VIN may be human papillomavirus (HPV)-related classic VIN or -unrelated VIN. The former is by far the most frequent vulvar cancer precursor. It occurs in adult women and tends to be multi-focal. It is caused by high-risk HPV (HR-HPV) types, essentially type 16, and histologically is made of poorly selleck kinase inhibitor to undifferentiated basal cells and/or highly atypical squamous epithelial cells . The involvement
of the entire thickness of the epithelium defines grade 3 of the disease. The disease progresses towards invasion in about 3% of treated patients and 9% of untreated patients, according to a review of more than 3000 cases . Classic VIN can also regress spontaneously  in young women presenting with multi-focal pigmented papular lesions. Previously, we studied a patient who presented with multi-focal classic VIN and showed complete clearance of viral lesions 8 months after disease onset and 2 months after electrocoagulation of less than 50% of the classic VIN lesions . Immunohistochemical
study of her initial vulvar biopsy revealed a marked dermal infiltrate containing a majority of CD4+ T lymphocytes and an epidermal infiltrate made up of both CD4+ and CD8+ T cells. She also showed a proliferating response against one peptide from E6 protein and a high-frequency anti-E6 and anti-E7 effector blood T cells by ex vivo enzyme-linked immunospot–interferon-γ (ELISPOT–IFN-γ) assay Epigenetics activator just before clinical regression. Such a study of blood cellular immune responses, together with the analysis of vulvar biopsies obtained simultaneously
and correlated with clinical outcome, has not been reported previously. In an anti-HPV vaccine trial conducted by Davidson et al., classic VIN lesions regressed completely in a patient following vaccination. Interestingly, immunostaining of vulvar biopsy prior to the vaccine showed a marked CD4+ and CD8+ T lymphocyte infiltrate of both epithelial and subepithelial sheets. It may be speculated whether the regression of these patient lesions could be related to a spontaneous regression. Therefore, the observation of a CD4+ and CD8+ infiltrate within subepithelial and epithelial sheets in the biopsy and the visualization of very strong blood anti-HPV T cell responses in patients with classic VIN could be predictive of spontaneous clinical outcome. medroxyprogesterone It may also be thought that high numbers of blood CD4+ and CD8+ lymphocytes after therapeutic vaccination could allow clearance of HPV-16 lesions in classic VIN, assuming that anti-HPV vaccine-induced T effector cells could home into the HPV cutaneous and mucosal lesions. In the present study, we assessed cellular responses against HPV-16 E6 and E7 peptides in 16 patients presenting with classic VIN with the aim of mapping and characterizing the highest immunogenic regions from these proteins as potential candidates for a peptidic therapeutic vaccination.