Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 11 de 11
Filtrar
1.
Med Microbiol Immunol ; 203(3): 155-63, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24446083

RESUMO

The genus beta human papillomavirus 8 (HPV8) is involved in the development of cutaneous squamous cell carcinomas (SCCs) in individuals with epidermodysplasia verruciformis. Immunosuppressed transplant recipients are prone to harbor particularly high betapapillomavirus DNA loads, which may contribute to their highly increased risk of SCC. Tumor induction in HPV8 transgenic mice correlates with increased expression of viral oncogenes E6 and E2. In an attempt to prevent skin tumor development, we evaluated an HPV8-E6-DNA vaccine, which was able to stimulate a detectable HPV8-E6-specific cell-mediated immune response in 8/15 immunized mice. When skin of HPV8 transgenic mice was grafted onto non-transgenic littermates, the grafted HPV8 transgenic tissue was not rejected and papillomas started to grow within 14 days all over the transplant of 9/9 non-vaccinated and 7/15 not successfully vaccinated mice. In contrast, no papillomas developed in 6/8 successfully vaccinated mice. In the other two of these eight mice, a large ulcerative lesion developed within the initial papilloma growth or papilloma development was highly delayed. As the vaccine completely or partially prevented papilloma development without rejecting the transplanted HPV8 positive skin, the immune system appears to attack only keratinocytes with increased levels of E6 protein, which would give rise to papillomas.


Assuntos
Betapapillomavirus/imunologia , Carcinoma de Células Escamosas/prevenção & controle , Proteínas Oncogênicas Virais/imunologia , Vacinas contra Papillomavirus/imunologia , Neoplasias Cutâneas/prevenção & controle , Vacinação/métodos , Vacinas de DNA/imunologia , Animais , Betapapillomavirus/genética , Carcinoma de Células Escamosas/imunologia , Imunidade Celular , Camundongos Transgênicos , Proteínas Oncogênicas Virais/genética , Vacinas contra Papillomavirus/administração & dosagem , Neoplasias Cutâneas/imunologia , Vacinas de DNA/administração & dosagem
2.
J Virol ; 83(24): 12692-701, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19793806

RESUMO

Human papillomavirus (PV) (HPV) types 2, 27, and 57 are closely related and, hence, represent a promising model system to study the correlation of phylogenetic relationship and immunological distinctiveness of PVs. These HPV types cause a large fraction of cutaneous warts occurring in immunocompromised patients. Therefore, they constitute a target for the development of virus-like particle (VLP)-based vaccines. However, the immunogenic structure of HPV type 2, 27, and 57 capsids has not been studied yet. Here we provide, for the first time, a characterization of the B-cell epitopes on VLPs of cutaneous alpha-HPVs using a panel of 94 monoclonal antibodies (MAbs) generated upon immunization with capsids from HPV types 2, 27, and 57. The MAbs generated were characterized regarding their reactivities with glutathione S-transferase-L1 fusion proteins from 18 different PV types, the nature of their recognized epitopes, their isotypes, and their ability to neutralize HPV type 2, 27, 57, or 16. In total, 33 of the 94 MAbs (35%) showed type-specific reactivity. All type-specific MAbs recognize linear epitopes, most of which map to the hypervariable surface loop regions of the L1 amino acid sequence. Four of the generated MAbs neutralized pseudovirions of the inoculated HPV type efficiently. All four MAbs recognized epitopes within the BC loop, which is required and sufficient for their neutralizing activity. Our data highlight the immunological distinctiveness of individual HPV types, even in comparison to their closest relatives, and they provide a basis for the development of VLP-based vaccines against cutaneous alpha-HPVs.


