A New Brazilian Device for Cervical Cancer Screening: Acceptability and Accuracy of Self-sampling / Um Novo Dispositivo Brasileiro para Diagnóstico de Câncer Cervical: Aceitabilidade e Precisão da Autoamostragem

Abstract Objective To evaluate the accuracy and patient acceptability toward self-sampling using a new device - SelfCervix® - for detecting HPV-DNA. Methods A total of 73 women aged 25-65 who underwent regular cervical cancer screening from March to October 2016 were included. Women performed self-sampling followed by a physician-sampling, and the samples were analyzed for HPV-DNA. After that, patients were surveyed about their acceptability of self-sampling. Results HPV-DNA detection rate of self-sampling presented high accuracy and was similar to physician-collection. Sixty-four (87.7%) patients answered the acceptability survey. Most patients (89%) considered the self-sampling comfortable, and 82.5% preferred self-sampling to physician-sampling. The reasons cited were time-saving and convenience. Fifty-one (79.7%) reported that they would recommend self-sampling. Conclusion Self-sampling using the new Brazilian device SelfCervix® is not inferior in HPV-DNA detection rate compared with physician-collection, and patients are supportive of the method. Therefore, it might be an option to reach under-screened populations in Brazil.

Resumo Objetivo Avaliar a acurácia e aceitabilidade da auto-coleta utilizando um novo coletor - SelfCervix® - para a detecção de DNA de HPV. Métodos Foram incluídas no estudo 73 mulheres com idade entre 25-65 anos que realizaram seu rastreamento regular do câncer de colo do útero entre Março e Outubro de 2016. Estas mulheres realizaram a auto-coleta, seguida de coleta profissional e as amostras foram analisadas paraa presença de DNA de HPV. Após, elas responderam um questionário sobre a experiência da auto-coleta. Resultados As taxas de detecção de DNA de HPV por auto-coleta foram altas e similares as da coleta profissional. Sessenta e quatro (87,7%) pacientes responderam o questionário de experiência. A maioria (89%) considerou a auto-coleta confortável, e 82,5% preferiram o método comparado a coleta profissional. As razões citadas foram economia de tempo e conveniência. Cinquenta e uma (79,7%) mulheres confirmaram que recomendariam a auto-coleta. Conclusão Auto-coleta utilizando o novo coletor desenvolvido no Brasil não é inferior na detecção de DNA de HPV quando comparada a coleta profissional, e apresenta uma boa aceitabilidade pelas mulheres. Desta maneira, pode ser uma opção para alcançar populações que não realizam o rastreamento padrão.

Oxidative stress: therapeutic approaches for cervical cancer treatment

OBJECTIVES: Oxidative stress results from an imbalance between the generation and elimination of oxidant species. This condition may result in DNA, RNA and protein damage, leading to the accumulation of genetic alterations that can favor malignant transformation. Persistent infection with high-risk human papillomavirus types is associated with inflammatory responses and reactive oxygen species production. In this context, oxidative stress, chronic inflammation and high-risk human papillomavirus can act in a synergistic manner. To counteract the harmful effects of oxidant species, protective molecules, known as antioxidant defenses, are produced by cells to maintain redox homeostasis. In recent years, the use of natural antioxidants as therapeutic strategies for cancer treatment has attracted the attention of the scientific community. This review discusses specific molecules and mechanisms that can act against or together with oxidative stress, presenting alternatives for cervical cancer prevention and treatment.

Innate immunity and HPV: friends or foes

Most human papillomavirus infections are readily cleared by the host immune response. However, in some individuals, human papillomavirus can establish a persistent infection. The persistence of high-risk human papillomavirus infection is the major risk factor for cervical cancer development. These viruses have developed mechanisms to evade the host immune system, which is an important step in persistence and, ultimately, in tumor development. Several cell types, receptors, transcription factors and inflammatory mediators involved in the antiviral immune response are viral targets and contribute to tumorigenesis. These targets include antigen-presenting cells, macrophages, natural killer cells, Toll-like receptors, nuclear factor kappa B and several cytokines and chemokines, such as interleukins, interferon and tumor necrosis factor. In the present review, we address both the main innate immune response mechanisms involved in HPV infection clearance and the viral strategies that promote viral persistence and may contribute to cancer development. Finally, we discuss the possibility of exploiting this knowledge to develop effective therapeutic strategies.

Biomarcadores na triagem do câncer do colo uterino / Biomarkers in cervical cancer screening

A infecção persistente por papilomavírus humano (HPV) é o principal fator de risco para o câncer do colo uterino e de suas lesões precursoras.Programas de triagem que utilizam a citologia oncótica (exame de Papanicolaou) levaram a uma diminuição significativa na incidência deste tipo tumoral, apesar de suas limitações na detecção de atipias leves e adenocarcinomas. Em vista disso, a identificação de novos biomarcadores que permitam monitorar eventos moleculares associados à progressão tumoral em amostras histológicas ou citológicas, poderá melhorar a detecção de lesões com maior risco de progredirem. A simples detecção do DNA de HPV como principal parâmetro na triagem do câncer do colo uterino e de suas lesões precursoras é ainda um ponto controverso por ter um valor preditivo positivo baixo. Por outro lado, o desenvolvimento de tecnologias que detectem e quantifiquem os transcritos dos oncogenes virais E6 e E7, estão sendo consideradas para a avaliação precisa da atividade oncogênica viral associada à progressão tumoral. Além disso, análises detalhadas das interações das oncoproteínas de HPV e seus alvos celulares permitirão definir possíveis novos biomarcadores. Umdos principais exemplos é o aumento da expressão da proteína inibitória das quinases dependentes de ciclina p16ink4a promovida pelapresença de E7. Diversos estudos utilizam o aumento da expressão da proteína p16ink4a para identificar células displásicas em amostrashistológicas e esfregaços cervicais. Esta revisão foca algumas das principais linhas de pesquisa na identificação de biomarcadores e suapossível utilização na triagem do câncer cervical e de suas lesões precursoras.

