Beruflich Dokumente
Kultur Dokumente
Abstract
The immune system uses innate and adaptive immunity to recognize and combat foreign agents that invade the body, but these methods
are sometimes ineffective against human papillomavirus (HPV). HPV has several mechanisms for avoiding the immune system. HPV infects,
and multiplies in keratinocytes, which are distant from immune centers and have a naturally short lifespan. The naturally short life cycle of the
keratinocyte circumvents the need for the virus to destroy the cell, which would trigger inflammation and immune response. In addition, HPV
downregulates the expression of interferon genes. Despite viral immune evasion, the immune system effectively repels most HPV infections,
and is associated with strong localized cell mediated immune responses. New prophylactic L1 virus-like protein vaccines for HPV 16 and 18
and HPV 6, 11, 16, and 18 are in phase 3 trials. Available data suggests that these vaccines are safe, produce high levels of antibodies, and
are effective at preventing HPV infection.
2005 Elsevier Ltd. All rights reserved.
Keywords: Immune responses; Human papillomavirus; Keratinocyte
0264-410X/$ see front matter 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.vaccine.2005.09.002
S1/17
S1/18
Fig. 1. The HPV infectious cycle. The virus infects a primitive basal keratinocyte (probably a stem cell) via microabrasion of the mucosal epithelium.
It is speculated that the immediate early events of virus growth involve an
amplification of virus copy number from 110 to 50100 virus episomes/cell.
The next phase of virus growth is one of plasmid maintenance in which the
virus and cell replicate in tandem and there is no amplification of virus copy
number. This occurs in the proliferative compartment of the epithelium.
The infected keratinocyte then enters the differentiating compartment of the
epithelium, exiting the cell cycle. Virus gene expression is hugely upregulated with viral DNA amplification generating thousands of viral genomes.
Late viral proteins L1, L2, and E4 are made, and virus assembly occurs in
the superficial terminally differentiated squames.
the endothelium of the wart capillaries [8]. This is characteristic of a Th1-based immune response, but it is important to
remember that cross-sectional studies provide only a snapshot of a dynamic process. Ethical and logistical issues inhibit
detailed longitudinal studies in humans, but in animal models of mucosal papillomavirus infection, such as the canine
oral papillomavirus, the immunologic events of the entire
wart cycle, from infection to regression, can be followed. In
these animal infections, wart regression is accompanied by
a cellular infiltrate similar to that seen in regressing genital warts. Systemic T cell responses directed towards HPV
early (E) proteins E2 and E6 peptides can be detected at low
frequency at distinct time points during the infectious cycle.
These responses occur in narrow time windows that coincide with periods of viral DNA amplification, are maximal
at wart regression, and decline quite rapidly thereafter (Jain
et al., 2003, personal communication). Furthermore, serum
levels of neutralizing antibody peak at wart regression [9].
Despite the low antibody titres induced by natural infection,
the animals remain resistant to challenge with large doses of
infectious virus for the rest of their lives.
Epidemiologic and natural history studies strongly suggest
that the human immune response to HPV infection (Fig. 2)
follows a similar pattern [10,11]. Virtually all studies show
that genital HPV infection is extremely common in young
sexually active women, with prevalence as high as 80% in
certain adolescent populations [14]. Most of these HPV infections clear, i.e., DNA for a specific HPV type can no longer
be detected. The time required for clearance of the high-risk
HPV types, particularly HPV 16, averages 814 months, considerably longer than the 56 months needed for the low-risk
HPV types [1214]. However, if the immune response fails
to clear or control the infection, then a persistent infection,
often with focally high levels of high-risk HPV DNA replication, is established. Persistently infected individuals have an
increased probability of progression to high-grade cervical
intraepithelial neoplasia and invasive carcinoma [10,1518].
The increased incidence and progression of HPV infections in immunosuppressed individuals illustrates the critical importance of cell-mediated immune responses in the
resolution and control of HPV infections. Patients infected
S1/19
S1/20
4. Summary
HPV infection of the genital tract is common in young
sexually active individuals, the majority of whom clear the
infection without overt clinical disease. Most of those who
develop benign lesions eventually mount an effective cellmediated immune response that results in lesion regression.
