PCR metoda u dijagnostici infekcija humanog papiloma virusa (HPV)
Prevencija karcinoma grlića materice kod žena
Tokom gotovo celog dvadesetog veka važilo je pravilo da je jednom postavljena dijagnoza maligne bolesti kod neke osobe, ujedno značila i sporiji ili brzi kraj života za tu osobu. Vrlo malo se znalo i o razlozima nastanka i početcima karcinogeneze u ljudskom organizmu pa je obolevanje bilo u velikoj meri stvar genetike, pa i puke slučajnosti i sreće.
Tek krajem dvadesetog veka, a naročito od početka 21. veka, medicina i ostale nauke pronalaze razne metode lečenja za značajan produžetak života obolelih od malignih bolesti a neretko i potpuna izlečenja maligniteta određenih lokalizacija. Sama dijagnoza raka po prvi put u istoriji ne znači i skori kraj života obolelog.
Istovremeno sa sve uspešnijim terapijskim metodama, dolazi se i do otkrića mogućih uzroka i uzročnika nastanka malignih bolesti. Ovi pronalasci logično dovode do mogućnosti prevencije tj. sprečavanja nastanka ili bar što ranijeg otkrivanja bolesti.
Značajni pomaci u prevenciji i lečenju malignih bolesti napravljeni su u svim oblastima onkologije ali se najveći napredak vidi u lečenju i prevenciji raka grlića materice, dojke i debelog creva.
Načini prevencije za svaku vrstu tumora se razlikuju i zahtevaju pojedinačno detaljne analize, a ovde ćemo ukazati na osnovne činjenice vezane za karcinom grlića materice i njegovu povezanost sa humanim papiloma virusom. Iz ovoga sledi i visoki značaj dostupnosti PCR dijagnostike u detekciji HPV infekcija i posledično smanjenju umiranja od ove bolesti.
Karcinom grlića materice spada u najčešće dijagnostikovane karcinome kod žena koji samim tim može dovesti i do velikog umiranja u ženskoj populaciji bilo gde u svetu. Vremenom je ustanovljeno da se hirurškim metodama, na vreme otkriven karcinom grlića materice, može dosta uspešno lečiti. Zbog toga su redovne kontrole žena kod ginekologa, koje su u mnogim državama čak i obavezne, značajno smanjile smrtnost od ove bolesti. Dakle, cilj je jasan a to je detekcija oboljenja u početnom stadijumu.
Daljim istraživanjima ove oblasti otkrivena je izuzetno visoka povezanost karcinoma grlića materice i HPV infekcije. Ovo je značilo da se sam početak nastanka maligniteta (početak karcinogeneze) može dobro kontrolisati ukoliko se na vreme detektuje HPV infekcija.
Sama infekcija HPV je vrlo česta kod pripadnika oba pola i prenosi se prvenstveno seksualnim kontaktom. Veliki broj infekcija prođe bez značajnijih simptoma i komplikacija i kod žena a naročito kod muškaraca. Ipak, kod određenog broja inficiranih, dolazi do komplikacija pa i onih najtežih u vidu maligniteta (karcinom grlića materice kod žena). Zbog toga je rana detekcija HPV infekcije najbolji i najvažniji prvi korak u sprečavanju nastanka ove bolesti.
PCR metoda je zlatni standard dijagnostike HPV infekcije. Ova metoda omogućava ne samo detekciju HPV virusa već se ujedno vrši i tzv. genotipizacija tj. vrlo precizno određivanje tipa virusa koji je infekciju izazvao. Ovo je izuzetno važno i vredno jer u prirodi postoji oko 100 različitih tipova HPV virusa od kojih su neki manje a neki vrlo visoko onkogeni. Tačna genotipizacija omogućava vrlo preciznu dalju kontrolu i tretman infekcije koja se stavlja pod potpuni nadzor a samim tim i bolest koju potencijalno može prouzrokovati.
Kao rezultat svih napora u najrazvijenijim zemljama sveta beleži se drastičan pad broja novoobolelih i umrlih žena od karcinoma grlića materice. Nesumnjiv doprinos ovoj činjenici daje podrška koju laboratorije, koje poseduju najsavremeniju PCR tehniku, pružaju u ranoj dijagnostici infekcija izazvanih HPV virusima visokog onkogenog potencijala.
ZZJZ Čačak, sa svojom PCR laboratorijom, direktno se uključio u sve aktivnosti vezane za najraniju dijagnostiku i kontrolu karcinoma grlića materice.
Želimo da podsetimo da je inicijativa za otvaranje nove PCR laboratorije sa najmodernijom molekularnom dijagnostičkom opremom došla kao rezultat saradnje unutar šire zajednice, zdravstvenih radnika, gradske bolnice, Instituta za javno zdravlje i Grada Čačka. Lokalna vlast, u cilju zaštite zdravlja svojih građana, obezbedila je sredstva za izgradnju nove i moderne zgrade u kojoj je uspostavljena PCR laboratorija. Istovremeno, servisne organizacije, poput Rotari kluba Čačak, kao lokalnog partnera, i Rotari kluba Austin, SAD, kao međunarodnog partnera, prepoznale su potrebe građana i predložile projekat „Stop Covid-19“.
