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February 08, 2018

Tonsil Crypts Can Hide HPV in Healthy Adults

Fascinating research was published in Jan 2018 describing how the HPV virus can remain hidden from a normal human immune response within the tonsil itself. How can the HPV virus manage this neat act of espionage? By hiding in the biofilm within tonsil crypts.

One can consider biofilm to be a thin layer of "sludge" that may coat the tonsil lining.

This finding may also explain why HPV oral infection appears to be so prevalent in so many adults and why HPV has now become one of the most common causes of throat cancer. [More info]

This discovery was made by examining tonsils removed for non-cancerous reasons from 102 adults between 20 and 39 years of age. 4.9% of the tonsils were found to contain HPV. 3.9% contained the high-risk HPV subtypes (16 and 18) known to cause throat cancer.

Keep in mind, these tonsils were removed from patients who were perfectly healthy and had "normal" tonsils removed due to other reasons such as chronic tonsillitis. Normally, one would expect the HPV virus to be detected and eradicated by the immune system. However, this did not appear to be the case in patients where HPV was "accidentally" found.

The location of where HPV was detected was within the biofilm accumulated inside tonsil crypts. Tonsil crypts are the holes and crevasses not uncommonly seen on the surface of tonsils contributing to the lumpy pock-marked appearance in some patients. It is also where tonsil stones develop.

The significance of the biofilm location is that the human immune system is not able to typically surveil nor eradicate pathogens hanging out in biofilm.

Of greater interest is the fact that even if a patient receives the HPV vaccine (ie, gardasil), it may not even matter since the vaccine-boosted immune system would still be blind to any viruses hanging out in biofilm.

However, this does provide a potential path for treatment now that HPV localization has been identified. Potential anti-viral, biofilm disrupting mouthwashes??? Of course, tonsillectomy can be considered an extreme for of treatment as well.


Reference:
Prevalence of High-Risk Human Papillomavirus in Tonsil Tissue in Healthy Adults and Colocalization in Biofilm of Tonsillar Crypts. JAMA Otolaryngol Head Neck Surg. Published online January 25, 2018. doi:10.1001/jamaoto.2017.2916
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. He is also the chief medical officer of O2Labz, a medical and scientific 3D animation company.Google+ Christopher Chang, MD Bio

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