|
Predicting the
behavior of RRP:
The University of Tennessee Study
Overview:
Despite our understanding of the HPV types responsible for the great majority of
juvenile-onset RRP, the
behavior of this disease in children remains frustratingly unpredictable. As
those familiar with the disease
can attest, some children with RRP have a relatively benign course, while others
have extremely
aggressive disease with distal spread and frequent recurrences. At the extreme
of this clinical spectrum can
lie malignant transformation or even death from uncontrollable disease.
In order to target pediatric patients with RRP at high risk for aggressive
disease, investigators have tried to
identify individual factors to reliably predict severity of disease. The
possible prognostic significance of
several markers in papilloma tissue has been reported; as of yet, however, no
easily obtainable blood tests
have been identified to predict the course of RRP in an individual child.
Background:
Cytokines, circulating proteins produced by white blood cells, have long been
known to play critical roles
in the body's disease response. Of special interest in the context of RRP is the
effect of cytokines on
tumor growth. Interleukin-2 (IL-2) is a key player in the cytokine response and
stimulates the proliferation
and activation of the body's T-cells. T-cells may be directed against
virus-infected or neoplastic tissue. In
this regard, IL-2 may have significant anti-papilloma activity.
The predictive role of IL-2 and its soluble receptor, sIL-2R, has been
investigated in patients with genital
HPV-related tumors. An inverse correlation has been reported between IL-2 levels
and recurrence rate of
genital HPV, and a direct correlation between IL-2R levels and recurrence rate.
To date, there have been
no studies investigating the predictive value of IL-2 or IL-2R in HPV infection
of the upper respiratory
tract.
Study purpose:
A pilot study is currently underway at the University of Tennessee comparing our
population to a group
of age-matched controls. Working with the Department of Hematology- Oncology at
St. Jude Children's
Research Hospital, we are performing quantitative in vitro determinations of
serum IL-2 and soluble IL-2
receptor levels in the serum of papilloma patients. The objective of our study
is to determine whether
levels of serum IL-2 and IL-2R in patients with RRP have value in predicting the
frequency of surgical
intervention.
Request for participants:
RRP is an uncommon disease, and the majority of patients who have it are spread
throughout the
country. Therefore, we are in the process of requesting serum samples from
patients with RRP at other
centers to assay for interleukin-2 and soluble IL-2 receptor. In this way, we
can accumulate a subject
population large enough to establish statistical significance.
We are now accepting blood specimens from other institutions for analysis. If
you are interested in
participation, we need the following for each patient:
1) 5 cc fresh whole blood sample collected in additive-free plastic Vacutainer
tubes
with date of collection.
2) Brief surgical history (patient's age, number of surgically treated
recurrences/ year, age at first
diagnosis, and whether or not patient has had tracheostomy).
Please send the information and specimen(s) in an appropriate container to the
address below. Specimens
may be sent at room temperature if shipped within 3 days of collection.
Interested healthcare providers, families, or patients are encouraged to
contact:
Jerome W. Thompson, MD
UTMG Pediatric Otolaryngology
777 Washington Avenue, Suite P110
Memphis, TN 38105-4526
(901) 572-4400
jwthompson@utmem1.utmem.edu
|