Persistent infection with oncogenic human papillomavirus (HPV) is the main risk factor for cervical cancer and its precursor lesions. Cytologicalscreening programs using the Pap test have led to a substantial reduction in the incidence of cervical cancer despite its limitation in detecting minor atypias and adenocarcinomas. Therefore, the identifi cation of new biomarkers that allow the monitoring of molecular events associated to tumor progression in histological or citological specimens may improve the detection of lesions with higher risk of progression. HPV DNA detection as a primary screening parameter has been controversially discussed due to its very low predictive value. On the other hand, the development of new technologies for the determination of high risk HPV activity by detecting E6 and E7 transcripts has the potential to more accurately evaluate tumor progression. Moreover, the detailed analysis of HPV oncoproteins and cellular targets will allow the defi nition of new possible biomarkers. One of the best examples is the up-regulation of the cyclin dependent kinase inhibitor p16ink4a expression by E7. Several studies use p16ink4a overexpression to identify dysplastic cells in histological samples and cytological smears. This review focuses on biomarkers studies and their possible role in screening cervical cancer and precursor lesions.

Efeitos da infecção por HPV na resposta imune e na expressão gênica global medianos pelo fator de necrose tumoral / HPV infection effects on immune response and global gene expression mediated by tumor necrosis factor

A infecção persistente por alguns tipos de HPV de alto risco (ex. tipos 16 e 18), é o principal fator de risco para o desenvolvimento de neoplasias intraepiteliais cervicais e lesões precursoras do carcinoma do colo uterino. Diversos estudos sugerem que a resposta imune mediada por células é fundamental para o controle e eliminação das infecções por estes e outros vírus. Um dos principais mediadores/reguladores deste tipo de resposta é o fator de necrose tumoral (TNF)... Estes dados sugerem que a aquisição de resistência à este fator é um evento importante na carcinogênese mediada por HPV. No entanto, os eventos moleculares associados ao efeito diferencial do TNF nestas linhagens são, até o momento, desconhecidos. No presente estudo, foram analisados os níveis de expressão de expressão de algumas proteínas envolvidas na via de ativação do fator NF-kB. Utilizando um anticorpo anti-IkBα, foi detectada uma proteína de aproximadamente 20KDa, induzida após 12 horas de tratamento com TNF e atingindo altos níveis de expressão em torno das 60 horas de tratamento... A expressão diferencial de alguns genes comuns nas células sensíveis ao efeito antiproliferativo do TNF, contrariamente das células resistentes, foi identificada. A expressão destes genes está relacionada à processos biológicos, como, resposta imunológica e inflamatória, proliferação e diferenciação celular e controle da transdução de sinal de diversas vias. A identificação de genes e proteínas cruciais nestes eventos, permitirá avanços no controle da infecção por HPV, além de contribuir para a eventual caracterização de marcadores moleculares na progressão tumoral do câncer cervical...(AU)

Persistent infection by some high risk HPV types (ie: types 16 and 18) is the main risk factor for the development of cervical intraepithelial neoplasia and the precursor lesions of cervical cancer. Many studies suggest that cellmediated immunity is important for viral infection contrai and clearence. Tumor necrosis factor (TNF) is one of the main mediators/regulators of inflammatory response. TNF has a potent anti-proliferative effect on normal and HPV16 immortalized keratinocytes (HF698). On the other hand, HPV-18 immortalized keratinocytes (HF18Nco) and severa! cervical carcinomaderived cell lines, are resistant to TNF. These observations suggest that the acquisition of TNF-resistance may constitute an important step in HPV mediated carcinogenesis. However, the molecular basis of this difference is not well understood. In the present study, we analyzed the effect of TNF on NF-KB pathway activation. Using an anti-IKBa antibody, we detected a protein of 20 kDa induced after 12 hours of treatment with TNF. This protein reached higher leveis of expression after 60 hours of treatment. Besides, we found that this protein is constitutively express in the HPV16-immortalized cell line. Severa! experiments are being conducted in arder to identify this protein. Furthermore, we addressed the effect of 3 and 60 hours of TNF treatment on global gene expression of primary human keratinocytes and two HPV-immortalized keratinocytes-derived cell !ines. We observed the differential expression of severa! genes common to both TNF-sensitive cell lines. On the other hand, this was not observed in the TNF-resistant cell line. These genes are involved in immune and inflammatory response, cell proliferation and differentiation and 1n signal transduction contrai. Understanding the mechanisms of host response regulation, as well as the identification of new genes and proteins involved in its regulation, may provide new strategies for HPV infection contrai (AU)