís S, Leyva-Vázquez MA, Cortes-Arciniega JE, Bracamontes-Benítez CJ, Illades-Aguiar B. HPV molecular detection from urine versus cervical samples: an alternative for HPV screening in indigenous populations. PeerJ 2021; 9:e11564. [PMID: 34178456 PMCID: PMC8214846 DOI: 10.7717/peerj.11564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/14/2021] [Indexed: 11/20/2022] Open
Abstract
Background Cervical cancer (CC) is the fourth leading cause of death from neoplasms in women and is caused by the human papilloma virus (HPV). Several methods have been developed for the screening of cervical lesions and HPV; however, some socio-cultural factors prevent women from undergoing gynecological inspection, which results in a higher risk of mortality from cervical cancer in certain population groups as indigenous communities. This study aimed to compare the concordance in HPV detection from urine and cervical samples, to propose an alternative to cervical scraping, which is commonly used in the cervical cancer screening. Methodology The DNA from cervical scrapings and urine samples was extracted using the proteinase K method followed by precipitation with alcohol, phenol andchloroform; a modification of the proteinase K method was developed in the management of urine sediment. Viral genotyping was performed using INNOLipa. Results The study population consisted of 108 patients from an indigenous population at southern Mexico, 32 without squamous intraepithelial lesions (NSIL) and 76 with low squamous intraepithelial lesions (LSIL). The majority of NSIL cervical scrapes were negative for HPV (90.63%), whereas more than half of LSIL cases were high-risk HPV positive (51.32%), followed by multiple infection by HR-HPV (17.11%), and multiple infection by LR- and HR-HPV (9.21%). No statistically significant relationship between the cytological diagnosis and the HPV genotypes detected in the urine samples was observed. A concordance of 68.27% for HPV positivity from urine and cervical samples was observed. Similarly, a concordance of 64.52% was observed in the grouping of HPVs by oncogenic risk. HR-HPV was detected in 71% of the urine samples from women with LSIL diagnosis, which suggests that HR-HPV detected in a urine sample could indicate the presence or risk of developing SIL. Conclusion HR-HPV detection in urine samples could be an initial approach for women at risk of developing LSIL and who, for cultural reasons, refuse to undergo a gynecological inspection.
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Affiliation(s)
- Francisco I Torres-Rojas
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Miguel A Mendoza-Catalán
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Luz Del C Alarcón-Romero
- Laboratorio de Citopatología e Histoquímica. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Isela Parra-Rojas
- Laboratorio de Investigación en Obesidad y Diabetes, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, México
| | - Sergio Paredes-Solís
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Marco A Leyva-Vázquez
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Jair E Cortes-Arciniega
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Carlos J Bracamontes-Benítez
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
| | - Berenice Illades-Aguiar
- Laboratorio de Biomedicina Molecular. Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo, Guerrero, Mexico
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9
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Human Papillomavirus Coinfection in the Cervical Intraepithelial Lesions and Cancer of Mexican Patients. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4542320. [PMID: 33274212 PMCID: PMC7683133 DOI: 10.1155/2020/4542320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 12/24/2022]
Abstract
According to their oncogenic properties, Human Papillomaviruses (HPVs) are classified into two types: Low-Risk (LR-HPVs) and High-Risk Human Papillomaviruses (HR-HPVs). The immune system naturally controls the majority of HPV infections; however, when the HR-HPV infection is persistent, the risk of developing cervical cancer increases. Previous studies indicate that multiple-infection or coinfection with HR-HPV occurs frequently and can potentiate the development of cervical lesions. This study aimed to establish the HPV coinfection rate in squamous intraepithelial lesions from Mexican patients. For HPV detection, we performed PCR on 55 cervical lesions diagnosed by colposcopy. We detected the presence of HPV infection in 87.27% (48/55) of the lesions; interestingly, HPV coinfection was observed in 70.83% (34/48) of these samples. We also evaluated HPV infection in adjacent areas without morphological changes from 25 samples. The results showed that 80% (20/25) of these were HPV-positive and, curiously, all presented HPV-16 infection. In conclusion, our results revealed a high prevalence of HPV coinfection in cervical lesions in Mexican patients, and these results contribute to future research focused on the role that HPV coinfection plays in the development of cervical cancer.
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10
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Molina-Pineda A, López-Cardona MG, Limón-Toledo LP, Cantón-Romero JC, Martínez-Silva MG, Ramos-Sánchez HV, Flores-Miramontes MG, de la Mata-González P, Jave-Suárez LF, Aguilar-Lemarroy A. High frequency of HPV genotypes 59, 66, 52, 51, 39 and 56 in women from Western Mexico. BMC Infect Dis 2020; 20:889. [PMID: 33238902 PMCID: PMC7690193 DOI: 10.1186/s12879-020-05627-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Human papillomavirus infection is an important factor associated with cervical cancer (CC) development. The prevalence and genotype distribution vary greatly worldwide. Examining local epidemiological data constitutes an important step towards the development of vaccines to prevent CC. In this work, we studied the prevalence of HPV genotypes in women from Western Mexico with the COBAS 4800 and/or Linear Array Genotyping Test (LA). METHODS The samples analysed in this study represent a population from Western Mexico, which includes six different states. Our approach was first to test for HPV in cervical samples from women who attended their health clinic for routine gynaecological studies (open-population, n = 3000) by utilizing COBAS 4800. Afterwards, 300 of the HPV-positive samples were randomly selected to be genotyped with LA; finally, we genotyped samples from women with cervical intraepithelial neoplasia grade 1 (CIN 1, n = 71) and CC (n = 96) with LA. Sociodemographic data of the diverse groups were also compared. RESULTS The overall HPV prevalence among the open-population of women as determined by COBAS 4800 was 12.1% (n = 364/3000). Among the HPV-positive samples, single infections (SI) with HPV16 were detected in 12.4% (n = 45/364), SI with HPV18 were detected in 1.4%, and infection with at least one of the genotypes included in the high-risk HPV pool was detected in 74.5% of the cases. LA analysis of the samples showed that in addition to HPV genotypes 16 and 18, there was a high prevalence of HPV genotypes 59, 66, 52, 51, 39 and 56 in women from Western Mexico. With respect to the sociodemographic data, we found statistically significant differences in the number of pregnancies, the use of hormonal contraceptives and tobacco intake. CONCLUSIONS Our data indicate that there is a high prevalence of HPV genotypes which are not covered by the vaccines currently available in Mexico; therefore, it is necessary to include HPVs 59, 66, 51, 39 and 56 in the design of future vaccines to reduce the risk of CC development. It is also essential to emphasize that the use of hormonal contraceptives and tobacco smoking are risk factors for CC development in addition to the presence of HPV.
