Recurrent respiratory papillomatosis: Altered CD8(+) T-cell subsets and T(H)1/T(H)2 cytokine imbalance

Human papillomaviruses (HPVs) cause benign papillomas and squamous cell car cinomas in the genital and respiratory tracts. Recurrent respiratory papill omas (RRP) generate a high level of morbidity and significant mortality bec ause of their location, resistance to treatment, and relentless recurrence that can vary in frequency in a given patient and between patients. We have found that T-cells from these patients, when exposed to or isolated from a utologous papilloma tissue, have an elevated percentage of CD8(+), CD28(-) T-cells, and that T-cells from many of these patients express an increase i n TH2-like cytokine mRNA in response to autologous papilloma tissue. Furthe rmore, both of these immunologic findings correlate with disease severity. These observations suggest that patients with RRP, and possibly others with refractory HPV-induced lesions, are unable to manage their disease with an appropriate and effective HPV-specific, T-cell response. This immune imbal ance may be responsible for the development and severity of HPV-induced res piratory papillomatosis. (C) 1999 Academic Press.