The Clinical And Experimental Study Of Subclinical Condylomata Acuminate

Background:Condyloma acuminata (CA) is a common sexually transmitted disease which is infected by human papillomavirus (HPV) with high incidence about 70/10 million, second only to non-gonococcal urethritis. Currently HPV was divided into more than 100 subtypes, and CA mainly caused by HPV-6,11,16,18 and other subtypes. HPV mainly infect epithelial tissue and its pathopoiesis on anogenital cancer has been fully affirmed by a large number of basic and clinical research, such as HPV-16,18,45,56, are the most common high-risk types which caused cervical cancer.Most genitoanal HPV are dormant or subclinical infection, which is one of the most important reasons of recurrence of CA. 90% CA patients are subclinical infection have been found in one study. Traditional remedies often get rid of CA lesions but with great side effects.5-aminolevulinic acid photodynamic therapy (ALA-PDT) has been successfully used for treatment of CA, with selective lethal effect (including subclinical infection cells) to proliferating cells, while no significant effect on the surrounding normal cells.MUC4, a large transmembrane mucin, has recently emerged as a novel marker for diagnosis, prognosis and therapy in several malignancies. An earlier study by Subhankar Chakraborty group revealed a progressive increase in MUC4 expression from the normal cervical epithelium through cervical intraepithelial neoplasia to cervical SCC,while 90% cervical SCC has been found HPV. Amoderately strong MUC4 expression was also noted in 10/19 cases of vulval CA. Taken together, the results of the two studies suggest, for what we believe is the first time, a novel association between HPV and MUC4.Objective:Study the treatment of subclinical infection, including selection of therapeutic method and the impact of treatment on the recurrence of CA, so as to provide a more scientific approach for diagnosis and treatment of subclinical CA to reduce the recurrence of CA ultimately; To supply basis for study on epidemiological to evaluate efficacy on the treatment of subclinical CA using 5-aminolevulinic acid- photodynamic therapy (ALA-PDT) and CO2 laser. To investigate the role of MUC4 mRNA and MUC4 in the cell proliferation and carcinogenesis in skin lesions of CA and subclinical infection.Methods: Clinical research The CA patients were newly diagnosed in department of Dematology and Venereology of Shenzhen Chronic Disease Contorl Center with acetic acid test, electronic colposcope examination or part of histopathological examination confirmed subclinical HPV infection patients(SPI), the positive rate of SPI is about 90.87%. First, the lesions of 92 CA patients were vaporizated one by one,than forty one patients with subclinical CA were treated by ALA-PDT and fifty one cases by CO2 laser. The therapeutic effect of two methods were no statistically significant.Experimental study The technique of reverse transcription Polymerase Chain Reaction(RT-PCR)and immunohistochemistry were used to detect the expression of MUC4 protein and MUC4 mRNA in clinical and subclinical infection lesions of CA and normal skin of genital area. Channelization Hybridization technique was used to measure the type of HPV DNA.Results: After six months the complete remission was 84.3% for CO2 laser and 90.2% for ALA-PDT, respectively ; the recurrence rate was 15.7% and 9.8%, respectively. There were no statistically significant in remission and recurrence rate. Out of 32 CA clinical specimens and 32 subclinical infection tissues, the expression of MUC4 mRNA were found in 19 cases and 18 cases; they were no statistically significant in MUC4 mRNA positive expression (χ~2=0.064, P>0.05). While the expression of MUC4 protein were found in 17 cases and 13 cases; there were no statistically significant in MUC4 protein positive expression in the same way (χ~2 = 1.004, P >0.05);while co-expression of MUC4 mRNA and MUC4 protein were found in 8 cases and 9 cases respectively with no statistically significant(χ~2=0.08, P>0.05). PCR showed CA was primarily infected by HPV6 and HPV11, MUC4 protein and mRNA positive expression were no related to HPV subtype.Conclusions:The results showed that the differences between the cure rates and the recurrence rates of CO2 laser and ALA- PDT were no statistically significant; However, ALA-PDT was much better than CO2 laser on side effects. The overexpression of MUC4 may be involved in proliferation and carcinomatous change of CA.