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Mapping viruses in non-malignant tonsils, nasal polyps, sinonasal inverted papilloma and laryngeal cancer
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.ORCID iD: 0000-0003-0007-8716
2022 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Kartläggning av virus i godartade halsmandlar, näspolyper och inverterat papillom i näsa-bihålor samt cancer i struphuvudet (Swedish)
Abstract [en]

Background: The upper respiratory tract is exposed to viruses, which can lead to infection and cancer development. We chose to study common and/or chronic diseases along with common and cancer related viruses in the upper airway. High-risk human papillomavirus (HPV) causes cancer in tonsils and base of tongue, and Epstein-Barr virus (EBV) in the nasopharynx. p16 is used as a site-specific tumor marker for HPV. Human cytomegalovirus (HCMV) and human adenovirus (HAdV) are proposed to be oncomodulatory. It is unclear what significance these viruses have in benign tonsillar disease, chronic rhinosinusitis with nasal polyps (CRSwNP), sinonasal inverted papillomas (SIP) and laryngeal squamous cell carcinoma (LSCC). If virus is identified, it could make possible the use of current vaccines in prevention and treatment, as well as protection of healthcare providers.

Material and Methods: We analyzed 40 benign tonsils, 45 paired nasal polyp and healthy nasal mucosa samples, 53 SIP and 78 LSCC samples. We used PCR/microarrays (PapilloCheck®) for HPV detection and genotyping, immunohistochemistry (IHC) for p16 expression and real-time PCR for EBV, HCMV and HAdV detection. Additionally, Epstein-Barr encoding region (EBER) in situ hybridization (ISH) was used for EBV localization and count.

Results: HPV and p16 were not co-expressed, and p16 levels were low in benign tonsils, nasal polyps, and paired controls. Also, 9% of LSCC samples were high-risk HPV 16 positive and over-expressed p16.

EBV-positive cells were detected in 65% of the tonsils, nasal polyps (36%) versus controls (12%), 30% of SIP cases and 33% of LSCC samples.

Conclusions: EBV is commonly identified in benign tonsils, nasal polyps, SIP and LSCC, when using sensitive and robust detection methods. At the same time, viral infection with HPV, HCMV or HAdV appears to be uncommon in these conditions. p16 does not emerge as a reliable marker for HPV infection in LSCC.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2022. , p. 72
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2188
Keywords [en]
Human papilloma virus, Epstein-Barr virus, Human cytomegalovirus, Human adenovirus, p16 tumor suppressor protein, Non-malignant tonsillar disease, Chronic rhino sinusitis with nasal polyps, sinonasal inverted papilloma, laryngeal cancer, EBER-ISH
National Category
Otorhinolaryngology
Research subject
Oto-Rhino-Laryngology
Identifiers
URN: urn:nbn:se:umu:diva-200180ISBN: 978-91-7855-841-4 (print)ISBN: 978-91-7855-842-1 (electronic)OAI: oai:DiVA.org:umu-200180DiVA, id: diva2:1703227
Public defence
2022-11-25, Hörsalen Snäckan, Hus 16, Östersunds Sjukhus, Östersunds sjukhus, Kyrkgatan 16, Östersund, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2022-11-04 Created: 2022-10-12 Last updated: 2022-10-13Bibliographically approved
List of papers
1. Mapping of Human Papilloma Virus, p16, and Epstein-Barr Virusin Non-Malignant Tonsillar Disease
Open this publication in new window or tab >>Mapping of Human Papilloma Virus, p16, and Epstein-Barr Virusin Non-Malignant Tonsillar Disease
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2019 (English)In: Laryngoscope Investigative Otolaryngology (LIO), E-ISSN 2378-8038, Vol. 4, no 3, p. 285-291Article in journal (Refereed) Published
Abstract [en]

Objectives: Due to their location in the entrance of the aero‐digestive tract, tonsils are steadily exposed to viruses. Human papilloma virus (HPV) and Epstein‐Barr virus (EBV) are two potentially oncogenic viruses that tonsils encounter. The incidence of HPV positive tonsillar cancer is on the rise and it is unknown when infection with HPV occurs.

Aim: To investigate if tonsils are infected with HPV and EBV, to study the co‐expression of HPV and its surrogate marker p16, and to evaluate the number of EBV positive cells in benign tonsillar disease.

Materials and Methods: Tonsils from 40 patients in a university hospital were removed due to hypertrophy, chronic or recurrent infection. These were analyzed for presence of HPV, its surrogate marker p16, and EBV. HPV was studied using PapilloCheck (a PCR method), while p16 was identified in epithelial and lymphoid tissue with immunohistochemistry and EBV using EBER‐ISH (Epstein‐Barr encoding region–in situ hybridization).

Results: HPV was not detected, and p16 was present at low numbers in all epithelial samples as well as in 92.5% of the lymphoid tonsillar samples. At least one EBER‐positive cell was seen in 65% of cases. Larger numbers of EBER‐expressing cells were only seen in two cases.

Conclusion: These findings demonstrate that EBV and HPV infect tonsils independently, but further studies are warranted to confirm their infectious relationship.

