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Lepine C, Leboulanger N, Badoual C. Juvenile onset recurrent respiratory papillomatosis: What do we know in 2024 ? Tumour Virus Res 2024; 17:200281. [PMID: 38685530 PMCID: PMC11088349 DOI: 10.1016/j.tvr.2024.200281] [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: 02/29/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
Juvenile onset recurrent respiratory papillomatosis is a lifelong benign squamous lesion associated with HPV infection, particularly HPV6 and HPV11 genotypes. These lesions are rare, but can lead to laryngeal obturations, which can cause disabling dyspnea, or transform into squamous cell carcinoma. The aim here is to provide an epidemiological, biological and clinical overview of this pathology, particularly in children, in order to understand the issues at stake in terms of research and the development of medical and therapeutic management tools.
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Affiliation(s)
- Charles Lepine
- Pathology Department, CHU de Nantes, F-44000 Nantes, France; Nantes University, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Nicolas Leboulanger
- Otolaryngology - Head and Necker Surgery Department, Necker Enfants Malades University Hospital, 149 Rue de Sèvres 75015 Paris, France; Université Paris Cité, France
| | - Cécile Badoual
- Université Paris Cité, France; Pathology Department, European George Pompidou Hospital, APHP, 20 Rue Leblanc 75015 Paris, France.
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2
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Qu X, Xiao Y, Ma L, Wang J. Distribution Characteristics of Juvenile-Onset Recurrent Respiratory Papillomatosis at First-Time Surgery. EAR, NOSE & THROAT JOURNAL 2024; 103:NP289-NP293. [PMID: 34702097 DOI: 10.1177/01455613211049845] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The lesion distribution of juvenile-onset recurrent respiratory papillomatosis (JORRP) during first-time surgery has been rarely reported. The purpose of this study was to describe the anatomical distribution of papilloma across 25 Derkay sites during initial surgery and to assess the impact of the lesion distribution on disease severity. METHODS Surgical videos and medical records of 106 patients with JORRP (27 aggressive and 79 nonaggressive cases) were retrospectively reviewed. Lesion locations were recorded using Derkay anatomical sites. Logistic regression was used to analyze the effect of the lesion distribution on disease severity. RESULTS Among the 106 patients, the true vocal cords (90.6% left, 84.0% right) were the most frequently involved site, followed by the false vocal cords (39.6% left, 35.8% right) and the anterior commissure (26.4%). Two patients (1.9%) had tracheal involvement. Patients with false vocal cord involvement (odds ratio [OR] = 3.425, 95% confidence interval [CI] [1.285, 9.132], P = .014) and a younger age at diagnosis (OR = .698, 95% CI [.539, .905], P = .007) were more likely to require more than 4 procedures in the year following first-time surgery. CONCLUSIONS Lesions were most common on the true vocal cords. False vocal cord involvement and a younger age at diagnosis were risk factors for disease severity.
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Affiliation(s)
- Xiaoli Qu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Xiao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lijing Ma
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jun Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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3
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Chantre-Justino M, Figueiredo MC, Alves G, Ornellas MHF. A pilot study on salivary HPV DNA detection to monitor active disease from patients with recurrent respiratory papillomatosis. Am J Otolaryngol 2024; 45:104157. [PMID: 38061173 DOI: 10.1016/j.amjoto.2023.104157] [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: 10/01/2023] [Accepted: 12/04/2023] [Indexed: 03/16/2024]
Abstract
PURPOSE Recurrent respiratory papillomatosis (RRP) is a human papillomavirus (HPV)-related disease affecting the upper airway and saliva could be an important non-invasive sampling source for viral screening and clinical monitoring. We investigated whether HPV DNA could be detected in saliva (cellular pellets and supernatant) from RRP patients and influence on clinical manifestation of the disease. MATERIALS AND METHODS In this pilot study, saliva samples from 14 RRP patients were obtained in preoperative condition (n = 7) and in disease-free interval (DFI; n = 7). Healthy donors (n = 14) were also included. HPV DNA was investigated by polymerase chain reaction (PCR)-based assays. RESULTS From cellular pellets, HPV-positive saliva was only detected from preoperative collections (5/7; 71.4 %) and showed a mean cycle threshold (Ct) value of 24.33 (±1.25), whereas all patients in DFI were HPV-negative (Ct ≥ 32.16), revealing significant difference between these two clinical moments (p = 0.021). Patients in DFI and healthy donors showed similar Ct values. From saliva supernatant, detectable HPV cell-free DNA (cfDNA) occurred in 42.9 % (3/7) and 57.1 % (4/7) of preoperative collections using the commercial cfDNA kits from Norgen and Qiagen, respectively. Salivary cfDNA size distribution obtained by TapeStation analysis showed a predominant size range of 150 to 400 bp in both patients and healthy controls, corresponding to mononucleosomal and dinucleosomal fragments. CONCLUSIONS In conclusion, HPV DNA screening in saliva (both cellular pellets and cfDNA) may have clinical utility to monitor active disease of RRP patients.
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Affiliation(s)
- Mariana Chantre-Justino
- Circulating Biomarkers Laboratory, Pathology Department, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro 20550-170, Brazil; Research Division, National Institute of Traumatology and Orthopaedics (INTO), Rio de Janeiro 20940-070, Brazil.
| | - Marcelo Cardoso Figueiredo
- Respiratory Endoscopy and Head and Neck Surgery Service at Hospital Federal de Bonsucesso, Rio de Janeiro 21041-030, Brazil
| | - Gilda Alves
- Circulating Biomarkers Laboratory, Pathology Department, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro 20550-170, Brazil
| | - Maria Helena Faria Ornellas
- Circulating Biomarkers Laboratory, Pathology Department, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro 20550-170, Brazil
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Kajal S, Kakkar A, Naz F, Tanwar P P, Khandakar H, Gupta A, Thakar A, Verma H. Clinico-pathological Factors in Malignant Transformation of RRP. Indian J Otolaryngol Head Neck Surg 2024; 76:596-603. [PMID: 38440468 PMCID: PMC10908916 DOI: 10.1007/s12070-023-04220-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 03/06/2024] Open
Abstract
Various clinico-pathological factors play role in the papilloma proliferation and pathogenesis of Recurrent respiratory papillomatosis (RRP). However, it is not known if they are directly responsible for malignant transformation of these papillomas or not. We did this study to elucidate any such association. The most recent debrided tissue of RRP in 20 patients was evaluated for p16 expression, VEGF estimation (tissue expression and serum levels), and tissue HPV DNA concentration. The final histopathology results were then correlated with these pathological factors and with clinical factors like duration of illness, age of onset of symptoms, extent of disease, etc. Squamous papilloma was seen in 60%, dysplasia in 25%, and squamous cell carcinoma (SCC) in 15% of the patients. Positive immunostaining for p16 (staining in ≥70% of tumor cells) was seen only in one case, which was SCC. There was no statistically significant difference between p16 expression, tissue VEGF expression, serum VEGF levels, and tissue HPV DNA in any of the histological groups. The mean age of disease onset was significantly higher in patients with SCC (p = 0.03). A significantly higher number of patients with dysplasia had tracheobronchial involvement (p = 0.022). We concluded that no single pathological factor is solely responsible for development of malignancy in RRP, whereas clinical factors like tracheobronchial involvement and age of onset may contribute to development of dysplasia or carcinoma.
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Affiliation(s)
- Smile Kajal
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Farhat Naz
- Laboratory Oncology Unit, Dr BR Ambedkar Institute Rotary Cancer Hospital, AIIMS, New Delhi, India
| | - Pranay Tanwar P
- Laboratory Oncology Unit, Dr BR Ambedkar Institute Rotary Cancer Hospital, AIIMS, New Delhi, India
| | | | - Anurag Gupta
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, Delhi India
| | - Alok Thakar
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Hitesh Verma
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Kamil S, Mohsen S. Diode Laser for Juvenile Recurrent Respiratory Papillomatosis: A Case Series of 13 Patients. Indian J Otolaryngol Head Neck Surg 2024; 76:536-539. [PMID: 38440491 PMCID: PMC10909036 DOI: 10.1007/s12070-023-04205-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/19/2023] [Indexed: 03/06/2024] Open
Abstract
Juvenile recurrent respiratory papillomatosis (JRRP) is the most common benign tumor in the larynx. It is uncommon; however, it is potentially life-threatening because it compromises the respiratory tract and required several surgeries to manage recurrences. Currently, the carbon dioxide laser is the treatment of choice. There are no studies about the role of the diode laser which is easy to use and has lower usage cost. This case series presentation reported on the therapeutic effects and recurrence rate of JRRP when using Diode laser. This is a case series presentation of 13 children, who were diagnosed with JRRP and operated for laryngeal papillomatosis with Diode laser in Otorhinolaryngology and Head and Nick Surgery Department et al. Mouwasat Hospital, Damascus, Syria between 2015 and 2022. 13 children required 56 surgeries at a rate of 1-2 surgeries/year, mean number of surgeries for each child was 4.31. That suggests that Diode laser might have a role in reducing the number of surgeries compared to a study used cold instrument and CO2 laser. The complications rate was 30.8%, which is considered a high rate compared to the other studies. In conclusion, we encourage using it when the CO2 laser device is not available. However, we suggest, reducing the power as low as possible and avoiding of two opposing raw surfaces, especially at the anterior commissure and deep excision. Further longitudinal studies are recommended to validate these results.
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Affiliation(s)
- Sara Kamil
- Department of Otolaryngology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Samer Mohsen
- Department of Otolaryngology, Faculty of Medicine, Damascus University, Damascus, Syria
- Department of Audiology, Faculty of Health Sciences, Damascus University, Damascus, Syria
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6
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Skolnik JM, Morrow MP. Vaccines for HPV-associated diseases. Mol Aspects Med 2023; 94:101224. [PMID: 37931422 DOI: 10.1016/j.mam.2023.101224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
Human papillomavirus (HPV) infection represents a significant global health concern owing to its role in the etiology of conditions ranging from benign low-grade lesions to cancers of the cervix, head and neck, anus, vagina, vulva, and penis. Prophylactic vaccination programs, primarily targeting adolescent girls, have achieved dramatic reductions in rates of HPV infection and cervical cancer in recent years. However, there is a clear demand for a strategy to manage the needs of the many people who are already living with persistent HPV infection and/or HPV-associated conditions. Unlike prophylactic vaccines, which act to prevent HPV infection, therapeutic vaccination presents an opportunity to induce cellular immunity against established HPV infections and lesions and prevent progression to cancer. Several HPV vaccines are undergoing clinical development, using a range of platforms. Peptide- or protein-based vaccines, vector-based vaccines, whole-cell vaccines, and nucleic acid vaccines each offer relative merits and limitations for the delivery of HPV antigens and the subsequent generation of targeted immune responses. There has been particular interest in DNA-based vaccines, which elicit both cellular and humoral immune responses to provide long-lasting immunity. DNA vaccines offer several practical advantages over other vaccine platforms, including the potential for rapid and scalable manufacturing, targeting of many different antigens, and potential for repeat boosting. Furthermore, unlike vectored approaches, DNA vaccines are thermostable over extended time periods, which may enable shipping and storage. Several delivery strategies are available to address the main challenge of DNA vaccines, namely their relatively low transfection efficiency. We review the latest clinical data supporting the development of DNA vaccines and reflect on this exciting prospect in the management of HPV-related disease.
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7
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Gogineni V, Gingell L, Varghese M, Hrinczenko B. Placental and Breast Metastasis of Squamous Cell Carcinoma in a Patient With Recurrent Respiratory Papillomatosis. Cureus 2023; 15:e46183. [PMID: 37905287 PMCID: PMC10613337 DOI: 10.7759/cureus.46183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Recurrent respiratory papillomatosis (RRP), which is usually benign, is an intractable disease characterized by recurrent papillomas (wart-like lesions). Although it most commonly involves the mucosal epithelial lining of the upper respiratory tract, on rare occasions, it can also involve lung parenchyma. RRP carries the risk of malignant transformation, most often to non-small-cell squamous lung cancer. Here, we present the case of a 32-year-old pregnant female with a past medical history of RRP who developed mild respiratory distress during her immediate postpartum period. This prompted imaging of the chest which revealed right lower lobe hypodensities with extensive hilar and perihilar lymphadenopathy. Histopathology of the bronchial specimen showed squamous cell carcinoma with 100% programmed death-ligand 1 (PD-L1) expression. Gross examination of the patient's placenta showed multiple tan-colored nodules which was confirmed on histopathological examination as multifocal regions of squamous cell carcinoma metastatic from the lung. The patient underwent a staging positron emission tomography (PET) scan which showed hypermetabolic regions in the right middle and lower lobes of the lung, with avidity in the right paratracheal region and an enhancing lesion in the left breast. Biopsy from the breast lesion was also positive for squamous cell carcinoma and PD-L1. She was diagnosed with Stage IVB (T1c, N3, M1c) non-small-cell squamous lung cancer and was started on pembrolizumab. Carboplatin and paclitaxel were added after an initial mixed response to therapy. The patient was non-compliant with her updated treatment regimen as well as with outpatient follow-up visits. A restaging PET scan demonstrated an inadequate response to the amended immunotherapy/chemotherapy regimen. Ultimately, she passed away within one and a half years of her initial diagnosis. Malignant transformation of papillomatous lesions into squamous cell cancer is infrequent, and the occurrence of metastasis to the breast and/or placenta is exceptionally rare. To our knowledge, this is the first reported case of placental and breast metastasis of squamous cell lung cancer in a patient with RRP.
