word count: 245 17 Importance word count: 150 18 Text word count: 6,965 Abstract 20 Human papillomavirus (HPV) infection is the world's most common sexually 21 transmitted infection, and is responsible for most cases of cervical cancer. Previous 22 studies of global gene expression changes induced by HPV infection have focused on 23 the cancerous stages of infection, and therefore, not much is known about global gene 24 expression changes at early pre-neoplastic stages of infection. We show for the first 25 time, global gene expression changes of early stage HPV16 infection in cervical tissue 26 using 3-dimensional organotypic raft cultures that produce high levels of progeny virions. 27cDNA microarray analysis showed that a total of 594 genes were upregulated 28 and 651 genes were downregulated at least 1.5-fold with HPV16 infection. Gene 29 ontology analysis showed that biological processes including cell cycle progression and 30 DNA metabolism were upregulated, while skin development, immune response, and cell 31 death were downregulated with HPV16 infection in cervical keratinocytes. Individual 32 genes were selected for validation at the transcriptional and translational levels 33 including UBC, which was central to the protein association network of immune 34 response genes, and top downregulated genes RPTN, SERPINB4, KRT23, and KLK8. 35 In particular, KLK8 and SERPINB4 have shown to be upregulated in cancer, which 36 contrasts our results. 37 Organotypic raft cultures that allow full progression of the HPV life-cycle have 38 allowed us to identify novel gene modulations and potential therapeutic targets of early 39 stage HPV infection in cervical tissue. Additionally, our results suggest that early stage 40 productive infection and cancerous stages of infection are distinct disease states 41 expressing different transcriptomes. 42 3 43 Importance 44 Persistent HPV infection is responsible for most cases of cervical cancer. 45 Transition from precancerous to cancerous stages of HPV infection is marked by a 46 significant reduction in virus production. Most global gene expression studies of HPV 47 infection have focused on the cancerous stages. Therefore, little is known about global 48 gene expression changes at precancerous stages. For the first time, we measured 49 global gene expression changes at precancerous stages of HPV16 infection in human 50 cervical tissue producing high levels of virus. We identified a group of genes that are 51 typically overexpressed in cancerous stages to be significantly downregulated at the 52 precancerous stage. Moreover, we identified significantly modulated genes that have 53 not yet been studied in the context of HPV infection. Studying the role of these genes in 54 HPV infection will help us understand what drives the transition from precancerous to 55 cancerous stages, and may lead to development of new therapeutic targets. 56 57 Introduction 58 Human papilloma virus (HPV) infection is the world's most common sexually 59 transmitted infection with approxi...