Assuntos
Epitopos de Linfócito B , Papillomaviridae/imunologia , Pele/virologia , Vírion/imunologia , Animais , Anticorpos Monoclonais/classificação , Anticorpos Monoclonais/imunologia , Proteínas do Capsídeo/química , Proteínas do Capsídeo/imunologia , Linhagem Celular , Mapeamento de Epitopos , Humanos , Imunização , Camundongos , Camundongos Endogâmicos BALB C , Testes de Neutralização , Proteínas Oncogênicas Virais/química , Proteínas Oncogênicas Virais/imunologia
3.
J Virol ; 83(15): 7690-705, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19457985

RESUMO

L1 capsomeres purified from Escherichia coli represent an economic alternative to the recently launched virus-like particle (VLP)-based prophylactic vaccines against infection with human papillomavirus types 16 and 18 (HPV-16 and HPV-18), which are causative agents of cervical cancer. It was recently reported that capsomeres are much less immunogenic than VLPs. Numerous modifications of the L1 protein leading to the formation of capsomeres but preventing capsid assembly have been described, such as the replacement of the cysteine residues that form capsid-stabilizing disulfide bonds or the deletion of helix 4. So far, the influence of these modifications on immunogenicity has not been thoroughly investigated. Here, we describe the purification of eight different HPV-16 L1 proteins as capsomeres from Escherichia coli. We compared them for yield, structure, and immunogenicity in mice. All L1 proteins formed almost identical pentameric structures yet differed strongly in their immunogenicity, especially regarding the humoral immune responses. Immunization of TLR4(-/-) mice and DNA immunization by the same constructs confirmed that immunogenicity was independent of different degrees of contamination with copurifying immune-stimulatory molecules from E. coli. We hypothesize that immunogenicity correlates with the intrinsic ability of the capsomeres to assemble into larger particles, as only assembly-competent L1 proteins induced high antibody responses. One of the proteins (L1DeltaN10) proved to be the most immunogenic, inducing antibody titers equivalent to those generated in response to VLPs. However, preassembly prior to injection did not increase immunogenicity. Our data suggest that certain L1 constructs can be used to produce highly immunogenic capsomeres in bacteria as economic alternatives to VLP-based formulations.


Assuntos
Proteínas do Capsídeo/imunologia , Papillomavirus Humano 16/fisiologia , Infecções por Papillomavirus/imunologia , Vírion/fisiologia , Montagem de Vírus , Motivos de Aminoácidos , Animais , Anticorpos Antivirais/sangue , Capsídeo/química , Capsídeo/imunologia , Proteínas do Capsídeo/química , Proteínas do Capsídeo/genética , Papillomavirus Humano 16/química , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/imunologia , Humanos , Imunização , Camundongos , Camundongos Endogâmicos C3H , Camundongos Endogâmicos C57BL , Infecções por Papillomavirus/virologia , Vírion/química , Vírion/genética , Vírion/imunologia
4.
J Virol ; 82(11): 5472-85, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18385253

RESUMO

Capsomeres are considered to be an alternative to viruslike particle (VLP)-based vaccines as they can be produced in prokaryotic expression systems. So far, no detailed side-by-side comparison of VLPs and capsomeres has been performed. In the present study, we immunized mice with insect cell-derived human papillomavirus type 16 VLPs and capsomeres. VLPs induced consistently higher antibody titers than capsomeres but the two forms induced similar CD8 T-cell responses after subcutaneous, intranasal, and oral immunization, and at least 20 to 40 times more L1 in the form of capsomeres than in the form of VLPs was needed to achieve comparable antibody responses. These results were confirmed by DNA immunization. The lower immunogenicity of capsomeres was independent of the isotype switch, as it was also observed for the early immunoglobulin M responses. Although there were differences in the display of surface epitopes between the L1 particles, these did not contribute significantly to the differences in the immune responses. capsomeres were less immunogenic than VLPs in Toll-like receptor 4 (TLR4)-deficient mice, suggesting that the lower immunogenicity is not due to a failure of capsomeres to trigger TLR4. We observed better correlation between antibody results from enzyme-linked immunosorbent assays and neutralization assays for sera from VLP-immunized mice than for sera from capsomere-immunized mice, suggesting qualitative differences between VLPs and capsomeres. We also showed that the lower immunogenicity of capsomeres could be compensated by the use of an adjuvant system containing MPL. Taken together, these results suggest that, presumably because of the lower degree of complexity of the antigen organization, capsomeres are significantly less immunogenic than VLPs with respect to the humoral immune response and that this characteristic should be considered in the design of putative capsomere-based prophylactic vaccines.