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Affiliation(s)
- Venumadhavi Gogineni
- Internal Medicine, Michigan State University, East Lansing, USA
- Internal Medicine, Michigan State University- Sparrow Hospital, Lansing, USA
| | - Luke Gingell
- Oncology, Michigan State University College of Human Medicine, East Lansing, USA
| | - Merryl Varghese
- Internal Medicine, Michigan State University, East Lansing, USA
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da Silva LL, Teles AM, Santos JMO, Souza de Andrade M, Medeiros R, Faustino-Rocha AI, Oliveira PA, dos Santos APA, Ferreira Lopes F, Braz G, Brito HO, da Costa RMG. Malignancy Associated with Low-Risk HPV6 and HPV11: A Systematic Review and Implications for Cancer Prevention. Cancers (Basel) 2023; 15:4068. [PMID: 37627099 PMCID: PMC10452364 DOI: 10.3390/cancers15164068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/28/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
High-risk human papillomavirus (HPV) is etiologically related to cervical cancer, other anogenital cancers and oropharyngeal carcinomas. Low-risk HPV, especially HPV6 and HPV11, cause genital warts and laryngeal papillomas. However, the accumulating data suggests that HPV6 and HPV11 may cause malignant lesions at non-cervical anatomic sites. This review aims to estimate the proportions of single and dual HPV6/11 infections in multiple cancers reported in the last 10 years in the Cochrane, Embasa and PubMed databases. Secondly, the genomes of HPV6/11 were compared with the most common high-risk genotype, HPV16, to determine the similarities and differences. A total of 11 articles were selected, including between one and 334 HPV+ cancer patients. The frequencies of single or dual HPV6/11 infections ranged between 0-5.5% for penile and 0-87.5% for laryngeal cancers and were null for vulvar, vaginal and oral cancers. The genomic similarities between HPV6/11 and HPV16 mainly involved the E7 gene, indicating a limited ability to block cell differentiation. The presence of single or dual HPV6/11 infections in variable proportions of penile and laryngeal cancers support the vaccination strategies that cover these genotypes, not only for preventing genital warts but also for cancer prevention. Other risk factors and co-carcinogens are likely to participate in epithelial carcinogenesis associated with low-risk HPV.
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Affiliation(s)
- Leandro Lima da Silva
- Post-Graduate Program in Adult Health (PPGSAD), Federal University of Maranhão (UFMA), São Luís 65080-805, MA, Brazil (A.P.A.d.S.); (H.O.B.)
| | - Amanda Mara Teles
- Post-Graduate Program in Adult Health (PPGSAD), Federal University of Maranhão (UFMA), São Luís 65080-805, MA, Brazil (A.P.A.d.S.); (H.O.B.)
- Post-Graduate Program in Animal Health, State University of Maranhão, São Luís 65099-110, MA, Brazil
| | - Joana M. O. Santos
- Molecular Oncology and Viral Pathology Group, Portuguese Institute of Oncology of Porto Research Center (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Institute of Oncology of Porto (IPO-Porto)/Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
| | - Marcelo Souza de Andrade
- Post-Graduate Program in Adult Health (PPGSAD), Federal University of Maranhão (UFMA), São Luís 65080-805, MA, Brazil (A.P.A.d.S.); (H.O.B.)
| | - Rui Medeiros
- Molecular Oncology and Viral Pathology Group, Portuguese Institute of Oncology of Porto Research Center (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Institute of Oncology of Porto (IPO-Porto)/Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
| | - Ana I. Faustino-Rocha
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal; (A.I.F.-R.)
- Inov4Agro—Institute for Innovation, Capacity Building and Sustainability of Agri-Food Production, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
| | - Paula A. Oliveira
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal; (A.I.F.-R.)
- Inov4Agro—Institute for Innovation, Capacity Building and Sustainability of Agri-Food Production, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
| | - Ana Paula Azevedo dos Santos
- Post-Graduate Program in Adult Health (PPGSAD), Federal University of Maranhão (UFMA), São Luís 65080-805, MA, Brazil (A.P.A.d.S.); (H.O.B.)
- Post-Graduate Program in Health Sciences, Federal University of Maranhão (UFMA), São Luís 65080-805, MA, Brazil
| | - Fernanda Ferreira Lopes
- Post-Graduate Program in Odontology, Federal University of Maranhão (UFMA), São Luís 65080-805, MA, Brazil;
| | - Geraldo Braz
- Post-Graduate Program in Computing Sciences, Federal University of Maranhão (UFMA), São Luís 65080-805, MA, Brazil;
| | - Haissa O. Brito
- Post-Graduate Program in Adult Health (PPGSAD), Federal University of Maranhão (UFMA), São Luís 65080-805, MA, Brazil (A.P.A.d.S.); (H.O.B.)
| | - Rui M. Gil da Costa
- Post-Graduate Program in Adult Health (PPGSAD), Federal University of Maranhão (UFMA), São Luís 65080-805, MA, Brazil (A.P.A.d.S.); (H.O.B.)
- Molecular Oncology and Viral Pathology Group, Portuguese Institute of Oncology of Porto Research Center (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Institute of Oncology of Porto (IPO-Porto)/Porto Comprehensive Cancer Center (Porto.CCC), 4200-072 Porto, Portugal
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal; (A.I.F.-R.)
- Inov4Agro—Institute for Innovation, Capacity Building and Sustainability of Agri-Food Production, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
- Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- Associate Laboratory in Chemical Engineering (ALiCE), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
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Ling SO, Cheng YF, Yau PYA, Yim CW, Kwan HY, Mok T. Recurrent respiratory papillomatosis (RRP) of tracheobronchial tree presenting as lung collapse with malignant transformation after a decade. Respir Med Case Rep 2023; 45:101904. [PMID: 37564786 PMCID: PMC10410594 DOI: 10.1016/j.rmcr.2023.101904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/20/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023] Open
Abstract
Recurrent respiratory papillomatosis is a rare disease caused by HPV infection. We hereby report a patient with recurrent respiratory papillomatosis of the tracheobronchial tree with no laryngeal involvement who remained clinically stable for more than 10 years but then developed malignant transformation with metastases. A 61-year-old lady with good past health presented to our department in 2010 because of chronic cough for years. Chest X-ray showed reduced left lung volume. Bronchoscopy showed multiple nodules over left main bronchus and left upper lobe progressing to involve the posterior trachea and left lower lobe. Biopsy revealed squamous papilloma with mild dysplasia. She refused surgical intervention. She remained relatively stable until November 2022 when she developed left chest pain. CT showed features of malignant transformation with local invasion and metastases. Fine needle aspiration suggested squamous cell carcinoma. She succumbed in December 2022. Bronchoscopy should be considered in the investigation of unexplained chronic cough so that this rare disease can be detected at an early stage. The disease may not require intervention if uncomplicated. Despite clinical stability for a prolonged period, close monitoring for malignant transformation is warranted indefinitely.
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Affiliation(s)
- Sai-on Ling
- Respiratory Medical Department, Kowloon Hospital, 147A, Argyle Street, Kowloon, HKSAR, Hong Kong
| | - Yiu-fai Cheng
- Respiratory Medical Department, Kowloon Hospital, 147A, Argyle Street, Kowloon, HKSAR, Hong Kong
| | - Pak-yuen Anthony Yau
- Respiratory Medical Department, Kowloon Hospital, 147A, Argyle Street, Kowloon, HKSAR, Hong Kong
| | - Chie-wai Yim
- Respiratory Medical Department, Kowloon Hospital, 147A, Argyle Street, Kowloon, HKSAR, Hong Kong
| | - Hoi-yee Kwan
- Respiratory Medical Department, Kowloon Hospital, 147A, Argyle Street, Kowloon, HKSAR, Hong Kong
| | - Thomas Mok
- Respiratory Medical Department, Kowloon Hospital, 147A, Argyle Street, Kowloon, HKSAR, Hong Kong
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10
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Guragain R, Gyawali BR. Intralesional Bevacizumab as Adjuvant Therapy for Juvenile Onset Recurrent Respiratory Papillomatosis: A Systematic Review. Indian J Otolaryngol Head Neck Surg 2023; 75:1296-1301. [PMID: 37275063 PMCID: PMC10235305 DOI: 10.1007/s12070-022-03204-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/23/2022] [Indexed: 11/08/2022] Open
Abstract
Background: Respiratory papillomatosis is one of the common benign lesions of the airway that is often difficult to treat and carries significant morbidity. Bevacizumab is a monoclonal antibody that acts upon vascular endothelial growth factor receptor and is known to have an effect in respiratory papillomatosis. This study aims to systematically review the literature on efficacy of intralesional Bevacizumab in juvenile onset respiratory papillomatosis. Materials and methods. A systematic search of literature in various databases was conducted. The search was restricted to the English language, however, no restrictions were made regarding the date of publication keeping December 31st, 2020 as the last date of publication. We strictly complied with the PRISMA guidelines. Results. Of 145 articles analyzed, only 3 were selected as eligible and a total of twenty-one cases were evaluated. There was improvement in anatomic Derkay score after initiating intralesional Bevacizumb with reduction in the number of surgeries. Where reported, voice related functional outcomes also were also improved. No adverse effect related to the drug was reported. Conclusion: Intralesional Bevacizumab can be a promising efficacious, and safe adjuvant in the management of JORRP. Well-designed studies are further required in the future to prove its efficacy and safety over other adjuvants available.
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Affiliation(s)
- Rajendra Guragain
- Department of ENT-HNS Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Bigyan Raj Gyawali
- Department of ENT-HNS Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
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11
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Goon P, Sauzet O, Schuermann M, Oppel F, Shao S, Scholtz LU, Sudhoff H, Goerner M. Recurrent Respiratory Papillomatosis (RRP)-Meta-analyses on the use of the HPV vaccine as adjuvant therapy. NPJ Vaccines 2023; 8:49. [PMID: 37005390 PMCID: PMC10067830 DOI: 10.1038/s41541-023-00644-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 03/10/2023] [Indexed: 04/04/2023] Open
Abstract
Recurrent Respiratory Papillomatosis(RRP) is a rare disease with severe morbidity. Treatment is surgical. Prevailing viewpoint is that prophylactic HPV vaccines do not have therapeutic benefit due to their modus operandi. Studies on HPV vaccination alongside surgery were meta-analysed to test effect on burden of disease. Databases were accessed Nov and Dec 2021 [PubMed, Cochrane, Embase and Web of Science]. Main outcome measured was: Mean paired differences in the number of surgeries or recurrences per month. Analyses was performed using: Random effect maximal likelihood estimation model using the Stata module Mataan(StataCorp. 2019. Stata Statistical Software: Release 16. College Station, TX:StataCorp LLC.) Our results found n = 38 patients, suitable for syntheses with one previous meta-analyses (4 published, 2 unpublished studies) n = 63, total of n = 101 patients. Analyses rendered an overall reduction of 0.123 recurrences or surgeries per month (95% confidence interval [0.064, 0.183]). Our meta-analyses concludes that HPV vaccine is a beneficial adjunct therapy alongside surgery.