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Affiliation(s)
- Andrea Molina-Pineda
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico.,Programa de Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - María Guadalupe López-Cardona
- Unidad de Medicina Genómica y Genética, Hospital Regional Dr. Valentín Gómez Farías, ISSSTE, Zapopan, Jalisco, Mexico.,Departamento de Fisiología, CUCS, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Laura Patricia Limón-Toledo
- Clínica de Displasias, Unidad Médica de Alta Especialidad (UMAE), Hospital de Ginecología y Obstetricia, Centro Médico Nacional de Occidente-IMSS, Guadalajara, Jalisco, Mexico
| | - Juan Carlos Cantón-Romero
- Servicio de Ginecología Oncológica, UMAE Hospital de Ginecología y Obstetricia, Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco, Mexico
| | | | - Holanda Vanesa Ramos-Sánchez
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - María Guadalupe Flores-Miramontes
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Pedro de la Mata-González
- Unidad de Medicina Genómica y Genética, Hospital Regional Dr. Valentín Gómez Farías, ISSSTE, Zapopan, Jalisco, Mexico.,Departamento de Fisiología, CUCS, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Luis F Jave-Suárez
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico. .,Programa de Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
| | - Adriana Aguilar-Lemarroy
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico. .,Programa de Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
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11
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Cisneros-Ramírez D, Martínez-Laguna Y, Martínez-Morales P, Aguilar-Lemarroy A, Jave-Suárez LF, Santos-López G, Reyes-Leyva J, Vallejo-Ruiz V. Glycogene expression profiles from a HaCaT cell line stably transfected with HPV16 E5 oncogene. Mol Med Rep 2020; 22:5444-5453. [PMID: 33174037 PMCID: PMC7647045 DOI: 10.3892/mmr.2020.11630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/29/2020] [Indexed: 11/25/2022] Open
Abstract
The altered expression of glycan antigens has been reported during cervix transformation, demonstrating increased mRNA levels of certain glycogenes. Human papillomavirus (HPV) is the aetiological agent of cervical cancer. High risk HPV E5 is considered an oncogene and has been implicated in cell transformation. E6 and E7 HPV oncoproteins modify the expression of certain glycogenes. The role of the E5 HPV protein in glycogene expression changes has not yet been reported. The aim of the present study was to determine the effects of HPV16 E5 oncoprotein on glycogene expression. For these, a microarray assay was performed using the HaCaT cell line and altered glycogenes were identified. The mRNA levels of certain glycogenes were determined via reverse transcription-quantitative PCR (RT-qPCR). Using in silico analysis, the present study identified that glycosylation pathways were altered by E5. Microarray analysis revealed alterations in certain glycogenes, including the upregulation of ST6GAL1, ST3GAL3, CHST2 and MANBA, and the downregulation of UGT2B15, GALNT11, NDST2 and UGT1A10. Increased mRNA levels were confirmed via RT-qPCR for sialyltransferases genes. Additionally, in silico analysis was performed to identify glycosylation networks altered in the presence of the E5 oncoprotein. The analysis revealed that E5 could modify glycan sialylation, the N-glycosylation pathway, keratan sulfate and glycosaminoglycan synthesis. To the best of our knowledge, the current study was the first to determine the role of the HPV16 E5 oncoprotein in glycogene expression changes. The results indicated that increased sialyltransferase mRNA levels reported in pre-malignant and malignant cervical tissues could be the result of E5 oncoprotein expression. The results provide a possible role of HPV infection on glycosylation changes reported during cervix transformation.
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Affiliation(s)
- Denisse Cisneros-Ramírez
- Laboratory of Molecular Biology, East Biomedical Research Center, Mexican Institute of Social Security, Metepec 74360, Mexico
| | - Ygnacio Martínez-Laguna
- Research Center of Microbiological Sciences, Institute of Sciences, Meritorious Autonomous University of Puebla, Puebla 72592, Mexico
| | - Patricia Martínez-Morales
- Consejo Nacional de Ciencia y Tecnología-Centro de Investigación Biomédica de Oriente, Metepec 74360, Mexico
| | - Adriana Aguilar-Lemarroy
- West Biomedical Research Center, Mexican Institute of Social Security, Guadalajara 44290, Mexico
| | - Luis Felipe Jave-Suárez
- West Biomedical Research Center, Mexican Institute of Social Security, Guadalajara 44290, Mexico
| | - Gerardo Santos-López
- Laboratory of Molecular Biology, East Biomedical Research Center, Mexican Institute of Social Security, Metepec 74360, Mexico
| | - Julio Reyes-Leyva
- Laboratory of Molecular Biology, East Biomedical Research Center, Mexican Institute of Social Security, Metepec 74360, Mexico
| | - Verónica Vallejo-Ruiz
- Laboratory of Molecular Biology, East Biomedical Research Center, Mexican Institute of Social Security, Metepec 74360, Mexico
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12
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High prevalence of human papillomavirus type 66 in low-grade cervical lesions of Mexican women. Arch Virol 2020; 165:2633-2640. [PMID: 32812092 DOI: 10.1007/s00705-020-04771-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022]
Abstract
Our aim was to analyze the prevalence of high-risk human papillomavirus (HR-HPV) and its association with risk factors related to cervical lesions. We used 362 cervical samples from a transversal study to detect nineteen types from the high-risk HPV clade by highly sensitive PCR. Unexpectedly, we found a very high prevalence of HPV type 66 (32.8%), particularly in low-grade squamous intraepithelial lesions. A significant association of HPV66 with previously sexually transmitted disease was observed (p < 0.05). Our results strongly suggest that HPV66 might be indicative of cervical lesions that will not progress to cancer. HPV genotyping by methods that grouped type 66 with other HR-HPV clade types should be interpreted with caution.
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13
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Flores-Miramontes MG, Olszewski D, Artaza-Irigaray C, Willemsen A, Bravo IG, Vallejo-Ruiz V, Leal-Herrera YA, Piña-Sánchez P, Molina-Pineda A, Cantón-Romero JC, Martínez-Silva MG, Jave-Suárez LF, Aguilar-Lemarroy A. Detection of Alpha, Beta, Gamma, and Unclassified Human Papillomaviruses in Cervical Cancer Samples From Mexican Women. Front Cell Infect Microbiol 2020; 10:234. [PMID: 32582561 PMCID: PMC7296070 DOI: 10.3389/fcimb.2020.00234] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Cervical cancer (CC) is associated to high-risk human papillomavirus (HPV) infections, for this reason it is crucial to have sensitive and accurate HPV diagnostic tests. To date, most research is focused on HPVs within the Alphapapillomavirus (α-PVs) genus and little attention has been paid to cervical infections with other HPV genotypes, like those of the Betapapillomavirus (β-PVs) and Gammapapillomavirus (γ-PVs) genera. The aim of this study was to determine the HPV genotypes from different genera in women with CC using Next-Generation Sequencing (NGS). Methods: The study comprised 48 HPV positive CC samples evaluated with the Linear Array HPV Genotyping test and individually sequenced by 454 NGS using PGMY09/11 and FAP primers. To determine the HPV genotypes present in each sample, the obtained sequences were compared with all HPV L1 gene reference sequences from the Papillomavirus Episteme database (PaVE). Moreover, 50 HPV positive low-grade cervical lesion samples individually genotyped with NGS were also included to determine the genotypes present preferentially in CC patients. Results: Among the 48 CC samples, 68.75% consisted of multiple HPV infections, 51 different genotypes were detected, of which 7 are still unclassified, 28 belong to α-PVs (6, 11, 16, 18, 26, 30, 33, 35, 39, 42, 43, 44, 45, 51, 52, 53, 54, 59, 62, 66, 68, 69, 70, 71, 74, 81, 102, 114), 10 to β-PVs (5, 12, 21, 37, 38b, 47, 80, 107, 118, 122), and 6 to γ-PVs (101, 103, 123, 135, 147, 214). Among them, HPV16 was the most prevalent genotype (54.2%), followed by HPV18 (16.7%), HPV38b (14.6%), and HPVs 52/62/80 (8.3%). Some genotypes were exclusively found in CC when compared with Cervical Intraepithelial Neoplasia grade 1 (CIN1) samples, such as HPVs 5, 18, 38b, 107, 122, FA39, FA116, mSK_120, and mSK_136. Conclusions: This work demonstrates the great diversity of HPV genotypes detected by combining PGMY and FAP primers with NGS in cervical swabs. The relatively high attribution of β- and γ- PVs in CC samples suggest their possible role as carcinogenic cofactors, but deeper studies need to be performed to determine if they have transforming properties and the significance of HPV-coinfections.
