1. Oral vaccination against HPV E7 for treatment of cervical intraepithelial neoplasia grade 3 (CIN3) elicits E7-specific mucosal immunity in the cervix of CIN3 patients
- Author
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Tomoyuki Fujii, Osamu Wada-Hiraike, Haruka Nishida, Ayumi Taguchi, Yutaka Osuga, Katsuyuki Adachi, Satoko Kojima, Katsutoshi Oda, Kazunori Nagasaka, Takahide Arimoto, Terufumi Yokoyama, Kei Kawana, Tomomitsu Sewaki, Kensuke Tomio, and Aki Yamashita
- Subjects
Adult ,medicine.medical_specialty ,Papillomavirus E7 Proteins ,T-Lymphocytes ,medicine.medical_treatment ,Administration, Oral ,Cervix Uteri ,Cervical intraepithelial neoplasia ,Gastroenterology ,Interferon-gamma ,Immune system ,Internal medicine ,Biopsy ,medicine ,Humans ,Papillomavirus Vaccines ,Adverse effect ,Immunity, Mucosal ,Cervix ,Immunity, Cellular ,General Veterinary ,General Immunology and Microbiology ,medicine.diagnostic_test ,business.industry ,ELISPOT ,Papillomavirus Infections ,Public Health, Environmental and Occupational Health ,Immunotherapy ,Uterine Cervical Dysplasia ,medicine.disease ,female genital diseases and pregnancy complications ,Vaccination ,Infectious Diseases ,medicine.anatomical_structure ,Immunology ,Molecular Medicine ,Female ,business - Abstract
Background Cervical intraepithelial neoplasia grade 3 (CIN3) is a mucosal precancerous lesion caused by high-risk human papillomavirus (HPV). Induction of immunological clearance of CIN3 by targeting HPV antigens is a promising strategy for CIN3 therapy. No successful HPV therapeutic vaccine has been developed. Methods We evaluated the safety and clinical efficacy of an attenuated Lactobacillus casei expressing modified full-length HPV16 E7 protein in patients with HPV16-associated CIN3. Ten patients were vaccinated orally during dose optimization studies (1, 2, 4, or 6 capsules/day) at weeks 1, 2, 4, and 8 (Step 1). Seven additional participants were only tested using the optimized vaccine formulation (Step 2), giving a total of 10 patients who received optimized vaccination. Cervical lymphocytes (CxLs) and peripheral blood mononuclear cells (PBMCs) were collected and E7 specific interferon-γ-producing cells were counted (E7 cell-mediated immune responses: E7-CMI) by ELISPOT assay. All patients were re-evaluated 9 weeks after initial vaccine exposure using cytology and biopsy to assess pathological efficacy. Results No patient experienced an adverse event. E7-CMI in both CxLs and PBMCs was negligible at baseline. All patients using 4–6 capsules/day showed increased E7-CMI in CxLs, whereas patients using 1–2 capsules/day did not. No patient demonstrated an increase in E7-CMI in their PBMCs. In comparison between patients of cohorts, E7-CMI at week 9 (9 wk) in patients on 4 capsules/day was significantly higher than those in patients on 1, 2, or 6 capsules/day. Most patients (70%) taking the optimized dose experienced a pathological down-grade to CIN2 at week 9 of treatment. E7-CMI in CxLs correlated directly with the pathological down-grade. Conclusions Oral administration of an E7-expressing Lactobacillus-based vaccine can elicit E7-specific mucosal immunity in the uterine cervical lesions. We are the first to report a correlation between mucosal E7-CMI in the cervix and clinical response after immunotherapy in human mucosal neoplasia.
- Published
- 2014
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