Expressão de indoleamina 2,3-dioxigenase (IDO) e triptofano 2,3-dioxigenase(TDO) no ambiente cervicovaginal normal, na vaginose bacteriana e nas lesões cervicais associadas ao HPV / Expression of indoleamine 2,3-dioxygenase (IDO) and tryptophan 2,3-dioxygenase (TDO) in normal cervicovaginal environment, bacterial vaginosis and cervical lesions associated with HPV

Neste estudo avaliamos o papel do metabolismo do triptofano (Trp) na homeostasia, na vaginose bacteriana e nas lesões cervicais associadas ao HPV. A importância do metabolismo do Trp se deve a sua ação na proliferação de microrganismos e de células do sistema imune. O consumo de triptofano tem sido identificado como uma forma de controlar o crescimento bacteriano limitando a infecção. Por outro lado, a oxidação de Trp produz quinurenina (QUIN), que tem papel chave na tolerância imunológica. A formação de QUIN se dá através das enzimas indoleamina 2,3-dioxigenase (IDO) e triptofano 2,3- dioxigenase (TDO). A mais estudada delas no âmbito das infecções/ imuno escape é a enzima IDO. Mais recentemente, tem-se dado ênfase ao papel da TDO no câncer. Nesta dissertação, o interesse foi avaliar a expressão da IDO no epitélio cervicovaginal de mulheres com vaginose bacteriana e de IDO e TDO em amostras cervicais de mulheres com diferentes graus de lesão cervical associada ao HPV. Foram incluídas 165 mulheres atendidas no CAISM/UNICAMP, as quais foram divididas em dois grupos: grupo caso composto por mulheres com lesão de baixo ou alto grau e carcinoma invasor (n=42) e grupo controle composto por mulheres com citologia oncológica normal, independente de apresentar infecção genital (n=123). IDO foi avaliada por imunocitoquímica em citologia em base líquida e IDO e TDO em biópsias cervicais. Mulheres com vaginose bacteriana apresentaram expressão aumentada de IDO em células escamosas em comparação às mulheres sem vaginose bacteriana (OR=7.41; IC 95%= 2.50 a 21.4; p <0.0001). No epitélio vaginal normal com ou sem infecção por HPV houve uma expressão leve de IDO em células escamosas. Na presença de lesões ou carcinoma, houve um aumento no número de células escamosas displásicas e de leucócitos IDO-positivos; aumento de IDO também pôde ser observada em culturas de pele organotípicas transduzidas com as oncoproteínas E6/ E7 do HPV16. Nas lesões cervicais, assim como visto para a IDO, a TDO esteve expressa em leucócitos, especialmente os infiltrados na região estromal e na parede dos vasos sanguíneos. A expressão basal de IDO no epitélio cervical normal e sua regulação positiva na infecção por HPV e lesões associadas sugerem a participação do metabolismo do Trp nos mecanismos imunossupressores envolvidos na doença. Embora o papel do IDO já tenha sido abordada anteriormente, até onde sabemos esta é a primeira evidência da expressão de TDO no epitélio vaginal, na neoplasia intraepitelial cervical e carcinoma de células escamosas. Ainda, em leucócitos, especialmente aqueles com morfologia típica de polimorfonucleares, parecem ser importantes fontes de IDO na cérvix uterina

