single nucleotide polymorphisms (sNps) in TLR genes may serve as a crucial marker for early susceptibility of various cancers including cervical cancer. the present study was therefore designed to ascertain the role of TLR4 and TLR9 sNps and haplotypes to hrHpV infection and cervical cancer susceptibility. The study included 110 cervical cancer biopsies and 141 cervical smears from age-matched healthy controls of Gujarati ethnicity of Western India. hrHPV 16 and 18 were detected using Realtime pCR. eight sNps, four each in TLR4 and TLR9 were analyzed using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism and Allele-Specific PCR. HPV 16 and 18 were detected in 68% cervical cancer cases. TLR4 rs4986790, rs1927911 and TLR9 rs187084 showed association with HPV 16/18 infection. CC and CT genotypes of TLR4 rs11536889 and rs1927911 respectively, and TC, CC genotypes of TLR9 rs187084, as well as minor alleles of TLR4 rs4986790 and TLR9 rs187084, were associated with the increased risk of cervical cancer. Stage-wise analysis revealed TLR9 rs187084 and rs352140 to be associated with early-stage cancer. TLR4 haplotype GtAC and TLR9 haplotype GATC were associated with the increased risk of cervical cancer while TLR4 haplotype GCAG was associated with the decreased risk. TLR4 haplotype GCAG and TLR9 haplotype GAtC showed association with increased susceptibility to hrHpV infection. In conclusion, the present study revealed association of TLR4 and TLR9 polymorphisms and haplotypes with hrHpV infection and cervical cancer risk. Further evaluation of a larger sample size covering diverse ethnic populations globally is warranted. With respect to gender-specific cancers, cervical cancer is the next major cause of global cancer deaths among women, after the cancer of the breast, wherein India accounts for almost one-fourth of total cervical cancer-related mortalities 1. Human papillomavirus (HPV) infection is considered as the most vital event in the development and progression of cervical cancer, as the HPV DNA has been detected in almost all of the cervical tumors globally 2. With more than 200 HPV types known till date,
Background
Cervicitis is one of the major health problems amongst women caused by infection of various pathogens including
Chlamydia trachomatis
(CT),
Neisseria gonorrhoeae
(NG),
Trichomonas vaginalis
(TV) as well as human papillomavirus (HPV), and persistent cervical inflammation is one of the etiologic agents of cervical cancer. Toll-like receptors (TLRs) play an important role in the recognition and subsequent elimination of these pathogens. Variations in the Toll-like receptor genes influence susceptibility to pathogens as well as disease progression independently.
Methods
Ten single nucleotide polymorphisms, five each of
TLR4
and
TLR9
genes were analyzed among 130 cervicitis patients and 150 controls either using polymerase chain reaction-restriction fragment length polymorphism or allele specific-PCR.
Results
T
.
vaginalis
infection was found at the highest frequency (30.7%) as compared to
C
.
trachomatis
(1.5%),
N
.
gonorrhoeae
(2.3%) and HPV (4.6%) infections in cervicitis patients.
TLR4
rs11536889 CC (age-adjusted OR, 2.469 [95% CI, 1.499 to 4.065]; p < 0.001) and
TLR9
rs187084 TC (age-adjusted OR, 2.165 [95% CI, 1.267–3.699]; p = 0.005) genotypes showed the higher distribution in cervicitis patients compared to controls. In addition, TLR4 rs11536889 C allele was shown to increase the risk of cervicitis (age-adjusted OR, 1.632 [95% CI, 1.132 to 2.352]; p = 0.009) compared to controls. The
TLR4
haplotype GCA (OR, 0.6 [95% CI, 0.38–0.95]; p = 0.0272) and
TLR9
haplotype GTA (OR, 1.99 [95% CI, 1.14–3.48]; p = 0.014) were found to be associated with decreased and increased risk of cervicitis respectively.
Conclusions
TLR4
and
TLR9
polymorphisms, as well as haplotypes were shown to modulate the cervicitis risk.
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