Projekat je imao za cilj nabavku opreme za PCR laboratoriju, istovremeno obučavajući stanovništvo za prevenciju i borbu protiv infektivnih bolesti. Projekat je osmišljen u vreme kada je kriza izazvana Covid-19 bila na vrhuncu, kako u našoj zemlji tako i globalno. Vredno je pomenuti da je PCR (ili lančana reakcija polimeraze) neophodna i najnaprednija metoda u današnjem molekularnom istraživanju. Projekat je finansiran kroz jedinstveno i vidljivo partnerstvo između Rotari Internacionala i USAID-a putem programa „Srca Evrope“ i predstavlja izvanredan primer izuzetne sinergije između lokalne vlasti, zdravstvene zajednice, stanovništva, Rotari organizacije i USAID-a.
„Ovaj članak je omogućen velikodušnom podrškom američkog naroda putem Agencije za međunarodni razvoj Sjedinjenih Američkih Država (USAID). Sadržaj je odgovornost Rotari kluba Čačak, Srbija i ne mora nužno odražavati stavove USAID-a ili Vlade Sjedinjenih Američkih Država.“
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PCR Method in the Diagnosis of Human Papillomavirus (HPV) Infections
Prevention of Cervical Cancer in Women
Throughout almost the entire twentieth century, it was a rule that once a diagnosis of a malignant disease was made in a person, it also meant a slower or faster end to their life. Very little was known about the reasons for the development and the beginning of carcinogenesis in the human body, so the disease was largely considered a matter of genetics and sheer chance or luck.
It was only at the end of the twentieth century, and especially since the beginning of the 21st century, that medicine and other sciences began to find various treatment methods for significantly prolonging the lives of those suffering from malignant diseases and often achieving complete cures for malignancies of certain localizations. For the first time in history, a cancer diagnosis does not necessarily mean the imminent end of the patient’s life.
Simultaneously with increasingly successful therapeutic methods, discoveries have been made regarding possible causes and agents responsible for the development of malignant diseases. These discoveries logically lead to the possibility of prevention, i.e., preventing the onset or at least early detection of the disease.
Significant progress has been made in the prevention and treatment of malignant diseases in all areas of oncology, but the greatest advancement is seen in the treatment and prevention of cervical, breast, and colorectal cancers.
Prevention methods for each type of tumor differ and require individual detailed analyses. Here, we will focus on the basic facts related to cervical cancer and its association with the human papillomavirus (HPV). From this, it follows the high importance of the availability of PCR diagnostics in detecting HPV infections and consequently reducing mortality from this disease.
Cervical cancer is among the most commonly diagnosed cancers in women, which can lead to high mortality in the female population anywhere in the world. Over time, it has been established that cervical cancer, if detected early through surgical methods, can be treated quite successfully. Regular check-ups for women with gynecologists, which are even mandatory in many countries, have significantly reduced mortality from this disease. Therefore, the goal is clear, and that is the detection of the disease in its early stage.
Further research in this area has revealed an extremely high correlation between cervical cancer and HPV infection. This means that the onset of malignancy (the beginning of carcinogenesis) can be well controlled if HPV infection is detected early.
HPV infection itself is very common in both sexes and is primarily transmitted through sexual contact. A large number of infections pass without significant symptoms and complications in women, and especially in men. However, in a certain number of infected individuals, complications occur, including the most severe ones such as malignancy (cervical cancer in women). Therefore, early detection of HPV infection is the best and most important first step in preventing the onset of this disease.
The PCR method is the gold standard in the diagnosis of HPV infection. This method allows not only the detection of the HPV virus but also the so-called genotyping, i.e., very precise determination of the type of virus that caused the infection. This is extremely important and valuable because there are around 100 different types of HPV viruses in nature, some of which are less and some very highly oncogenic. Accurate genotyping enables very precise further control and treatment of the infection, which is put under complete control and therefore also the disease it can potentially cause.
As a result of all efforts in the most developed countries of the world, there has been a drastic decrease in the number of newly diagnosed and deceased women from cervical cancer. Undoubtedly, the support provided by laboratories possessing the most advanced PCR techniques in early diagnosis of infections caused by high oncogenic potential HPV viruses contributes significantly to this fact.
The Institute of Public Health of the City of Cacak, with its PCR laboratory, has directly engaged in all activities related to the earliest diagnosis and control of cervical cancer.
We remind that the initiative to open a new PCR laboratory with the most modern molecular diagnostic equipment came as a result of cooperation within the broader community, health workers, city hospital, Institute of Public Health, and the City of Cacak. The local government, in order to protect the health of its citizens, provided funds for the construction of a new and modern building in which the PCR laboratory was established. At the same time, service organizations, such as Rotary Club Cacak, as a local partner, and Rotary Club Austin, USA, as an international partner, recognized the needs of the citizens and proposed the „Stop Covid-19“ project. The project aimed to procure equipment for the PCR laboratory while simultaneously educating the population for the prevention and fight against infectious diseases. The project was conceived at a time when the crisis caused by Covid-19 was at its peak, both in our country and globally. It is worth mentioning that PCR (or polymerase chain reaction) is necessary and the most advanced method in today’s molecular research. The project is funded through a unique and visible partnership between Rotary International and USAID throught the programme « Hearts of Europe » and is a prime example of exceptional synergy between local government, health community, population, Rotary organization, and USAID.
“This article is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of Rotary Club Cacak, Serbia and do not necessarily reflect the views of USAID or the United States Government.”