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Affiliation(s)
| | - Dominik Olszewski
- Department of Molecular Life Sciences, University of Zurich, Zurich, Switzerland
| | - Cristina Artaza-Irigaray
- Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Mexico
| | - Anouk Willemsen
- Centre National de la Recherche Scientifique (CNRS), Laboratory MIVEGEC (UMR CNRS IRD Uni Montpellier), Montpellier, France
| | - Ignacio G Bravo
- Centre National de la Recherche Scientifique (CNRS), Laboratory MIVEGEC (UMR CNRS IRD Uni Montpellier), Montpellier, France
| | - Verónica Vallejo-Ruiz
- Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social (IMSS), Metepec, Mexico
| | - Yelda Aurora Leal-Herrera
- Centro Institucional de Capacitación y Registro de Cáncer (CICyRC), Unidad Médica de Alta Especialidad (UMAE), Instituto Mexicano del Seguro Social (IMSS), Mérida, Mexico
| | - Patricia Piña-Sánchez
- Laboratorio de Oncología Molecular, Unidad de Investigación Médica en Enfermedades Oncológicas (UIMEO), Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Andrea Molina-Pineda
- Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Mexico.,Programa de Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Juan Carlos Cantón-Romero
- Unidad Médica de Alta Especialidad (UMAE), Hospital de Ginecología y Obstetricia, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Mexico
| | - María Guadalupe Martínez-Silva
- Departamento de Anatomía Patológica, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Mexico
| | - Luis Felipe Jave-Suárez
- Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Mexico
| | - Adriana Aguilar-Lemarroy
- Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Mexico
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14
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Martínez-Leal B, Álvarez-Banderas KI, Sánchez-Dávila H, Dávila-Rodríguez MI, Cortés-Gutiérrez EI. Human papillomavirus as a single infection in pregnant women from Northeastern Mexico: Cross-sectional study. Int J Reprod Biomed 2020; 18:129-134. [PMID: 32259007 PMCID: PMC7097173 DOI: 10.18502/ijrm.v18i2.6433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 12/01/2018] [Accepted: 10/08/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The role of human papillomavirus (HPV) as single or multiple infections in pregnant women would be relevant to determine the time to progression and/or the time to regression of cervical lesions. OBJECTIVE In this preliminary study, we determined the prevalence of HPV as single or multiple infections in pregnant women from Northeastern Mexico. MATERIALS AND METHODS Samples from 31 pregnant and 62 nonpregnant women were examined between January 2015 and November 2015 at UMAE-23 of the Instituto Mexicano del Seguro Social (IMSS). The samples of cervicovaginal exudate were obtained for HPV DNA detection using the INNO-LiPA test, and HPV infections were analyzed as single or multiple infections. Participants completed a questionnaire on sociodemographic, gynecological, obstetric, and sexual behavior characteristics. RESULTS The mean age of the pregnant women was 25.7 ± 4.8 yr, with an average time of pregnancy of 6 ± 1 months at the time of the study. With respect to age, parity, smoking history, or oral contraceptive use no statistically significant differences between the two studied groups was observed. The HPV infection was 2.7 times higher in pregnant women (35%) than in the control group (13%). In total, 78% of the pregnant women who were HPV-positive presented with single infections compared with 28% of the nonpregnant women. CONCLUSION A higher prevalence of HPV as a single infection was found in this sample of pregnant Mexican women. Follow-up is necessary to evaluate the persistence or regression of the infection.
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Affiliation(s)
- Bernardo Martínez-Leal
- Universidad de Monterrey, Vicerrectoría Ciencias de la Salud, San Pedro Garza García, México
| | - Karla Ivette Álvarez-Banderas
- Department of Clinical Dysplasia, Gynecology and Obstetrics No.23 Hospital, Mexican Institute of Social Security, Monterrey, Mexico
| | - Homero Sánchez-Dávila
- Department of Clinical Dysplasia, Gynecology and Obstetrics No.23 Hospital, Mexican Institute of Social Security, Monterrey, Mexico
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15
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Martínez-Bailón C, Mantilla-Morales A, Méndez-Matías G, Alvarado-Cabrero I, Maldonado-Rodríguez R, Quintero-Becerra J, Arias-Flores R, Piña-Sánchez P. Human papillomavirus genotypes and P16INK4A expression in squamous penile carcinoma in Mexican patients. BMC Infect Dis 2019; 19:1068. [PMID: 31856740 PMCID: PMC6924036 DOI: 10.1186/s12879-019-4696-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 12/09/2019] [Indexed: 01/22/2023] Open
Abstract
Background Approximately 50% of cases of penile carcinoma (PeCa), a rare neoplasm worldwide, are associated with human papillomavirus (HPV). However, the detection of HPV-DNA is not sufficient to consider it the etiological factor in the development of this type of cancer. Currently, the overexpression of P16INK4A is used as a surrogate biomarker of HPV carcinogenesis. Information on PeCa in Mexico is scarce, particularly regarding cases related to HPV and genotype frequency. Objective To evaluate the presence of HPV, its genotypes, and the presence of multiple genotypes, and the expression of P16INK4A, as well as its clinical and histopathological parameters. Methods For HPV-DNA detection and P16INK4A expression, we used the INNO-LiPA® test and immunohistochemistry, respectively. Results Sixty cases of PeCa were evaluated, of which 75% were HPV-non-related histological variants. We found that 58.9% (33/56) of PeCa cases were HPV-DNA positive, while 30.9% of the cases evaluated (17/55) were positive for P16INK4A. HPV16 was the main genotype in 42.9% of the cases, followed by HPV52 in 7.1% and HPV18 in 5.4%. Within the HPV-positive cases, 27.3% had multiple genotypes. All HPV-positive patients under the age of 45 years were positive only for HPV16. Conclusions HPV16 was the most commonly detected genotype in PeCa. HPV 31, 35 and 39 were infrequent; however, they were related to a single infection and P16INK4A overexpression; thus, they seem to be relevant in PeCa carcinogenesis. Our results suggest that P16INK4A overexpression could be useful for the classification of HPV-related PeCa. The role of multiple HPV genotypes in the development and prognosis of PeCa is still not completely understood. Thus, it is necessary to define criteria to establish reliable ways to classify HPV-related PeCa that could lead to optimal therapeutic approaches.
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Affiliation(s)
- Cecilia Martínez-Bailón
- Molecular Oncology Laboratory, Oncology Research Unit, Instituto Mexicano del Seguro Social, CMN S XXI IMSS, Mexico City, Mexico
| | - Alejandra Mantilla-Morales
- Department of Pathology, UMAE Oncology Hospital, Instituto Mexicano del Seguro Social, CMN S XXI IMSS, Mexico City, Mexico
| | - Galo Méndez-Matías
- Molecular Oncology Laboratory, Oncology Research Unit, Instituto Mexicano del Seguro Social, CMN S XXI IMSS, Mexico City, Mexico
| | - Isabel Alvarado-Cabrero
- Department of Pathology, UMAE Oncology Hospital, Instituto Mexicano del Seguro Social, CMN S XXI IMSS, Mexico City, Mexico
| | - Rogelio Maldonado-Rodríguez
- Department of Biochemistry, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Joel Quintero-Becerra
- Department of Urology, UMAE Oncology Hospital, Instituto Mexicano del Seguro Social, CMN S XXI, Mexico City, Mexico
| | - Rafael Arias-Flores
- Department of Epidemiology, UMAE Pediatrics Hospital, Instituto Mexicano del Seguro Social, CMN S XXI, Mexico City, Mexico
| | - Patricia Piña-Sánchez
- Molecular Oncology Laboratory, Oncology Research Unit, Instituto Mexicano del Seguro Social, CMN S XXI IMSS, Mexico City, Mexico.
