Increased detection of clue cells in smears from cervical intraepithelial lesions with reduced expression of COX‐2

Abstract

The relation between the detection of clue cells in cervical smears of women with CIN and the expression of COX-2 in these lesions were determined. Samples from 228 women, treated due to CIN and who underwent cervical conization, were obtained. Hybrid Capture II and Pap smear samples were collected immediately before performing conization. Pathological diagnoses were 11 (5%) normal cervix, 35 (15%) CIN1, 31 (14%) CIN2, and 151 (66%) CIN3. COX-2 immunoreactivity grading on the pathological specimens was based on the German ImmunoReactive score. In cervical smears, 20 fields (40x) were examined, each of them with a minimum count of 10 epithelial cells. When 20% or more of clue cells were detected the sample was considered positive for clue cells. The prevalence of clue cells was similar across histological strata (P = 0.42). Although the expression of COX-2 did not differ in lesions with varying severities (P = 0.24), there was a negative association between the expression of COX-2 and the presence of clue cells in Pap smear (OR = 0.4; 95% CI = 0.2-0.9): only 12% of women with moderate and strong expression of COX-2 had clue cells in their smears, contrasted to 22% of those with negative and weak expression of COX-2. HPV infection was associated in a borderline manner to the expression of COX-2 (P = 0.04; OR = 2.3 95% CI = 1.0-5.4). The reduced expression of COX-2 in CIN specimens may suggest that clue cells interfere with the inflammatory component of the carcinogenic process that lead to CIN.

Relationship among bacterial vaginosis, local inflammatory response and presence of cervical intraepithelial neoplasia in women with and without human papilloma virus infection

“…PMNLs recruitment and activation is considered the main innate immune response against microbal and viral infections of the vaginal mucosa [16]. Women with BV and HPV infection have vaginal smears on which the neutrophils are typically relatively absent, as a sign of potentially altered immune response by enzymes produced by anaerobic vaginal bacteria [17]. In our study, in HPV group we found: no inflammation in one third of the group and a significant predominance of the MNLs -vs. PMNls -cervicitis, as a sign of the altered local immune response.…”

“…Lesion-derived T cells are primarily of an activated memory phenotype, and HPV antigens are present in locally differentiation keratinocytes, which could present these antigens to T cells [16]. Disorders of humoral immunity do not correlate with increased susceptibility to HPV infection or disease [17].…”

Bacterial vaginosis is associated with uterine cervical human papillomavirus infection: a meta-analysis

“…Web of Science was further searched using the same strings, and yielding a total of 115 different publications. Only one additional eligible article was found beyond the Medline search [15]. Studies that addressed the relationship between BV and cervical HPV infection were reviewed for predefined eligibility criteria.…”

“…Meta-analysis was conducted for twelve studies that fulfil the above-reported criteria [13-15,17,18,20-26], using packages for STATA provided by Sterne et al [27]. Odds ratios and their respective standard errors were calculated from the provided raw data.…”

Filaggrin, Human Papillomavirus, and the Cervix

“…In a metaanalysis from 2011 by Gillet et al [ 54 ] including a total of 6,372 women, a positive association between bacterial vaginosis and HPV was found with an odds ratio 1.43 (95 % CI, 1.11-1.84). It should be emphasized that bacterial vaginosis exerts several changes in the vaginal milieu besides elevated pH, including changes in cytokine production [ 75 ] and decreased signs of infl ammation [ 76 ], which may play a role in this possible association.…”