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Affiliation(s)
- Peter Goon
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and Departments of Dermatology & Otolaryngology, National University Health System, Singapore, Singapore.
| | - Odile Sauzet
- Bielefeld School of Public Health and Department of Business Administration and Economics, University of Bielefeld, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Matthias Schuermann
- University Dept of Otolaryngology, Campus Klinikum Bielefeld Mitte, University Hospital OWL of Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Felix Oppel
- University Dept of Otolaryngology, Campus Klinikum Bielefeld Mitte, University Hospital OWL of Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - SenYao Shao
- University Dept of Otolaryngology, Campus Klinikum Bielefeld Mitte, University Hospital OWL of Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Lars-Uwe Scholtz
- University Dept of Otolaryngology, Campus Klinikum Bielefeld Mitte, University Hospital OWL of Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Holger Sudhoff
- University Dept of Otolaryngology, Campus Klinikum Bielefeld Mitte, University Hospital OWL of Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Martin Goerner
- Dept of Haematology, Oncology and Palliative Medicine, Campus Klinikum Bielefeld Mitte, University Hospital OWL of Bielefeld University, Teutoburger Str. 50, 33604, Bielefeld, Germany
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12
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McGuire JK, Kabagenyi F, Peer S. Human papillomavirus vaccination in Africa: An airway perspective. Int J Pediatr Otorhinolaryngol 2023; 165:111423. [PMID: 36681046 DOI: 10.1016/j.ijporl.2022.111423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Recurrent respiratory papillomatosis (RRP) is a chronic condition caused by Human papillomavirus six (HPV-6) and HPV-11 that involves the respiratory tract. Disease severity ranges from mild (hoarseness), through to severe (stridor, respiratory distress and airway emergencies). Africa has the fastest growing and youngest population of all the continents. It also has the greatest burden of cervical cancer. There is an association with infection of the oncogenic HPV strains and the strains responsible for RRP. It is reasonable to conclude that although RRP may be underestimated in low-to-middle-income countries, it poses a considerable health risk to Africa. The primary aim of this project was to assess the suitability of HPV vaccination coverage on the African continent. METHODS A prospective study was designed to consist of an online survey. It was distributed to 135 African otolaryngologists. Questions focussed on HPV vaccination programmes; whether they were government directed; and their rollout. Information from countries that had multiple otolaryngologists respond to the survey were compared. Additionally, data review and corroboration were performed. RESULTS There were 58 (43%) participants from 19 countries. Nine countries reported a national vaccination programme (NVP), five used Cervarix; four used quadrivalent Gardasil. Collateral data revealed 18 of 54 countries had NVP in Africa and 26 countries had completed HPV vaccine pilot or demonstration projects. CONCLUSIONS HPV vaccination in Africa should be urgently re-evaluated to include the HPV-6 and HPV-11 strains that cause JORRP, which have not been recognised during national vaccination programme planning.
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Affiliation(s)
- J K McGuire
- Division of Otolaryngology, Department of Surgery, University of Cape Town, South Africa.
| | - F Kabagenyi
- Division of Otolaryngology, Department of Surgery, University of Cape Town, South Africa
| | - S Peer
- Division of Otolaryngology, Department of Surgery, University of Cape Town, South Africa
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13
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Ding D, Yin G, Guo W, Huang Z. Analysis of lesion location and disease characteristics of pharyngeal and laryngeal papilloma in adult. Eur Arch Otorhinolaryngol 2023; 280:289-295. [PMID: 35939058 DOI: 10.1007/s00405-022-07575-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Papilloma is a common benign epithelial tumor of the respiratory tract in adults. Its histological structure and immune environment vary from site to site. This study investigated the disease characteristics and prognostic differences of papillomas at various primary locations. METHODS Clinical data was collected from patients with adult glossal root and hypopharyngeal papilloma admitted to our tertiary referral center between January 2010 and December 2020, and compared with patients with laryngeal papilloma. Differences in age, sex, smoking, alcohol consumption, single or multiple lesions, surgical methods, immunohistochemical indexes, Ki-67 and p16, were analyzed in patients with different primary papilloma sites. RESULTS A total of 84 cases of glossal root papilloma, 51 cases of hypopharyngeal papilloma, and 51 cases of laryngeal papilloma were included. Differential analysis between groups showed that there were statistically significant differences in age, sex, smoking, single and multiple lesions, and surgical methods in the different primary sites. Ki-67 expression in laryngeal papilloma was higher than that in glossal root and hypopharyngeal papilloma. There was no significant difference in p16 expression in the three groups. In terms of prognosis, laryngeal papilloma is more likely to relapse than glossal root or hypopharyngeal papilloma, and the recurrence time is shorter. CONCLUSIONS As the largest clinical study of papilloma in different primary locations, this study found that the clinical characteristics and postoperative recurrence of papilloma of the glossal root and hypopharynx differ from those of papilloma of the larynx. This finding supports the current clinical experience in treating papillomas in different locations and facilitates the development of clinical treatment plans.
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Affiliation(s)
- Dong Ding
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Room 501, No. 8 Chongwenmennei Street, Dongcheng District, Beijing, China
| | - Gaofei Yin
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Room 501, No. 8 Chongwenmennei Street, Dongcheng District, Beijing, China
| | - Wei Guo
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Room 501, No. 8 Chongwenmennei Street, Dongcheng District, Beijing, China
| | - Zhigang Huang
- Department of Otorhinolaryngology and Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Room 501, No. 8 Chongwenmennei Street, Dongcheng District, Beijing, China.
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14
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Israr M, DeVoti JA, Papayannakos CJ, Bonagura VR. Role of chemokines in HPV-induced cancers. Semin Cancer Biol 2022; 87:170-183. [PMID: 36402301 DOI: 10.1016/j.semcancer.2022.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
Human papillomaviruses (HPVs) cause cancers of the uterine cervix, oropharynx, anus, and vulvovaginal tract. Low-risk HPVs, such as HPV6 and 11, can also cause benign mucosal lesions including genital warts, and in patients with recurrent respiratory papillomatosis, lesions in the larynx, and on occasion, in the lungs. However, both high and less tumorigenic HPVs share a striking commonality in manipulating both innate and adaptive immune responses in HPV- infected keratinocytes, the natural host for HPV infection. In addition, immune/inflammatory cell infiltration into the tumor microenvironment influences cancer growth and prognosis, and this process is tightly regulated by different chemokines. Chemokines are small proteins and exert their biological effects by binding with G protein-coupled chemokine receptors (GPCRs) that are found on the surfaces of select target cells. Chemokines are not only involved in the establishment of a pro-tumorigenic microenvironment and organ-directed metastases but also involved in disease progression through enhancing tumor cell growth and proliferation. Therefore, having a solid grasp on chemokines and immune checkpoint modulators can help in the treatment of these cancers. In this review, we discuss the recent advances on the expression patterns and regulation of the main chemokines found in HPV-induced cancers, and their effects on both immune and non-immune cells in these lesions. Importantly, we also present the current knowledge of therapeutic interventions on the expression of specific chemokine and their receptors that have been shown to influence the development and progression of HPV-induced cancers.
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Affiliation(s)
- Mohd Israr
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States; The Department of Pediatrics, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - James A DeVoti
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States; The Department of Pediatrics, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Christopher J Papayannakos
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States; The Department of Pediatrics, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Vincent R Bonagura
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States; The Department of Pediatrics, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
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15
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Yeung V, Sackstein P, Grant NN, Krochmal R, Gandhi N, Aggarwal C, Halmos B, Reuss JE, Liu SV, Kim C. Use of Erdafitinib in FGFR3-Mutated Recurrent Respiratory Papillomatosis. JCO Precis Oncol 2022; 6:e2200435. [DOI: 10.1200/po.22.00435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Vincent Yeung
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Paul Sackstein
- Department of Internal Medicine, Georgetown University, Washington, DC
| | | | - Rebecca Krochmal
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Georgetown University, Washington, DC
| | | | - Charu Aggarwal
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Balazs Halmos
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Joshua E. Reuss
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Stephen V. Liu
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Chul Kim
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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The Drivers, Mechanisms, and Consequences of Genome Instability in HPV-Driven Cancers. Cancers (Basel) 2022; 14:cancers14194623. [PMID: 36230545 PMCID: PMC9564061 DOI: 10.3390/cancers14194623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/28/2022] Open
Abstract
Simple Summary Cells infected with high-risk human papillomaviruses (HPV) can accumulate DNA damage and eventually transform into HPV-driven cancers. Genome instability, or the progressive accumulation of DNA alterations (e.g., mutations), in HPV-infected cells is directly induced by the HPV genes and indirectly promoted by HPV infection through the consequences of chronic infection maintenance, increased cell growth, and accumulation of damaging mutations in genes that themselves affect genome instability. While the HPV genome typically exists as a separate entity within cells, genome instability increases the chances of HPV integrating within the host (human) genome, which is common in HPV-induced cancers. The DNA regions surrounding HPV integrations are unstable and can undergo complex alterations that affect both human and HPV genes. This review discusses HPV-dependent and -independent drivers and mechanisms of genome instability in HPV-driven cancers, both globally and around sites of HPV integration, and describes the changes induced in the tumour genome. Abstract Human papillomavirus (HPV) is the causative driver of cervical cancer and a contributing risk factor of head and neck cancer and several anogenital cancers. HPV’s ability to induce genome instability contributes to its oncogenicity. HPV genes can induce genome instability in several ways, including modulating the cell cycle to favour proliferation, interacting with DNA damage repair pathways to bring high-fidelity repair pathways to viral episomes and away from the host genome, inducing DNA-damaging oxidative stress, and altering the length of telomeres. In addition, the presence of a chronic viral infection can lead to immune responses that also cause genome instability of the infected tissue. The HPV genome can become integrated into the host genome during HPV-induced tumorigenesis. Viral integration requires double-stranded breaks on the DNA; therefore, regions around the integration event are prone to structural alterations and themselves are targets of genome instability. In this review, we present the mechanisms by which HPV-dependent and -independent genome instability is initiated and maintained in HPV-driven cancers, both across the genome and at regions of HPV integration.
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Potential Role for Active Hexose Correlated Compound (AHCC) in Treatment of Recurrent Respiratory Papillomatosis. J Voice 2022; 36:441-442. [PMID: 35773058 DOI: 10.1016/j.jvoice.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 11/23/2022]
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King RE, Ward-Shaw ET, Hu R, Lambert PF, Thibeault SL. Expanded Basal Compartment and Disrupted Barrier in Vocal Fold Epithelium Infected with Mouse Papillomavirus MmuPV1. Viruses 2022; 14:v14051059. [PMID: 35632798 PMCID: PMC9146965 DOI: 10.3390/v14051059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023] Open
Abstract
Laryngeal infection with low-risk human papillomaviruses can cause recurrent respiratory papillomatosis (RRP), a disease with severe effects on vocal fold epithelium resulting in impaired voice function and communication. RRP research has been stymied by limited preclinical models. We recently reported a murine model of laryngeal MmuPV1 infection and disease in immunodeficient mice. In the current study, we compare quantitative and qualitative measures of epithelial proliferation, apoptosis, differentiation, and barrier between mice with MmuPV1-induced disease of the larynx and surrounding tissues and equal numbers of uninfected controls. Findings supported our hypothesis that laryngeal MmuPV1 infection recapitulates many features of RRP. Like RRP, MmuPV1 increased proliferation in infected vocal fold epithelium, expanded the basal compartment of cells, decreased differentiated cells, and altered cell–cell junctions and basement membrane. Effects of MmuPV1 on apoptosis were equivocal, as with RRP. Barrier markers resembled human neoplastic disease in severe MmuPV1-induced disease. We conclude that MmuPV1 infection of the mouse larynx provides a useful, if imperfect, preclinical model for RRP that will facilitate further study and treatment development for this intractable and devastating disease.
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Affiliation(s)
- Renee E. King
- McArdle Laboratory for Cancer Research, Department of Oncology, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.E.K.); (E.T.W.-S.); (P.F.L.)
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Ella T. Ward-Shaw
- McArdle Laboratory for Cancer Research, Department of Oncology, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.E.K.); (E.T.W.-S.); (P.F.L.)
| | - Rong Hu
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Paul F. Lambert
- McArdle Laboratory for Cancer Research, Department of Oncology, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.E.K.); (E.T.W.-S.); (P.F.L.)
| | - Susan L. Thibeault
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53705, USA
- Correspondence:
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A Novel In Vivo Model of Laryngeal Papillomavirus-Associated Disease Using Mus musculus Papillomavirus. Viruses 2022; 14:v14051000. [PMID: 35632742 PMCID: PMC9147793 DOI: 10.3390/v14051000] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/01/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
Recurrent respiratory papillomatosis (RRP), caused by laryngeal infection with low-risk human papillomaviruses, has devastating effects on vocal communication and quality of life. Factors in RRP onset, other than viral presence in the airway, are poorly understood. RRP research has been stalled by limited preclinical models. The only known papillomavirus able to infect laboratory mice, Mus musculus papillomavirus (MmuPV1), induces disease in a variety of tissues. We hypothesized that MmuPV1 could infect the larynx as a foundation for a preclinical model of RRP. We further hypothesized that epithelial injury would enhance the ability of MmuPV1 to cause laryngeal disease, because injury is a potential factor in RRP and promotes MmuPV1 infection in other tissues. In this report, we infected larynges of NOD scid gamma mice with MmuPV1 with and without vocal fold abrasion and measured infection and disease pathogenesis over 12 weeks. Laryngeal disease incidence and severity increased earlier in mice that underwent injury in addition to infection. However, laryngeal disease emerged in all infected mice by week 12, with or without injury. Secondary laryngeal infections and disease arose in nude mice after MmuPV1 skin infections, confirming that experimentally induced injury is dispensable for laryngeal MmuPV1 infection and disease in immunocompromised mice. Unlike RRP, lesions were relatively flat dysplasias and they could progress to cancer. Similar to RRP, MmuPV1 transcript was detected in all laryngeal disease and in clinically normal larynges. MmuPV1 capsid protein was largely absent from the larynx, but productive infection arose in a case of squamous metaplasia at the level of the cricoid cartilage. Similar to RRP, disease spread beyond the larynx to the trachea and bronchi. This first report of laryngeal MmuPV1 infection provides a foundation for a preclinical model of RRP.
