Local T-Cell Dysregulation and Immune Checkpoint Expression in Human Papillomavirus-Mediated Recurrent Respiratory Papillomatosis

Human papillomavirus-mediated recurrent respiratory papillomatosis (RRP) is a premalignant neoplasia of the upper airway characterized by significant dysphonia and respiratory obstruction. Immune checkpoint blockade has emerged as a potential alternative to repeated surgical interventions in RRP. He...

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Main Authors: Hans N. C. Eckel, Su Ir Lyu, Frederik Faste, Shachi J. Sharma, Anne Nobis, Nora Wuerdemann, Maria Ziogas, Marcel Mayer, Malte C. Suchan, Kerstin Wennhold, Maria A. Garcia-Marquez, Martin Thelen, Elena Hagen, Julia Eßer, Charlotte Klasen, Oliver Siefer, Martin Otte, Hans A. Schloesser, Jens P. Klussmann, Alexander Quaas, Kevin K. Hansen
Format: Article
Language:English
Published: MDPI AG 2025-06-01
Series:Cells
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Online Access:https://www.mdpi.com/2073-4409/14/13/985
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author Hans N. C. Eckel
Su Ir Lyu
Frederik Faste
Shachi J. Sharma
Anne Nobis
Nora Wuerdemann
Maria Ziogas
Marcel Mayer
Malte C. Suchan
Kerstin Wennhold
Maria A. Garcia-Marquez
Martin Thelen
Elena Hagen
Julia Eßer
Charlotte Klasen
Oliver Siefer
Martin Otte
Hans A. Schloesser
Jens P. Klussmann
Alexander Quaas
Kevin K. Hansen
author_facet Hans N. C. Eckel
Su Ir Lyu
Frederik Faste
Shachi J. Sharma
Anne Nobis
Nora Wuerdemann
Maria Ziogas
Marcel Mayer
Malte C. Suchan
Kerstin Wennhold
Maria A. Garcia-Marquez
Martin Thelen
Elena Hagen
Julia Eßer
Charlotte Klasen
Oliver Siefer
Martin Otte
Hans A. Schloesser
Jens P. Klussmann
Alexander Quaas
Kevin K. Hansen
author_sort Hans N. C. Eckel
collection DOAJ
description Human papillomavirus-mediated recurrent respiratory papillomatosis (RRP) is a premalignant neoplasia of the upper airway characterized by significant dysphonia and respiratory obstruction. Immune checkpoint blockade has emerged as a potential alternative to repeated surgical interventions in RRP. Here, we investigated the intralesional T-cell composition and expression of the immune checkpoints programmed death-ligand 1 (PD-L1) and cytotoxic T-lymphocyte antigen 4 (CTLA-4) in RRP. We analyzed tissue samples from 30 patients treated at a tertiary care center between 2009 and 2021, including paired samples from individual patients collected at different time points. Immunohistochemical staining was performed for CD4, CD8, CTLA-4, FoxP3, and PD-L1 and correlated with disease severity and previous adjuvant therapies. Overall disease burden and intervention-free survival were not associated with the abundance of CD4<sup>+</sup>, CD8<sup>+</sup>, or FoxP3<sup>+</sup> T cells, nor with immune checkpoint expression. However, patients with aggressive disease exhibited a higher intralesional FoxP3/CD4 T-cell ratio. Prior intralesional cidofovir treatment was associated with reduced CD4<sup>+</sup> T-cell infiltration. These findings suggest that a locally immunosuppressive microenvironment, reflected by an elevated FoxP3/CD4 ratio, contributes to disease severity in RRP. Consistent CTLA-4 expression across all evaluated samples supports further investigation of anti-CTLA-4 therapy, either alone or in combination with other checkpoint inhibitors.
