Рекурентната респираторна папиломатоза (RRP) се причинява от човешки папиломавирус (HPV) тип 6 и тип 11. Засяга както деца, така и възрастни. В млък брой от случаите заболяването може да бъде много агресивно и да предизвика значителна заболеваемост и евентуално смърт.
Хирургичната терапия е първично лечение, но при пациенти с агресивно заболяване се започва допълнителна терапия. Повечето от тези допълнителни мероприятия се концентрират върху имуномодулиране, прекъсване на молекулни сигнални каскади или нарушаване на вирусната репликация, за да се намали тежестта на заболяването.
Наскоро беше разработена превантивна ваксина, но данни за ефективността £ реално ще има най-рано след едно десетилетие. Междувременно учените изследват други стратегии за ваксиниране в борбата с HPV.
Ще прегледаме следните терапии, използвани като допълнително лечение на RRP: интерферон и терапевтични или превантивни ваксинации. Но все още остава надеждата за HPV ваксината и нейния потенциал да предотврати бъдещото разпространение на заболяването.
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Recurrent respiratory papillomatosis is caused by the human papillomavirus types (HPV) 6 and 11. It affects both children and adults. In a small number of cases, the disease can be very aggressive causing significant morbidity and possibly death.
Surgical therapy is the primary treatment but in patients with aggressive disease, adjunctive therapy is initiated. The majority of these adjuncts center on immunomodulation, disruption of molecular signaling cascades or interruption of viral replication to help decrease the severity of the disease.
Recently, a preventative vaccine has become available but data on its effectiveness will be at least a decade away. In the mean time, researchers are examining other vaccination strategies in the fight against HPV disease.
We will review the following therapies used in the adjunct treatment of RRP: interferon et therapeutic or preventative vaccines. However, there is hope on the horizon with regard to the HPV vaccine and its potential to prevent future transmission of this disease.
Alberts DS, Coulthard SW, Meyskens FL. Regression of aggressive laryngeal papillomatosis with 13 – cis – retinoic acid. J Boil Response
Mod 1986; 5: 124-8
Arndt O, Johannes A, Zeise K, Brock J. High – risk HPV types in oral and laryngeal papilloma and leukoplakia. Laryngorhinootology 1997; 76: 142-149
Avidano MA, Singleton GT. Adjuvant drug strategies in the treatment of recurrent respiratory papillomatosis. Otolaryngol Head Neck Surg 1995; 112: 187-202
Benjamin BN, Gatenby PA, Kitchen R, Harrison H, Cameron K, Basten A. Alpha – interferon (Wellferon) as an adjunct to standard surgical therapy in the management of recurrent respiratory papillomatosis. Ann Otol Rhinol Laryngol 1988; 87: 370-80
Bishai D, Kashima H, Shah K. The cost of juvenile – onset recurrent respiratory papillomatosis. Arch Otolaryngol Head Neck Surg 2000; 126: 935-9
Boston M, Derkay CS. Recurrent respiratory papillomatosis. Clin Pulm Med 2003; 10: 10-16
Bothwell M. Human papilloma virus papilloma. Otolaryngol Head Neck Surg 2005; 133: 308-9
Chireshkin DG, Kuznetsov VP, Onufreva EK, Pritsker AD. Effectivenes of human leucocytiv interferon with papillomatosis of the larynx, trachea and bronchi. Vestn Otorhinolar 1991; 5: 19-21
Dickens P, Srivastava G, Loke SL, Larkin S. Human papilloma virus 6, 11 and 16 in laryngeal papillomas. J Pathol 1991; 165: 243-246
Doyle DJ, Henderson LA, LeJeune FE, Miller RH. Changes in human papillomavirus typing of recurrent respiratory papillomatosis progressing
to malignant neoplasm. Arch otolaryngol Head Neck Sug 1994; 120: 1273-6
Gerein V, lodemann E, Bell G, vonIlberg C, Kornhuber B. Results of long – term leucocyte interferon (alpha IFN) therapy using an individually
determined dose schedule in recurrent laryngeal papillomatosis. Klin Pediatr 1987; 199: 224-9
Gereom V, Rastprguev E, Gerein J, Jecker P, Pfister H. Use of interferon – alpha in recurrent respiratory papillomatosis: 20-year foolow – up.
Ann Otol Rhinol Laryngol 2005; 114:463-71
Haglund S, Lindquist P, Cantell K, Strander H. Interferon therapy in juvenile laryngeal papillomatosis Arch Otolaryngol 1981; 107: 327-32
Healy GB, Gelber RD, Trowbridge AL, et al. Treatment of recurrent respiratory papillomatosis with human leucocyte interferon. Results of a
multicenter randomized clinical trial N Engl J Med 1988; 319: 401-7.
Kashima H, Leventhal B, Clark K, Cohen S, Dedo H, Donovan D, Fearon B, Gardiner L, Goepfert H, Lusk R. Interferon – alpha – N1
(Wellferon) in juvenile – onset recurrent respiratory papillomatosis: resuts of a randomized study in twelve collaborative institutions. Laryngoscope
; 98: 334-40
Koltson VD, Chireshkin DG, Onufrieva EK, Nurmukhametov RK, Malinovskaia VV,, Ershov FI. Assessment of the formation of antibodies to interferon in patients with juvenile respiratory papillomatosis on interferon therapy. Vestn Otorhinolaryngol 1996; 7: 25-7
Leventhal BG, Kashima HK, Mounts P, Thurmond L, Chapman S, Buckley S, Wold D. Long – term response of recurrent respiratory papollomatosis
to treatment with lymphblastoid interferon alfa – n1. Papilloma study group. N Engl J Med 1991; 325: 613 –7
Lusk RP, McCabe BF, Mixon JH. Three – year experience of trating recurrent respiratory papilloma with interferon. Ann Otol Rhinol Laryngol 1987; 96: 158-62
Leventhal Bg, Kashima HK, Weck PW, Mounts P, Whisnant JK, Clark KL, Cohen S, Dedo HH, Donovan DJ, Fearon BW. Randomized surgical adjuvant trial of interferon alfa n – 1 in recurrent papillomatosis. Arch Otolaryngol Head Neck Surg 1988; 114: 1163-9.
Mullooly VM, Abramson AL, Steinberg BM, Horowitz MS. Clinical effects of alpha – interferon dose variation on laryngeal papilloma. Laryngoscope 1988; 98: 1324-29
Nigel R, Pashley MB. Can mumps vaccine induce remission in recurrent respiratory papilloma? Arch Otolaryngol Head Neck Surg 2002; 783-6.
Pritsker AD, Grigorian SS, Onufrieva SS, Chireshkin DG, Ershov FI. The interferon status and circulating immunoglobulins during the interferon
therapy of respiratory papillomatosis. Vopr Virusol 1991; 36: 411-4
Strome M. Analysis of an autogenuos vaccine in the treatment of juvenile papillomatosis of the larynx. Laryngoscope 1969; 79: 272-9
Thurmond LM, Brand CM, Leventhal BG, Finter NB, Johnston JM. Antibodies in patients with recurrent respiratory papillomatosis treated with lymphoblastoid interferon. J Lab Clin Med 1991; 118: 232-40
Zenner HP, Kley W, Claros B, Lahas Z, Lobe LP, Pavelka R, Plath P, Ribari O, Xiethammer D, Hirche H. Recombinant Interferon – alpha – 2c in laryngeal papillomatosis: preliminary results of a preospective multicentre trial. Oncology 1985; Suppl 1; 42: 15-18