In this study we evaluated the role of tryptophan (Trp) metabolism in cervix homeostasis, bacterial vaginosis and HPV-associated lesions. The importance of Trp metabolism is due to its action on microorganisms and immune cells. Tryptophan consumption has been identified as a way to controlling bacterial growth limiting infection. On the other hand, the oxidation of Trp produces kynurenine (Kyn) which plays a key role in immunological tolerance. The formation of Kyn occurs through the enzymes indoleamine 2,3-dioxygenase (IDO) and tryptophan 2,3-dioxygenase (TDO). IDO is the most studied of them within the context of infections / immune escape. More recently, TDO has also been considered in studies of cancer progression. In this thesis, we were interested in cervicovaginal epithelium IDO expression in women with bacterial vaginosis and of IDO and TDO in cervical samples of women with different degrees of cervical lesion associated with HPV. A total of 165 women attended at CAISM/UNICAMP were divided into two groups: a case group composed of women with low or high grade lesions and invasive carcinoma (n = 42) and a control group composed of women with normal cytology, independent to present genital infection (n =123). IDO was evaluated by immunocytochemistry in liquid-based cytology and IDO and TDO in cervical biopsies. Women with bacterial vaginosis had increased IDO expression in squamous cells compared to women without bacterial vaginosis (OR = 7.41, 95% CI = 2.50- 21.74; p<0.0001). In normal vaginal epithelium with or without HPV infection there was a mild IDO expression in squamous cells. In the presence of cervical intraepithelial lesions or squamous cell carcinoma, there was an increase in the number of IDO-positive dysplastic squamous cells and leukocytes; increase in IDO can also be observed in organotypic skin cultures transduced with HPV-16 E6/E7 oncoproteins. In cervical lesions, as observed for IDO, TDO was expressed in leukocytes, especially infiltrates in the stromal region and in the wall of blood vessels. The basal expression of IDO in the normal cervical epithelium and its positive regulation in HPV infection and associated lesions suggests the participation of Trp metabolism in the immunosuppressive mechanisms involved in the disease. Although some previous data have already considered the role of IDO, as far as we know this is the first evidence of the participation of TDO in the vaginal epithelium, cervical intraepithelial neoplasia and squamous cell carcinoma. In addition, in leukocytes, especially those with a typical polymorphonuclear morphology, appear to be important sources of IDO in the uterine cervix

Glucocorticoid-induced tumor necrosis factor receptor expression in patients with cervical human papillomavirus infection

Introduction The progression of human papillomavirus (HPV) infection in the anogenital tract has been associated with the involvement of cells with regulatory properties. Evidence has shown that glucocorticoid-induced tumor necrosis factor receptor (GITR) is an important surface molecule for the characterization of these cells and proposes that GITR ligand may constitute a rational treatment for many cancer types. We aimed to detect the presence of GITR and CD25 in cervical stroma cells with and without pathological changes or HPV infection to better understand the immune response in the infected tissue microenvironment. Methods We subjected 49 paraffin-embedded cervical tissue samples to HPV DNA detection and histopathological analysis, and subsequently immunohistochemistry to detect GITR and CD25 in lymphocytes. Results We observed that 76.9% of all samples with high GITR expression were HPV-positive regardless of histopathological findings. High GITR expression (77.8%) was predominant in samples with ≥1,000 RLU/PCB. Of the HPV-positive samples negative for intraepithelial lesion and malignancy, 62.5% had high GITR expression. High GITR expression was observed in both carcinoma and high-grade squamous intraepithelial lesion (HSIL) samples (p = 0.16). CD25 was present in great quantities in all samples. Conclusions The predominance of high GITR expression in samples with high viral load that were classified as HSIL and carcinoma suggests that GITR+ cells can exhibit regulatory properties and may contribute to the progression of HPV-induced cervical neoplasia, emphasizing the importance of GITR as a potential target for immune therapy of cervical cancer and as a disease evolution biomarker. .

S100, CD68, and MHC class II molecule expression in cervical high- and low-grade HPV-induced lesions / Expressão de S100, CD68 e moléculas de MHC classe II em lesões cervicais de alto e baixo grau induzidas por HPV

INTRODUCTION: Some human papillomavirus (HPV) types are involved in malignant processes in the cervical epithelium, with 99 percent of cases attributed to oncogenic HPV infection. This study aimed to detect S100, CD68, and major histocompatibility complex class II (MHC-II) molecules in cervical uterine epithelial samples in patients with high- and low-grade lesions induced by HPV. METHODS: Fifty-eight samples from patients who were confirmed positive or negative for high-risk oncogenic HPV DNA, had histopathological diagnosis of cervical intraepithelial neoplasia (CIN) of grades I, II, or III, or were negative for intraepithelial lesion or malignancy were subjected to immunohistochemistry reaction to S100 protein, CD68, and MHC-II (HLA-DR alpha chain). RESULTS: The presence of MHC-II predominated in samples exhibiting histopathological alterations (p < 0.05). S100 detection was more numerous in carcinoma samples (CIN III) (75 percent). Presence of this protein correlated significantly (p < 0.05) with histopathological findings and viral load. CONCLUSIONS: A small expression of CD68 was observed, which may be explained by the observation in our study having been made on random microscopic fields and not on specific areas. The findings, such as the presence of S100 protein and MHC-II expression in samples with histological alterations, could suggest that the immune system fails to control HPV replication at the early stages of infection. Further studies with larger prospective data are necessary to confirm this result.