Regression of anogenital warts is accompanied histologically by a CD4+ T cell-dominated Th1 response, and data
from animal models suggest that the response is modulated
by CD4+ T cell-dependent mechanisms. Failure to develop
effective cell-mediated immunity to clear or control infection
results in persistent infection and, in the case of the highrisk HPVs, an increased probability of progression to highgrade squamous intraepithelial lesions or invasive carcinoma.
The increased prevalence of HPV infections and high-grade
lesions in individuals immunosuppressed as a consequence
of HIV infection demonstrates the importance of CD4+ T
cells in the control of HPV infection. The prolonged duration of infection associated with HPV seems to be associated
with effective evasion of innate immunity as reflected in the
absence of inflammation during virus replication, assembly,
and release, and downregulation of interferon secretion and
response, thus delaying the activation of adaptive immunity.
Serum neutralizing antibody to the major capsid protein
L1 is usually produced after successful induction of cellmediated immunity, and these antibody and cell-mediated
responses protect against subsequent viral challenge in natural infections in animals. Prophylactic immunization using
L1 VLPs has proven effective in all animal models tested,
and phase 2 results in humans suggest that HPV VLP vaccines are safe, immunogenic, and efficacious; these vaccines
are expected to yield significant public health benefits.
References
[1] Medzhitov R, Janeway Jr CA. Decoding the patterns of self and
nonself by the innate immune system. Science 2002;296:298300.
[2] Rouse BT, Suvas S. Regulatory cells and infectious agents: detentes
cordiale and contraire. J Immunol 2004;173:22115.
[3] McHeyzer-Williams LJ, McHeyzer-Williams MG. Antigen-specific
memory B cell development. Annu Rev Immunol 2005;23:487513.
[4] Sterling JC, Skepper JN, Stanley MA. Immunoelectron microscopical localization of human papillomavirus type 16 L1 and E4 proteins in cervical keratinocytes cultured in vivo. J Invest Dermatol
1993;100:1548.
[5] Stanley MA. Replication of human papillomaviruses in cell culture.
Antiviral Res 1994;24:115.
[6] Middleton K, Peh W, Southern S, Griffin H, Sotlar K, Nakahara T,
et al. Organization of human papillomavirus productive cycle during
neoplastic progression provides a basis for selection of diagnostic
markers. J Virol 2003;77:10186201.
[7] Oriel JD. Natural history of genital warts. Br J Vener Dis
1971;47:113.
[8] Coleman N, Birley HDL, Renton AM, Hanna NF, Ryait BK, Byrne
M, et al. Immunological events in regressing genital warts. Am J
Clin Pathol 1994;102:76874.
[9] Ghim S, Newsome J, Sundberg JP, Schlegel R, Jenson AB.
Spontaneously regressing oral papillomas induce systemic antibodies that neutralize canine oral papillomavirus. Exp Mol Pathol
2000;68:14751.
[10] Ho GYF, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural
history of cervicovaginal papillomavirus infection in young women.
N Engl J Med 1998;338:4238.
S1/21
S1/22
[29] Barnard P, McMillan NA. The human papillomavirus E7 oncoprotein abrogates signaling mediated by interferon-. Virology
1999;259:30513.
[30] Ronco LV, Karpova AY, Vidal M, Howley PM. Human papillomavirus 16 E6 oncoprotein binds to interferon regulatory factor-3
and inhibits its transcriptional activity. Genes Dev 1998;12:206172.
[31] Fausch SC, Da Silva DM, Rudolf MP, Kast WM. Human papillomavirus virus-like particles do not activate Langerhans cells: a possible immune escape mechanism used by human papillomaviruses.
J Immunol 2002;169:32429.
[32] Fausch SC, Da Silva DM, Kast WM. Heterologous papillomavirus
virus-like particles and human papillomavirus virus-like particle immune complexes activate human Langerhans cells. Vaccine
2005;23:17209.
[33] Kobayashi A, Greenblatt RM, Anastos K, Minkoff H, Massad LS,
Young M, et al. Functional attributes of mucosal immunity in cervical
intraepithelial neoplasia and effects of HIV infection. Cancer Res
2004;64:676674.
[34] Kirnbauer R, Hubbert NL, Wheeler CM, Becker TM, Lowy DR,
Schiller JT. A virus-like particle enzyme-linked immunosorbent
assay detects serum antibodies in a majority of women infected with
human papillomavirus type 16. J Natl Cancer Inst 1994;86:4949.