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16
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Carrión Ordoñez JI, Soto Brito Y, Pupo Antúnez M, Loja Chango R. Infección por Virus del Papiloma Humano y citología cérvico-vaginal en mujeres indígenas del Cañar, Ecuador. BIONATURA 2019. [DOI: 10.21931/rb/2019.04.03.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
There are few studies on the circulation of Human Papilloma Virus (HPV) in indigenous Ecuadorian women. The aim of the study is to determine the circulation of HPV and identify cytological alterations in cervical samples of indigenous Ecuadorian women and to define the behavior of some socio-demographic and clinical-epidemiological variables. An analytical cross-sectional study was done between July 2017 and September 2018 to determine the presence of cytological alterations and HPV infection in 100 indigenous women between 15 and 55 years of age, residing in Cañar, Ecuador. The association between socio-demographic and clinical-epidemiological variables with viral infection was investigated. Was obtained a 98% of negative cytology for malignancy and 2% of cervical lesions. Cases with high-grade lesions were not diagnosed. In general, a 34% (34/100) tested was positive for HPV, predominating oncogenic genotypes. HPV 31 was the most frequent in 41.2% (14/34) of cases followed by HPV 16 in 20.6% (7/34). Women between 20 and 30 years of age were five times more likely to be infected with HPV (44.1%, 15/34). The frequency of infection was significantly higher in single women and in those who reported having 2 to 3 births. Infection with HPV 16 was associated with the use of hormonal contraceptives, in 57.1% (4/7) of the cases; p = 0.005, RP = 12.44 IC95% (2.40-64.62). The high prevalence of oncogenic HPV infection indicates the need to incorporate this indigenous population into early detection programs for cervical cancer.
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Affiliation(s)
- Julia Irma Carrión Ordoñez
- Universidad Católica de Cuenca. Departamento de Docencia e Investigación. Av. Américas &, Humboldt, Cuenca-Ecuador
| | - Yudira Soto Brito
- Instituto de Medicina Tropical Pedro Kourí. Departamento de Virología. Laboratorio de Enfermedades de Transmisión Sexual. Carretera Novia del Mediodía Km 6 ½ PO Box 601. Marianao 13. La Habana, Cuba
| | - Maritza Pupo Antúnez
- Universidad de la Habana. Facultad de Biología. Departamento de Virología. Calle 25 entre J e I, Municipio Plaza de la Revolución. La Habana, Cuba
| | - Rita Loja Chango
- Instituto de Biomedicina, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil. Avenida. Carlos Julio Arosemena Km. 1 1/2 Vía Daule, Guayaquil, Ecuador
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17
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Campos-Romero A, Anderson KS, Longatto-Filho A, Luna-Ruiz Esparza MA, Morán-Portela DJ, Castro-Menéndez JA, Moreno-Camacho JL, Calva-Espinosa DY, Acosta-Alfaro MA, Meynard-Mejía FA, Muñoz-Gaitán M, Alcántar-Fernández J. The burden of 14 hr-HPV genotypes in women attending routine cervical cancer screening in 20 states of Mexico: a cross-sectional study. Sci Rep 2019; 9:10094. [PMID: 31300693 PMCID: PMC6626130 DOI: 10.1038/s41598-019-46543-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/01/2019] [Indexed: 11/23/2022] Open
Abstract
In Mexico, HPV vaccines available immunize against genotypes 16/18 and 16/18/6/11; however, there is limited surveillance about carcinogenic subtypes in different states of the country that allow evaluating the effectiveness of vaccination and cervical cancer screening programs. Here, we report the regional and age-specific prevalence of 14 hr-HPV genotypes as well as their prevalence in abnormal cytology (from ASCUS to cervical cancer) among Mexican women which were undergoing from cervical cancer screening in the Salud Digna clinics in 20 states of the country. This study includes women with social security from the majority of public health institutions (IMSS, ISSSTE, SEMAR, and PEMEX), and women without social security. For cervical cancer screening, we used the SurePath liquid-based cytology and the BD Onclarity HPV Assay. From December 1, 2016, to August 2, 2018, the hr-HPV prevalence among 60,135 women was 24.78%, the most prevalent types were HPV 16 (4.13%), HPV 31 (4.12%) and HPV 51 (3.39%), while HPV 18 (1.70%) was less prevalent among infected women. Interestingly, the genotypes not covered by current vaccines in Mexico were commonly found in precancerous lesions, evidencing their carcinogenic potential, so it is necessary to increase their surveillance and inclusion in cervical cancer screening triage.
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Affiliation(s)
| | - Karen S Anderson
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, 85287, USA
- School of Life Sciences, Arizona State University, Tempe, AZ, 85287, USA
| | - Adhemar Longatto-Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
- Life and Health Sciences Research Institute, ICVS, School of Medicine, Minho University, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
- Department of Pathology, LIM14, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - David J Morán-Portela
- National Reference Center, Salud Digna, 80300, Culiacan, Sinaloa, Mexico
- Clinical Laboratory Department, Salud Digna, Culiacan, 80000, Sinaloa, Mexico
| | - Javier A Castro-Menéndez
- National Reference Center, Salud Digna, 80300, Culiacan, Sinaloa, Mexico
- Clinical Laboratory Department, Salud Digna, Culiacan, 80000, Sinaloa, Mexico
| | - José L Moreno-Camacho
- National Reference Center, Salud Digna, 80300, Culiacan, Sinaloa, Mexico
- Clinical Laboratory Department, Salud Digna, Culiacan, 80000, Sinaloa, Mexico
| | | | | | - Freddy A Meynard-Mejía
- Medical Sciences Faculty, Universidad Nacional Autonoma de Nicaragua, Managua, Nicaragua
| | - Marlene Muñoz-Gaitán
- Medical Sciences Faculty, Universidad Nacional Autonoma de Nicaragua, Managua, Nicaragua
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Artaza-Irigaray C, Flores-Miramontes MG, Olszewski D, Vallejo-Ruiz V, Limón-Toledo LP, Sánchez-Roque C, Mayoral-Torres R, Jave-Suárez LF, Aguilar-Lemarroy A. Cross-hybridization between HPV genotypes in the Linear Array Genotyping Test confirmed by Next-Generation Sequencing. Diagn Pathol 2019; 14:31. [PMID: 31010421 PMCID: PMC6477707 DOI: 10.1186/s13000-019-0808-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/09/2019] [Indexed: 01/13/2023] Open
Abstract
Background Linear Array Genotyping Test (LA) is one of the gold standards used for Human Papillomavirus (HPV) genotyping, however, since its launching in 2006, new HPV genotypes are still being characterized with the use of high specificity techniques such as Next-Generation Sequencing (NGS). Derived from a previous study of the IMSS Research Network on HPV, which suggested that there might be cross-reaction of some HPV genotypes in the LA test, the aim of this study was to elucidate this point. Methods Double stranded L1 fragments (gBlocks) from different HPVs were used to perform LA test, additionally, 14 HPV83+ and 26 HPV84+ cervical samples determined with LA, were individually genotyped by NGS. Results From the LA HPV83+ samples, 64.3% were truly HPV83+, while 42.9% were found to be HPV102+. On the other hand, 69.2% of the LA HPV84+ samples were HPV84+, while 3.8, 11.5 and 30.8% of the samples were indeed HPV 86, 87 and 114 positive, respectively. Additionally, novel nucleotide changes in L1 gene from HPV genotypes 83, 84, 87, 102 and 114 were determined in Mexican cervical samples, some of them lead to changes in the protein sequence. Conclusions We demonstrated that there is cross-hybridization between alpha3-HPV genotypes 86, 87 and 114 with HPV84 probe in LA strips and between HPV102 with HPV83 probe; this may be causing over or under estimation in the prevalence of these genotypes. In the upcoming years, a switch to more specific and sensitive genotyping methods that detect a broader spectrum of HPV genotypes needs to be implemented.
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Affiliation(s)
- Cristina Artaza-Irigaray
- División de Inmunología, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - María Guadalupe Flores-Miramontes
- División de Inmunología, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Dominik Olszewski
- Institute of Pharmacy and Molecular Biotechnology, University of Heidelberg, Heidelberg, Germany
| | | | - Laura Patricia Limón-Toledo
- Clínica de Displasias, UMAE - Hospital de Ginecología y Obstetricia, Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco, Mexico
| | | | - Rocío Mayoral-Torres
- Joint Master Program in Neuroscience, Université de Strasbourg, Strasbourg, France
| | - Luis Felipe Jave-Suárez
- División de Inmunología, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico.
| | - Adriana Aguilar-Lemarroy
- División de Inmunología, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico.
