Background
Human papillomavirus (HPV) can be categorized into five genera: α, β, γ, μ, and ν. HPV α and γ genera infect the skin and mucous membrane tissues, while β, μ, and ν genera infect the skin area. High-risk HPVs that can cause cancer belong to the α genus, such as HPV33. HPV is an unenveloped epitheliotropic virus with an icosahedron of 72 capsomers on the outside and a double-stranded circular DNA genome on the inside. The HPV genome is divided into three regions: early (E), late (L), and long control region (LCR), with the E region encoding early proteins responsible for replication, transcription, viral release, and the creation of favorable conditions for the virus. The L region encodes the L1 and L2 capsid proteins, with L2 being more conserved than the L1 genome, and the non-coding LCR being involved in viral replication and gene expression regulation.
The virus reaches the basal lamina through subtle wounds in the epithelium, and HPV can only infect dividing keratin-forming cells of the basal lamina. First the major capsid protein L1 binds to laminin-332 on the basement membrane, which is subsequently cleaved by KLK8 leading to a conformational change, followed by fusion of L1 with heparan sulfate proteoglycans (HSPGs). Interaction between positively charged lysine residues in L1 and negatively charged HSPGs further affects the conformation of L1 and L2, exposing the N-terminus of the L2 protein to furin cleavage in the presence of CyPB, which leads to a decrease in the affinity of capsid protein for HSPGs. Subsequently L2 mediates the endocytosis of HPV into cells in a clathrin protein-independent form. Upon entry into the cell, viral DNA is released from the capsid and transported to the nucleus, where it takes advantage of the rupture of the nuclear membrane at the beginning of mitosis to enter the nucleus. Vesicles containing viral DNA, L2 and possibly L1, are transported along microtubules, attached to the mitotic chromatin, and at the end of mitosis become part of newly formed promyelocytic leukemia nucleosomes (PML NBs), which protect the viral DNA from damage by host restriction endonucleases. The L1 and L2 genes are expressed in the upper layer of terminally differentiated cells of epithelial cells.
Figure 1. The life cycle of HPV
(Source: Mlynarczyk-Bonikowska B, et al. 2024)
Persistent HPV infection is necessary for the development of cervical cancer, but the disease can be prevented by vaccination and regular screening. The L1 protein was chosen as the centerpiece of HPV vaccine development due to its ability to form virus-like particles (VLPs) on its own, and almost all available HPV prophylactic vaccines contain recombinant L1 protein. The HPV vaccine currently on the market prevents more than 90% of cervical, vulvar, and penile intraepithelial neoplasia caused by the HPV types covered by the vaccine.
Alternative Names
Human Papilloma Virus 33 L1 protein
HPV 33 L1 protein
References
- 1. Vieira GV, et al. Proteases and HPV-Induced Carcinogenesis. Cancers (Basel). 2022 Jun 21;14(13):3038.
- 2. Mlynarczyk-Bonikowska B, et al. HPV Infections—Classification, Pathogenesis, and Potential New Therapies. International Journal of Molecular Sciences. 2024 Jun; 25(14):7616.
References
A public health approach to cervical cancer screening in Africa through community-based self-administered HPV testing and mobile treatment provision
CANCER MEDICINE
Authors: Nakalembe, Miriam; Makanga, Philippa; Kambugu, Andrew; Laker-Oketta, Miriam; Huchko, Megan J.; Martin, Jeffrey
Abstract
The World Health Organization (WHO) refers to cervical cancer as a public health problem, and sub-Saharan Africa bears the world's highest incidence. In the realm of screening, simplified WHO recommendations for low-resource countries now present an opportunity for a public health approach to this public health problem. We evaluated the feasibility of such a public health approach to cervical cancer screening that features community-based self-administered HPV testing and mobile treatment provision. In two rural districts of western-central Uganda, Village Health Team members led community mobilization for cervical cancer screening fairs in their communities, which offered self-collection of vaginal samples for high-risk human papillomavirus (hrHPV) testing. High-risk human papillomavirus-positive women were re-contacted and referred for treatment with cryotherapy by a mobile treatment unit in their community. We also determined penetrance of the mobilization campaign message by interviewing a probability sample of adult women in study communities about the fair and their attendance. In 16 communities, 2142 women attended the health fairs; 1902 were eligible for cervical cancer screening of which 1892 (99.5%) provided a self-collected vaginal sample. Among the 393 (21%) women with detectable hrHPV, 89% were successfully contacted about their results, of which 86% returned for treatment by a mobile treatment team. Most of the women in the community (93%) reported hearing about the fair, and among those who had heard of the fair, 68% attended. This public health approach to cervical cancer screening was feasible, effectively penetrated the communities, and was readily accepted by community women. The findings support further optimization and evaluation of this approach as a means of scaling up cervical cancer control in low-resource settings.
Assessing Physician Adherence to Guidelines for CervicalCancer Screening and Management of AbnormalScreening Results
JOURNAL OF LOWER GENITAL TRACT DISEASE
Authors: Min, Caroline J.; Massad, L. Stewart; Dick, Rebecca; Powell, Matthew A.; Kuroki, Lindsay M.
Abstract
Objective The aim of the study was to survey obstetrician-gynecologists' cervical cancer screening practices and management of cervical abnormalities to ascertain adherence to guidelines. Methods From January to July 2019, obstetrician-gynecologists at 5 St. Louis area hospitals were surveyed online about cervical cancer screening and management practices through 13 clinical vignettes. Survey scores and the American Society of Colposcopy and Cervical Pathology (ASCCP) app use were compared using Mann-Whitney tests. Results When screening 30- to 65-year-old participants, 114 (98%) of the 116 total participants used co-testing, but only 71 (61%) screened at 5-year intervals. None used primary human papillomavirus (HPV) testing. For 21- to 29-year-old participants, 17 (15%) screened with annual cytology, whereas 14 (12%) used annual or every 3-year co-testing. Forty eight (41%) screened younger than 21 years, regardless of risk factors or only if immunocompromised. Eleven (9%) continued screening after total hysterectomy for benign indications. Only 2 (2%) responded to all clinical vignettes in adherence to guidelines. More than 30% of participants would pursue unnecessary HPV testing and/or loop electrosurgical excision procedure for persistent low-grade cytology. Fifty eight (48%) incorrectly reported hysterectomy as management for adenocarcinoma in situ on biopsy. Participants would undertreat young women with high-grade abnormalities including high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia 3 (48, 41%) and high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia 1 (65, 56%). Forty one (35%) reported exiting women from screening prematurely. The median score for participants using the ASCCP app was significantly greater than those who did not (79% vs 71%,p= .002). Conclusions Midwestern obstetrician-gynecologists' adherence to the guidelines for cervical cancer screening and management of abnormal results is suboptimal. Although co-testing for women aged 30-65 years has been broadly adopted, primary HPV testing has not. Physicians overscreen, overtreat low-grade lesions, and undertreat high-grade lesions in young women.