INTRODUÇÃO: Alguns tipos de papilomavirus humano (HPV) estão envolvidos em processos malignos no epitélio cervical, com 99 por cento dos casos atribuídos à infecção por HPV oncogênico. O objetivo deste estudo foi detectar a proteína S100, CD68 e moléculas de MHC-II (complexo principal de histocompatibilidade classe II) em amostras de epitélio cervical uterino, de pacientes com lesões de alto e baixo grau induzidas pelo HPV. MÉTODOS: Cinquenta e oito amostras de pacientes positivos ou negativos, confirmados, para DNA de HPV de alto ou baixo risco oncogênico, e que tiveram diagnóstico histopatológico de neoplasia intraepithelial cervical (NIC) de graus I, II ou III ou foram negativas para lesão intraepithelial e malignidade (NILM), foram submetidas à reação de imunohistoquímica (IHQ) para proteína S100, CD68 e MHC-II (HLA-DR cadeia alfa). RESULTADOS: A presença da molécula MHC-II predominou em amostras exibindo alterações histopatológicas (p < 0,05). A detecção de S100+ foi mais numerosa em amostras com carcinoma (NIC III) (75 por cento). A presença dessa proteína correlacionou-se significantemente (p < 0,05) com achados histopatológicos e a carga viral. CONCLUSÕES: Pequena expressão CD68+ foi observada, uma possível explicação seria que em nosso estudo as observações foram feitas em campo microscópicos aleatórios e não em áreas específicas. Os achados como a presença de S100 e a expressão de MHC-II, em amostras com alterações histológicas, podem sugerir que o sistema imune falha em controlar a replicação do HPV nas fases iniciais da infecção. Maiores estudos, com mais dados prospectivos, são necessários para confirmar esses resultados.

Respuesta inmune celular en pacientes con lesiones benignas y malignas del cuello uterino / Cellular immune response in patients presenting with benign and malignant lesions of cervix

Objetivo: estudiar parámetros inmunológicos en pacientes con lesiones intraepiteliales (NIC) y carcinoma in situ del cuello uterino en el Instituto Nacional de Oncología y Radiobiología durante el año 2009. Métodos: se realizó un estudio en 20 pacientes donde se determinaron las características inmunofenotípicas de los linfocitos de sangre periférica mediante citometría de flujo y la capacidad funcional frente a diversos mitógenos utilizando el método de síntesis de DNA. El análisis de correlación entre variables inmunológicas y epidemiológicas se realizó mediante el cálculo del coeficiente de correlación de Pearson. Para las pruebas estadísticas se utilizó el paquete estadístico SPSS (versión 11.5). Resultados: la subpoblación de los linfocitos Tc CD8+, mostró valores superiores estadísticamente significativos (p=0,004) solo para las pacientes con NIC I. En todas las pacientes, independientemente del estadio de la enfermedad y del mitógeno utilizado, los índices de estimulación (IE) resultaron inferiores a los valores del grupo control. Conclusión: las alteraciones en el sistema inmune en las pacientes con patología de cuello están asociadas al progreso de la enfermedad y las células T son fundamentales en el control de la progresión de las lesiones

Objective: To study the immunologic parameters in patients presenting with intraepithelial lesions (IEL) and carcinoma in situ of cervix in the National Institute of Oncology and Radiotherapy over 2009. Methods: A study was conducted in 20 patients to determine the immuno-phenotypical of lymphocytes in peripheral blood by flow-cytometry and the functional ability in face of diverse mitogen using the AND synthesis method. The correlation analysis among the immunologic and epidemiologic variables was carried out by an estimation of Pearson's correlation coefficient. For the statistic test the SPSS statistical package was used (version 11.5). Results: The subgroup of Tc + CD8 lymphocytes showed higher values statistically significant ( p= 0.004) only for patients presenting with IEL. In all patients, independently of disease stage and of the mitogen used, the stimulation rates (SR) were lower than the values of controls. Conclusions: The alterations in the immune system in patients with cervix pathology are associated with the progress of lesions

Linfócitos CD4, CD8 e células NK no estroma da cérvice uterina de mulheres infectadas pelo papilomavírus humano / CD4 and CD8 T lymphocytes and NK cells in the stroma of the uterine cervix of women infected with human papillomavirus