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Campos RG, Malacara Rosas A, Gutiérrez Santillán E, Delgado Gutiérrez M, Torres Orozco RE, García Martínez ED, Torres Bernal LF, Rosas Cabral A. Unusual prevalence of high-risk genotypes of human papillomavirus in a group of women with neoplastic lesions and cervical cancer from Central Mexico. PLoS One 2019; 14:e0215222. [PMID: 30998701 PMCID: PMC6474327 DOI: 10.1371/journal.pone.0215222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/28/2019] [Indexed: 12/18/2022] Open
Abstract
Human papillomavirus has been identified as a main etiological agent in the
development of cervical cancer. HPV 16 and 18 have been reported the most widely
prevalent genotypes worldwide. We conducted a study analyzing the prevalence of
high and low risk human papillomavirus viral types in the Mexican state of
Aguascalientes and neighboring cities in the states of Jalisco and Zacatecas in
central Mexico. Specific viral genotype was determined by a PCR and
hybridization-based detection test. The presence of 37 high- and low-risk HPV
genotypes was evaluated in 883 female participants. Of these, 350 presented
low-grade squamous intraepithelial lesions (LGSIL), 176 presented high-grade
squamous intraepithelial lesions (HGSIL), 107 suffered from cervical cancer and
250 women with negative cytological report for intraepithelial lesion or
malignancy (NILM). HPV 51 was the most prevalent genotype, followed by HPV 16:
overall prevalence of HPV 51, including single infections and co-infections was
31.2% in women with LGSIL, whereas prevalence of HPV 16 was 25.1%. Among women
with HGSIL, HPV 51 prevalence was 47.2% and HPV 16 was 30.1%. Prevalence of HPV
51 in women with cervical cancer was 49.5% and type 16 was 33.6%. Between single
and co-infections, most co-infections were not associated with later stages of
the disease, except 51/16 and some others. HPV 51 showed a significant
correlation with the progression of the disease (OR = 10.81 for LGSIL, 19.38 for
HGSIL and 22.95 for ICC), and when analyzing all other genotypes, five different
groups depending on their correlation with all lesion grades were determined.
According to our findings, HPV genotype 51 has a higher prevalence than HPV 16
and 18 in the Mexican state of Aguascalientes and neighboring cities in the
states of Jalisco and Zacatecas in Central Mexico.
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Affiliation(s)
- Rafael Gutiérrez Campos
- Department of Chemistry, Center for Basic Sciences, Autonomous University
of Aguascalientes, Aguascalientes, Aguascalientes, México
- * E-mail:
| | - Angélica Malacara Rosas
- Department of Chemistry, Center for Basic Sciences, Autonomous University
of Aguascalientes, Aguascalientes, Aguascalientes, México
| | - Elvia Gutiérrez Santillán
- Hospital General de Zona Número 6, Instituto Mexicano del Seguro Social,
Monterrey, Nuevo León, México
| | - Mireya Delgado Gutiérrez
- Hospital General de Zona Número 1, Instituto Mexicano del Seguro Social,
Aguascalientes, Aguascalientes, México
| | - Rusland Enrique Torres Orozco
- Department of Chemistry, Center for Basic Sciences, Autonomous University
of Aguascalientes, Aguascalientes, Aguascalientes, México
| | - Elí Daniel García Martínez
- Department of Chemistry, Center for Basic Sciences, Autonomous University
of Aguascalientes, Aguascalientes, Aguascalientes, México
| | - Luis Fernando Torres Bernal
- Department of Medicine, Center for Health Sciences, Autonomous University
of Aguascalientes, Aguascalientes, México
| | - Alejandro Rosas Cabral
- Department of Medicine, Center for Health Sciences, Autonomous University
of Aguascalientes, Aguascalientes, México
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20
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Medel-Flores O, Valenzuela-Rodríguez VA, Ocadiz-Delgado R, Castro-Muñoz LJ, Hernández-Leyva S, Lara-Hernández G, Silva-Escobedo JG, Vidal PG, Sánchez-Monroy V. Association between HPV infection and prostate cancer in a Mexican population. Genet Mol Biol 2018; 41:781-789. [PMID: 30508006 PMCID: PMC6415601 DOI: 10.1590/1678-4685-gmb-2017-0331] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/29/2018] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to evaluate the association between prostate cancer (PCa) and Human papillomavirus (HPV) infection in the Mexican population. We studied 356 paraffin-embedded tissues from unrelated Mexican men with PCa or benign prostatic hyperplasia (BPH), with the latter serving as control. HPV detection was performed by polymerase chain reaction (PCR) using universal primers, and viral genotypes were detected using sequencing or multiplex PCR. Light microscopy analyses enabled the identification of koilocytes in samples subsequently analyzed for HPV detection by in situ PCR and for p16-INK4A expression by immunohistochemistry. The results showed that high risk- (HR) HPVs were detected in 37/189 (19.6%) PCa specimens compared to 16/167 (9.6%) of BHP specimens (odds ratio 2.3; 95% CI= 1.2 to 4.3; p=0.01). These data suggest HR-HPV may play a role in PCa. HPV 52 and 58 were the most frequent genotypes (33 and 17%, respectively) detected in the population studied. Koilocytes were detected in all in situ PCR-HPV-positive samples, representing a pathognomonic feature of infection, and we observed the overexpression of p16-INK4A in HPV-positive samples compared to HPV-negative samples, indirectly suggesting the presence of HR-HPV E7 oncoprotein. These results suggest that HPV infection plays an important role in prostate cancer development.
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Affiliation(s)
- Olivia Medel-Flores
- Laboratorio de Biomedicina Molecular I, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | | | - Rodolfo Ocadiz-Delgado
- Departamento de Genética y Biología Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Leonardo Josué Castro-Muñoz
- Laboratorio de Biomedicina Molecular I, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Sandra Hernández-Leyva
- Laboratorio Multidisciplinario de Investigación, Escuela Militar de Graduados de Sanidad, Secretaría de la Defensa Nacional, Ciudad de México, Mexico
| | - Gabriel Lara-Hernández
- Laboratorio Multidisciplinario de Investigación, Escuela Militar de Graduados de Sanidad, Secretaría de la Defensa Nacional, Ciudad de México, Mexico
| | - Jesús-Gabriel Silva-Escobedo
- Laboratorio Multidisciplinario de Investigación, Escuela Militar de Graduados de Sanidad, Secretaría de la Defensa Nacional, Ciudad de México, Mexico
| | - Patricio Gariglio Vidal
- Departamento de Genética y Biología Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Virginia Sánchez-Monroy
- Laboratorio de Biomedicina Molecular I, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Ciudad de México, Mexico
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21
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Prevalence and Genotype Distribution of Human Papillomavirus in Invasive Cervical Cancer, Cervical Intraepithelial Neoplasia, and Asymptomatic Women in Southeast China. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2897937. [PMID: 30402468 PMCID: PMC6196990 DOI: 10.1155/2018/2897937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 02/14/2018] [Indexed: 01/12/2023]
Abstract
Cervical cancer is one of the leading causes of cancer-related deaths among women and it is caused by the human papillomavirus (HPV). High variation has been reported in the attribution of specific HPV genotypes to cervical neoplasia among various geographic regions. For effective control of cervical cancer through HPV vaccination, it is essential to estimate the cost-effectiveness of vaccination, to monitor the potential transition into other HPV genotypes, and to understand the distribution of specific HPV genotypes across a specific geographic region. In this study, the distribution of HPV genotypes was investigated in southeast China, from 2011 to 2016. The 12,816 cervical swabs collected from women (age 18–78 years, median 43.6 years) outpatients were analyzed. HPV prevalence among 12,816 cervical swabs analyzed was 22.3% (2,856/12,816). Among these positive cases, 2,216 had only one HPV genotype while 640 had multiple HPV genotypes. The cases with multiple types revealed 23 different HPV genotypes with the five most prevalent being HPV18 (18.2%), HPV52 (14.1%), HPV16 (11.9%), HPV58 (10.6%), and HPV33 (5.5%). The rates of HPV infection in patients with cervical inflammation, CIN-1, CIN-2, CIN-3, squamous carcinoma, and adenocarcinoma were 38.4%, 80.5%, 82.6%, 92.3%, 97.5%, and 93.4%, respectively. Four HPV genotypes, HPV18, HPV16, HPV52, and HPV58, were more prevalent in patients with CIN-2-CIN-3 and invasive cervical cancer. A comparison of HPV genotypes attribution to cervical cancer between southeast China and global incidences revealed distinct differences. Due to this unique prevalence, it is essential to streamline the vaccination development protocol prior to administering vaccines based on global data.
