The first evidence of an association between HPV and non-melanoma skin cancer comes from patients with epidermodysplasia verruciformis (EV). EV is a rare heritable disease characterized by cutaneous warts that display not only a high rate of progression to squamous cell carcinoma on sun-exposed sites, but also a strong predisposition to infection by b-HPVs, for which HPV 5 and 8 predominate. Two EV genes (EVER1 and EVER2) have been identified, and we tested the hypothesis that variation in the EVER2 gene (rs7208422) is related to seropositivity to HPV (of the genus b types) and risk of squamous cell carcinoma in a population-based casecontrol study of SCC (n 5 239 cases and 432 controls). Among controls, variant genotype was associated with b-HPV seropositvity (OR 5 2.3, 95%CI 5 1.2-4.3), specifically HPV5 or 8 seropositivity (OR 5 2.4, 95%CI 5 1.1-5.1) and seropositivity for multiple b-HPV types (OR 5 2.7, 95%CI 5 1.1-6.6). Furthermore, variant genotype was also related to SCC risk [adjusted OR for homozygous variant versus homozygous wild type for the EVER2 polymorphism 1.7, 95% CI 1.1-2.7]. These data provide evidence for a role of genetic variation in the EVER2 gene in b-HPV infection and risk of SCC, shedding light on the link between HPVs and skin cancers. ' 2008 Wiley-Liss, Inc.Key words: human papillomavirus; skin cancer; EVER2The initial link between HPV and skin cancers was a rare autosomal inherited disease called Epidermodysplasia Verruciformis (EV) first described nearly a century ago.1 The disease is characterized by cutaneous lesions that display a high rate of progression to squamous cell carcinomas (SCCs) beginning in the second decade of life. Furthermore, EV patients experience diminished cell-mediated immunity possibly resulting in an observed susceptibility to infection by specific HPV types falling into the genus b, with HPV5 and HPV8 the most prevalent infections in this patient population. Genome-wide linkage studies were performed to map two EV loci 3,4 and to identify the EVER genes (EVER1 or EVER2, also referred to as TMC6 and TMC8, respectively) in one of these loci.
5The identification of EVER1 and EVER2 expressed sequence tags and cDNA from lymphoid tissue is consistent with a model in which EV mutations exert their direct effects in the immune system. It was recently discovered that 75% of EV patients studied have rare mutations in either of these adjacent, related, novel genes. To date, 10 truncating, loss of function mutations have been identified, 4 in EVER1 and 6 in EVER2 and were identified in EV patients from Algeria, Columbia, Poland and Japan.5 More recently, 5 additional mutations have been detected in the EVER genes supporting the hypothesis that EVER1 and EVER2 are the molecular basis of EV. [6][7][8] b-HPV DNA has been detected in up to 50% of SCC tumors from immunocompetent individuals and in up to 90% of lesions from immunocompromised individuals, 9,10 further emphasizing the role of host susceptibility in infection with these viruses. Recently, we reported that the ...