Abstract
BackgroundAnogenital warts are the leading sexually transmitted infection in patients seeking care at specialized clinics. They may display a vast array of forms, according to the interaction of the virus with the host's immunity. Cellular immunity is the epithelium's main form of defense against the virus, involving an active participation of the Langerhans cells and pro-inflammatory cytokines such as TNF-α. ObjectiveTo assess the epithelial immune response of anogenital warts in males, according to the number of lesions presented. MethodsThis is a prospective, cross-sectional study carried out at the dermatology outpatient clinic in a tertiary hospital. We included male patients over 18 years of age without comorbidities who had anogenital condylomata and no previous treatments.In order to evaluate the local epithelial immunity, the lesions were quantified, then removed and employed in CD1a immunohistochemistry assays for assessing the morphometry and morphology of Langerhans cells; TNF-α; reaction was used for determining cytokine positivity in the epithelium. Results48 patients were included in the study. There was no statistically significant difference as to the number of Langerhans cells, in their morphology, or the presence of TNF-α. However, patients presenting with more Langerhans cells in the lesions had cells with a star-like and dendritic morphology, whereas in those with a lower cell count had cells with a rounded morphology and no dendrites (p<0.001). Study limitationsSmall number of patients analyzed. ConclusionThere was no difference in epithelial immunity between patients having few or many anogenital condyloma lesions as measured by the morphology and morphometry of Langerhans cells and TNF-α; positivity. Such an assessment employing immunity markers differing from the usual ones is expected to yield useful results.
Highlights
Anogenital warts, known as condylomata acuminata (CA), are sexually transmitted infections (STIs) caused by the human papillomavirus (HPV)
Our study aims to assess the epithelial immunity of anogenital warts of men treated at a dermatology outpatient clinic, correlate the clinical presentation of warts with local immunity, as measured by the quantification and morphological aspects of the Langerhans cells in them, and correlate the number of lesions with either the presence or absence of TNF-␣ labeling in them
Excluded from the study were: systemically immunocompromised patients (transplanted patients; patients testing seropositive for the human immunodeficiency virus (HIV); having acquired immunodeficiency syndrome (AIDS); and cancer patients); patients on systemic immunosuppressive medications; patients who had received any previous or current topical treatment for the lesion; patients presenting with lesions that could not undergo surgical excision
Summary
Anogenital warts, known as condylomata acuminata (CA), are sexually transmitted infections (STIs) caused by the human papillomavirus (HPV). They are considered the most frequent STI in developing countries and can be classified as a global epidemic. The progression of HPV-induced lesions is correlated with viral type, genetic factors, environmental factors, and mostly with host immunity.[3,4] This immune defense of the epithelium has the participation of dendritic cells, which, in the skin, are represented by the Langerhans cells (LC) and keratinocytes themselves.[5] As the primary target of HPV, keratinocytes play an important role during the onset of virus infection and subsequently becomes involved in promoting an effective adaptive immune response. The activation of these receptors, in turn, promotes the production of cytokines, thereby creating a powerful pro-inflammatory environment, in particular upon the activation of TLR-9, which stimulates keratinocyte to produce TNF-␣.6---8
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