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spelling doaj-art-e3a791a15d924be2a0bef2d1205ab9422025-08-20T02:35:59ZengMDPI AGCells2073-44092025-06-01141398510.3390/cells14130985Local T-Cell Dysregulation and Immune Checkpoint Expression in Human Papillomavirus-Mediated Recurrent Respiratory PapillomatosisHans N. C. Eckel0Su Ir Lyu1Frederik Faste2Shachi J. Sharma3Anne Nobis4Nora Wuerdemann5Maria Ziogas6Marcel Mayer7Malte C. Suchan8Kerstin Wennhold9Maria A. Garcia-Marquez10Martin Thelen11Elena Hagen12Julia Eßer13Charlotte Klasen14Oliver Siefer15Martin Otte16Hans A. Schloesser17Jens P. Klussmann18Alexander Quaas19Kevin K. Hansen20Faculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50931 Cologne, GermanyFaculty of Medicine and University Hospital of Cologne, Institute of Pathology, University of Cologne, 50937 Cologne, GermanyFaculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50931 Cologne, GermanyFaculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50931 Cologne, GermanyFaculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50931 Cologne, GermanyCenter for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50931 Cologne, GermanyFaculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50931 Cologne, GermanyFaculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50931 Cologne, GermanyFaculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50931 Cologne, GermanyCenter for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50931 Cologne, GermanyCenter for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50931 Cologne, GermanyCenter for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50931 Cologne, GermanyCenter for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50931 Cologne, GermanyFaculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50931 Cologne, GermanyFaculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50931 Cologne, GermanyCenter for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50931 Cologne, GermanyFaculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50931 Cologne, GermanyCenter for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50931 Cologne, GermanyFaculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50931 Cologne, GermanyFaculty of Medicine and University Hospital of Cologne, Institute of Pathology, University of Cologne, 50937 Cologne, GermanyFaculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50931 Cologne, GermanyHuman papillomavirus-mediated recurrent respiratory papillomatosis (RRP) is a premalignant neoplasia of the upper airway characterized by significant dysphonia and respiratory obstruction. Immune checkpoint blockade has emerged as a potential alternative to repeated surgical interventions in RRP. Here, we investigated the intralesional T-cell composition and expression of the immune checkpoints programmed death-ligand 1 (PD-L1) and cytotoxic T-lymphocyte antigen 4 (CTLA-4) in RRP. We analyzed tissue samples from 30 patients treated at a tertiary care center between 2009 and 2021, including paired samples from individual patients collected at different time points. Immunohistochemical staining was performed for CD4, CD8, CTLA-4, FoxP3, and PD-L1 and correlated with disease severity and previous adjuvant therapies. Overall disease burden and intervention-free survival were not associated with the abundance of CD4<sup>+</sup>, CD8<sup>+</sup>, or FoxP3<sup>+</sup> T cells, nor with immune checkpoint expression. However, patients with aggressive disease exhibited a higher intralesional FoxP3/CD4 T-cell ratio. Prior intralesional cidofovir treatment was associated with reduced CD4<sup>+</sup> T-cell infiltration. These findings suggest that a locally immunosuppressive microenvironment, reflected by an elevated FoxP3/CD4 ratio, contributes to disease severity in RRP. Consistent CTLA-4 expression across all evaluated samples supports further investigation of anti-CTLA-4 therapy, either alone or in combination with other checkpoint inhibitors.https://www.mdpi.com/2073-4409/14/13/985human papillomavirusrecurrent respiratory papillomatosislymphocytesCTLA4
spellingShingle Hans N. C. Eckel
Su Ir Lyu
Frederik Faste
Shachi J. Sharma
Anne Nobis
Nora Wuerdemann
Maria Ziogas
Marcel Mayer
Malte C. Suchan
Kerstin Wennhold
Maria A. Garcia-Marquez
Martin Thelen
Elena Hagen
Julia Eßer
Charlotte Klasen
Oliver Siefer
Martin Otte
Hans A. Schloesser
Jens P. Klussmann
Alexander Quaas
Kevin K. Hansen
Local T-Cell Dysregulation and Immune Checkpoint Expression in Human Papillomavirus-Mediated Recurrent Respiratory Papillomatosis
Cells
human papillomavirus
recurrent respiratory papillomatosis
lymphocytes
CTLA4
title Local T-Cell Dysregulation and Immune Checkpoint Expression in Human Papillomavirus-Mediated Recurrent Respiratory Papillomatosis
title_full Local T-Cell Dysregulation and Immune Checkpoint Expression in Human Papillomavirus-Mediated Recurrent Respiratory Papillomatosis
title_fullStr Local T-Cell Dysregulation and Immune Checkpoint Expression in Human Papillomavirus-Mediated Recurrent Respiratory Papillomatosis
title_full_unstemmed Local T-Cell Dysregulation and Immune Checkpoint Expression in Human Papillomavirus-Mediated Recurrent Respiratory Papillomatosis
title_short Local T-Cell Dysregulation and Immune Checkpoint Expression in Human Papillomavirus-Mediated Recurrent Respiratory Papillomatosis
title_sort local t cell dysregulation and immune checkpoint expression in human papillomavirus mediated recurrent respiratory papillomatosis
topic human papillomavirus
recurrent respiratory papillomatosis
lymphocytes
CTLA4
url https://www.mdpi.com/2073-4409/14/13/985
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