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20
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Daniels V, Saxena K, Patterson-Lomba O, Gomez-Lievano A, Saah A, Luxembourg A, Velicer C, Chen YT, Elbasha E. Modeling the health and economic implications of adopting a 1-dose 9-valent human papillomavirus vaccination regimen in a high-income country setting: An analysis in the United Kingdom. Vaccine 2022; 40:2173-2183. [PMID: 35232593 DOI: 10.1016/j.vaccine.2022.02.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/19/2021] [Accepted: 02/18/2022] [Indexed: 02/07/2023]
Abstract
Although no human papillomavirus (HPV) vaccine is indicated for single-dose administration, some observational evidence suggests that a 1-dose regimen might reduce HPV infection risk to that achieved with 2 doses. This study estimated the potential health and economic outcomes associated with switching from a 2-dose HPV vaccination program for girls and boys aged 13-14 years to an off-label 9-valent (9vHPV), 1-dose regimen, accounting for the uncertainty of the effectiveness and durability of a single dose. A dynamic HPV transmission infection and disease model was adapted to the United Kingdom and included a probabilistic sensitivity analysis using estimated distributions for duration of protection of 1-dose and degree of protection of 1 relative to 2 doses. One-way sensitivity analyses of key inputs were performed. Outcomes included additional cancer and disease cases and the difference in net monetary benefit (NMB). The 1-dose program was predicted to result in 81,738 additional HPV-related cancer cases in males and females over 100 years compared to the 2-dose program, ranging from 36,673 to 134,347 additional cases (2.5% and 97.5% quantiles, respectively), and had a 7.8% probability of being cost-effective at the £20,000/quality-adjusted life years willingness-to-pay (WTP) threshold. In one-way sensitivity analyses, the number of additional cancer cases was sensitive to the median of the duration of protection distribution and coverage rates. The differences in NMBs were sensitive to the median of the duration of protection distribution, dose price and discount rate, but not coverage variations. Across sensitivity analyses, the probability of 1 dose being cost-effective vs 2 doses was < 50% at the standard WTP threshold. Adoption of a 1-dose 9vHPV vaccination program resulted in more vaccine-preventable HPV-related cancer and disease cases in males and females, introduced substantial uncertainty in health and economic outcomes, and had a low probability of being cost-effective compared to the 2-dose program.
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Affiliation(s)
- Vincent Daniels
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Kunal Saxena
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | | | | | - Alfred Saah
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Alain Luxembourg
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Christine Velicer
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Ya-Ting Chen
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
| | - Elamin Elbasha
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
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Li SL, Wang W, Zhao J, Zhang FZ, Zhang J, Ni X. A review of the risk factors associated with juvenile-onset recurrent respiratory papillomatosis: genetic, immune and clinical aspects. World J Pediatr 2022; 18:75-82. [PMID: 35072893 DOI: 10.1007/s12519-021-00496-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is one of the most common benign lesions of hyperplastic respiratory epithelial tissue in children and is predominantly caused by human papillomaviruses (HPVs) 6 and 11. The clinical course of the disease is variable, and some patients even develop a malignancy. The purpose of this review was to summarize the related factors affecting the disease course in patients with JoRRP. DATA SOURCES We used databases, including PubMed and Google Scholar, to search for publications on factors associated with the genetic, immune, and clinical aspects of JoRRP. The most relevant articles to the scope of this review were chosen for analysis. RESULTS Mother-to-child transmission is the most important mode of disease transmission; other factors, such as immune condition or genetic susceptibility, may be important determinants of JoRRP occurrence. Genetically, the presence of DRB1*0301 and HPV 6/11 E6/E7 is associated with a more severe disease. Immunewise, patients have an enhanced T helper 2-like response. In addition, regulatory T cells are enriched in tumors and may become one of the effective prognostic indicators. For clinical characteristics, patients infected with HPV-11 have more aggressive disease. However, compared with HPV type, age at first onset is a more important factor related to the aggressiveness of JoRRP. Furthermore, socioeconomic status may also affect the course. CONCLUSIONS Genetic, immune, and some clinical factors have been noted to play an important role in the course of JoRRP. Exploring definite influencing factors will be an important direction of research in the future.
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Affiliation(s)
- Shi-Lan Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
| | - Wei Wang
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
| | - Jing Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
| | - Feng-Zhen Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China
| | - Jie Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China.
| | - Xin Ni
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, China.
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22
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Chantre-Justino M, Figueiredo MC, Alves G, Ornellas MHF. Prevalence of Epstein–Barr virus infection in recurrent respiratory papillomatosis and the influence on disease severity. Diagn Microbiol Infect Dis 2022; 103:115655. [DOI: 10.1016/j.diagmicrobio.2022.115655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
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Bertinazzi M, Gheit T, Polesel J, McKay-Chopin S, Cutrone C, Sari M, Sbaraglia M, Tos APD, Nicolai P, Tommasino M, Boscolo-Rizzo P. Clinical implications of alpha, beta, and gamma HPV infection in juvenile onset recurrent respiratory papillomatosis. Eur Arch Otorhinolaryngol 2022; 279:285-292. [PMID: 34453571 PMCID: PMC8738360 DOI: 10.1007/s00405-021-07040-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of our study was to evaluate the prevalence of different HPV genera-alpha, beta and gamma-in Juvenile onset Recurrent Respiratory Papillomatosis (JoRRP) and examine the association of type and genus-specific viral features with the clinical outcome of disease. METHODS This retrospective observational study included consecutive patients with JoRRP who were treated in a referral centre between October 2000 and October 2020. All patients underwent cold excision and laser vaporisation of papillomatous lesions. Samples were analysed for the presence of 120 viral genotypes (22 alpha-HPV, 46 beta-HPV, 52 gamma-HPV) using a highly sensitive multiplex genotyping assay. RESULTS Twenty patients with JoRRP, aged 0.3-11 years, were included, with a median follow-up of 13.5 years. All samples were HPV DNA positive: 20 (100%) for alpha-HPV DNA; 7 (35%) for beta-HPV DNA; 0 for gamma-HPV DNA. Three groups were defined according to the number of infections: seven cases (35%) with HPV mono-infection; ten cases (50%) with HPV double-infection; three cases (15%) with ≥ 3 HPV infections. At diagnosis, patients with ≥ 3 HPV infections reported higher median Derkay's score than those with mono-infection (21 vs 14, P = 0.018). Number of HPV infections was also associated with clinical outcomes, with an average of 0.5 surgical procedures/year in patients with mono-infection, 1.2 for double-infection, 2.6 for ≥ 3 infections (P = 0.006). CONCLUSION Despite the small sample size, these preliminary data support an association between the number of different alpha and beta HPV co-infections and the clinical severity of the disease.
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Affiliation(s)
- Martina Bertinazzi
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Tarik Gheit
- International Agency for Research On Cancer, Lyon, France
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro Di Riferimento Oncologico Di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Cesare Cutrone
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Marianna Sari
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Marta Sbaraglia
- Department of Medicine, Section of Pathology, University of Padova, Padova, Italy
| | - Angelo Paolo Dei Tos
- Department of Medicine, Section of Pathology, University of Padova, Padova, Italy
| | - Piero Nicolai
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy
| | | | - Paolo Boscolo-Rizzo
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy.
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
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Chantre-Justino M, Gonçalves da Veiga Pires I, Cardoso Figueiredo M, Dos Santos Moreira A, Alves G, Faria Ornellas MH. Genetic and methylation status of CDKN2A (p14 ARF/p16 INK4A) and TP53 genes in recurrent respiratory papillomatosis. Hum Pathol 2021; 119:94-104. [PMID: 34826422 DOI: 10.1016/j.humpath.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/21/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) is a rare and chronic disease affecting the upper airway with papillomatous lesions caused by the human papillomavirus (HPV) infection, especially HPV-6 and/or HPV-11 types. Little is known about the genetic and epigenetic drivers in RRP pathophysiology. For this purpose, we analyzed 27 papillomatous lesions from patients with RRP to evaluate somatic mutations and methylation status in CDKN2A (p14ARF/p16INK4A) and TP53, which are key tumor suppressor genes for the cell cycle control. Sanger sequencing analysis revealed one somatic mutation in TP53 (c.733_734insA) and four mutations in CDKN2A (c.-30G > T, c.29_30insA, c.69delT, and c.300C > A). These mutations were observed in 10 patients, 6 of which carried double mutation. Furthermore, 50% (5/10) of these patients carrying somatic mutations had RRP severity, representing 62.5% (5/8) of the severity cases in this study, albeit no significant association was found between somatic mutations and disease severity. Methylation-specific polymerase chain reaction assays revealed p14ARF promoter hypermethylation in 100% of cases, followed by TP53 (96.3%) and p16INK4A (55.6%), suggesting the influence of HPV in the DNA methylation machinery. In conclusion, somatic mutations were not common events identified in patients with RRP. However, epigenetic modulation by high methylation rates, particularly for the p14ARF/TP53 pathway, seems to be in the course of RRP development.
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Affiliation(s)
- Mariana Chantre-Justino
- Circulating Biomarkers Laboratory, Pathology Department, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro 20550-170, Brazil.
| | - Ingrid Gonçalves da Veiga Pires
- Circulating Biomarkers Laboratory, Pathology Department, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro 20550-170, Brazil
| | - Marcelo Cardoso Figueiredo
- Respiratory Endoscopy and Head and Neck Surgery Service at Hospital Federal de Bonsucesso, Rio de Janeiro 21041-030, Brazil
| | - Aline Dos Santos Moreira
- Laboratory of Functional Genomics and Bioinformatics, PTDIS/FIOCRUZ, Rio de Janeiro 21040-900, Brazil
| | - Gilda Alves
- Circulating Biomarkers Laboratory, Pathology Department, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro 20550-170, Brazil
| | - Maria Helena Faria Ornellas
- Circulating Biomarkers Laboratory, Pathology Department, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro 20550-170, Brazil
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Gluvajić D, Šereg-Bahar M, Jerin A, Janša R, Hočevar-Boltežar I. The Impact of Laryngopharyngeal Reflux on Occurrence and Clinical Course of Recurrent Respiratory Papillomatosis. Laryngoscope 2021; 132:619-625. [PMID: 34338331 DOI: 10.1002/lary.29793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES/HYPOTHESIS Laryngopharyngeal reflux (LPR) has been proposed both as a trigger for recurrent respiratory papillomatosis (RRP) onset and as a factor favoring an aggressive clinical course. STUDY DESIGN In this prospective study, 106 participants were recruited within a period of 24 months at the Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana. METHODS This study compared a group of RRP patients (N = 36) with a group of LPR patients (N = 28) and a group of healthy participants (N = 42) based on Reflux Symptom Index (RSI), Reflux Finding Scores (RFS), and saliva analyses (pH, pepsin concentration, bile acid concentration, and pepsin enzymatic activity). RESULTS The RRP group compared to the LPR group showed a statistically significant difference only in RSI and RFS scores, while the RRP group compared to healthy controls showed significantly higher values in all tested parameters (RSI score, RFS, saliva pH, pepsin concentration, bile acids concentration, pepsin enzymatic activity). CONCLUSIONS LPR is common in RRP patients and significantly more prevalent compared to healthy controls. Our results show that saliva analyses are a better office-based tool than RSI questionnaires and RFS scores for diagnosing LPR in RRP patients. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2021.
