Human Papillomaviruses Flashcards

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1
Q

HPV belongs to the family of viruses known as ____________.

A

Papovaviridae [which was named for it’s three main genera: Papillomavirus, Polyomavirus, and Simian Vacuolating Agent]

Further notes:
The family contains two genera of oncogenic viruses, Papilloma and Polyoma viruses.

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2
Q

Briefly discuss the structure of human papillomaviruses.

A

These are small, non-enveloped viruses with icosahedral symmetry, and whose genome is in the form of a circular double-stranded DNA.
[Image 1] [Image 2]

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3
Q

Briefly describe the organisation of the genome of Papillomaviruses.

A

Papillomaviruses are small DNA viruses. The DNA genome is comprised of six early (E1, E2, E4, E5, E6, E7) and two late (L1 and L2) genes. The early genes are involved in viral replication and regulation of the host cell cycle, while the late genes encode the structural proteins necessary for assembling new virions [capsid proteins].
E6 and E7 are viral oncogenes. [Diagram]

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4
Q

State the function of the E2 protein and the effect of the disruption of the E2 gene.

A

The E2 protein acts as a transcriptional regulator, controlling the expression of other viral genes, including the oncogenes E6 and E7. By binding to specific DNA sequences in the viral genome, E2 can either activate or repress the transcription of these genes.

Integration of the HPV genome in the host cell chromosome usually disrupts E2 expression, causing deregulated expression of E6 and E7.

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5
Q

State the function of E6 protein.

A

E6 binds to the tumor suppressor protein p53 and targets it for degradation. This degradation prevents p53 from performing its normal function of inducing cell cycle arrest and apoptosis in response to DNA damage, allowing infected cells to proliferate uncontrollably.

Further notes:
E6 recruits the ubiquitin ligase E6AP (E6-Associated Protein) to target the tumor suppressor protein p53 for ubiquitination and subsequent degradation by the proteasome. This degradation of p53 prevents apoptosis, allowing infected cells to proliferate uncontrollably, which can lead to cancer.

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6
Q

State the function of E7 protein.

A

E7 protein disrupts the function of the retinoblastoma protein (pRb), promotes cell cycle progression, interferes with other cellular proteins, induces genomic stability, and modulates the immune response.

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7
Q

How are HPVs categorized?

A

HPV types are categorized into low-risk and high-risk strains. Low-risk types cause genital warts, while high-risk types can lead to cancers.

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8
Q

What are the high-risk variants of HPV responsible for 70% of all cervical cancers worldwide?

A

16, 18

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9
Q

What are the low risk variants of HPV responsible for 90% of genital warts?

A

6, 11

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10
Q

How is HPV transmitted?

A

HPV is primarily spread through intimate skin-to-skin contact, including vaginal, anal, and oral sex. It can also be transmitted from mother to child during childbirth.

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11
Q

Which cancers are associated with high-risk HPV types?

A

High-risk HPV types can cause cervical, anal, penile, vulvar, vaginal, and oropharyngeal cancers.

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12
Q

List common clinical manifestations of HPV infection.

A

[Human papillomavirus (HPV) infections often do not cause any noticeable symptoms, especially in the early stages. However, when symptoms do appear, they can vary depending on the type of HPV involved. Here are some common signs and symptoms associated with HPV:]

(1) Genital warts: small bumps or flat lesions
Location in women: vulva, cervix, vagina, or around the anus Location in men: penis, scrotum, or around the anus
[Image 1] [Image 2]

(2) Common warts: rough, raised bumps
Location: typically on the hands and fingers.
[Image]

(3) Plantar warts: hard, grainy growths
Loction: soles of feet
[Image]

(4) Flat warts: flat-topped, slightly raised lesions
Location: can appear anywhere on the body but are more common on the face, neck, hands, wrists, and knees
Symptoms: generally painless
[Image 1] [Image 2]

(5) Cervical dysplasia:
Appearance: Abnormal precancerous cells on the cervix. [Image]
Symptoms: Usually asymptomatic and detected through routine Pap smears.

(6) Oropharyngeal lesions:
Appearance: lesions in the mouth or throat
Symptoms: can include sore throat, ear pain, and difficulty swallowing

(7) Cancer: cervical, anal, penile, vulvar/vaginal, oropharyngeal

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13
Q

Laboratory diagnosis of HPV

What is HPV DNA typing?

A

HPV DNA typing involves detecting the presence of HPV DNA in a sample, typically using PCR to identify specific HPV DNA sequences and determine the HPV type.

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14
Q

Laboratory diagnosis of HPV

What does the detection of E6 and E7 mRNA indicate?

A

Detection of E6 and E7 mRNA indicates active viral replication and integration into the host genome, which is a marker for potential progression to cancer.

Further notes:
High-risk HPV types express the E6 and E7 oncogenes, which are involved in the disruption of tumor suppressor proteins like p53 and Rb.

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15
Q

What is the purpose of a Pap smear in the laboratory diagnosis of HPV?

A

A Pap smear involves collecting cells from the cervix and examining them under a microscope to detect abnormalities, such as precancerous changes caused by persistent HPV infection.

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16
Q

What is colposcopy in HPV diagnosis?

A

Colposcopy uses a specialized microscope to closely examine the cervix, vagina and vulva for signs of disease. If abnormal areas are identified, a biopsy can be taken for histological examination.

17
Q

Laboratory diagnosis of HPV

How does Visual Inspection with Acetic Acid (VIA) work?

A

VIA involves applying a 3-5% acetic acid solution to the cervix. HPV-infected areas turn white (acetowhite), making abnormal areas more visible to the naked eye. [Image]

18
Q

Laboratory diagnosis of HPV

How does Visual Inspection with Lugol’s Iodine (VILI) work?

A

VILI involves applying Lugol’s iodine solution to the cervix. Normal cells stain dark brown due to high glycogen content, while abnormal areas appear yellow or pale.
[Image 1] [Image 2]

19
Q

In broad terms, what are two treament options for HPV?

A

(1) use of pharmacological agents
(2) surgical ablation [cryosurgery, electrosurgery, laser ablation, simple excision]

20
Q

What are some risk factors for HPV infection?

A

lower socio-economic status, concurrent STIs [including other strains of HPV], multiple sexual partners

21
Q

What are some risk factors for HPV-induced cervical cancer?

A

early age sexual debut, smoking, high parity [women who have given birth multiple times], long-term use of estrogen, HIV

22
Q

prevention measures against HPV

A

abstinence, long-term mutual monogamy with a single uninfected partner

Further notes:
Condoms do not provide reliable protection against HPV since transmission can occur through male and female genital areas not covered.

23
Q

vaccines used against HPV

A

Gardasil, Cervarix: both protect against HPV-16 and HPV-18