A novel CD4 T-cell epitope described from one of the cervical cancer patients vaccinated with HPV 16 or 18 E7-pulsed dendritic cells

Previously, safety and immunogenicity of human papillomavirus type 16 (HPV16) or 18 E7-pulsed dendritic cells (DC) vaccinations were demonstrated in a dose-escalation Phase I clinical trial which enrolled ten patients diagnosed with stage IB or IIA cervical cancer (nine HPV 16-positive, one HPV 18-positive). The goal of the study was to define the T-cell epitopes of HPV 16 or 18 E7 protein in these patients in order to develop new strategies for treating HPV-associated malignancies. This was accomplished through establishing T-cell lines by stimulating peripheral blood mononuclear cells with autologous mature DC pulsed with the HPV 16 or 18 E7 protein, examining the T-cell responses using ELISPOT assays, and isolating E7-specific T-cell clones based on IFN-γ secretion. Then, the epitope was characterized in terms of its core sequence and the restriction element. Twelve T-cell lines from eight subjects (seven HPV 16-positive, one HPV 18-positive) were evaluated. Positive T-cell responses were demonstrated in four subjects (all HPV 16-positive). All four were positive for the HPV 16 E7 46-70 (EPDRAHYNIVTFCCKCDSTLRLCVQ) region. T-cell clones specific for the E7 47–70 region were isolated from one of the subjects. Further analyses revealed a novel, naturally processed, CD4 T-cell epitope, E7 58–68 (CCKCDSTLRLC), restricted by the HLA-DR17 molecule. This work was supported by the National Institutes of Health (R21CA094507). An erratum to this article can be found at     

Enhancement of immunogenicity of HPV16 E7 oncogene by fusion with E. coli beta-glucuronidase

BACKGROUND: Human papillomavirus type 16 (HPV16) E7 is an unstable oncoprotein with low immunogenicity. In previous work, we prepared the E7GGG gene containing point mutations resulting in substitution of three amino acids in the pRb-binding site of the HPV16 E7 protein. METHODS AND RESULTS: To increase E7GGG immunogenicity we constructed fusion genes of E. coli beta-glucuronidase (GUS) with one or three copies of E7GGG. Furthermore, a similar construct was prepared with partial E7GGG (E7GGGp, 41 amino acids from the N-terminus). The expression of the fusion genes was examined in human 293T cells. Quantification of GUS activity and the amount of E7 antigen showed substantially reduced GUS activity of fusion proteins with complete E7GGG that was mainly caused by decrease of their steady-state level in comparison with GUS or E7GGGpGUS. Still, the steady-state level of E7GGG.GUS was about 20-fold higher than that of the E7GGG protein. The immunogenicity of the fusion genes with complete E7GGG was tested by DNA immunisation of C57BL/6 mice with a gene gun. TC-1 cells and their clone TC-1/A9 with down-regulated MHC class I expression were subcutaneously (s.c.) inoculated to induce tumour formation. All mice were protected against challenge with TC-1 cells and most animals remained tumour-free in therapeutic-immunisation experiments with these cells, in contrast to immunisation with unfused E7GGG and the fusion with the lysosome-associated membrane protein 1 (Sig/E7GGG/LAMP-1). Significant protection was also recorded against TC-1/A9 cells. Both tetramer staining and ELISPOT assay showed substantially higher activation of E7-specific CD8+ lymphocytes in comparison with E7GGG and Sig/E7GGG/LAMP-1. Deletion of 231 bp in the GUS gene eliminated enzymatic activity, but did not influence the immunogenicity of the E7GGG.GUS gene. CONCLUSIONS: The findings demonstrate the superior immunisation efficacy of the fusion genes of E7GGG with GUS when compared with E7GGG and Sig/E7GGG/LAMP-1. The E7GGG.GUS-based DNA vaccine might also be efficient against human tumour cells with reduced MHC class I expression.     

Transforming activity of a novel mutant of HPV16 E6E7 fusion gene

An optimized recombinant HPV16 E6E7 fusion gene(HPV16 ofE6E7)was constructed according to codon usage for mammalian cell expression,and a mutant of HPV16 ofE6E7 fusion gene(HPV16 omfE6E7)was generated by site-directed mutagenesis at L57G,C113R for the E6 protein and C24G,E26G for the E7 protein for HPV16 ofE6E7 [patent pending(CN 101100672)].The HPV16 omfE6E7 gene constructed in this work not only lost the transformation capability to NIH 3T3 cells and tumorigenicity in SCID mice,but also maintained very good stability and antigenicity.These results suggests that the HPV16 omfE6E7 gene should undergo further study for application as a safe antigen-specific therapeutic vaccine for HPV16-associated tumors.     