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Affiliation(s)
- Daša Gluvajić
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Maja Šereg-Bahar
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Aleš Jerin
- Institute of Chemistry and Biochemistry, University Medical Centre, Ljubljana, Slovenia
| | - Rado Janša
- Clinical Department of Gastroenterology, University Medical Centre, Ljubljana, Slovenia
| | - Irena Hočevar-Boltežar
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Donne AJ, Kinshuck A. Pharmacotherapy for recurrent respiratory papillomatosis (RRP): a treatment update. Expert Opin Pharmacother 2021; 22:1901-1908. [PMID: 34080517 DOI: 10.1080/14656566.2021.1935870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Recurrent respiratory papillomatosis is a rare human papillomavirus (HPV)-induced condition where warts grow within the airway and especially the larynx to effect voice and restrict breathing.Areas covered: A PubMed search using the following search terms was performed: respiratory papillomatosis and cidofovir, alpha-interferon, bevacizumab, PD1, and HPV vaccines. Surgery remains the mainstay of treatment. There has been a change in options available for adjuvant therapies with systemic bevacizumab and the potential benefits of prophylactic HPV vaccine. Despite efforts to identify a drug therapy to control RRP, no therapy yet remains which is predictable and effective in all. The current status of therapeutic vaccines and immunotherapy is discussed.Expert opinion: The current adjuvant therapies do offer a reasonable expectation of control but the effect for the individual is unpredictable despite the therapies being based on good science. The current therapies would allow an escalating treatment strategy to be formulated, however a single therapy is unlikely to be curative. Multi-center trials are required such that adequate numbers to show an effect are achieved.
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Affiliation(s)
- Adam J Donne
- Consultant Paediatric Otolaryngologist, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Andy Kinshuck
- Consultant in Otolaryngology/Head & Neck Surgery, Aintree University Hospital, Liverpool, UK
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27
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Perdana RF. Management of two cases of tracheobronchial management of two cases of tracheobronchial papillomatosis at tertiary hospital in Indonesia: A case report. Int J Surg Case Rep 2021; 83:106054. [PMID: 34090191 PMCID: PMC8188390 DOI: 10.1016/j.ijscr.2021.106054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance Tracheobronchial papillomatosis is an aggressive form of RRP with the spread of papillomas to the subglottis, trachea, bronchus and pulmonary parehchyma. Surgical operation for removing the papilloma is extremely difficult and need a lot of periodical bronchoscopy. Case presentation The first patient was a 25-year-old male who had an RRP history since the age of 6 months. Patients undergo papilloma cleaning surgery every 2 to 4 months. So far, the patient has undergone 88 operations. The frequency of surgery did not decrease even though the patient had reached adulthood. Moreover, the second patient was a 9-year-old woman suffering from RRP since the age of 6 months. The history of surgery has been carried out four times. The patient did not regularly go to the hospital. Consequently, the papilloma blocked the airway and the patient underwent tracheotomy at 3 years-old. A recent endoscopic examination showed papillomas growing in the trachea so that the tracheal stoma was maintained at this time to keep the upper airway patent and access for surgery. Clinical discussion Endoscopic removal surgery is required for larynx and tracheobronchial papillomas. Debulking through bronchoscopy regularly in order to maintain the airway patency. Tracheal stoma is needed for surgical access. Hence, accurate monitoring of disease progression and potential changes in malignancy is needed. Conclussion Tracheobronchial papillomatosis is very rare disease that needs periodically surgery for clean the tumor and monitoring the possibility for malignancy. Recurrent respiratory papillomatosis (RRP) Human Papillomavirus (HPV); type 6 and 11 Tracheobronchial system and lung parenchyma Endoscopic surgery is required on the larynx-trachea. Monitoring of disease progression and potential changes to malignancy is needed.
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Affiliation(s)
- Rizka Fathoni Perdana
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Hospital, Indonesia.
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28
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HPV Strain Predicts Severity of Juvenile-Onset Recurrent Respiratory Papillomatosis with Implications for Disease Screening. Cancers (Basel) 2021; 13:cancers13112556. [PMID: 34070981 PMCID: PMC8197133 DOI: 10.3390/cancers13112556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is the most common benign neoplasm of the larynx in children, presenting with significant variation in clinical course and potential for progression to malignancy. Since JoRRP is driven by human papillomavirus (HPV), we evaluated viral factors in a prospective cohort to identify predictive factors of disease severity. Twenty children with JoRRP undergoing routine debridement of papillomas were recruited and followed for ≥1 year. Demographical features, clinical severity scores, and surgeries over time were tabulated. Biopsies were used to establish a tissue bank and primary cell cultures for HPV6 vs. HPV11 genotyping and evaluation of viral gene expression. We found that patients with HPV11+ disease had an earlier age at disease onset, higher frequency of surgeries, increased number of lifetime surgeries, and were more likely to progress to malignancy. However, the amplitude of viral E6/E7 gene expression did not account for increased disease severity in HPV11+ patients. Determination of HPV strain is not routinely performed in the standard of care for JoRRP patients; we demonstrate the utility and feasibility of HPV genotyping using RNA-ISH for screening of HPV11+ disease as a biomarker for disease severity and progression in JoRRP patients.
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Simoens S, Bento-Abreu A, Merckx B, Joubert S, Vermeersch S, Pavelyev A, Varga S, Morais E. Health Impact and Cost-Effectiveness of Implementing Gender-Neutral Vaccination With the 9-Valent Human Papillomavirus Vaccine in Belgium. Front Pharmacol 2021; 12:628434. [PMID: 33912045 PMCID: PMC8072375 DOI: 10.3389/fphar.2021.628434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/09/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Routine human papillomavirus (HPV) immunization in Belgium is currently regionally managed, with school-aged girls receiving the 9-valent HPV (9vHPV) vaccine in Flanders and Wallonia-Brussels with a national catch-up program for females only. This study will assess whether expanding these programs to gender-neutral vaccination (GNV) with the 9vHPV vaccine is a cost-effective strategy in Belgium. Methods: A validated HPV-type transmission dynamic model estimated the potential health and economic impact of regional vaccination programs, comparing GNV versus female-only vaccination (FOV) with the 9vHPV vaccine in individuals aged 11-12 years in Flanders, GNV with the 9vHPV vaccine versus FOV with the 2-valent HPV (2vHPV) vaccine in individuals aged 12-13 years in Wallonia-Brussels, and national catch-up GNV versus FOV with the 9vHPV vaccine for those aged 12-18 years. Vaccination coverage rates of 90, 50, and 50% in both males and females were used in the base cases for the three programs, respectively, and sensitivity analyses were conducted. All costs are from the third-party payer perspective, and outcome measures were reported over a 100-year time horizon. Results: GNV with the 9vHPV vaccine was projected to decrease the cumulative incidence of HPV 6/11/16/18/31/33/45/52/58-related diseases relative to FOV in both Flanders and Wallonia-Brussels. Further reductions were also projected for catch-up GNV with the 9vHPV vaccine, including reductions of 6.8% (2,256 cases) for cervical cancer, 7.1% (386 cases) and 18.8% (2,784 cases) for head and neck cancer in females and males, respectively, and 30.3% (82,103 cases) and 44.6% (102,936 cases) for genital warts in females and males, respectively. As a result, a GNV strategy would lead to reductions in HPV-related deaths. Both regional and national catch-up GNV strategies were projected to reduce cumulative HPV-related disease costs and were estimated to be cost-effective compared with FOV with incremental cost-effectiveness ratios of €8,062, €4,179, and €6,127 per quality-adjusted life-years in the three programs, respectively. Sensitivity analyses were consistent with the base cases. Conclusions: A GNV strategy with the 9vHPV vaccine can reduce the burden of HPV-related disease and is cost-effective compared with FOV for both regional vaccination programs and the national catch-up program in Belgium.
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Affiliation(s)
- Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | | | | | | | | | - Andrew Pavelyev
- Merck & Co., Inc., Kenilworth, NJ, United States
- HCL America, Inc., Sunnyvale, CA, United States
| | - Stefan Varga
- Merck & Co., Inc., Kenilworth, NJ, United States
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30
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Lépine C, Klein P, Voron T, Mandavit M, Berrebi D, Outh-Gauer S, Péré H, Tournier L, Pagès F, Tartour E, Le Meur T, Berlemont S, Teissier N, Carlevan M, Leboulanger N, Galmiche L, Badoual C. Histological Severity Risk Factors Identification in Juvenile-Onset Recurrent Respiratory Papillomatosis: How Immunohistochemistry and AI Algorithms Can Help? Front Oncol 2021; 11:596499. [PMID: 33763347 PMCID: PMC7982831 DOI: 10.3389/fonc.2021.596499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/12/2021] [Indexed: 11/23/2022] Open
Abstract
Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a condition characterized by the repeated growth of benign exophytic papilloma in the respiratory tract. The course of the disease remains unpredictable: some children experience minor symptoms, while others require multiple interventions due to florid growth. Our study aimed to identify histologic severity risk factors in patients with JoRRP. Forty-eight children from two French pediatric centers were included retrospectively. Criteria for a severe disease were: annual rate of surgical endoscopy ≥ 5, spread to the lung, carcinomatous transformation or death. We conducted a multi-stage study with image analysis. First, with Hematoxylin and eosin (HE) digital slides of papilloma, we searched for morphological patterns associated with a severe JoRRP using a deep-learning algorithm. Then, immunohistochemistry with antibody against p53 and p63 was performed on sections of FFPE samples of laryngeal papilloma obtained between 2008 and 2018. Immunostainings were quantified according to the staining intensity through two automated workflows: one using machine learning, the other using deep learning. Twenty-four patients had severe disease. For the HE analysis, no significative results were obtained with cross-validation. For immunostaining with anti-p63 antibody, we found similar results between the two image analysis methods. Using machine learning, we found 23.98% of stained nuclei for medium intensity for mild JoRRP vs. 36.1% for severe JoRRP (p = 0.041); and for medium and strong intensity together, 24.14% for mild JoRRP vs. 36.9% for severe JoRRP (p = 0.048). Using deep learning, we found 58.32% for mild JoRRP vs. 67.45% for severe JoRRP (p = 0.045) for medium and strong intensity together. Regarding p53, we did not find any significant difference in the number of nuclei stained between the two groups of patients. In conclusion, we highlighted that immunochemistry with the anti-p63 antibody is a potential biomarker to predict the severity of the JoRRP.
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Affiliation(s)
- Charles Lépine
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Pathology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | | | | | | | | | - Sophie Outh-Gauer
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Pathology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Hélène Péré
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Virology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Louis Tournier
- Department of Pathology, Hôpital Robert Debré, APHP, Paris, France
| | - Franck Pagès
- Department of Immunology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Eric Tartour
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Immunology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | | | | | - Natacha Teissier
- Department of Pediatric ENT Surgery, Hôpital Robert Debré, APHP, Paris, France
| | - Mathilde Carlevan
- Department of Pediatric ENT Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Nicolas Leboulanger
- Department of Pediatric ENT Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Louise Galmiche
- Department of Pathology, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Cécile Badoual
- INSERM-U970, PARCC, Université de Paris, Paris, France.,Department of Pathology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
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31
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Bosco L, Serra N, Fasciana T, Pistoia D, Vella M, Di Gregorio L, Schillaci R, Perino A, Calagna G, Firenze A, Capra G. Potential impact of a nonavalent anti HPV vaccine in Italian men with and without clinical manifestations. Sci Rep 2021; 11:4096. [PMID: 33603082 PMCID: PMC7892856 DOI: 10.1038/s41598-021-83639-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 01/27/2021] [Indexed: 11/09/2022] Open
Abstract
Human papilloma virus infection (HPV) is the most common sexually transmitted disease. Little is known about male infection. Nonavalent vaccine against types 6/11/16/18/31/33/45/52/58 was approved and neutral gender immunization programs have been proposed. This study evaluates the potential impact of nonavalent vaccine compared to quadrivalent in male living in Sicily (Italy). 58.7% of samples were HPV positive and forty-four types of HPV were identified. A significant higher estimated coverage of nonavalent vaccine than quadrivalent was observed (64.3% vs. 45.8%), with absolute and relative additional impact of 20.1% and 47.2%, respectively. Low impact of the vaccine were calculated as the empirical probability of HPV genotypes 6/11/16/18/31/33/45/52/58 alone or in combination; the high impact as empirical probability of HPV6/11/16/18/31/33/45/52/58 genotypes alone or in association with other genotypes. The potential impact of the nonavalent vaccine vs quadrivalent was significant for low and high impact (29.7% > 18:8%; 34:6% > 26.6%, respectively). Particularly, in men with lesions and risky sexual contact was significant only for low impact (35.5% > 29.7%; 31.4% > 19.7%, respectively). In partners with positive females was significant for low impact (26.3% > 15.1%) and high impact (33.7% > 23.2%). Nonavalent vaccine offers broader protection in men with HPV positive partners, who would have a potential role in the transmission of the infection.
