Persistent human papillomavirus (HPV) infection is the vital factor driving cervical carcinogenesis; however, other features of the local cervicovaginal microenvironment (CVM) may play a critical role in development of precancerous cervical dysplasia and progression to invasive cervical carcinoma (ICC). Here we investigated relationships between immunoproteomic and metabolic profiles and features of the cervicovaginal microenvironment, such as HPV status, vaginal microbiota (VMB), vaginal pH and genital inflammation, to better understand the complex interplay between host, virus and bacteria. In this multicenter study we enrolled 78 women with ICC, high- and low-grade squamous intraepithelial lesions, as well as HPV-positive and healthy HPV-negative controls. Vaginal swabs and cervicovaginal lavages (CVL) were collected for HPV genotyping, microbiome, metabolome and immunoproteome analyses. The VMB compositions were determined using 16S rRNA gene sequencing. Cervicovaginal metabolic fingerprints were profiled using liquid chromatography-mass spectrometry. Levels of immune mediators and other proteins in CVL samples were evaluated using multiplex cytometric bead arrays. Abnormal vaginal pH and dysbiotic non-Lactobacillus-dominated VMB were associated with Hispanic ethnicity and severity of cervical neoplasm. We also identified microbial signatures (e.g. Sneathia spp.) to be enriched in ICC and all precancerous groups. Notably, Sneathia abundance was also increased in patients with abnormal pH and those of Hispanic origin. Analyses of 62 protein targets in CVL samples revealed elevated levels of pro-inflammatory cytokines and chemokines, growth and angiogenic factors, apoptosis-related, immune checkpoint and other proteins in ICC patients. Levels of many of these proteins depended on the VMB structure and genital inflammation. These proteomic signatures positively correlated with dysbiotic non-Lactobacillus-dominated VMB and abnormal vaginal pH, both features associated with Hispanic ethnicity. Furthermore, metabolomic analysis also revealed that VMB, together with genital inflammation, are the major drivers of metabolic profiles in the local CVM. Finally, using hierarchical clustering analyses, we identified groups of patients who significantly varied in the levels of cancer-related proteins, genital inflammation, vaginal pH and VMB composition regardless of disease severity. These microenvironmental factors may impact the HPV persistence/progression and consequently increase the risk of cervical cancer. Our study demonstrated that the racial/ethnic differences in the VMB compositions may contribute to cervical cancer disparity in Hispanic women. In the future we are planning to expand our investigation of the VMB in Native American women, which will further illuminate the relationship between race/ethnicity, the VMB, and HPV.

Citation Format: Pawel Laniewski, Zehra Esra Ilhan, Nicholas A. Bokulich, Haiyan Cui, Denise J. Roe, Dana M. Chase, J. Gregory Caporaso, Melissa M. Herbst-Kralovetz. Integrative multi-omics approach reveals complex interplay between HPV, host and microbiome during cervical carcinogenesis in Hispanic and non-Hispanic women [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A094.