基于颜色判定的环介导等温扩增技术检测HPV6和HPV16

建立了一种基于颜色判定的简单、快速和灵敏的检测方法,即环介导等温核酸扩增技术(LAMP)应用于HPV6和HPV16亚型的检测。该技术设计分别对应于HPV6和16的E6和E7基因序列中6个区段的4条特异引物,在等温条件下(63℃)进行核酸扩增反应1h,在扩增前加入HNB染料(羟基萘酚蓝)作为反应指示剂,以HNB染料颜色的变化做为结果判定的标准,并经LA-320实时浊度仪和琼脂糖电泳证实。文中利用这种技术对13份已知的单重感染13种HPV不同亚型的临床样本进行了特异性分析,同时对2个含目的片段的克隆质粒的系列稀释物进行了灵敏度分析。结果显示LAMP方法特异性高,颜色法判断的灵敏度均为1000个拷贝DNA分子水平,比Real-time PCR低10～20倍,对62份宫颈刮片临床标本的HPV6和HPV16检出率和HPV分型试剂盒一致。因此,基于颜色判定的环介导等温扩增方法有望应用于人乳头瘤病毒HPV6和HPV16感染的快速筛选,具有在基层疾病预防控制中心和医院推广和应用的潜力。     

Caski细胞内Daxx与HPV16 E2蛋白的结合作用

目的研究人乳头瘤病毒16型(HPV16)E2蛋白在Caski细胞内与Daxx的相互作用,探讨它们在HPV16所致宫颈癌发生发展中的作用。方法利用间接免疫荧光染色技术观察HPV16 E2和Daxx在Caski细胞中的分布或共定位;通过免疫共沉淀试验和免疫印迹分析HPV16 E2与Daxx在Caski细胞内的相互作用。结果在Caski细胞内,Daxx和HPV16 E2主要分布于胞浆,少数分布于胞核,且两种信号在细胞浆内有一定的共存;抗E2抗体能沉淀Daxx,反之抗Daxx抗体同样能够沉淀HPV16 E2。结论 HPV16 E2与Daxx在Caski细胞存在直接的相互作用。     

人乳头瘤病毒16E6基因通过增加HMGB1表达调节口腔癌CAL27细胞侵袭的实验研究

人乳头瘤病毒16型(Human papillomavirus type 16,HPV16)感染与口腔癌、宫颈癌的发病有关,HPV16 E6基因编码的蛋白是重要的癌蛋白,已经被证实能够通过增加高迁移率族蛋白B1(High mobility group box-B1,HMGB1)表达来促进宫颈癌细胞的侵袭,但是否能调控口腔癌细胞的侵袭仍未明确。为研究HPV16 E6基因通过增加HMGB1表达调节口腔癌CAL27细胞侵袭的作用,口腔癌CAL27细胞被分为对照组、空白质粒组、HPV16 E6质粒组、NC-si RNA组(短片断干扰RNA阴性对照组)、NC-si RNA+HPV16 E6质粒组、HMGB1-si RNA+HPV16E6质粒组,检测细胞中HPV16 E6及HMGB1的表达、细胞的侵袭数目、培养基中HMGB1的含量。结果显示,HPV16 E6质粒组细胞中HPV16 E6及HMGB1的表达量、培养基中HMBG1的含量、细胞的侵袭数目均高于对照组及空白质粒组(P<0.05);HMGB1-si RNA组细胞中HMGB1的表达量明显低于对照组及NC-si RNA组(P<0.05);NC-si RNA+HPV16 E6质粒组的细胞侵袭数目均明显高于NC-si RNA组(P<0.05),HMGB1-si RNA+HPV16 E6质粒组的细胞侵袭数目均明显低于NC-si RNA+HPV16 E6质粒组(P<0.05)。本研究提示,HPV16 E6基因能够促进口腔癌CAL27细胞的侵袭且这一作用与增加HMGB1表达有关。     