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22
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Méndez-Martínez S, García-Carrasco M, Jiménez-Herrera EA, Mendoza-Pinto C, Etchegaray-Morales I, Barahona-Rubio PW, Gálvez-Romero JL, Munguía-Realpozo P, Muñóz-Guarneros CO, Cedillo-Ramírez ML, Silva-Gómez SE, Linares-Fleites G, Rojas-Vallaraga A. Factors of the epidemiological triad that influence the persistence of human papilloma virus infection in women with systemic lupus erythematosus. Lupus 2018; 27:1542-1546. [PMID: 29732937 DOI: 10.1177/0961203318773176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We studied the epidemiologic triad-related factors influencing human papilloma virus (HPV) persistence in Mexican women with systemic lupus erythematosus (SLE). Patients aged ≥18 years with SLE (American College of Rheumatology criteria), with and without HPV persistence, were selected. Groups were analyzed by (1) host: clinical disease characteristics; (2) agent: (I) infectious (prevalence, incidence, HPV genotype and co-infections (≥2 HPV genotypes or mycoplasmas)), (II) chemical (contraceptives and immunosuppressive drugs) and (III) physical (vitamin D deficiency) and (3) environment. A total of 121 SLE patients were selected over a two-year period. (1) Host: mean age 45.8 years and disease duration 12.7 years. (2) Agent: (I) infectious. HPV infection prevalence in the second sample was 26.4%, high-risk HPV genotypes 21.5% and co-infections 7.4%. HPV infection incidence was 13.2%, persistence 13.2% and clearance 15.7%. (II) Chemical: use of oral hormonal contraceptives 5% and immunosuppressive treatment 97.5%. (III) Physical: Vitamin D levels were similar in both groups. (3) Environment: (I) natural. A total of 60.6% of patients were residents of Puebla City. (II) Social: The mean education level was 10.9. Poverty levels were: III degree 52.4%, IV degree 28% and II degree 17%. (III) Cultural behavioral: Onset of sexual life was 20.5 years, 10% had ≥3 sexual partners and 51.2% were postmenopausal. In conclusion, no factor of the epidemiologic triad was associated with HPV infection prevalence.
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Affiliation(s)
- S Méndez-Martínez
- 1 Environment Sciences Posgrade, Science Institute, Benemerita Universidad Autonoma de Puebla, Puebla, México.,2 Research Coordination, Instituto Mexicano del Seguro Social, Puebla, México
| | - M García-Carrasco
- 3 Systemic Autoimmune Research Unit, General Regional Hospital #36, Instituto Mexicano del Seguro Social, Puebla, México.,4 Department of Immunology and Rheumatology, Medicine School, Benemerita Universidad Autonoma de Puebla, Puebla, México
| | - E A Jiménez-Herrera
- 3 Systemic Autoimmune Research Unit, General Regional Hospital #36, Instituto Mexicano del Seguro Social, Puebla, México
| | - C Mendoza-Pinto
- 3 Systemic Autoimmune Research Unit, General Regional Hospital #36, Instituto Mexicano del Seguro Social, Puebla, México.,4 Department of Immunology and Rheumatology, Medicine School, Benemerita Universidad Autonoma de Puebla, Puebla, México
| | - I Etchegaray-Morales
- 3 Systemic Autoimmune Research Unit, General Regional Hospital #36, Instituto Mexicano del Seguro Social, Puebla, México
| | - P W Barahona-Rubio
- 5 Medicine School, Universidad Autonoma de Guadalajara, Guadalajara, México
| | - J L Gálvez-Romero
- 3 Systemic Autoimmune Research Unit, General Regional Hospital #36, Instituto Mexicano del Seguro Social, Puebla, México.,6 Department of Immuno-alergology, Regional Hospital of Puebla, Instituto de Seguridad Social y Servicios de Trabajadores del Estado, Puebla, México
| | - P Munguía-Realpozo
- 7 Department of Rheumatology, La Raza Medical Centre, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - C O Muñóz-Guarneros
- 8 Posgrade, School of Medicine, Benemerita Universidad Autonoma de Puebla, Puebla, México
| | - M L Cedillo-Ramírez
- 1 Environment Sciences Posgrade, Science Institute, Benemerita Universidad Autonoma de Puebla, Puebla, México
| | - S E Silva-Gómez
- 1 Environment Sciences Posgrade, Science Institute, Benemerita Universidad Autonoma de Puebla, Puebla, México
| | - G Linares-Fleites
- 1 Environment Sciences Posgrade, Science Institute, Benemerita Universidad Autonoma de Puebla, Puebla, México
| | - A Rojas-Vallaraga
- 9 Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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23
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HPV genotypes detected by linear array and next-generation sequencing in anal samples from HIV positive men who have sex with men in Mexico. Arch Virol 2018; 163:925-935. [PMID: 29299683 DOI: 10.1007/s00705-017-3697-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/20/2017] [Indexed: 12/17/2022]
Abstract
The incidence of anal cancer has been rising, especially in HIV+ patients and has been associated with HPV infection. HIV+ patients are more at risk of HPV coinfection and are seven times more likely to have persistent HPV infection; moreover, HIV+ men have an increased risk of developing anal cancer compared to HIV+ women. The development of screening strategies for the detection of HPV in HIV+ men is of major importance; however, there is not enough information about the HPV genotypes and variants that are colonizing the anal epithelia of HIV+ men in diverse geographical regions. Therefore, this work was aimed at identifying HPV genotypes present in the anal epithelium of HIV+ men who have sex with men (MSM), with or without anal lesions (n = 75). For HPV genotyping, two approaches were performed: Linear Array HPV Genotyping Test and next-generation sequencing (NGS). In general, the six most frequent HPV genotypes found by Linear Array were HPV6, 62, 61, 81, 16 and 51. On the other hand, employing NGS, a total of 36 HPV genotypes belonging to both alpha and beta genera were found. The genotypes with the greatest number of reads, according to the diagnostic group, were: HPV81, 45, 6, 51 and 61 in MSM without anal lesions (WAIN); HPV6, 61, 70, 62 and 66 in MSM with atypical lesions (AAL); HPV6, 11, 66, 81 and 61 in MSM with anal intraepithelial neoplasia grade I (AIN I); and HPV16, 81, 58, 61 and 52 with AIN III. Additionally, a great diversity of L1 variants was observed, especially in genotypes HPV16, 58, 61, 52, 45 and 59.