Assuntos
Formação de Anticorpos/imunologia , Proteínas do Capsídeo/genética , Proteínas do Capsídeo/imunologia , Capsídeo/imunologia , Capsídeo/metabolismo , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/imunologia , Proteínas Oncogênicas Virais/genética , Proteínas Oncogênicas Virais/imunologia , Animais , Linfócitos T CD8-Positivos/imunologia , Proteínas do Capsídeo/metabolismo , Linhagem Celular , DNA Viral/imunologia , Epitopos/imunologia , Papillomavirus Humano 16/metabolismo , Humanos , Imunidade nas Mucosas/imunologia , Imunogenética , Switching de Imunoglobulina/imunologia , Camundongos , Proteínas Oncogênicas Virais/metabolismo , Receptores Toll-Like/metabolismo
5.
J Virol Methods ; 146(1-2): 218-25, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17727966

RESUMO

This report describes the generation of novel encapsidated RNA particles and their evaluation as in-tube internal controls in diagnostic real-time reverse-transcription PCR (rRT-PCR) assays for the detection of RNA viruses. A cassette containing sequences of 2 diagnostic primer sets for foot-and-mouth disease virus (FMDV) and a set for swine vesicular disease virus (SVDV) was engineered into a full-length cDNA clone containing the RNA-2 segment of Cowpea Mosaic Virus (CPMV). After co-inoculation with a plasmid that expressed CPMV RNA-1, recombinant virus particles were rescued from cowpea plants (Vigna unguiculata). RNA contained in these particles was amplified in diagnostic rRT-PCR assays used for detection of FMDV and SVDV. Amplification of these internal controls was used to confirm that rRT-PCR inhibitors were absent from clinical samples, thereby verifying negative assay results. The recombinant CPMVs did not reduce the analytical sensitivity of the rRT-PCRs when amplification of the insert was performed in the same tube as the diagnostic target. This system provides an attractive solution to the production of internal controls for rRT-PCR assays since CPMV grows to high yields in plants, the particles are thermostable, RNase resistant and simple purification of RNA-2 containing capsids yields a preparation which is non-infectious.


Assuntos
Enterovirus Humano B/isolamento & purificação , Vírus da Febre Aftosa/isolamento & purificação , RNA/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Animais , Comovirus/genética , Febre Aftosa/virologia , Vetores Genéticos , Sensibilidade e Especificidade , Suínos/virologia , Doença Vesicular Suína/virologia
6.
Viral Immunol ; 29(5): 276-87, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27058179

RESUMO

Development of cervical cancer is associated with persistent infections by high-risk human papillomavirus (HPV). Although current HPV L1-based prophylactic vaccines prevent infection, they do not help to eliminate prevalent infections or lesions. Our aims were (i) to generate a vaccine combining prophylactic and therapeutic properties by producing chimeric capsomers after fusion of the L1 protein to different fragments of E2 from HPV 16, and (ii) to evaluate their capacity to generate an antitumoral cellular response, while conserving L1 neutralizing epitopes. Chimeric proteins were produced in Escherichia coli and purified by glutathione S-transferase (GST)-affinity chromatography. Their structure was characterized using size exclusion chromatography, sucrose gradient centrifugation, electron microscopy, and anti-L1 enzyme-linked immunosorbent assay. All chimeric proteins form capsomers and heterogeneous aggregates. One, containing part of the carboxy-terminal domain of E2 and its hinge region (L1Δ+E2H/NC, aa 206-307), conserved the neutralizing epitope H16.V5. We then evaluated the capacity of this chimeric protein to induce a cytotoxic T-cell response against HPV 16 E2. In (51)Cr release cytotoxicity assays, splenocytes from C57BL/6 immunized mice recognized and lysed TC-1/E2 cells, which express and present endogenously processed E2 peptides. Moreover, this E2-specific cytotoxic response inhibited the growth of tumors of TC-1/E2 cells in mice. Finally, we identified an epitope (aa 292-301) of E2 involved in this cytotoxic response. We conclude that the L1Δ+E2H/NC chimeric protein produced in bacteria can be an effective and economically interesting candidate for a combined prophylactic and therapeutic vaccine that could help eliminating HPV16-positive low-grade cervical lesions and persistent viral infections, thus preventing the development of lesions and, at the same time, the establishment of new infections.


