Complement component 3c and tumor necrosis factor-α systemic assessment after Candida antigen immunotherapy in cutaneous warts

Abstract

Background Cutaneous warts are the commonest benign lesion produced by human papillomavirus. Lesions often regress spontaneously yet have a high rate of recurrence. They impair patients' quality of life and carry the potential risk of cancer. Nowadays, Candida antigen immunotherapy has become an encouraging therapeutic modality for warts. We tried to assess the role of the complement pathway and T helper 1 immune response in clinical response to Candida antigen immunotherapy via complement component 3c (C3c) and tumor necrosis factor (TNF)-α, respectively. Methods A total of 44 patients with cutaneous warts were enrolled in the study. Patients were injected with Candida antigen at 2week interval until complete clearance of the lesion or for a maximum of 5 sessions. Blood samples were collected before initiation and after completion of immunotherapy. C3 and C4 were measured using an automated turbidimetric method. Mannose-binding lectin (MBL), C3c, and TNF-α were measured using enzyme-linked immune sorbent assay. Results A total of 56.4%, 17.9%, and 25.7% of the patients showed complete, partial, and no response to immunotherapy, respectively. Lesions on the dorsum of the foot and sole showed significant clearance (p value = 0.037). All patients had no deficient C3, C4, and MBL serum levels. C3c and TNF-α serum levels were significantly higher in non-responder group (p value < 0.001 and < 0.001, respectively). C3c and TNF-α serum levels were strongly correlated in all the studied patients (r = 0.8, p value < 0.001). Conclusions Candida antigen immunotherapy is an effective therapeutic modality for cutaneous warts. C3c and TNF-α serum levels were higher in patients who failed to respond to immunotherapy. Clinical trial registry number NCT04399577, May 2020 "retrospectively registered"

Intralesional bivalent and quadrivalent human papillomavirus vaccines didn’t significantly enhance the response of multiple anogenital warts when co-administered with intralesional Candida antigen immunotherapy. A randomized controlled trial

“…Also, Candida cell wall components may bind to toll-like receptors (TLRs), primarily TLR-2 and TLR-4, inducing the production of tumor necrosis factor (TNF)-α and type I IFNs that eliminate viral infections [ 18 ]. Furthermore, it has the potential to activate the complement system, resulting in chemotaxis of various inflammatory cells and direct destruction of virally infected cells via a membrane attack complex [ 19 ].…”

Predictors of the Therapeutic Response to Intralesional Bivalent HPV Vaccine in Wart Immunotherapy

“…Patients received injections at two-week intervals until the complete elimination of their warts or until a maximum of six sessions had been completed. The evaluation of the therapeutic response depended on the contraction in the size and reduction in the number of warts [28]. The response was considered complete if there was a 100% clearance of warts, partial if there was a 50-99% reduction in wart size, and no response if there was less than a 50% reduction in wart size.…”