H igh-risk human papillomaviruses (HPV), such as HPV type 16 (HPV-16), are associated with a spectrum of precancerous neoplastic changes which occur within the locally infected epithelium. HPV infections that exhibit mild neoplastic changes are classified as low-grade squamous intraepithelial lesions (LSIL), whereas infections showing more severe neoplastic changes are classified as high-grade squamous intraepithelial lesions (HSIL). LSIL and HSIL occur in mucosal epithelia, such as the cervix, and equivalent lesion grades can occur in cutaneous epithelia, such as the vulva (3).How the virus influences the pathological progression from LSIL to HSIL is not completely understood. Recent studies of both cutaneous and mucosal epithelial lesions have shown that the numbers of cells expressing cell cycle proteins, such as the E7 surrogate marker, minichromosome maintenance protein 7 (MCM-7), are increased in HSIL (2,15,22). Furthermore, the prolonged expression of E7 and MCM-7 in cells of the upper epithelial layers coincides with a delay in HPV-16 late gene expression, including that of the genes coding for the E4 and L1 capsid proteins (15). Regions of HSIL often do not support a productive virus life cycle, even though the majority of cells within the lesion still maintain intact viral episomes (8, 11). These observations suggest a model in which the deregulated expression of the HPV-16 early E7 and/or E6 oncogene from intact viral episomes allows infected cells to remain in cycle throughout the upper epithelial layers, thus resulting in an HSIL and an abortive virus life cycle.While studying viral gene expression patterns in organotypic raft cultures of an HPV-16 episome-containing normal immortalized human keratinocyte line (NIKS), we noticed that in marked contrast to what is seen with cell populations, individual HPV-16 cell line clones of the same early passage number were heterogeneous when propagated in raft culture and could mimic either LSIL or HSIL phenotypes with respect to viral gene expression patterns (i.e., E7/MCM, E4, and L1) and cellular pathology. In both the LSIL-like and HSIL-like clones, the viral oncogenes were expressed exclusively from intact viral episomes rather than from integrated sequences, with expression at confluence correlating closely with both the phenotype in raft culture and the extent of suprabasal E7/MCM-7 expression. This work supports the recent vaccine trial results showing that LSIL and HSIL may sometimes arise within a similar time frame and that, in some instances, a cervical intraepithelial neoplasia grade of 2ϩ (CIN2ϩ) can be detected within months or even weeks of first infection (16,17,20). The use of episomal cell lines provides a novel model of early-stage cervical disease and has revealed a correlation between the extent of expression of viral oncogenes and the severity of neoplasia prior to the acquisition of the cancer phenotype.Characterization of HPV16 LSIL-and HSIL-like phenotypes following life cycle reconstruction in organotypic raft culture. To study episo...