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24
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Genotipificación del virus del papiloma humano en un grupo de mujeres mexicanas atendidas en un hospital de alta especialidad: las infecciones múltiples y su potencial trascendencia en el esquema actual de vacunación. Med Clin (Barc) 2017; 149:287-292. [DOI: 10.1016/j.medcli.2017.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/04/2017] [Accepted: 02/09/2017] [Indexed: 11/22/2022]
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25
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Artaza-Irigaray C, Flores-Miramontes MG, Olszewski D, Magaña-Torres MT, López-Cardona MG, Leal-Herrera YA, Piña-Sánchez P, Jave-Suárez LF, Aguilar-Lemarroy A. Genetic variability in E6, E7 and L1 genes of Human Papillomavirus 62 and its prevalence in Mexico. Infect Agent Cancer 2017; 12:15. [PMID: 28270859 PMCID: PMC5336664 DOI: 10.1186/s13027-017-0125-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/20/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is the main etiological agent of cervical cancer, the third most common cancer among women globally and the second most frequent in Mexico. Persistent infection with high-risk HPV genotypes is associated with premalignant lesions and cervical cancer development. HPVs considered as low risk or not yet classified, are often found in coinfection with different HPV genotypes. Indeed, HPV62 is one of the most prevalent HPV detected in some countries, but there is limited information about its prevalence in other regions and there are no HPV62 variants currently described. The aim of this study was to determine the prevalence of HPV62 in cervical samples from Mexican women and to identify mutations in the L1, E6 and E7 genes, which have never been reported in our population. METHODS HPV screening was performed by Cobas HPV Test in women who attended prevention health programs and dysplasia clinics. All HPV positive samples (n = 491) and 87 additional cervical cancer samples were then genotyped with Linear Array HPV Genotyping test. Some samples were selected to corroborate genotyping by Next-Generation sequencing. On the other hand, nucleotide changes in L1, E6 and E7 genes were determined using PCR, Sanger sequencing and analysis with the CLC-MainWorkbench 7.6.1 software. L1 protein structure was predicted with the I-TASSER server. RESULTS Using Linear Array, HPV62 prevalence was 7.6% in general population, 8% in Cervical Intraepithelial Neoplasia grade 1 (CIN1) samples and 4.6% in cervical samples. The presence of HPV62 was confirmed with Next-Generation sequencing. Regarding L1 gene, novel sequence variations were detected, but they did not alter the tertiary structure of the protein. Moreover, several nucleotide substitutions were found in E6 and E7 genes compared to reference HPV62 genomic sequence. Specifically, three non-synonymous sequence variations were detected, two in E6 and one in E7. CONCLUSIONS HPV62 is a frequent HPV genotype found mainly in general population and in women with CIN1, and in 90.5% of the cases it was found in coinfection with other HPVs. Novel nucleotide changes in its L1, E6 and E7 genes were detected, some of them lead to changes in the protein sequence.
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Affiliation(s)
- Cristina Artaza-Irigaray
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco Mexico.,Programa de Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Jalisco, Mexico
| | - María Guadalupe Flores-Miramontes
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco Mexico.,Programa de Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Jalisco, Mexico
| | - Dominik Olszewski
- Institute of Pharmacy and Molecular Biotechnology, University of Heidelberg, Heidelberg, Germany
| | - María Teresa Magaña-Torres
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco Mexico
| | - María Guadalupe López-Cardona
- Unidad de Medicina Genómica y Genética, Hospital Regional Dr. Valentín Gómez Farías - ISSSTE, Guadalajara, Jalisco Mexico
| | | | - Patricia Piña-Sánchez
- Laboratorio de Oncología Molecular, Unidad de Investigación Médica en Enfermedades Oncológicas (UIMEO) - IMSS, Ciudad de Mexico, Mexico
| | - Luis Felipe Jave-Suárez
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco Mexico
| | - Adriana Aguilar-Lemarroy
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco Mexico
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26
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Mendoza-Pinto C, García-Carrasco M, Vallejo-Ruiz V, Méndez-Martínez S, Taboada-Cole A, Etchegaray-Morales I, Muñóz-Guarneros M, Reyes-Leyva J, López-Colombo A. Incidence of cervical human papillomavirus infection in systemic lupus erythematosus women. Lupus 2017; 26:944-951. [PMID: 28059024 DOI: 10.1177/0961203316686708] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Our objective was to study the incidence, persistence and clearance of human papillomavirus infection in systemic lupus erythematosus women and assess risk factors for persistence of human papillomavirus infection. Methods We carried out a prospective, observational cohort study of 127 systemic lupus erythematosus women. Patients were evaluated at baseline and at three years. Traditional and systemic lupus erythematosus women-related disease risk factors were collected. Gynaecological evaluations and cervical cytology screening were made. Human papillomavirus detection and genotyping were made by polymerase chain reaction and linear array. Results The cumulative prevalence of human papillomavirus infection increased from 22.8% at baseline to 33.8% at three years; p = < 0.001: 20.1% of patients experienced 43 incident infections. The risk of any human papillomavirus infection was 10.1 per 1000 patient-months. At three years, 47 (88.6%) prevalent infections were cleared. Independent risk factors associated with incident human papillomavirus infection included more lifetime sexual partners (odds ratio = 1.8, 95% confidence interval = 1.11-3.0) and cumulative cyclophosphamide dose (odds ratio = 3.9, 95% confidence interval = 1.2-12.8). Conclusions In systemic lupus erythematosus women, the cumulative prevalence of human papillomavirus infection, including high risk-human papillomavirus and multiple human papillomavirus infections, may increase over time. Most persistent infections were low risk-human papillomavirus. The number of lifetime sexual partners and the cumulative cyclophosphamide dose were independently associated with incident human papillomavirus infection.
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Affiliation(s)
- C Mendoza-Pinto
- 1 Systemic Autoimmune Diseases Research Unit, HGR 36-CIBIOR, Instituto Mexicano del Seguro Social, Puebla, México.,2 Department of Immunology and Rheumatology, Benemérita Universidad Autónoma de Puebla, México
| | - M García-Carrasco
- 1 Systemic Autoimmune Diseases Research Unit, HGR 36-CIBIOR, Instituto Mexicano del Seguro Social, Puebla, México.,2 Department of Immunology and Rheumatology, Benemérita Universidad Autónoma de Puebla, México
| | - V Vallejo-Ruiz
- 3 Molecular and Virology Laboratory, CIBIOR, Instituto Mexicano del Seguro Social, Metepec, Puebla, México
| | - S Méndez-Martínez
- 4 State Research Department, Instituto Mexicano del Seguro Social, Puebla, México
| | - A Taboada-Cole
- 5 Department of Obstetrics and Gynecology, HGR 36, Instituto Mexicano del Seguro Social, Puebla, México
| | - I Etchegaray-Morales
- 1 Systemic Autoimmune Diseases Research Unit, HGR 36-CIBIOR, Instituto Mexicano del Seguro Social, Puebla, México
| | - M Muñóz-Guarneros
- 6 Secretary of Research and Postgraduate Studies, Benemérita Universidad Autónoma de Puebla, México
| | - J Reyes-Leyva
- 3 Molecular and Virology Laboratory, CIBIOR, Instituto Mexicano del Seguro Social, Metepec, Puebla, México
| | - A López-Colombo
- 7 State Research and Education Department, Instituto Mexicano del Seguro Social, Puebla, México
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Zouheir Y, Fechtali T, Elgnaoui N. Human Papillomavirus Genotyping and p16(INK4a) Expression in Cervical Lesions: A Combined Test to Avoid Cervical Cancer Progression. J Cancer Prev 2016; 21:121-5. [PMID: 27390742 PMCID: PMC4933437 DOI: 10.15430/jcp.2016.21.2.121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/09/2016] [Accepted: 05/12/2016] [Indexed: 12/15/2022] Open
Abstract
Cervical cancer is a major public health problem in Morocco. The cervical cancer has a long precancerous period that provides an opportunity for the screening and treatment. Improving screening tests is a priority goal for the early diagnosis of cervical cancer. This study was conducted to evaluate the combination of p16(INK4a) protein expression, human papillomavirus (HPV) typing, and histopathology for the identification of cervical lesions with high risk to progress to cervical cancer among Moroccan women. A total of 96 cervical biopsies were included in this study. Signal amplification in situ hybridization with biotinylated probes was used to detect HPV. Immunohistochemistry was used to evaluate the expression of p16(INK4a) protein. HPV DNA was detected in 74.0% of the biopsies (71/96). Of the seventy-one positive HPV cases, we detected 67.6% (48/71) of high risk (HR)-HPV (HPV 16 and 18), 24% of low risk-HPV (HPV 6 and 11), 1.4% intermediate risk-HPV (HPV 31, 33, and 35), and 7% coinfections (HPV 6/11 and 16/18). Overexpression of p16(INK4a) protein was observed in 72.9% (70/96) of the biopsies. In addition, p16(INK4a) protein detection was closely correlated with recovery of HR HPV. Our result showed that p16(INK4a) expression level is correlated with HR-HPV status.
