bViruses are obligate intracellular parasites and need to reprogram host cells to establish long-term persistent infection and/or to produce viral progeny. Cellular changes initiated by the virus trigger cellular defense responses to cripple viral replication, and viruses have evolved countermeasures to neutralize them. Established models have suggested that human papillomaviruses target the retinoblastoma (RB1) and TP53 tumor suppressor networks to usurp cellular replication, which drives carcinogenesis. More recent studies, however, suggest that modulating the activity of the Polycomb family of transcriptional repressors and the resulting changes in epigenetic regulation are proximal steps in the rewiring of cellular signaling circuits. Consequently, RB1 inactivation evolved to tolerate the resulting cellular alterations. Therefore, epigenetic reprograming results in cellular "addictions" to pathways for survival. Inhibition of such a pathway could cause "synthetic lethality" in adapted cells while not markedly affecting normal cells and could prove to be an effective therapeutic approach.
HUMAN PAPILLOMAVIRUS-ASSOCIATED CANCERS
Papillomaviruses are ubiquitous viruses with 8-kb doublestranded circular genomes. They specifically infect squamous epithelial tissues and cause hyperplastic lesions, referred to as warts. Based on their tissue tropism, the ϳ200 human papillomavirus (HPV) types can be divided into mucosal and cutaneous types. Mucosal HPVs are classified as "low risk" and "high risk" for malignant progression of the lesions that they cause. Approximately 5% of all human cancers, including Ͼ99% of cervical carcinomas, many penile, vulvar, vaginal, and anal carcinomas, and a growing fraction of head and neck squamous cell carcinomas, are caused by high-risk HPVs (1). With an estimated 4,100 deaths in 2015 in the United States, one woman succumbs to cervical cancer approximately every 2 h in this country (and every 2 min worldwide) (2). Given the low vaccination rates in the United States and the fact that the available prophylactic vaccines do not inhibit malignant progression in individuals who are already infected, and because HPV-associated cancers often develop years to decades after the initial infection, these dire numbers are not likely to change in the foreseeable future.
HPV-ASSOCIATED CANCERS ARE FUELED BY E6 AND E7 EXPRESSIONHigh-risk HPV-associated cancers are generally nonproductive infections, i.e., viral proteins are produced but no viral progeny is generated. Importantly, the HPV E6 and E7 genes are the only viral genes that are consistently expressed in these cancers. Although the recently identified, recurrent cellular mutations in cervical carcinoma likely also contribute to oncogenesis (3), cervical cancer lines remain "addicted" to E6/E7 expression, and extinguishing HPV E6/E7 expression in cervical cancer lines causes senescence (4).High-risk HPV E6 and E7 are potently oncogenic in cell-based transformation assays and in transgenic mouse models. In contrast, the low-risk HPV E6 and ...