INTRODUÇÃO: A resposta imune pode ser um elemento chave para a progressão ou remissão da infecção pelo papilomavírus humano (HPV) no estroma da cérvice uterina. Este estudo objetivou quantificar no estroma cervical a presença de linfócitos T CD4, CD8 e células NK, por imunohistoquímica, em lesões de alto e baixo grau em pacientes infectadas por HPV MÉTODOS: Utilizou-se 56 amostras de biópsia da estroma cervical, sendo 43 amostras positivas para DNA de HPV de alto risco oncogênico e com diagnóstico histopatológico de neoplasia intraepitelial cervical (NIC) de alto e baixo grau, ou negativa para lesão intraepitelial e malignidade (NILM), e 13 amostras de pacientes negativas para DNA de HPV com diagnóstico histopatológico NILM RESULTADOS: Maior quantidade de linfócitos T CD4 foi observada em amostras NIC II/III, carcinoma e NILM (p=0,04) e naquelas cuja carga viral esteve entre 10 e 1,000 RLU/PCB. O predomínio de linfócitos T CD8 ocorreu em maior proporção nas amostras NIC II/III (p=0,02) e em amostras com carga viral entre 100 e 1.000 RLU/PCB. As células NK prevaleceram nas amostras com lesões de baixo grau e com baixa carga viral CONCLUSÕES: Este estudo comprovou que nas fases iniciais da infecção, onde não há ainda alterações celulares de alto grau, não temos a presença de células que possam desencadear a fase efetora da resposta imune.

INTRODUCTION: Immune response might be a key element regarding the progression or regression of human papillomavirus (HPV) infection in the stroma of the uterine cervix. This study aimed to quantify the presence of CD4 and CD8 T lymphocytes and NK cells in the cervical stroma, by means of immunohistochemistry, in high and low grade lesions in patients infected by HPV METHODS: Fifty-six biopsy samples from the uterine cervix were used. Forty-three samples were positive for oncogenic high-risk HPV DNA and had a histopathological diagnosis of high and low-grade cervical intraepithelial neoplasia (CIN) or negative for intraepithelial lesion and malignancy (NILM); while the other 13 samples were negative for HPV DNA with a histopathological diagnosis of NILM RESULTS: Higher quantities of CD4 T lymphocytes were observed in CIN II/III, carcinoma and NILM samples (p = 0.04) and in those in which the viral load was between 10 and 1.000 RLU/PCB. CD8 T lymphocytes were predominant in CIN II/III samples (p = 0.02) and also in samples with viral loads between 100 and 1,000 RLU/PCB. NK cells predominated in samples with low-grade lesions and low viral load CONCLUSIONS: This study proved that in the initial stages of the infection, in which no high-grade cell abnormalities have yet occurred, no cells that might trigger the effector phase of the immune response.

Local lymphocytes and nitric oxide synthase in the uterine cervical stroma of patients with grade III cervical intraepithelial neoplasia

OBJECTIVES: Precancerous and cancerous cells can trigger an immune response that may limit tumor development and can be used as a prognostic marker. The aims of the present study were to quantify the presence of B and T lymphocytes, macrophages and cells expressing inducible nitric oxide synthase (iNOS) in the cervical stroma of women with grade III cervical intraepithelial neoplasia (CIN III) or in the intratumoral and peritumoral tissue of women with stage I invasive carcinoma. METHODS: Cervical tissue specimens were obtained from 60 women (20 each from control tissues, CIN III and invasive carcinomas). The average ages in the control, CIN III and invasive groups were 43.9 (± 4.3), 35.5 (± 9.5), and 50 (± 11.2) years, respectively. The specimens were immunohistochemically labeled with antibodies to identify T lymphocytes (CD3), cytotoxic lymphocytes (CD8), B lymphocytes (CD20), macrophages (CD68) and iNOS. We evaluated the markers in the stroma above the squamocolumnar junction (control), at the intraepithelial lesion (CIN cases), and in the nfiltrating tumor. Two independent observers performed the immunohistochemical analysis. RESULTS: T lymphocytes, B lymphocytes, macrophages and iNOS were present more frequently (P<0.05) in the stroma of peritumoral invasive tumors compared to the controls and intratumoral invasive cancer samples. CD3+ and CD20+ lymphocytes were present more frequently in CIN III patients compared to samples from patients with intratumoral invasive cancer (P<0.05). CONCLUSION: High numbers of T and B lymphocytes, macrophages and iNOS-expressing cells in the peritumoral stroma of the invasive tumors were observed. Cell migration appeared to be proportional to the progression of the lesion.

