Intradermal injection of PPD as a novel approach of immunotherapy in anogenital warts in pregnant women

Abstract

Immunotherapy for treatment of recalcitrant warts was used through different modalities including intralesional injection of purified protein derivative (PPD), which is an extract of Mycobacterium tuberculosis, used for testing exposure to tuberculin protein, either from a previous vaccination or from the environment. This method is used to evaluate the efficacy of a new approach of intradermal injection of PPD in the treatment of anogenital warts in pregnant women. A total of 40 pregnant women, aged 20-35 years, and presented with anogenital warts were enrolled in this study. Human papillomavirus (HPV) typing was done using the GP5+/GP6+ PCR assay. The patients were treated with weekly injections of PPD given intradermally in the forearms, and evaluated for the response regularly. HPV type-6 was the predominant genotype (67.5%). Overall, the improvement in this study was 85% and was related to the extent of tuberculin reactivity. Nineteen (47.5%) patients demonstrated complete clearance, 15 (37.5%) had partial response, and three (7.5%) had minimal response. Three (7.5%) cases did not respond to treatment. Side effects were minimal and insignificant. Treatment of anogenital warts in pregnant women with intradermal injection of PPD was found to be a unique, safe, and effective modality of immunotherapy.

Intralesional Injection ofMycobacterium wVaccine vs Imiquimod, 5%, Cream in Patients With Anogenital Warts

“…21 The higher clearance rates with imiquimod in our study may have been the result of needle-prick trauma during concomitant injection of the vehicle, which may have added to the inflammation and enhanced the immune response induced by imiquimod, 5%. There are several reports on the use of intralesional antigen and vaccine therapies in cutaneous warts, but none of them was a double-blind randomized trial, and only 3 studies 3,13,22 looked at the effect of these therapies on AGWs. A retrospective analysis 22 There was no statistically significant difference in percentage resolution at any point except at week 4, when the imiquimod, 5%, cream group showed a higher percentage of resolution compared with the Mw group.…”

Evaluation of serum interleukin-12 and interferon-γ in patients with multiple warts treated with intralesional tuberculin injection

“…Antigens such as mumps, candida, trichophyton, Bacillus Calmette-Guerin, and PPD tuberculin were tried in different studies [15][16][17][18][19][20][21][22][23][24][25][26]. The mechanism of action of immunotherapy is still unclear as the human papilloma virus (HPV) antigen is usually produced in upper epithelial cells and is not exposed to antigen-presenting cells [30].…”

“…PPD, tuberculin, was used in many studies as an immunotherapy [15][16][17][18][19][20][21]. The number of injections varied from 3, 4, 6, to 12 injections at 2-4-week intervals, with success rates ranging from 58.8 to 96%.…”

“…The other option is the induction of delayed hypersensitivity using different injectable agents as protein purified derivative (PPD) tuberculin [15][16][17][18][19][20][21], candida [22,23], trichophyton [24], mumps vaccine [24,25], or Bacillus Calmette-Guerin vaccine [26]. The exact mechanism of action is still unknown [5], but it is believed that cellmediated immunity (CMI) has a major role in wart clearance [15].…”

Cross-Reactivity, Epitope Spreading, andDe NovoImmune Stimulation Are Possible Mechanisms of Cross-Protection of Nonvaccine Human Papillomavirus (HPV) Types in Recipients of HPV Therapeutic Vaccines

“…In vitro experiments have demonstrated that Candida has a proliferative effect on T-cells and that the cytokine most frequently produced by Langerhans cells exposed to Candida was interleukin 12, which promotes T-cell response (56,57). Intriguingly, injecting the wart, which is the site of active infection, may not be necessary to induce T-cell responses, as one group reported that weekly intradermal injections of PPD in the forearms was effective in treating anogenital warts in pregnant women (58). Additional evidence of de novo immune stimulation was demonstrated in our clinical trial of the HPV therapeutic vaccine mentioned above (33).…”