[35] Wikstrom A, van Doornum GJJ, Quint WGV, Schiller JT, Dillner J.
Identification of human papillomavirus seroconversions. J Gen Virol
1995;76:52939.
[36] Carter JJ, Wipf GC, Hagensee ME, McKnight B, Habel LA, Lee
SK, et al. Use of human papillomavirus type 6 capsids to detect
antibodies in people with genital warts. J Infect Dis 1995;172:118.
[37] Villa LL, Costa RLR, Petta CA, Andrade RP, Ault KA, Giuliano
AR, et al. Prophylactic quadrivalent human papillomavirus (types
6, 11 16 and 18) L1 virus-like particle vaccine in young women:
a randomised double-blind placebo-controlled multicentre phase II
efficacy trial. Lancet Oncol 2005;6:2718.
[38] Kreider JW, Bartlett GL. The Shope papilloma-carcinoma complex
of rabbits: a model system of neoplastic progression and spontaneous
regression. Adv Cancer Res 1981;35:81110.
[39] Suzich JA, Ghim SJ, Palmer-Hill FJ, White WI, Tamura JK, Bell
JA, et al. Systemic immunization with papillomavirus L1 protein
completely prevents the development of viral mucosal papillomas.
Proc Natl Acad Sci USA 1995;92:115537.
[40] Dillner J. The serological response to papillomaviruses. Semin Cancer Biol 1999;9:42330.
[41] Zhou J, Sun XY, Stenzel DJ, Frazer IH. Expression of vaccinia
recombinant HPV 16 L1 and L2 ORF proteins in epithelial cells
is sufficient for assembly of HPV virion-like particles. Virology
1991;185:2517.
[42] Kirnbauer R, Booy F, Cheng N, Lowy DR, Schiller JT. Papillomavirus L1 major capsid protein self-assembles into virus-like
particles that are highly immunogenic. Proc Natl Acad Sci USA
1992;89:121804.
[43] Hagensee ME, Olson NH, Baker TS, Galloway DA. Threedimensional structure of vaccinia virus-produced human papillomavirus type 1 capsids. J Virol 1994;68:45035.
[44] Christensen ND, Reed CA, Cladel NM, Hall K, Leiserowitz GS.
Monoclonal antibodies to HPV-6 L1 virus-like particles identify conformational and linear neutralizing epitopes on HPV-11 in addition
to type-specific epitopes on HPV-6. Virology 1996;224:47786.
[45] Stanley MA. Human papillomavirus vaccines. Curr Opin Mol Ther
2002;4:1522.
[46] Harro CD, Pang YYS, Roden RBS, Hildesheim A, Wang Z,
Reynolds MJ, et al. Safety and immunogenicity trial in adult volun-
[47]
[48]
[49]
[50]
[51]
[52]
[53]
[54]
[55]
[56]
[57]
[58]
[59]
[60]
[61]
[62]
Ohlschl
ager P, Osen W, Dell K, Faath S, Garcea RL, Jochmus I, et
al. Human papillomavirus type 16 L1 capsomeres induce L1-specific
cytotoxic T lymphocytes and tumor regression in C57BL/6 mice. J
Virol 2003;77:463545.
Emeny RT, Wheeler CM, Jansen KU, Hunt WC, Fu TM, Smith JF,
et al. Priming of human papillomavirus type 11-specific humoral and
cellular immune responses in college-aged women with a virus-like
particle vaccine. J Virol 2002;76:783242.
Pinto LA, Edwards J, Castle PE, Harro CD, Lowy DR, Schiller JT,
et al. Cellular immune responses to human papillomavirus (HPV)-16
L1 in healthy volunteers immunized with recombinant HPV-16 L1
virus-like particles. J Infect Dis 2003;188:32738.
Harper DM, Franco EL, Wheeler C, Ferris DG, Jenkins D, Schuind
A, et al. Efficacy of a bivalent L1 virus-like particle vaccine
in prevention of infection with human papillomavirus types 16
and 18 in young women: a randomised controlled trial. Lancet
2004;364:175765.
Koutsky LA, Ault KA, Wheeler CM, Brown DR, Barr E, Alvarez
FB, et al. A controlled trial of a human papillomavirus type 16
vaccine. N Engl J Med 2002;347:164551.