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Affiliation(s)
- Yassine Zouheir
- Laboratory of Histo-Cytopathology of Institut Pasteur du Maroc, Hassan II University Casablanca, Casablanca, Morocco; Biosciences laboratory, Functional exploration, Integrated and Molecular, Faculty of Sciences and Technics Mohammedia, Hassan II University Casablanca, Casablanca, Morocco
| | - Taoufiq Fechtali
- Biosciences laboratory, Functional exploration, Integrated and Molecular, Faculty of Sciences and Technics Mohammedia, Hassan II University Casablanca, Casablanca, Morocco
| | - Nadia Elgnaoui
- Laboratory of Histo-Cytopathology of Institut Pasteur du Maroc, Hassan II University Casablanca, Casablanca, Morocco
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García-Vielma C, Dávila-Rodríguez MI, Hernández-Garza F, Cerda-Flores RM, Cortés-Gutiérrez EI. Digital image analysis of AgNORs in cervical smears of women with premalignant and malignant lesions of the uterine cervix. Biotech Histochem 2015; 91:102-7. [PMID: 26528580 DOI: 10.3109/10520295.2015.1078909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We performed a hospital-based, unmatched case-control study to investigate the association between progressive stages of cervical neoplasia and digital analysis of cell proliferation by silver stained nucleolus organizer region associated proteins (AgNORs). We measured cell proliferation levels in the cervical epithelial cells of 10 women with low grade squamous intraepithelial lesions (LG-SIL), eight with high grade squamous intraepithelial lesions (HG-SIL), 11 with cervical cancer (CC) and eight with no cervical lesions (controls) using the AgNORs technique. Cell proliferation was measured by digital image analysis (DIA). DIA revealed increased total areas of AgNORs in HG-SIL and CC compared to LG-SIL and control patients. AgNORs with a kidney or cluster shape exhibited greater areas than those with a spherical or long shape. We propose a cut-off of 118 pixels to differentiate benign (control and LG-SIL) from malignant (HG-SIL and CC) lesions. DIA of AgNORs is a simple and inexpensive method for studying proliferation. The increased total area of AgNORs in malignant lesions provides information regarding cell behavior and may be related to cervical carcinogenesis; however, further validation studies are required to establish its usefulness in cytological analysis.
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Affiliation(s)
- C García-Vielma
- a Department of Genetics , Northeastern Biomedical Research Center, The Mexican Social Security Institute (IMSS) , Monterrey , Mexico
| | - M I Dávila-Rodríguez
- a Department of Genetics , Northeastern Biomedical Research Center, The Mexican Social Security Institute (IMSS) , Monterrey , Mexico
| | - F Hernández-Garza
- b Dysplasia Clinic, Medical Unit of High Specialty No. 23-IMSS , Monterrey , Mexico
| | - R M Cerda-Flores
- c Nursing Faculty, Autonomous University of Nuevo León , Monterrey , Mexico
| | - E I Cortés-Gutiérrez
- a Department of Genetics , Northeastern Biomedical Research Center, The Mexican Social Security Institute (IMSS) , Monterrey , Mexico
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Flores-Miramontes MG, Torres-Reyes LA, Alvarado-Ruíz L, Romero-Martínez SA, Ramírez-Rodríguez V, Balderas-Peña LMA, Vallejo-Ruíz V, Piña-Sánchez P, Cortés-Gutiérrez EI, Jave-Suárez LF, Aguilar-Lemarroy A. Human papillomavirus genotyping by Linear Array and Next-Generation Sequencing in cervical samples from Western Mexico. Virol J 2015; 12:161. [PMID: 26444975 PMCID: PMC4596464 DOI: 10.1186/s12985-015-0391-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Linear Array® (LA) genotyping test is one of the most used methodologies for Human papillomavirus (HPV) genotyping, in that it is able to detect 37 HPV genotypes and co-infections in the same sample. However, the assay is limited to a restricted number of HPV, and sequence variations in the detection region of the HPV probes could give false negatives results. Recently, 454 Next-Generation sequencing (NGS) technology has been efficiently used also for HPV genotyping; this methodology is based on massive sequencing of HPV fragments and is expected to be highly specific and sensitive. In this work, we studied HPV prevalence in cervixes of women in Western Mexico by LA and confirmed the genotypes found by NGS. METHODS Two hundred thirty three cervical samples from women Without cervical lesions (WCL, n = 48), with Cervical intraepithelial neoplasia grade 1 (CIN I, n = 98), or with Cervical cancer (CC, n = 87) were recruited, DNA was extracted, and HPV positivity was determined by PCR amplification using PGMY09/11 primers. All HPV- positive samples were genotyped individually by LA. Additionally, pools of amplicons from the PGMY-PCR products were sequenced using 454 NGS technology. Results obtained by NGS were compared with those of LA for each group of samples. RESULTS We identified 35 HPV genotypes, among which 30 were identified by both technologies; in addition, the HPV genotypes 32, 44, 74, 102 and 114 were detected by NGS. These latter genotypes, to our knowledge, have not been previously reported in Mexican population. Furthermore, we found that LA did not detect, in some diagnosis groups, certain HPV genotypes included in the test, such as 6, 11, 16, 26, 35, 51, 58, 68, 73, and 89, which indicates possible variations at the species level. CONCLUSIONS There are HPV genotypes in Mexican population that cannot be detected by LA, which is, at present, the most complete commercial genotyping test. More studies are necessary to determine the impact of HPV-44, 74, 102 and 114 on the risk of developing CC. A greater number of samples must be analyzed by NGS for the most accurate determination of Mexican HPV variants.
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Affiliation(s)
- María Guadalupe Flores-Miramontes
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico. .,Programa de Doctorado en Ciencias Biomédica, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Jalisco, Mexico.
| | - Luis Alberto Torres-Reyes
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico. .,Programa de Doctorado en Ciencias Biomédica, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Jalisco, Mexico.
| | - Liliana Alvarado-Ruíz
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico. .,Programa de Doctorado en Ciencias Biomédica, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Jalisco, Mexico.
| | | | | | - Luz María Adriana Balderas-Peña
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Nacional de Occidente (CMNO)-IMSS, Guadalajara, Jalisco, Mexico.
| | - Verónica Vallejo-Ruíz
- Centro de Investigación Biomédica de Oriente (CIBIOR)-IMSS, Metepec, Puebla, Mexico.
| | - Patricia Piña-Sánchez
- Laboratorio de Oncología Molecular, Unidad de Investigación Médica en Enfermedades Oncológicas (UIMEO)-IMSS, Mexico City, Mexico.
| | | | - Luis Felipe Jave-Suárez
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico.
| | - Adriana Aguilar-Lemarroy
- División de Inmunología, Centro de Investigación Biomédica de Occidente (CIBO)-Instituto Mexicano del Seguro Social (IMSS), Sierra Mojada No. 800, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico.
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Mitos y realidades de la vacunación contra el virus del papiloma humano. GACETA MEXICANA DE ONCOLOGÍA 2015. [DOI: 10.1016/j.gamo.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Infección por virus del papiloma humano en mujeres y su prevención. GACETA MEXICANA DE ONCOLOGÍA 2015. [DOI: 10.1016/j.gamo.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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