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Affiliation(s)
- Liana Bosco
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), Section of Biology and Genetics, University of Palermo, Palermo, Italy
| | - Nicola Serra
- Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, Naples, Italy
| | - Teresa Fasciana
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) "G. D'Alessandro", University of Palermo, Via del Vespro, 133, 90127, Palermo, Italy
| | - Daniela Pistoia
- UOC of Microbiology, Virology and Parasitology, Polyclinic Hospital, Palermo, Italy
| | - Marco Vella
- Section of Urology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Leonardo Di Gregorio
- UOC of Urology and Extracorporeal Lithotripsy, Polyclinic Hospital, Palermo, Italy
| | - Rosaria Schillaci
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) "G. D'Alessandro", University of Palermo, Via del Vespro, 133, 90127, Palermo, Italy
| | - Antonino Perino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) "G. D'Alessandro", University of Palermo, Via del Vespro, 133, 90127, Palermo, Italy
| | - Gloria Calagna
- Villa Sofia Cervello Hospital, University of Palermo, Palermo, Italy
| | - Alberto Firenze
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) "G. D'Alessandro", University of Palermo, Via del Vespro, 133, 90127, Palermo, Italy
| | - Giuseppina Capra
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) "G. D'Alessandro", University of Palermo, Via del Vespro, 133, 90127, Palermo, Italy.
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Yang Q, Li Y, Ma L, Xiao Y, Wang H, Ding Y, Hu R, Wang X, Meng L, Wang J, Xu W. Long-term Outcomes of Juvenile Onset Recurrent Respiratory Papillomatosis with Pulmonary Involvement. Laryngoscope 2021; 131:EE2277-E2283. [PMID: 33411979 DOI: 10.1002/lary.29376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the clinical characteristics and long-term outcomes of juvenile onset recurrent respiratory papillomatosis (JORRP) with or without pulmonary involvement. METHODS A group of patients with JORRP who had clinical course over an extended period of time (at least 5 years) in the Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital were included in this retrospective study. Lung/bronchus involvement was revealed by lung imaging. Data on mortality rate, frequency of surgical interventions, and age of disease onset were collected and analyzed. RESULTS The 192 patients (107 male and 85 female) included had a median [quartiles] age of JORRP onset of 2 [1, 4] years, and median follow-up duration of 10 [7, 13] years; 17 patients (8.9%) had papilloma with bronchial and pulmonary involvement 7.0 [4.0, 12.5] years after the onset of the disease. Compared to patients without lung involvement, patients with lung involvement had a younger age of disease onset (P = .001), higher frequency of surgical interventions (P < .001), higher mortality rate (OR = 94.909), and an increased risk of tracheotomy that could not be decannulated (P < .001). They also had a younger age of disease onset, and a higher frequency of surgical interventions and mortality compared to patients with tracheotomy but free from lung involvement (P < .001). CONCLUSIONS Children with JORRP and with pulmonary involvement have a higher average number of operations per year than those without pulmonary involvement, and pulmonary involvement indicates a higher incidence of tracheotomy that cannot be decannulated. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2277-E2283, 2021.
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Affiliation(s)
- Qingwen Yang
- Department of Otolaryngology Head and Neck Surgery. Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing, China
| | - Yanru Li
- Department of Otolaryngology Head and Neck Surgery. Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing, China
| | - Lijing Ma
- Department of Otolaryngology Head and Neck Surgery. Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing, China
| | - Yang Xiao
- Department of Otolaryngology Head and Neck Surgery. Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing, China
| | - Huijun Wang
- Department of Otolaryngology Head and Neck Surgery. Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing, China
| | - Yiming Ding
- Department of Otolaryngology Head and Neck Surgery. Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing, China
| | - Rong Hu
- Department of Otolaryngology Head and Neck Surgery. Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing, China
| | - Xiaoyi Wang
- Department of Otolaryngology Head and Neck Surgery. Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing, China
| | - Lingzhen Meng
- Western University of Health Sciences, Pomona, California, U.S.A
| | - Jun Wang
- Department of Otolaryngology Head and Neck Surgery. Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing, China
| | - Wen Xu
- Department of Otolaryngology Head and Neck Surgery. Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing, China
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33
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Gluvajić D, Hošnjak L, Stegel V, Novaković S, Gale N, Poljak M, Boltežar IH. Risk factors for the development of high-grade dysplasia and carcinoma in patients with laryngeal squamous cell papillomas: Large retrospective cohort study. Head Neck 2020; 43:956-966. [PMID: 33289174 DOI: 10.1002/hed.26560] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/16/2020] [Accepted: 11/18/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The incidence and risk factors for the development of high-grade dysplasia (HG-D) and laryngeal squamous cell carcinoma (LSCC) were assessed in patients with laryngeal squamous cell papillomas (LSP). METHODS Clinical data, human papillomaviruses (HPV) typing, HPV E6/E7 mRNA in situ hybridization, and sequencing of host genes in LSP biopsies of 163 patients were analyzed. RESULTS Progression to HG-D and LSCC was identified in 21.5% and 4.3% of LSP patients, respectively. A more advanced age at LSP onset and lack of HPV infection were detected as risk factors for the development of HG-D and LSCC (P < .05). The identification of HG-D was associated with its progression to LSCC (P < .05). Host gene mutations were identified in 3 of 7 patients with LSCC. CONCLUSIONS The histological monitoring of LSP and HPV typing are necessary for early detection of epithelial changes. Further research is needed to elucidate the role of host gene mutations in LSCC transformation.
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Affiliation(s)
- Daša Gluvajić
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Lea Hošnjak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Vida Stegel
- Department of Molecular Diagnostics, Institute of Oncology, Ljubljana, Slovenia
| | - Srdjan Novaković
- Department of Molecular Diagnostics, Institute of Oncology, Ljubljana, Slovenia
| | - Nina Gale
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Irena Hočevar Boltežar
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia
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Lépine C, Voron T, Berrebi D, Mandavit M, Nervo M, Outh-Gauer S, Péré H, Tournier L, Teissier N, Tartour E, Leboulanger N, Galmiche L, Badoual C. Juvenile-Onset Recurrent Respiratory Papillomatosis Aggressiveness: In Situ Study of the Level of Transcription of HPV E6 and E7. Cancers (Basel) 2020; 12:cancers12102836. [PMID: 33019611 PMCID: PMC7601884 DOI: 10.3390/cancers12102836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a condition related to HPV 6 and 11 infection which is characterized by the repeated growth of benign exophytic papilloma in the respiratory tract of children. Disease progression is unpredictable leading sometimes to airway compromise and death. The aim of this study was to explore p16INK4a and expression of the RNA of HPV genes E6 and E7 with a chromogenic in situ hybridization (CISH) as biomarkers of JoRRP aggressiveness on a bicentric cohort of forty-eight children. CISH was scored semi-quantitatively as high (2+ score) and low (1+ score) levels of transcription of E6 and E7. Patients with a 2+ score had a more aggressive disease compared to those with a 1+ score. These data are a first step towards the use of biomarkers predictive of disease severity in JoRRP, this could improve the disease management, for example, by implementing adjuvant treatment at the early stages. Abstract Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a condition related to HPV 6 and 11 infection which is characterized by the repeated growth of benign exophytic papilloma in the respiratory tract. Disease progression is unpredictable: some children experience minor symptoms, while others require multiple interventions due to florid growth. The aim of this study was to explore the biomarkers of JoRRP severity on a bicentric cohort of forty-eight children. We performed a CISH on the most recent sample of papilloma with a probe targeting the mRNA of the E6 and E7 genes of HPV 6 and 11 and an immunostaining with p16INK4a antibody. For each patient HPV RNA CISH staining was assessed semi-quantitatively to define two scores: 1+, defined as a low staining extent, and 2+, defined as a high staining extent. This series contained 19 patients with a score of 1+ and 29 with a score of 2+. Patients with a score of 2+ had a median of surgical excision (SE) per year that was twice that of patients with a score of 1+ (respectively 6.1 versus 2.8, p = 0.036). We found similar results with the median number of SE the first year. Regarding p16INK4a, all patients were negative. To conclude, HPV RNA CISH might be a biomarker which is predictive of disease aggressiveness in JoRRP, and might help in patient care management.
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Affiliation(s)
- Charles Lépine
- Department of Pathology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France; (C.L.); (M.N.); (S.O.-G.)
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Thibault Voron
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Dominique Berrebi
- Department of Pathology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France; (D.B.); (L.T.)
| | - Marion Mandavit
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Marine Nervo
- Department of Pathology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France; (C.L.); (M.N.); (S.O.-G.)
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Sophie Outh-Gauer
- Department of Pathology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France; (C.L.); (M.N.); (S.O.-G.)
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
| | - Hélène Péré
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
- Department of Virology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France
| | - Louis Tournier
- Department of Pathology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France; (D.B.); (L.T.)
| | - Natacha Teissier
- Department of Pediatric ENT Surgery, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France;
| | - Eric Tartour
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
- Department of Immunology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France
| | - Nicolas Leboulanger
- Department of Pediatric ENT Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France;
| | - Louise Galmiche
- Department of Pathology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France;
| | - Cécile Badoual
- Department of Pathology, European Hospital Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France; (C.L.); (M.N.); (S.O.-G.)
- Université de Paris, PARCC, INSERM-U970, F-75015 Paris, France; (T.V.); (M.M.); (H.P.); (E.T.)
- Correspondence: ; Tel.: +33-156-093-888
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Farahmand Z, Soleimanjahi H, Garshasbi M, Hasanzadeh M, Zafari E. Distribution of the most common types of HPV in Iranian women with and without cervical cancer. Women Health 2020; 61:73-82. [PMID: 32957835 DOI: 10.1080/03630242.2020.1822490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cervical cancer is an important cause of death in women worldwide. About 99.7% of all cervical cancers have been related to human papillomavirus, especially types 16 and 18. Types 6 and 11 cause genital warts. We aimed to determine the prevalence of common HPV genotypes among women in the general population and women with cervical cancer. A total of 571 healthy women cytology specimens and 113 tissue samples of cervical cancer were investigated using HPV type-specific primers. HPV DNA was detected in 24% of healthy women: 3.3% were positive for high-risk HPV and 11.6% for low-risk HPV. HPV6 (9.3%) had the highest prevalence followed by HPV11 (2.3%), HPV16 (1.8%), HPV18 (1.2%), and 9.1% of samples were positive for unknown types. Among cervical cancer samples, HPV DNA was found in 78.8% including 43.4% HPV16, 8% HPV18, and 27.4% an unknown HPV type. HPV6 and HPV11 were not detected in any cervical cancer cases and 21.2% were negative for HPV. We found no association between HPV-16/18 and age in cervical cancer. The prevalence of HPV infection is relatively high in Iran without vaccination backgrounds. HPV DNA screening and vaccination programs can prevent cervical cancer and health problems caused by genital warts.
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Affiliation(s)
- Zohreh Farahmand
- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University , Tehran, Iran
| | - Hoorieh Soleimanjahi
- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University , Tehran, Iran
| | - Masoud Garshasbi
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University , Tehran, Iran
| | - Malihe Hasanzadeh
- Department of Gynecology Oncology, Woman Health Research Center, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Ehsan Zafari
- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University , Tehran, Iran
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Nogueira RL, Küpper DS, do Bonfim CM, Aragon DC, Damico TA, Miura CS, Passos IM, Nogueira ML, Rahal P, Valera FCP. HPV genotype is a prognosticator for recurrence of respiratory papillomatosis in children. Clin Otolaryngol 2020; 46:181-188. [PMID: 32869523 DOI: 10.1111/coa.13640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/03/2020] [Accepted: 08/16/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to compare the prognosis according to age, genotype or human papillomavirus (HPV) variant in patients with recurrent respiratory papillomatosis (RRP). DESIGN Non-concurrent cohort. PARTICIPANTS Forty one patients with RRP. SETTING Tertiary referral hospital. MAIN OUTCOME MEASURES Disease severity was defined by the number of surgeries performed, and Derkay score at surgeries, obtained from medical records. HPV was detected and genotyped, and HPV-6 variants were also assessed. RESULTS Fifteen (36.58%) individuals belonged to the juvenile RRP group (JoRRP, less than 18 years), while 26 patients (63.41%) were allocated at the adult group (AoRRP, equal or more than 18 years). JoRRP patients needed, in average, a higher number of surgeries to control the disease than AoRRP patients (mean difference: 3.36). Also, JoRRP patients showed a higher Derkay score at each surgery (mean difference: 3.76). There was no significant difference in the number of surgeries when we compared patients infected with HPV-6 or HPV-11, neither in accordance to HPV-6 variants. Patients with HPV-11 presented a higher mean Derkay score at surgery than those with HPV-6 (mean difference: 4.39); when co-variated by age, we observed that this difference occurred only among JoRRP patients (mean difference: 6.15). CONCLUSIONS Age of onset of RRP has an important impact on number of surgeries to control disease. Patients with JoRRP and HPV-11 tend to present worse Derkay score at each surgery. HPV genotype among adults and HPV-6 variants had no impact on the outcome of the disease.
