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Ranasinghe V, McMillan N. Novel therapeutic strategies for targeting E6 and E7 oncoproteins in cervical cancer. Crit Rev Oncol Hematol 2025; 211:104721. [PMID: 40216282 DOI: 10.1016/j.critrevonc.2025.104721] [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: 02/27/2025] [Revised: 04/06/2025] [Accepted: 04/07/2025] [Indexed: 04/20/2025] Open
Abstract
Cervical cancer is the fourth most common cause of cancer-related mortality among women worldwide. The main aetiological factor for developing cervical cancer is the persistent infection of Human papillomavirus (HPV). The E6 and E7 oncoproteins produced by HPV mainly contribute to the carcinogenic process by inhibiting the function of tumour suppressor genes. The E6 protein causes degradation of p53 leading to impaired cellular stress response. In contrast, the E7 protein impairs the activity of retinoblastoma protein (pRb) resulting in continuous cell cycle propagation. Even though screening programmes and prophylactic vaccination have reduced the incidence of cervical cancer, the disease burden is still high, especially in low socioeconomic countries. Treatment of cervical cancer involves a multimodal strategy incorporating surgery, chemotherapy, and radiotherapy. Most of these management approaches use invasive techniques and are associated with adverse effects. Drug resistance is observed over time with chemotherapeutic agents. Hence there is a crucial need for developing novel targeted treatment strategies for cervical cancer. The E6 and E7 viral oncoproteins are continuously expressed in HPV infected cells making them ideal targets for developing therapies. Therapeutic DNA vaccines, gene therapy involving RNA interference technology, and CRISPR are currently under intensive study. These technologies represent a productive and promising approach for the future treatment of cervical cancer. Moreover, several new compounds demonstrate significant anti-cancer effects against cervical cancer. This review provides an updated account of therapeutic strategies currently under research targeting the E6 and E7 viral oncoproteins.
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Affiliation(s)
- Vindya Ranasinghe
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4215, Australia; Institute for Biomedicine and Glycomics, Griffith University, Gold Coast, QLD 4215, Australia.
| | - Nigel McMillan
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4215, Australia; Institute for Biomedicine and Glycomics, Griffith University, Gold Coast, QLD 4215, Australia.
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Wang DY, Cui YY, Zhang WW, Fan MS, Qiu KX, Yan L. Effect of different interventions on the treatment of high-risk human papillomavirus infection: a systematic review and network meta-analysis. Front Med (Lausanne) 2024; 11:1274568. [PMID: 38420364 PMCID: PMC10899477 DOI: 10.3389/fmed.2024.1274568] [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] [Received: 08/08/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Background Persistent infection with high-risk human papillomavirus (HR-HPV) can lead to cervical intraepithelial neoplasia and cancer. At present, there is no medication that specifically targets HR-HPV infection. Objective This study aimed to evaluate the effectiveness of different interventions in promoting HR-HPV regression using a MeSH meta-analysis method. Methods A search for randomized controlled trials (RCTs) reporting different interventions for the treatment of HR-HPV infection included PubMed, Web of Science, Embase and Cochrane Library from the inception of the databases to March 8, 2023. Two researchers independently screened the articles, extracted data, and evaluated the quality. The literature that met the inclusion criteria was selected, the quality and risk of bias of the included studies were assessed according to the Cochrane 5.1 manual, and NMA was performed using Stata 16.0. The area under the cumulative ranking probability graph (SUCRA) represented the probability that each treatment would be the best intervention. Results Nine studies involving 961 patients and 7 treatment options were included in the analysis. The results of the network meta-analysis indicated the following rank order in terms of promoting HR-HPV conversion: Anti-HPV biological dressing > vaginal gel > imiquimod > REBACIN® > interferon > probiotics > observation/placebo > Polyphenon E. Conclusion Anti-HPV biological dressing treatment was found to be significantly effective in promoting HR-HPV conversion. However, further validation of the findings is necessary due to the limited number and quality of studies included in the analysis. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023413917.