Assuntos
Antígenos Virais/imunologia , Proteínas do Capsídeo/imunologia , Proteínas de Ligação a DNA/imunologia , Proteínas Oncogênicas Virais/imunologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Proteínas Recombinantes de Fusão/administração & dosagem , Animais , Antígenos Virais/química , Proteínas do Capsídeo/química , Proteínas do Capsídeo/genética , Citotoxicidade Imunológica , Proteínas de Ligação a DNA/química , Proteínas de Ligação a DNA/genética , Modelos Animais de Doenças , Mapeamento de Epitopos , Epitopos/química , Epitopos/imunologia , Escherichia coli/genética , Escherichia coli/metabolismo , Feminino , Expressão Gênica , Papillomavirus Humano 16/crescimento & desenvolvimento , Papillomavirus Humano 16/imunologia , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Proteínas Oncogênicas Virais/química , Proteínas Oncogênicas Virais/genética , Infecções por Papillomavirus/tratamento farmacológico , Infecções por Papillomavirus/imunologia , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/genética , Vacinas contra Papillomavirus/imunologia , Plasmídeos/química , Plasmídeos/metabolismo , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/imunologia , Linfócitos T Citotóxicos/imunologia , Linfócitos T Citotóxicos/virologia
7.
J Dermatol Sci ; 77(1): 37-45, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25439730

RESUMO

BACKGROUND: Infection with different species of cutaneous human papillomaviruses (cHPV) of genus alpha (cαHPVs) and associated skin disease are highly prevalent in solid organ transplant recipients (OTR), documenting the importance of the immunological control of HPV infection. OBJECTIVES: To investigate the natural course of cαHPV-specific cellular and humoral immune responses during systemic long-term immunosuppression. METHODS: Integrating bead-based multiplex serology and flow cytometry we analyzed natural cαHPV-specific antibodies and T(H) cell responses against the major capsid protein L1 of HPV types 2, 27, 57 (species 4) and 3, 10 and 77 (species 2) in sera and blood of OTR before and after initiation of iatrogenic immunosuppression and in comparison to immunocompetent individuals (IC). RESULTS: Among OTR we observed an overall 42% decrease in humoral L1-specific immune responses during the course of iatrogenic immunosuppression, comparing median values 30 d before and 30 d after initiation of immunosuppressive therapy (p < 0.05). This difference disappeared after long-term (>1 year) immunosuppression. The predominant cellular L1-specific immune response was of type T(H)1 (CD4(+)CD40L(+)IL-2(+)IFN-γ(+)). Consistent with the detected L1-specific antibody titers, L1-specific T(H)1 responses were unchanged in long-term immunosuppressed OTR compared to IC. Notably, cαHPV-L1-specific IL-2(+)/CD40L(+)CD4(+) or IFN-γ(+)/CD40L(+) CD4(+) T(H) cell responses against any of the cαHPV-L1 types were significantly higher in OTR with clinically apparent common warts. CONCLUSION: The systemic humoral immune response against cαHPV may reflect the individual degree of iatrogenic immunosuppression indicating a higher susceptibility for cαHPV infection among OTR during the early phase after organ transplantation. Humoral cαHPV-specific immune responses may show a reconstitution to pre-transplantation levels despite continuous potent immunosuppression.