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Affiliation(s)
- Rodrigo L Nogueira
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Daniel S Küpper
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Caroline M do Bonfim
- Department of Biology, IBILCE, Institute of Bioscience, Language & Literature and Exact Science, University of São Paulo State (UNESP), Sao Jose do Rio Preto, Brazil
| | - Davi C Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Thiago A Damico
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Carolina S Miura
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Ivna M Passos
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
| | - Maurício L Nogueira
- Laboratory of Research in Virology, School of Medicine of São José do Rio Preto, FAMERP, Sao Jose do Rio Preto, Brazil
| | - Paula Rahal
- Department of Biology, IBILCE, Institute of Bioscience, Language & Literature and Exact Science, University of São Paulo State (UNESP), Sao Jose do Rio Preto, Brazil
| | - Fabiana C P Valera
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirao Preto, Brazil
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Swain S, Mohanty S, Nahak B, Sahu M. Recurrent respiratory papillomatosis: A challenging clinical entity. APOLLO MEDICINE 2020. [DOI: 10.4103/am.am_45_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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38
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Costa V, El-Achkar VN, de Barros PP, León JE, Ribeiro-Silva A, Carlos R, Pignatari SSN, Ferreira S, Mello BP, Sichero L, Villa LL, Kaminagakura E. Role of epstein-barr virus in the severity of recurrent respiratory papillomatosis. Laryngoscope 2019; 130:E611-E618. [PMID: 31860132 DOI: 10.1002/lary.28465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/08/2019] [Accepted: 11/26/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective was to investigate the prevalence of the Epstein-Barr virus (EBV) and its association with human papilloma virus (HPV) detection, clinicopathological features, and the severity of recurrent respiratory papillomatosis (RRP). METHODS Cases of juvenile recurrent respiratory papillomatosis (JRRP) (n = 36) and adult recurrent respiratory papillomatosis (ARRP) (n = 44) were collected retrospectively and subdivided into low- and high-risk severity groups based on the Derkay score. We performed HPV detection and genotyping using a reverse hybridization protocol and investigated the presence of EBV by polymerase chain reaction (PCR) and in situ hybridization. CD21 levels were accessed by immunohistochemistry. RESULTS All samples were HPV-positive, including 49 cases of HPV 6, 26 cases of HPV 11, four cases of HPV 6 and 11 coinfections, and one case of HPV 16. EBV-DNA was detected in nine samples by PCR, although none of the cases were positive by means of in situ hybridization. CD21 immunoexpression was not statistically associated with any of the variables analyzed. HPV 6 detection was significantly higher in ARRP cases (P = 0.03), whereas HPV 11 was more prevalent in JRRP cases (P = 0.02) and was even more prevalent in JRRP cases of greater severity (Derkay laryngoscopic scale ≥20) (P = 0.04). CONCLUSION The presence of EBV does not seem to play an important role in the progression/severity of RRP. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E611-E618, 2020.
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Affiliation(s)
- Victor Costa
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | - Vivian Narana El-Achkar
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | - Patrícia Pimentel de Barros
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | - Jorge Esquiche León
- Department of Stomatology, Collective Health and Legal Dentistry, Ribeirão Preto School of Dentistry, São Paulo, Brazil
| | - Alfredo Ribeiro-Silva
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Román Carlos
- Centro Clínico de Cabeza y Cuello, Guatemala City, Guatemala
| | | | - Silvaneide Ferreira
- Center for Translational Investigation in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Barbara Pereira Mello
- Department of Radiology and Oncology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Laura Sichero
- Center for Translational Investigation in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luisa Lina Villa
- Center for Translational Investigation in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Department of Radiology and Oncology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Benboujja F, Bowe S, Boudoux C, Hartnick C. Utility of Optical Coherence Tomography for Guiding Laser Therapy Among Patients With Recurrent Respiratory Papillomatosis. JAMA Otolaryngol Head Neck Surg 2019; 144:831-837. [PMID: 30098151 DOI: 10.1001/jamaoto.2018.1375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Recurrent respiratory papillomatosis (RRP) is a viral-induced disease caused by human papillomavirus and the second leading cause of dysphonia in children; however, neither a cure nor a definitive surgical treatment is currently available for RRP. Although laser therapy is often used in the treatment of RRP, the lack of real-time laser-tissue interaction feedback undermines the ability of physicians to provide treatments with low morbidity. Therefore, an intraoperative tool to monitor and control laser treatment depth is needed. Objective To investigate the potential of combining optical coherence tomography (OCT) with laser therapy for patient-tailored laryngeal RRP treatments. Design, Setting, and Participants This in vivo study was performed at the Massachusetts Eye and Ear Infirmary from February 1, 2017, to September 1, 2017. Three-dimensional OCT images were acquired before, during, and after photoangiolytic laser therapy in 10 pediatric patients with a history of papilloma growth who presented with lesions and hoarseness. Main Outcomes and Measures Whether intraoperative OCT monitoring of changes in optical scattering and absorption provides quantitative information to control thermal damage in tissue. Results Among the 10 pediatric patients (age range, 4-11 years; 6 male) included in the study, high-resolution OCT images revealed epithelial hyperplasia with clear RRP lesion margins. Images acquired during therapy indicated coagulation deep in tissue, and posttherapy images showed the ability to quantify the amount of tissue ablated by the photoangiolytic laser. Conclusions and Relevance Concurrent use of OCT imaging and laser therapy may improve postoperative outcomes for patients with RRP by delivering an optimal, patient-tailored treatment. Additional studies investigating the correlation between optical properties with vocal outcomes are required.
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Affiliation(s)
- Fouzi Benboujja
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Sarah Bowe
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Caroline Boudoux
- Engineering Physics Department, Polytechnique Montreal, Montreal, Quebec, Canada
| | - Christopher Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston
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Chen Z, Li Q, Huang J, Li J, Yang F, Min X, Chen Z. E6 and E7 gene polymorphisms in human papillomavirus Type-6 identified in Southwest China. Virol J 2019; 16:114. [PMID: 31511025 PMCID: PMC6740006 DOI: 10.1186/s12985-019-1221-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus type-6 (HPV6) is the major etiological agent of anogenital warts both men and women. The present study aimed to characterize the genetic diversity among HPV6 in Southwest China, and to investigate the origin of, selective pressure experienced by, and impact of the resultantly identified genetic variants on the HPV6 secondary structure. METHODS Phylogenetic trees were constructed by Maximum-likelihood and the Kimura 2-parameters methods by Molecular Evolutionary Genetics Analysis version 6.0. The diversity of secondary structure was analyzed by PSIPred software. The selection pressures acting on the E6/E7 genes were estimated by Phylogenetic Analyses by Maximum Likelihood version 4.8 software. RESULTS HPV6 was the most prevalent low risk HPV type in southwest China. In total, 143 E6 and E7 gene sequences of HPV6 isolated from patients were sequenced and compared to GenBank HPV6 reference sequence X00203. The results of these analyses revealed that both the HPV6 E6 and E7 were highly conserved within the analyzed patient samples, and comprised only 3 types of variant sequence, respectively. Furthermore, the analysis of HPV6 E6 and E7 sequences revealed seven/five single-nucleotide mutations, two/four and five/one of which were non-synonymous and synonymous, respectively. The phylogenetic analyses of the E6 and E7 sequences indicated that they belonged to sub-lineage A1 and sub-lineage B1, whereas the selective pressure analyses showed that only the E7 mutation sites 4R, 34E, and 52F were positive selection. CONCLUSIONS HPV6 (detection rate = 13.10%) was very prevalent in southwest China, both the HPV6 E6 and E7 sequences were highly conserved within the analyzed patient samples in southwest China, indicating that the low risk HPV6 can adapt to the environment well without much evolution.
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Affiliation(s)
- Zuyi Chen
- Department of Laboratory medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People's Republic of China.,Bio-resource Research and Utilization Joint Key Laboratory of Sichuan and Chongqing, Chongqing, Sichuan, People's Republic of China
| | - Qiongyao Li
- Bio-resource Research and Utilization Joint Key Laboratory of Sichuan and Chongqing, Chongqing, Sichuan, People's Republic of China.,Department of Information Technology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People's Republic of China
| | - Jian Huang
- Department of Laboratory medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People's Republic of China
| | - Jin Li
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People's Republic of China
| | - Feng Yang
- Department of Information Technology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People's Republic of China
| | - Xun Min
- Department of Laboratory medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People's Republic of China.
| | - Zehui Chen
- Department of Laboratory medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People's Republic of China
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Lazcano-Ponce E, Sudenga SL, Torres BN, Stoler M, León-Maldonado L, Allen-Leigh B, Posso H, Quiterio M, Hernández-Nevarez MDP, Salmerón J, Giuliano AR. Incidence of external genital lesions related to human papillomavirus among Mexican men. A cohort study. SALUD PUBLICA DE MEXICO 2019; 60:633-644. [PMID: 30699268 DOI: 10.21149/8461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 09/18/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To determine external genital lesion (EGL) incidence -condyloma and penile intraepithelial neoplasia (PeIN)- and genital HPV-genotype progression to these EGLs. MATERIALS AND METHODS Participants (healthy males 18- 74y from Cuernavaca, Mexico, recruited 2005-2009, n=954) underwent a questionnaire, anogenital examination, and sample collection every six months;including excision biopsy on suspicious EGL with histological confirmation.Linear array assay PCR characterized 37 high/low-risk HPV-DNA types. EGL incidence and cumulative incidence were calculated, the latter with Kaplan-Meier. RESULTS EGL incidence was 1.84 (95%CI=1.42-2.39) per 100-person-years (py); 2.9% (95%CI=1.9-4.2) 12-month cumulative EGL.Highest EGL inci- dence was found in men 18-30 years:1.99 (95%CI=1.22-3.25) per 100py. Seven subjects had PeIN I-III (four with HPV16). HPV11 most commonly progresses to condyloma (6-month cumulative incidence=44.4%, 95%CI=14.3-137.8). Subject with high-risk sexual behavior had higher EGL incidence. CONCLUSIONS In Mexico, anogenital HPV infection in men is high and can cause condyloma. Estimation of EGL magnitude and associated healthcare costs is necessary to assess the need for male anti-HPV vaccination.
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Affiliation(s)
- Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico
| | - Staci L Sudenga
- Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute.Tampa, Florida
| | - B Nelson Torres
- Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute.Tampa, Florida
| | - Mark Stoler
- University of Virginia Health System. Charlottesville, VA, USA
| | - Leith León-Maldonado
- Cátedra Conacyt, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Betania Allen-Leigh
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Héctor Posso
- Universidad de la Sabana. Chia-Cundinamarca, Colombia
| | - Manuel Quiterio
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico
| | | | - Jorge Salmerón
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico.,Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social. Cuernavaca, Morelos, México
| | - Anna R Giuliano
- Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute.Tampa, Florida
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Mennini FS, Fabiano G, Favato G, Sciattella P, Bonanni P, Pinto C, Marcellusi A. Economic burden of HPV9-related diseases: a real-world cost analysis from Italy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:829-840. [PMID: 30900047 DOI: 10.1007/s10198-019-01044-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 03/14/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The objectives of this study were to estimate the economic burden of HPV in Italy, accounting for total direct medical costs associated with nine major HPV-related diseases, and to provide a measure of the burden attributable to HPV 6, 11, 16, 18, 31, 33, 45, 52, 58 infections. METHODS A cost-of-illness incidence-based model was developed to estimate the incidences and costs of invasive cervical cancer, cervical dysplasia, cancer of the vulva, vagina, anus, penis, oropharyngeal, anogenital warts, and recurrent respiratory papillomatosis (RRP) in the context of the Italian National Health System (NHS). We used data from hospital discharge records (HDRs) of an Italian region and conducted a systematic literature review to estimate the lifetime cost per case, the number of incident cases, the prevalence of HPV9 types. Costs of therapeutic options not included in the diagnosis-related group (DRG) tariffs were estimated through a scenario analysis. RESULTS In 2018, the total annual direct costs were €542.7 million, with a range of €346.7-€782.0 million. These costs could increase considering innovative therapies for cancer treatment (range €16.2-€37.5 million). The fraction attributable to the HPV9 genotypes without innovative cancers treatment was €329.5 million, accounting for 61% of the total annual burden of HPV-related diseases in Italy. Of this amount, €135.9 million (41%) was related to men, accounting for 64% of the costs associated with non-cervical conditions. CONCLUSIONS The infections by HPV9 strains and the economic burden of non-cervical HPV-related diseases in men were found to be the main drivers of direct costs.
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Affiliation(s)
- F S Mennini
- Economic Evaluation and HTA (EEHTA)-CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
- Institute for Leadership and Management in Health, Kingston University, London, UK
| | - Gianluca Fabiano
- Economic Evaluation and HTA (EEHTA)-CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy.