Normal Human Fibroblasts Immortalized by Introduction of Human Papillomavirus Type 16 (HPV-16) E6-E7 Genes

This report demonstrates that normal human fibroblasts can be immortalized by the introduction of HPV-16 E6-E7 genes. We designed zinc-inducible expression plasmids with HPV-16 E6, E7 or both. Each plasmid was introduced into normal human fibroblasts (TIG-3 cells) using lipofection methods. Only trans-fectants with the HPV-16 E6-E7 zinc-inducible expression plasmid, which were cultured in medium supplemented with 100 μM ZnSO₄, overcame crisis and could be cultured over 200 population doubling levels (PDLs). These cell lines showed the reactivation of telomerase after crisis, and morphological alterations were also observed.     

HPV16型E7复制型DNA疫苗诱发的抗肿瘤免疫反应

为了研制有效的疫苗 ,用于HPV16型重度感染和与其感染相关的宫颈癌晚期病人手术后的免疫治疗 ,用复制型DAN疫苗载体 pSCA1,在其CMVIE启动子之下插入修饰的HPV16型E7基因mE7- 3( 2 4G、2 6G、6 7R) ,构建成 pSCA1mE7- 3复制型DNA疫苗。以重组质粒免疫C5 7BL/ 6小鼠 ,检测诱发的特异性CTL活性 ;将免疫后的小鼠用TC - 1肿瘤细胞攻击 ,观察免疫保护效果。实验结果显示 :pSCA1mE7- 3复制型DNA疫苗能诱导小鼠产生针对TC - 1肿瘤细胞的特异性CTL反应 ;复制型DNA疫苗免疫后的小鼠能耐受 1× 10 4 TC - 1细胞的攻击 ,成瘤时间推迟 ,并且成瘤率明显下降 ,部分小鼠得到保护能免受肿瘤攻击。因此pSCA1mE7- 3复制型DNA疫苗可作为HPV16相关肿瘤的癌前病变及中晚期病人术后免疫治疗的候选疫苗。     

应用TDI-FP技术分析宫颈癌组织HPV16 E7基因A647G点突变

模板指导的末端碱基掺入反应结合荧光偏振检测技术(template direct dye-terminator incorporation with fluorescence- polarization,TDI-FP) 是SNP检测新技术. 应用TDI-FP方法分析中国陕西HPV16阳性宫颈组织HPV16 E7基因第647位核苷酸A→G热点突变(即A647G),首先在HPV16阳性的91例宫颈癌及49例正常/宫颈炎妇女宫颈DNA标本中,PCR扩增含647位点在内的HPV16 E7部分基因, 然后将紧邻647位点5′端的寡核苷酸探针与PCR产物内的模板杂交,并延伸一个与647位点碱基互补的荧光标记碱基：TAMRA-ddTTP或R110-ddCTP. 用荧光偏振仪读取荧光偏振 (FP) 值,根据升高的相应FP值判断647位点碱基. 结果表明,宫颈组织HPV16 E7 A647G的总体检出率为35.71% (50/140). 宫颈癌组的A→G突变率为42.86% (39/91),显著高于正常/宫颈炎组22.45% (11/49) 的突变率 (x2 = 5.778, P = 0.016),两组间的OR值为2.59 (95% CI = 1.17~5.71). 提示TDI-FP 可用于HPV有意义点突变的分析;我国陕西地区妇女HPV 16 A647G突变率及其对宫颈癌的警示性与其他地区相比有明显差异,该地区携带此突变病毒株的妇女患宫颈癌的风险可能较高     

表达HPV16E6和E7蛋白的非复制型重组痘苗病毒的构建

为研制HPV16的治疗性疫苗,首先将表达质粒pJSA1175与非复制型痘苗病毒NTVJTK+进行同源重组,构建了痘苗重组病毒NTVJLac.再将表达质粒pJSDME6E7R与NTVJLac进行同源重组,构建了表达HPV16 E6和E7蛋白的非复制型重组痘苗病毒NTVJmE6E7,并对获得的重组病毒进行了鉴定.Southern杂交显示,重组痘苗病毒NTVJmE6E7基因组中有E6和E7基因插入.该重组病毒在人源细胞中不复制.Western blot显示,重组病毒在人源TK-143细胞中能表达E6和E7蛋白.非复制型重组痘苗病毒NTVJmE6E7可作为HPV16相关肿瘤及其癌前病变免疫治疗的实验性疫苗株.     