Assuntos
Proteínas do Capsídeo/química , Imunidade Celular , Imunidade Humoral , Proteínas Oncogênicas Virais/química , Transplante de Órgãos , Verrugas/imunologia , Linfócitos T CD4-Positivos/citologia , Feminino , Citometria de Fluxo , Glutationa Transferase/metabolismo , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18 , Humanos , Terapia de Imunossupressão , Imunossupressores/uso terapêutico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Papillomaviridae , Vacinas contra Papillomavirus/uso terapêutico , Fenótipo , Verrugas/virologia
8.
Antivir Ther ; 15(7): 951-7, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21041909

RESUMO

Recently, two prophylactic vaccines against the most significant oncogenic human papillomaviruses (HPV; 16 and 18) became available that efficiently protect against persistent HPV infection and cancer precursors. However, clinical trials performed with these vaccines did not provide evidence that they would influence the natural history of prevalent HPV infections, that is, their eventual malignant progression. Because, even under the optimistic assumption of high vaccine coverage, a significant reduction of cancer incidence can only be expected after two decades, there is a need for immune therapeutic strategies to be offered to persistently infected individuals who do not benefit from the prophylactic vaccines. Here, we describe the reasons for failure of most of the published approaches to HPV-specific therapies, highlight promising developments and present our view for future developments.


Assuntos
Ensaios Clínicos como Assunto , Imunoterapia/tendências , Papillomaviridae/imunologia , Infecções por Papillomavirus/prevenção & controle , Feminino , Humanos , Incidência , Infecções por Papillomavirus/epidemiologia , Vacinas contra Papillomavirus/uso terapêutico , Vacinação
9.
Vaccine ; 28(6): 1583-93, 2010 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-20003923

RESUMO

The potential as prophylactic vaccines of L1-based particles from cutaneous genus alpha human papillomavirus (HPV) types has not been assessed so far. However, there is a high medical need for such vaccines since HPV-induced skin warts represent a major burden for children and for immunocompromised adults, such as organ transplant recipients. In this study, we have examined the immunogenicity of capsomeres and virus-like particles (VLPs) from HPV types 2, 27, and 57, the most frequent causative agents of skin warts. Immunization of mice induced immune responses resembling those observed upon vaccination with HPV 16 L1-based antigens. The antibody responses were cross-reactive but type-restricted in their neutralizing capacities. Application of adjuvant led to an enhanced potential to neutralize the respective immunogen type but did not improve cross-neutralization. Vaccination with capsomeres and VLPs from all four analyzed HPV types induced robust IFNgamma-associated T-cell activation. Immunization with mixed VLPs from HPV types 2, 27, and 57 triggered an antibody response similar to that after single-type immunization and capable of efficiently neutralizing all three types. Our results imply that vaccination with combinations of VLPs from cutaneous HPV types constitutes a promising strategy to prevent HPV-induced skin lesions.


Assuntos
Alphapapillomavirus/imunologia , Proteínas do Capsídeo/imunologia , Capsídeo/imunologia , Proteínas Oncogênicas Virais/imunologia , Vacinas contra Papillomavirus/imunologia , Dermatopatias Virais/prevenção & controle , Virossomos/imunologia , Verrugas/prevenção & controle , Adjuvantes Imunológicos/administração & dosagem , Animais , Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , Reações Cruzadas , Interferon gama/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Dermatopatias Virais/imunologia , Linfócitos T/imunologia , Vacinas Virossomais , Verrugas/imunologia
10.
Virology ; 388(2): 344-53, 2009 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-19409593