- Institute for Leadership and Management in Health, Kingston University, London, UK.
| | - G Favato
- Institute for Leadership and Management in Health, Kingston University, London, UK
| | - P Sciattella
- Economic Evaluation and HTA (EEHTA)-CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
| | - P Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - C Pinto
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - A Marcellusi
- Economic Evaluation and HTA (EEHTA)-CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
- Institute for Leadership and Management in Health, Kingston University, London, UK
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Figueiredo MC, Justino MC, Delmonico L, Silvestre RT, de Castro TL, dos Santos Moreira A, Macedo JMB, da Costa Carvalho MDG, Scherrer L, de Medeiros Lima DJM, Alves G, Ornellas MH. Prevalence and clinical implications of low-risk human papillomavirus among patients with recurrent respiratory papillomatosis in Rio de Janeiro, Brazil. Auris Nasus Larynx 2019; 46:570-575. [DOI: 10.1016/j.anl.2018.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/30/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
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Experimental research on the therapeutic effect of MMR vaccine to juvenile-onset recurrent respiratory papillomatosis. Eur Arch Otorhinolaryngol 2019; 276:801-803. [PMID: 30806807 DOI: 10.1007/s00405-019-05351-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/17/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the efficacy of MMR vaccine in the treatment of juvenile-onset recurrent respiratory papillomatosis as adjuvant therapy by experimental research. METHODS Thirty-one children with RRP were enrolled and assigned randomly to intervention group or control group. Fifteen subjects in intervention group were treated with local application MMR vaccine on the lesion after surgery; sixteen subjects in the control group were treated with surgical excision alone. The quantity of virus of positive specimens was measured by fluorescence quantitative polymerase chain reaction. RESULTS After treatment with MMR vaccine, viral load of intervention group was (9.56 ± 11.03) × 108 copies/ml, that of control group was (22.01 ± 17.78) × 108 copies/ml, and there was significant difference between the two groups (P = 0.040). CONCLUSIONS Local application MMR vaccine as adjuvant therapy can reduce HPV viral load significantly. It is suggested that the MMR vaccine may inhibit replication of HPV DNA, but the curative effect needs further confirmation.
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Katsenos S, Nikolopoulou M. Pharyngeal Papilloma: a Rare Non-Pulmonary Cause of Hemoptysis. ACTA MEDICA (HRADEC KRÁLOVÉ) 2019; 61:158-161. [PMID: 30664450 DOI: 10.14712/18059694.2018.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The most common benign neoplasm of the pharynx is papilloma. It is characterized by bulging brittle lesions, which are pedicled or sessile, whitish-grey or pinkish colour. Progressive hoarseness is the main clinical feature. When the papillomata spread throughout the tracheobronchial tree symptoms such as chronic cough, stridor, dyspnea or acute respiratory distress are mostly present. Hemoptysis as a presenting symptom is exceptionally rare in patients with pharyngeal papillomatosis. Herein, we report a case of pharyngeal papillomatosis in which hemoptysis was the primary clinical manifestation. The clinical and therapeutic aspects of the disease are briefly discussed.
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Affiliation(s)
- Stamatis Katsenos
- Department of Pneumonology, Army General Hospital of Athens, Athens, Greece.
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Cabo Beltran OR, Rosales Ledezma R. MVA E2 therapeutic vaccine for marked reduction in likelihood of recurrence of respiratory papillomatosis. Head Neck 2019; 41:657-665. [PMID: 30605254 PMCID: PMC6590416 DOI: 10.1002/hed.25477] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/20/2018] [Accepted: 07/06/2018] [Indexed: 12/14/2022] Open
Abstract
Background Recurrent respiratory papillomatosis (RRP) or laryngeal papillomatosis is a disease caused by papillomavirus infection. Methods In this phase I/II clinical trial, we evaluated the efficacy of the modified vaccinia Ankara (MVA) E2 virus in the treatment of RRP. Twenty‐nine patients (18 female and 11 male) underwent injection of MVA E2 directly into the borders of the vocal cords where lesions were seen and were monitored by direct laryngoscopy. The immune response was assessed by the determination of CD3+, CD4+, and CD8+ lymphocytes counts. The presence of papillomavirus was determined by polymerase chain reaction analysis. Results Lesions were completely eliminated in 13 patients (44.8%). In 16 patients (55.2%), lesions recurred between 6 and 18 months after treatment; these patients received a second round of treatment with MVA E2, and they are not seen with new recurrences. Conclusion The MVA E2 vaccine has excellent potential for generating complete regression of RRP lesions.
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Matinhira N, Soko ND, Bandason T, Jenson RG, Dzongodza T, von Buchwald C, Chidziva C. Human papillomavirus types causing recurrent respiratory papillomatosis in Zimbabwe. Int J Pediatr Otorhinolaryngol 2019; 116:147-152. [PMID: 30554686 DOI: 10.1016/j.ijporl.2018.10.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Recurrent respiratory papillomatosis (RRP) caused by human papillomavirus (HPV) is preventable through vaccination. This study was motivated by the recent thrust of the Zimbabwean government to reduce incidence of HPV related cervical cancer in Zimbabwe through vaccination against HPV. We therefore set out to type HPV genotypes causing RRP in Zimbabwe. We also describe for the first time, the demographics of Zimbabwean RRP patients, the characteristics of patients with different HPV types and possible risk factors of HPV infection in our setting. METHODS We conducted a prospective, hospital based study were patients were recruited from two national otorhinolaryngology hospitals in Zimbabwe. All patients diagnosed with RRP during a twenty four month period were included in the study. A questionnaire was administered per patient to collect both demographic and clinical variables. HPV DNA was extracted from formalin fixed paraffin embedded laryngeal tissue. The extracted HPV DNA was amplified using polymerase chain reaction and next generation sequencing was used to genotype the HPV types. RESULTS A total of 52 patients all aged 14 years and under were recruited into the study. Only Juvenile onset RRP cases were observed over the two year period and 64% of the patients were HPV positive. HPV types 6 and 11 were the dominant types observed constituting 85% of all HPV types. The remaining 15% constituted of HPV 16 and HPV 18. 27% of the patients had coinfection with at least two different HPV types. There were no statistically significant differences between the characteristics of HPV positive and HPV negative patients. No statistically significant risk factors were observed. CONCLUSION HPV types 6 and 11 were the predominant genotypes causing RRP in Zimbabwe. Thus the use of quadrivalent or even nonavalent HPV vaccines may play an important role in the prevention and management of RRP in Zimbabwe.
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Affiliation(s)
- Naboth Matinhira
- Harare Eye, Ear, Nose and Throat Institute, Milton Park, Harare, Zimbabwe; Department of Surgery, Faculty of Medicine, University of Zimbabwe, Harare, Zimbabwe.
| | - Nyarai D Soko
- Harare Eye, Ear, Nose and Throat Institute, Milton Park, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
| | - Ramon G Jenson
- Department of ORL, H&N Surgery, Rigshospitalet and University of Copenhagen, Denmark
| | - Titus Dzongodza
- Harare Eye, Ear, Nose and Throat Institute, Milton Park, Harare, Zimbabwe; Department of Surgery, Faculty of Medicine, University of Zimbabwe, Harare, Zimbabwe
| | | | - Clemence Chidziva
- Harare Eye, Ear, Nose and Throat Institute, Milton Park, Harare, Zimbabwe; Department of Surgery, Faculty of Medicine, University of Zimbabwe, Harare, Zimbabwe
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Fortes HR, Ranke FMV, Escuissato DL, Araujo Neto CA, Zanetti G, Hochhegger B, Irion KL, Souza CA, Marchiori E. Laryngotracheobronchial papillomatosis: chest CT findings. J Bras Pneumol 2018; 43:259-263. [PMID: 29364999 PMCID: PMC5687961 DOI: 10.1590/s1806-37562016000000351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/17/2017] [Indexed: 01/13/2023] Open
Abstract
To evaluate the findings on chest CTs in 16 patients (8 men and 8 women) with laryngotracheobronchial papillomatosis.
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Affiliation(s)
- Helena Ribeiro Fortes
- . Programa de Pós-Graduação em Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Dante Luiz Escuissato
- . Disciplina de Radiologia, Departamento de Clínica Médica, Universidade Federal do Paraná - UFPR- Curitiba (PR) Brasil
| | - Cesar Augusto Araujo Neto
- . Departamento de Medicina e Apoio Diagnóstico, Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | - Gláucia Zanetti
- . Programa de Pós-Graduação em Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.,. Disciplina de Clinica Médica, Faculdade de Medicina de Petrópolis, Petrópolis (RJ) Brasil
| | - Bruno Hochhegger
- . Disciplina de Diagnóstico por Imagem, Universidade Federal de Ciências da Saúde de Porto Alegre (RS) Brasil
| | | | - Carolina Althoff Souza
- . Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Edson Marchiori
- . Programa de Pós-Graduação em Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.,. Disciplina de Radiologia, Universidade Federal Fluminense, Niterói (RJ) Brasil
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Fortes HR, von Ranke FM, Escuissato DL, Araujo Neto CA, Zanetti G, Hochhegger B, Souza CA, Marchiori E. Recurrent respiratory papillomatosis: A state-of-the-art review. Respir Med 2017; 126:116-121. [DOI: 10.1016/j.rmed.2017.03.030] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/26/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
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Liu T, Greenberg M, Wentland C, Sepe B, Bowe S, Diercks G, Huynh T, Mino-Kenudson M, Schlegel R, Kodack D, Benes C, Engelman J, Hartnick C. PD-L1 expression and CD8+ infiltration shows heterogeneity in juvenile recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2017; 95:133-138. [PMID: 28576522 DOI: 10.1016/j.ijporl.2017.02.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/13/2017] [Accepted: 02/17/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Tumor immunotherapy have broadened therapeutic options for tumor treatment. The role of immune function in juvenile recurrent respiratory papillomatosis (JRRP) has not been investigated. Applying immunoblockade inhibitors as a novel disease treatment is unclear. Our study, for the first time, evaluates immune infiltration and immuno-suppressive molecule expression in JRRP. Our study provides insights in possibly treating this disease with tumor immunotherapies. We aimed to determine expression of programmed death-ligand 1 (PD-L1), a cancer escape protein, and presence of CD8+ T cell infiltration in tumor microenvironment. MATERIAL AND METHODS Seven patients with JRRP (mean age: 7.43; age range 3-17) in this study routinely have their tumors surgical debulked at Massachusetts Eye and Ear Infirmary. Following surgery, samples were de-identified and sent to pathology where they were stained and analyzed. RESULTS Six out of seven patients expressed PD-L1 on tumor cells to various extents. Three patients showed concurrent PD-L1 expression on tumor cells and abundant CD8+ tumor infiltrating lymphocytes as well as PD-L1+ stromal lymphocytes, while PD-L1 expression on tumor cells were not associated with CD8+ tumor infiltrating T cells nor PD-L1+ stromal lymphocytes in the other three patients. HPV 6/11 and p16 was detected in all the patients. There appeared to be no correlation between either PD-L1 expression and CD8+ infiltration and clinical severity as measured by both the number of surgeries per year or Derkay score. CONCLUSIONS Despite a small cohort, the expression of p16 and HPV 6/11 in all of the patients confirms the tissues were HPV tumor cells. PD-L1 expression was detected in the vast majority of tumor samples, while inflammatory cell compartments showed a higher degree of variation. Expression of PD-L1 on tumor cells but not inflammatory cells raises the possibility of a tumor cell intrinsic manner of PD-L1 expression. In contrast, a group of patients showed PD-L1 positivity in both tumor and inflammatory cells along with abundant CD8+ tumor infiltrating lymphocytes, suggesting adoptive immune resistance in these tumors and potential benefits from tumor immunotherapy.
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Affiliation(s)
- Tingyu Liu
- Novartis Institutes for Biomedical Research, 250 Massachusetts Ave, Cambridge, MA 02139, United States
| | - Max Greenberg
- Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA 02114, United States
| | - Carissa Wentland
- Department of Otolaryngology Head and Neck Surgery, University Hospital Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, United States
| | - Brandon Sepe
- Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA 02114, United States
| | - Sarah Bowe
- Pediatric Otolaryngology Service, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, United States
| | - Gillian Diercks
- Pediatric Otolaryngology Service, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, United States
| | - Tiffany Huynh
- Department of Pathology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
| | - Richard Schlegel
- Department of Pathology, Georgetown University Medical School, 3800 Reservoir Rd NW, Washington, DC 20007, United States
| | - David Kodack
- Novartis Institutes for Biomedical Research, 250 Massachusetts Ave, Cambridge, MA 02139, United States
| | - Cyril Benes
- Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA 02114, United States
| | - Jeffrey Engelman
- Novartis Institutes for Biomedical Research, 250 Massachusetts Ave, Cambridge, MA 02139, United States
| | - Christopher Hartnick
- Pediatric Otolaryngology Service, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, United States.
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