表达人乳头瘤病毒16型E6/E7融合蛋白的非复制型重组痘苗病毒的构建及免疫效果观察

采用基因工程方法将HPV16E6、E7基因融合后插入痘苗病毒载体,通过同源重组构建表达人乳头瘤病毒16型E6/E7融合蛋白的非复制型重组痘苗病毒疫苗,用C57BL/6小鼠观察其免疫原性和抗肿瘤移植情况。测序结果表明融合的HPV16E6、E7基因序列与设计相符;构建的非复制型重组痘苗病毒经Dot blot鉴定,显示有E6、E7融合基因的插入;Western blot检测表明该重组病毒在鸡胚成纤维细胞中能表达HPV16型E6/E7融合蛋白。动物免疫试验表明,该重组病毒在小鼠体内可诱发E6、E7特异性抗体;被免疫小鼠能抵抗TC-1肿瘤细胞的攻击。此结果为将来进一步研制HPV16、18型联合疫苗打下了基础。     

北京地区宫颈癌HPV16上游调控序列、E6、E7癌基因序列初步分析

为检测HPV16上游调控序列(Upstream regulatory region, URR)、E6、E7癌基因变异在北京地区宫颈癌患者癌组织中的分布特征, 探讨该地区宫颈癌发生同HPV16变异株间的相关性, 文章以提取的31例HPV16检测阳性宫颈癌组织DNA为模板, 设计针对性引物扩增URR、E6、E7 3个目的片段, PCR产物直接测序并通过GenBank对比分析变异和分支鉴定情况。在所分析的宫颈癌组织中, URR是突变频率最高的片段, 其次为E7, 最保守的序列为E6。共发现热突变位点8个, 分别为URR序列上G7521A(100%)、C7435G(96.77%)、C24T(45.16%)、A7729C(45.16%)、G7839A(45.16%); E6序列上T178G(41.94%); E7序列上A647G(45.16%)、T846C(45.16%)。HPV16分支分布频率最广的是As型(54.84%), 其次为E型(45.16%)。研究结果提示, HPV16URR序列上G7521A、A7729C、G7839A, E6序列上T178G、T350G, E7序列上A647G、G658A等位点的变异可能与病毒致癌潜能及宫颈癌的发生相关。北京地区宫颈癌患者中As和E型可能是两种最主要的HPV16分支, 这有可能会为HPV疫苗的研制和感染治疗提供有价值的信息。As型和E型病毒在不同年龄组和不同肿瘤分期组的患者中分布频率有差异, 这可能会为揭示宫颈癌年轻化趋势提供新的线索。     

基于HPV16E7蛋白CTLs抗原肽的病毒样颗粒治疗性疫苗的构建

目的:构建呈递HPV16 E7 CTLs抗原表位的病毒样颗粒,并初步评价病毒样颗粒作为治疗性疫苗载体的潜能。方法:根据文献选择有效的HPV16 E7 CTLs表位,合成其正负链寡核苷酸序列,并通过退火形成双链DNA片段。将片段克隆于表达乙肝核心抗原的重组质粒p Thio His AHBc Ag,使抗原肽得以呈现于病毒样颗粒。重组菌经IPTG诱导后经SDS-PAGE鉴定目的蛋白表达。菌体破碎后经硫酸铵盐析法和蔗糖密度梯度离心进行纯化,并经高效液相凝胶过滤色谱和电镜鉴定病毒样颗粒的存在。制备的病毒样颗粒免疫接种了TC-1细胞的肿瘤模型小鼠,检测小鼠肿瘤大小。此外,在体外以抗原肽刺激脾细胞,以ELISA检测IFN-γ表达水平。结果:构建的三个重组表达质粒经酶切鉴定及测序分析证实构建正确。表达的重组蛋白大小与预期相符,并形成了病毒样颗粒。免疫小鼠后显示了抑制肿瘤增长的一定作用趋势。此外,抗原肽体外刺激促进了疫苗免疫小鼠脾细胞IFN-γ的表达,显示疫苗引起机体产生E7特异性的细胞免疫应答。结论:HBc Ag VLPs是有潜能的治疗性疫苗载体。     

Human papillomavirus genotyping by multiplex pyrosequencing in cervical cancer patients from India