RESUMO

Human papillomavirus (HPV) L1 self-assembles into virus-like particles (VLPs), which are the basis for the two commercially available prophylactic vaccines. For one of them (Cervarix) HPV 16 and 18 VLPs are being produced in insect cells using the baculovirus expression system. However, due to low yield, production of VLPs remains challenging for certain other PV types. Here we report that employment of a modified baculovirus-based (MultiBac) expression system (Berger, I., Fitzgerald, D. J., and Richmond, T. J. (2004). Baculovirus expression system for heterologous multiprotein complexes. Nat. Biotechnol. 22(12), 1583-7) permits substantially improved VLP production of several PV types up to 40-fold. Highest VLP yields were achieved when two copies of the L1 gene were expressed from independently controlled cassettes. We have evaluated the production of HPV 57 L1 VLPs by the MultiBac system in more detail. Whereas the level of the HPV 57 L1 protein was only slightly increased in comparison to the standard protocol we monitored a strongly enhanced yield of HPV 57 VLPs. Our results imply that a critical concentration of L1 within the producer cell is required for efficient VLPs assembly. We show evidence that in addition a dominant negative factor in conventionally produced recombinant baculoviruses contributes to differences in VLP yield. This phenomenon might be attributable to the absence of the viral cysteine protease V-CATH in the modified baculovirus system. We anticipate that use of the MultiBac expression system will facilitate capsid production for papillomaviruses and thereby enable the generation of vaccines against infections by many of the as yet untargeted HPV types.


Assuntos
Biotecnologia/métodos , Proteínas do Capsídeo/isolamento & purificação , Insetos/virologia , Papillomaviridae/fisiologia , Vírion/metabolismo , Virologia/métodos , Replicação Viral/fisiologia , Animais , Anticorpos Antivirais , Baculoviridae/genética , Baculoviridae/metabolismo , Baculoviridae/fisiologia , Proteínas do Capsídeo/metabolismo , Linhagem Celular , DNA Viral/química , DNA Viral/genética , DNA Viral/metabolismo , Regulação Viral da Expressão Gênica , Papillomaviridae/genética , Papillomaviridae/metabolismo , Vírion/imunologia , Montagem de Vírus/genética , Montagem de Vírus/fisiologia
11.
Vaccine ; 27(10): 1511-22, 2009 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-19174177

RESUMO

HPV 16 L1 capsomeres purified from Escherichia coli represent a promising and potentially cost-effective alternative to the recently licensed VLP-based vaccines for the prevention of cervical cancer. However, recombinant protein preparations from bacteria always bear the risk of contaminating endotoxins which are highly toxic in humans and therefore have to be eliminated from vaccine preparations. In this study, we measured the LPS concentration at various stages of the purification of HPV 16 L1 from E. coli and determined that it enhances the immunogenicity of HPV 16 VLPs and capsomeres. We confirmed the immunogenicity of the L1 capsomeres in TLR4(-/-) mice without the enhancing effect of the LPS and then elaborated a suitable protocol using Triton X-114 phase separation for the removal of LPS without any significant protein loss or influence on the structural integrity of the particles. The LPS-free capsomeres purified from E. coli induced neutralizing L1-specific antibodies. Our results demonstrate the excellent potential of capsomeres as an economically interesting alternative vaccine to prevent cervical cancer that could be made available in developing countries.


Assuntos
Proteínas do Capsídeo/isolamento & purificação , Papillomavirus Humano 16/imunologia , Proteínas Oncogênicas Virais/isolamento & purificação , Animais , Anticorpos Antivirais/biossíntese , Proteínas do Capsídeo/genética , Proteínas do Capsídeo/imunologia , Linhagem Celular , Contaminação de Medicamentos/prevenção & controle , Endotoxinas/imunologia , Endotoxinas/isolamento & purificação , Escherichia coli/genética , Escherichia coli/imunologia , Feminino , Papillomavirus Humano 16/genética , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Proteínas Oncogênicas Virais/genética , Proteínas Oncogênicas Virais/imunologia , Infecções por Papillomavirus/imunologia , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/genética , Vacinas contra Papillomavirus/imunologia , Vacinas contra Papillomavirus/isolamento & purificação , Proteínas Recombinantes/genética , Proteínas Recombinantes/imunologia , Proteínas Recombinantes/isolamento & purificação , Linfócitos T Citotóxicos/imunologia , Neoplasias do Colo do Útero/imunologia , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia
SELEÇÃO DE REFERÊNCIAS
Detalhe da pesquisa