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Affiliation(s)
- Dong-Yue Wang
- Department of Gynecology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
- Key Laboratory of Laparoscopic Technology, department of Gynecology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Ying-Ying Cui
- Key Laboratory of Laparoscopic Technology, department of Gynecology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Wei-Wei Zhang
- Department of Gynecology, Tengzhou Maternal and Child Health Hospital, Tengzhou, China
| | - Meng-Si Fan
- School of Public Health, Weifang Medical University, Weifang, China
| | - Ke-Xin Qiu
- School of Public Health, Weifang Medical University, Weifang, China
| | - Li Yan
- Key Laboratory of Laparoscopic Technology, department of Gynecology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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Wang Y, Gong Y, Zhou Q, Qu W, Chen F, Wang Y, Mo J, Zhang H, Lin L, Bi T, Wang X, Gu J, Xu C, Li Y. Genetic variability analysis of human papillomavirus 58: Novel sublineage identification and persistent infection association. J Med Virol 2023; 95:e29262. [PMID: 38037452 DOI: 10.1002/jmv.29262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/20/2023] [Accepted: 11/12/2023] [Indexed: 12/02/2023]
Abstract
This study aims to characterize the genetic variability of HPV58, identify novel lineages and sublineages, and explore the association between persistent/multiple HPV58 infections and genetic variation. In this study, samples from 124 women with HPV58 infection in Eastern China were collected and 81 isolates of E6 and L1 full-length genes were successfully amplified from 55 samples. We evaluated the diversity of genetic variants and performed correlation analyses between genetic variability and pathology, vaccination, multiple infections, and persistent infections. Among the E6 and L1 gene sequences collected, the dominant prevailing sublineages were A1 (46.2%) and A2 (23.1%). In addition, we found two potential novel sublineages denoted as the A4 and A5 sublineage. A total of 50 nucleotide substitutions, including 28 synonymous substitutions and 22 nonsynonymous substitutions, were observed in the E6 and L1 genes. Among them, variants with A388C/K93N substitutions in the E6 gene correlated with persistent infection (≥1 and ≥2 years) (p < 0.005), and C307T/C66C was associated with persistent infection (≥2 years) (p < 0.005). Notably, two mutations above were detected in the isolate from the patient with breakthrough vaccine infection. Our study found two novel sublineages and sites of genetic variability in multiple and persistent infection variants. In addition, we identified two mutational sites associated with persistent infection. This study provides new insight into the clinical characteristics of HPV 58 genetic variations and offers new ideas for research on next-generation vaccines in Eastern China.
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Affiliation(s)
- Yan Wang
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Yingxin Gong
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Qi Zhou
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Wenjie Qu
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Fang Chen
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yaping Wang
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Jiayin Mo
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Hongwei Zhang
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Lin Lin
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Tianyi Bi
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Xujie Wang
- Department of Gynecology and Obstetrics, Shanghai Changning Maternity and Infant Health Hospital, Shanghai, China
| | - Jiashi Gu
- Department of Gynecology and Obstetrics, Shanghai Pudong Hospital, Fudan University, Shanghai, China
| | - Congjian Xu
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yanyun Li
- Department of Gynecology and Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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Chen F, Zhang GN, Lei W, Zhou SG, Zhang Y, Liu L, Jia Y, Xie RK, Tian XF, Guo J, Yang YB, Wang XF, Wu XM, Sun QJ, Zhou X, Lin Y, Zhang YZ, Ma JQ, Liu YX, Cheng YF, Chen JC, Qu QX, Du DM, Wang GY, Wang S, Ling YL, Wu DF, Zhang CF, Lang JH. Effectiveness and safety of REBACIN as a non-invasive intervention for persistent high-risk human papillomavirus infection: A real-world prospective multicenter cohort study. Gynecol Oncol 2023; 178:8-13. [PMID: 37734188 DOI: 10.1016/j.ygyno.2023.09.004] [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: 06/28/2023] [Revised: 08/06/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND We previously reported that REBACIN effectively eliminates persistent high-risk human papillomavirus (hrHPV) infection. Here, we conducted a prospective multicenter cohort study to evaluate the safety and effectiveness of REBACIN, taking into account factors such as specific hrHPV subtype and patient's age. METHODS According to inclusion/exclusion criteria and participant willingness, 3252 patients were divided into REBACIN group while 249 patients into control group. Patients in REBACIN group received one course treatment of intravaginal administration of REBACIN while no treatment in control group. After drug withdrawal, participants in both groups were followed up. RESULTS The clearance rate of persistent hrHPV infection in REBACIN group was 60.64%, compared to 20.08% in control group. Specifically, the clearance rates for single-type infection of HPV16 or HPV18 were 70.62% and 69.23%, respectively, which was higher than that of HPV52 (59.04%) or HPV58 (62.64%). In addition, the single, double, and triple/triple+ infections had a clearance rate of 65.70%, 53.31%, and 38.30%, respectively. Moreover, 1635 patients under 40 years old had a clearance rate of 65.14%, while it was 55.08% for 1447 patients over 40 years old. No serious adverse effects were found. CONCLUSION This study confirmed that REBACIN can effectively and safely eliminate persistent hrHPV infection, which the clearance rate of HPV16/18 is higher than that of HPV52/58, the clearance rate of single-type infection is higher than that of multiple-type infections, and the clearance rate in young patients is higher than that in elder patients, providing a guidance for REBACIN application in clearing hrHPV persistent infection in real-world settings. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry Registration Number: ChiCTR1800015617 http://www.chictr.org.cn/showproj.aspx?proj=26529 Date of Registration: 2018-04-11.
