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#923 PD-1/PD-L1 pathway expression in imiquimod treatment of high-grade cervical lesions
  1. Andrej Cokan1,
  2. Neila Caroline Henrique Da Silva2,
  3. Sheilla Andrade De Oliveira2,
  4. Sheilla Andrade De Oliveira3,
  5. Rajko Kavalar,
  6. Maja Pakiž1,
  7. Igor But4 and
  8. Norma Lucena-Silva2
  1. 1UMC Maribor, Department for gynaecological and breast oncology, Maribor, Slovenia
  2. 2Laboratório de Imunogenética, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz de Pernambuco, Recife – Pe, Brazil
  3. 3UMC Maribor, Department for pathology, Maribor, Slovenia
  4. 4UMC Maribor, Department for general gynaecology and gynaecologic urology, Maribor, Slovenia


Introduction/Background Programmed cell death protein (PD-1) after contact with its ligands (PD-L1 and PD-L2) exerts an inhibitory role on immune cells, playing an important role in maintaining self-response. Knowing that increased expression of the PD-1/PD-L1 pathway can interfere with cervical immunity for the progression of cervical lesions, we decided to investigate whether the use of 5% imiquimod can modulate the expression of the PD-1/PD-L1 pathway in uterine cervix injuries.

Methodology We studied 52 women aged 18 to 40 years with histological diagnosis of high-grade HSIL intraepithelial lesion (CIN2p16+ and CIN3), who self-applied 250mg cream containing 5% imiquimod three times a week for 16 weeks. Biopsies were collected on admission and after completion of treatment, and the successful treatment was defined by lesion regression after treatment. The expression of PD-1 and PD-L1 was evaluated by immunohistochemistry, whose values (in pixels) were used to assess protein levels.

Results The success of topical imiquimod treatment in high-grade cervical lesions was associated with lesions that had the highest levels of PD-1 (P= 0.0319) and PD-L1 (P= 0.0199) before treatment. Paired sample analysis before and after treatment showed that imiquimod acts on the PD-1/PD-L1 pathway, decreasing PD-1 expression (P= 0.0155) in cases of successful treatment (figure 1), possibly controlling the inflammation. We observed that PD-1 levels were not correlated with PD-L1 levels (p=0.5177).

Conclusion Our results suggested that imiquimod modulates PD-1 expression in cervical lesions and that treatment success depends on PD-1 levels at admission. In contrast, increased PD-L1 expression is associated with a higher risk of unsuccessful treatment.

Disclosures The authors report no conflict of interests.

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