Level of Evidence: Cross‐sectional study

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
Human papillomavirus, Epstein-Barr virus, non-malignant tonsillar disease, EBER-ISH, PapilloCheck, immunohistochemistry
National Category
Otorhinolaryngology
Research subject
Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:umu:diva-158485 (URN)10.1002/lio2.260 (DOI)000471907200002 ()31236460 (PubMedID)
Funder
Västerbotten County Council
Available from: 2019-04-29 Created: 2019-04-29 Last updated: 2024-07-02Bibliographically approved
2. Epstein-Barr virus in patients with chronic rhinosinusitis and nasal polyps
Open this publication in new window or tab >>Epstein-Barr virus in patients with chronic rhinosinusitis and nasal polyps
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(English)Manuscript (preprint) (Other academic)
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:umu:diva-200177 (URN)
Available from: 2022-10-11 Created: 2022-10-11 Last updated: 2022-10-12
3. Low Epstein-Barr virus count in sinonasal inverted papilloma
Open this publication in new window or tab >>Low Epstein-Barr virus count in sinonasal inverted papilloma
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2020 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 140, no 5, p. 413-417Article in journal (Refereed) Published
Abstract [en]

Background: Sinonasal inverted papilloma (SIP) is a benign tumour originating from the sinonasal mucosa showing an extensive growth pattern, a high risk of recurrence and a 5–10% risk to malignify. Epstein-Barr virus (EBV) is an oncogenic herpesvirus which infects most individuals via the saliva eliciting a latent infection. Previous studies have been reporting variable data on EBV in SIP, and there is no present appreciation regarding the association between these.

Aims/objectives: The aims were to investigate the presence and count of EBV in SIP and map the viral distribution in the epithelium versus the connective tissue.

Material and method: Fifty-three SIP patients were identified in the Pathology Department register at the University Hospital of Umeå. The biopsies were analysed with Epstein-Barr Encoded Region (EBER) in situ hybridization. EBER-positive cells were counted in the epithelium and connective tissue.

Results: We found EBER-stained cells in 30% of the cases, where 19% of these had an abundance of stained cells, and the rest showed a low count.

Conclusions/significance: These findings demonstrate a low EBV count in SIP. EBV is less likely to be a causative agent in the formation of SIP, or its malignant transformation.

Place, publisher, year, edition, pages
Taylor & Francis, 2020
Keywords
Epstein-Barr virus, sinonasal inverted papilloma, EBER-ISH
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:umu:diva-168828 (URN)10.1080/00016489.2020.1724330 (DOI)000514736300001 ()32068495 (PubMedID)2-s2.0-85079719070 (Scopus ID)
Funder
Region Västerbotten
Available from: 2020-03-19 Created: 2020-03-19 Last updated: 2023-03-24Bibliographically approved
4. Mapping human papillomavirus, Epstein–Barr virus, cytomegalovirus, adenovirus, and p16 in laryngeal cancer
Open this publication in new window or tab >>Mapping human papillomavirus, Epstein–Barr virus, cytomegalovirus, adenovirus, and p16 in laryngeal cancer
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2022 (English)In: Discover Oncology, E-ISSN 2730-6011, Vol. 13, no 1, article id 18Article in journal (Refereed) Published
Abstract [en]

Purpose: Apart from tobacco and alcohol, viral infections are proposed as risk factors for laryngeal cancer. The occurrence of oncogenic viruses including human papilloma virus (HPV) and Epstein–Barr virus (EBV), in laryngeal squamous cell carcinoma (LSCC) varies in the world. Carcinogenesis is a multi-step process, and the role of viruses in LSCC progression has not been clarified. We aimed to analyze the presence and co-expression of HPV, EBV, human cytomegalovirus (HCMV) and human adenovirus (HAdV) in LSCC. We also investigated if p16 can act as surrogate marker for HPV in LSCC.

Methods: Combined PCR/microarrays (PapilloCheck®) were used for detection and genotyping of HPV DNA, real-time PCR for EBV, HCMV and HAdV DNA detection, and EBER in situ hybridization (EBER-ISH) for EBV detection in tissue from 78 LSCC patients. Additionally, we analyzed p16 expression with immunohistochemistry.

Results: Thirty-three percent (26/78) of LSCC tumor samples were EBV positive, 9% (7/78) HCMV positive and 4% (3/78) HAdV positive. Due to DNA fragmentation, 45 samples could not be analyzed with PapilloCheck®; 9% of the remaining (3/33) were high-risk HPV16 positive and also over-expressed p16. A total of 14% (11/78) of the samples over-expressed p16.

Conclusion: These findings present a mapping of HPV, EBV, HCMV and HAdV, including the HPV surrogate marker p16, in LSCC in this cohort. Except for EBV, which was detected in a third of the samples, data show viral infection to be uncommon, and that p16 does not appear to be a specific surrogate marker for high-risk HPV infection in LSCC.

Place, publisher, year, edition, pages
Springer, 2022
National Category
Cancer and Oncology Otorhinolaryngology
Research subject
Oncology
Identifiers
urn:nbn:se:umu:diva-193581 (URN)10.1007/s12672-022-00475-4 (DOI)000771496000002 ()35312853 (PubMedID)2-s2.0-85126886934 (Scopus ID)
Available from: 2022-04-19 Created: 2022-04-19 Last updated: 2022-10-12Bibliographically approved

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