Naturaleza de la infección por papillomavirus en mujeres infectadas por el virus de la inmunodeficiencia humana / Nature of the papillomavirus infection in human immunodeficiency virus-infected women

Numerosos estudios demuestran que los individuos VIH-positivos presentan elevado riesgo de adquirir infecciones por papillomavirus humanos (HPV) en mucosa oral y anogenital...

Many studies have shown that HIV-infected individuals are at increased risk of anogenital and oral PV infection. The prevalence of HPV infection and the severity of the associated intra-epithelial lesions in HIV-positive individuals are associated to progressively decrease fo CD4+ levels...

Immune response in cervical dysplasia induced by human papillomavirus: the influence of human immunodeficiency virus-1 co-infection - review

Human immunodeficiency virus (HIV-1) has become an important risk factor for human papillomavirus (HPV) infection and the development of HPV associated lesions in the female genital tract. HIV-1 may also increase the oncogenicity of high risk HPV types and the activation of low risk types. The Center for Disease Control and Prevention declared invasive cervical cancer an acquired immunodeficience virus (AIDS) defining illness in HIV positive women. Furthermore, cervical cancer happens to be the second most common female cancer worldwide. The host's local immune response plays a critical factor in controlling these conditions, as well as in changes in the number of professional antigen-presenting cells, cytokine, and MHC molecules expression. Also, the production of cytokines may determine which arm of the immune response will be stimulated and may influence the magnitude of immune protection. Although there are many studies describing the inflammatory response in HPV infection, few data are available to demonstrate the influence of the HIV infection and several questions regarding the cervical immune response are still unknown. In this review we present a brief account of the current understanding of HIV/HPV co-infection, emphasizing cervical immune response.

Ki-67 labelling as a proliferation marker in pre-invasive squamous epithelial lesions of cervix.

Study was conducted to evaluate proliferation in squamous intraepithelial lesions of cervix. 36 cases of cervical biopsies were chosen including unremarkable cervix, basal cell hyperplasia, cervical intraepithelial neoplasia (CIN I, CIN II, CIN III). Ki-67 immunostaining was performed by peroxidase-antiperoxidase method. Ki-67 labelling index in basal and parabasal layers of cervix showed progressive rise with increasing grade of lesion but may not be helpful in classification of individual lesion. Also extent of staining from the basement membrane increases with increasing grade. High basal Ki-67 reactivity might be of greater biological significance than surface differentiation.

Immunology of cancer cervix.

It is not clear how much genetic factor is responsible for causing cervical cancer, but certainly there has some mutation abnormality in the suppressive p53 gene which is to be proved beyond doubt. In addition to this, there are some environmental factors which make insults on cervical epithelium. Immunology of cancer cervix is well represented by (1) immunology of cancer, (2) immunology of virally controlled antigen and (3) cancer cervix antigen markers. The cancer is an example of transplantation immunology changes in the surface of tumour cells during replication. Human papillomavirus (HPV) DNA has been shown to be associated with high grade cervical intra-epithelial neoplasia (CIN). Squamous cell carcinoma antigen has been investigated for predictive value in cancer cervix. Colony stimulating factor-1 causes monocytic cells aggregation in neoplastic area and plays as initiators of the sequence of inflammation up to neoplasia.

Estudio serológico de HV2 e inmunocitoquímico de HPV2 y HPV en displasia y neoplasia / Serologic study of HV2 and immunocytochemistry of HPV2 and HPV in dysplasia and neoplam

Se hace una revisión de la alta incidencia y prevalencia del cáncer cérvico uterino en el Perú, así como una revisión de trabajos publicados sobre factores de riesgo, estudio epidemiológico, etc. dando énfasis a la importancia actual del Herpes Virus Humano tipo 2 y el Papiloma Virus Humano mucotrófico. De una encuesta epidemiológica-citológica en 70,094 mujeres en riesgo de presentar cáncer de cuello uterino de la Costa, Sierra y Selva del Perú se encontró mediante estudio serológico de Inmunofluorescencia, anticuerpos para HV2 en el 100 por ciento de las mujeres portadoras de Displasia y Neoplasia en comparación al 10 por ciento del grupo control. Utilizando técnica de Inmuno peroxidasa-antiperoxidasa se demostró en las células exfoliadas del tracto cérvico vaginal del antígeno del Papiloma Virus Humano en el 9 por ciento de las Displasias y en 6.3 por ciento de la Neoplasia. Se encontró la presencia de HV2 y HPV simultáneamente en el 8.8 por ciento de las Displasias y 4.5 por ciento de la Neoplasia utilizando las técnicas ya mencionadas.