Cervical cancer is a leading cause of cancer-related deaths among women in India.Human papillomavirus (HPV) infection is the causative agent of cervical cancer; and infection with the high-risk genotypes, predominantly HPV16 and 18,is the biggest risk factor.Vaccines targeting HPV16 and 18 have been found to confer protection in large- scale clinical trials.HPV genotyping has traditionally been carried out to screen the population "at risk" using indirect methods based on polymerase chain reaction (PCR) using consensus primers combined with various DNA hybridization techniques,and often followed by the sequencing of candidate products.Recently,a high-throughput and direct method based on DNA sequencing has been described for HPV genotyping using multiplex pyrosequencing. We present a pilot study on HPV genotyping of cervical cancer and non-malignant cervical samples using multiplex pyrosequencing.Using genomic DNA from cell lines,cervical biopsies,surgical tissues or formalin-fixed,paraffin- embedded tissue samples,we could successfully resolve 6 different HPV types out of the 7 tested,with their prevalence found to be in agreement with earlier reports. We also resolved coinfections with two different HPV types in several samples. An HPV16 genotype with a specific and recurrent sequence variation was observed in 8 cancer samples and one non-malignant sample. We find this technique eminently suited for high-throughput applications,which can be easily extended to large sample cohorts to determine a robust benchmark for HPV genotypes prevalent in India.     

RNA interference against HPV16 E7 oncogene leads to viral E6 and E7 suppression in cervical cancer cells and apoptosis via upregulation of Rb and p53

The simultaneous expression of human papillomavirus type 16 (HPV16) E6 and E7 oncogenes is pivotal for malignant transformation and maintenance of malignant phenotypes. Silencing these oncogenes is considered to be applicable in molecular therapies of human cervical cancer. However, it remains to be determined whether HPV16 E6 and E7 could be both silenced to obtain most efficient antitumor activity by using RNA interference (RNAi) technology. Herein, we designed a small interfering RNA (siRNA) targeting HPV16-E7 region to degrade either E6, or truncated E6 (E6*) and E7 mRNAs and to simultaneously knockdown both E6 and E7 expression. Firstly, the sequence targeting HPV16-E7 region was inserted into the shRNA packing vector pSIREN-DNR, yielding pSIREN-16E7 to stably express corresponding shRNA. HPV16-transformed SiHa and CaSki cells were used as a model system; RT-PCR, Western Blotting, MTT assay, TUNEL staining, Annexin V apoptosis assay and flow cytometry were applied to examine the effects of pSIREN-16E7. Our results indicated that HPV16-E7 specific shRNA (16E7-shRNA) induced selective degradation of E6 and E7 mRNAs and proteins. E6 silencing induced accumulation of cellular p53 and p21. In contrast, E7 silencing induced hypophosphorylation of retinoblastoma (Rb) protein. The loss of E6 and E7 reduced cell growth and ultimately resulted in massive apoptotic cell death selectively in HPV-positive cancer cells, compared with the HPV-negative ones. We demonstrated that 16E7-shRNA can induce simultaneous E6 and E7 suppression and lead to striking apoptosis in HPV16-related cancer cells by activating cellular p53, p21 and Rb. Therefore, RNAi using E7 shRNA may have the gene-specific therapy potential for HPV16-related cancers.     

Induction of senescence-like state and suppression of telomerase activity through inhibition of HPV E6/E7 gene expression in cells immortalized by HPV16 DNA

The E6 and E7 oncoproteins of human papillomavirus (HPV) play a major role in the development of cervical carcinoma. In this study, a recombinant adenovirus that expresses the bovine papillomavirus (BPV) E2, which has been shown to inhibit HPV early gene expression, was delivered to two HPV-immortalized cell lines as well as CaSki, a cervical carcinoma cell line. We tested whether the carcinoma and the immortal cells were equally affected by the expression of BPV E2. In all cell lines, BPV E2-mediated inhibition of HPV E6/E7 expression caused a dramatic suppression of cell growth, being preceded by the activation of the p53-Rb growth-inhibitory pathway, and a decrease in hTERT mRNA expression and telomerase activity. This suggests that the HPV E6 and E7 proteins are required not only for induction of the proliferative phenotype and telomerase activity, but also for their maintenance. In both the carcinoma and the immortal lines, the number of cells with enlarged cytoplasm and senescence-associated beta-galactosidase activity, which are markers for cellular senescence, was significantly increased. These results suggest that a senescence program exists in cells immortalized by HPV DNA as well as in cervical carcinoma cells.     