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Affiliation(s)
- Fei Chen
- National Clinical Research Center for Obstetric & Gynecologic Diseases, and Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | | | - Wei Lei
- West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shu-Guang Zhou
- Anhui Medical University Affiliated Maternity and Child Healthcare Hospital, Hefei, China
| | - Ying Zhang
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lin Liu
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ying Jia
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rong-Kai Xie
- Xinqiao Hospital Army Medical University, Chongqing, China
| | | | - Jie Guo
- The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yue-Bo Yang
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xue-Feng Wang
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Xiao-Mei Wu
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Qi-Jian Sun
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xu Zhou
- The Second Hospital of Jilin University, Changchun, China
| | - Yang Lin
- The Second Hospital of Jilin University, Changchun, China
| | | | - Jun-Qi Ma
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yu-Xiu Liu
- China-Mongolia Hospital of Ulanqab, Ulanqab, China
| | - Yi-Fan Cheng
- The Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Jian-Cui Chen
- Fujian Provincial Maternal and Child Health Care Hospital, Fuzhou, China
| | - Quan-Xin Qu
- Tianjin First Central Hospital, Tianjin, China
| | - Dong-Mei Du
- Key Laboratory of Protein Engineering and Drug Development of Hainan, Haikou, China
| | - Gui-Yu Wang
- Key Laboratory of Protein Engineering and Drug Development of Hainan, Haikou, China
| | - Sheng Wang
- Key Laboratory of Protein Engineering and Drug Development of Hainan, Haikou, China
| | - Yu-Li Ling
- Key Laboratory of Protein Engineering and Drug Development of Hainan, Haikou, China
| | | | | | - Jing-He Lang
- National Clinical Research Center for Obstetric & Gynecologic Diseases, and Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Ye J, Zheng L, He Y, Qi X. Human papillomavirus associated cervical lesion: pathogenesis and therapeutic interventions. MedComm (Beijing) 2023; 4:e368. [PMID: 37719443 PMCID: PMC10501338 DOI: 10.1002/mco2.368] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Human papillomavirus (HPV) is the most prevalent sexually transmitted virus globally. Persistent high-risk HPV infection can result in cervical precancerous lesions and cervical cancer, with 70% of cervical cancer cases associated with high-risk types HPV16 and 18. HPV infection imposes a significant financial and psychological burden. Therefore, studying methods to eradicate HPV infection and halt the progression of precancerous lesions remains crucial. This review comprehensively explores the mechanisms underlying HPV-related cervical lesions, including the viral life cycle, immune factors, epithelial cell malignant transformation, and host and environmental contributing factors. Additionally, we provide a comprehensive overview of treatment methods for HPV-related cervical precancerous lesions and cervical cancer. Our focus is on immunotherapy, encompassing HPV therapeutic vaccines, immune checkpoint inhibitors, and advanced adoptive T cell therapy. Furthermore, we summarize the commonly employed drugs and other nonsurgical treatments currently utilized in clinical practice for managing HPV infection and associated cervical lesions. Gene editing technology is currently undergoing clinical research and, although not yet employed officially in clinical treatment of cervical lesions, numerous preclinical studies have substantiated its efficacy. Therefore, it holds promise as a precise treatment strategy for HPV-related cervical lesions.
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Affiliation(s)
- Jiatian Ye
- Department of Gynecology and ObstetricsKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second Hospital, Sichuan UniversityChengduChina
| | - Lan Zheng
- Department of Pathology and Lab MedicineUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Yuedong He
- Department of Gynecology and ObstetricsKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second Hospital, Sichuan UniversityChengduChina
| | - Xiaorong Qi
- Department of Gynecology and ObstetricsKey Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second Hospital, Sichuan UniversityChengduChina
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Zhuang Y, Yang H. The significance of nonsurgical therapies for cervical infection of high-risk human papilloma virus: A systematic review and meta-analysis. J Obstet Gynaecol Res 2023; 49:2213-2231. [PMID: 37365015 DOI: 10.1111/jog.15726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To assess whether nonsurgical therapies were related with clearance of cervical infection of high-risk human papilloma virus (hr-HPV) or regression of mild abnormal cytology related with hr-HPV. METHODS Until March 2023, we identified a total of 10 424 women with cervical infection of hr-HPV and 1966 women with mild abnormal cytology related with hr-HPV from 44 studies that met the inclusion criteria. RESULTS After systematically retrieving literature, we identified 2317 citations and 44 randomized controlled studies (RCT) were enrolled. Cumulative results suggested women with cervical infection of hr-HPV might benefit from nonsurgical therapies. Both the clearance of hr-HPV (OR: 3.83, I2 = 99%, p < 0.00001) and regression of mild abnormal cytology related with hr-HPV (OR: 3.12, I2 = 63%, p < 0.00001) were significantly higher than control group. Subgroup analysis stratified by systematic therapy, topical therapy, traditional Chinese medicines (TCMs), and presistent hr-HPV got consistent results. There was substantial heterogeneity between trials (I2 = 87% for clearance of hr-HPV and 63% for regression of cytology), sensitivity analysis was performed by excluding single study one by one, and found the cumulative results were stable and dependable. Both the funnel plots for clearance of hr-HPV and regression of abnormal cytology were asymmetrical, significant publication bias might exist. CONCLUSION Nonsurgical therapies might benefit women who had a cervical infection of hr-HPV with/without mild abnormal cytology related with hr-HPV. Both the clearance of hr-HPV and regression of abnormal cytology were significantly higher than control group. More studies with less heterogeneity were needed urgently to draw concrete conclusion.
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Affiliation(s)
- Yuan Zhuang
- Department of Gynecology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Hua Yang
- Department of Gynecology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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