人乳头瘤病毒16型E7变异株免疫原性研究

采用分子克隆技术,构建E7变异株重组质粒[pcDNA3．1-(by)E7]和E7标准株重组质粒【pcDNA3．1．(ys)-E7】,并将两种质粒分别皮下免疫Balb／c小鼠,免疫后于不同时间提取小鼠血清和制备脾淋巴细胞悬液,分别用ELISA法和MTT比色法检测特异性抗体和特异性淋巴细胞增殖反应。基因免疫后,ELISA法显示,HPVl6E7变异株和标准株均能诱导特异性抗E7抗体;MTTT比色法显示,E7标准株免疫组脾淋巴细胞在体外受到变异株E7蛋白的再次刺激后出现特异性淋巴细胞增殖反应,变异株E7免疫组脾淋巴细胞经过同样处理后,出现非特异性淋巴细胞增殖反应。结果表明HPV16E7变异株能诱导特异性体液免疫应答而不能诱导特异性细胞免疫应答,HPVl6E7变异株无论在结构还是免疫原性上均与标准株有差异。由此推测,HPV16E7变异可能导致其逃逸机体自然感染或疫苗诱导的免疫应答。用基因免疫方法研究E7变异株免疫原性也为其它不能或难以进行体外培养的病毒变异研究提供借鉴。     

人乳头瘤病毒16型E7变异株免疫原性研究

采用分子克隆技术,构建E7变异株重组质粒[pcDNA3.1-(by)E7]和E7标准株重组质粒[pcDNA3.1-(ys)-E7],并将两种质粒分别皮下免疫Balb/c小鼠,免疫后于不同时间提取小鼠血清和制备脾淋巴细胞悬液,分别用ELISA法和MTT比色法检测特异性抗体和特异性淋巴细胞增殖反应.基因免疫后,ELISA法显示,HPV16 E7变异株和标准株均能诱导特异性抗E7抗体;MTT比色法显示,E7标准株免疫组脾淋巴细胞在体外受到变异株E7蛋白的再次刺激后出现特异性淋巴细胞增殖反应,变异株E7免疫组脾淋巴细胞经过同样处理后,出现非特异性淋巴细胞增殖反应.结果表明HPV16E7变异株能诱导特异性体液免疫应答而不能诱导特异性细胞免疫应答,HPV16 E7变异株无论在结构还是免疫原性上均与标准株有差异.由此推测,HPV16E7变异可能导致其逃逸机体自然感染或疫苗诱导的免疫应答.用基因免疫方法研究E7变异株免疫原性也为其它不能或难以进行体外培养的病毒变异研究提供借鉴.     

De-oncogenic HPV E6/E7 vaccine gets enhanced antigenicity and promotes tumoricidal synergy with cisplatin

In order to develop more effective therapeutic vaccines against cancers with high-risk human papillomavirus （HPV） infection, it is crucial to enhance the immunogenicity, eliminate the oncogenicity of oncoproteins, and take a combination of ET- and E6-containing vaccines. It has been shown recently that PE（AIII）-E7-KDEL3 （E7）, a fusion protein containing the HPVI6 oncoprotein E7 and the trans- location domain of Pseudomonas aeruginosa exotoxin A, is effective against TC-1 tumor cells inoculated in mice, there- fore, we engineered PE（AIII）-E6-CRL-KDEL3 （E6）, the deoncogenic versions of the E7 and E6 fusion proteins [i.e. PE（AIII）-E7（d）-KDEL3, E7（d）, and PE（AIII）-E6（d）-CRL- KDEL3, E6（d）] and tested the immunoefficacies of these fusion proteins as mono- and bivalent vaccines. Results indicated that the E7（d） get higher immunogenicity than its wild type and the E6 fusion proteins augmented the im- munogenicity and antitumor effects of their E7 counterparts. Furthermore, the bivalent vaccine system E7（d） plus E6（d）, in the presence of cisplatin, showed the best tumori- static and tumoricidal effects against established tumors in vivo. Therefore, it can be concluded that this novel therapeutic vaccine system, upon further optimization, may shed new light on clinical management of HPV-related carcinomas.