Human Papillomavirus (HPV) Genes detection using Real-Time PCR: Introduction, Principle, Test Requirements, Procedure, Result Interpretation and Keynotes

 Introduction of Human Papillomavirus (HPV) Genes Detection

Human papillomaviruses (HPV) are small double-stranded (ds) DNA viruses that belong to the family of Papillomaviridae. having a circular genome of the size of approximately 7.9-kilobases. There are more than 100 types of HPV that have been identified, so far among them, certain HPV types called high-risk HPV (hrHPV) like HPV 16 and 18, are associated with the induction of mucosal lesions that can progress to malignancy. The viral genome contains early (E) and late (L) genes, which encode proteins necessary for the early and late stages of the HPV life cycle, respectively. The E6 and E7 gene products of hrHPV types have carcinogenic properties and are necessary for the malignant transformation of the host cell.

Malignant progression is often associated with viral integration into the genome of the host cell. Integration results in the interruption of the viral genome in a region that may extend from the E1 to the L1 open reading frame (ORF). This may have consequences for PCR-mediated amplification of viral DNA in these regions. As initiation and maintenance of the transformed phenotype depend on the continuous expression of the viral oncoproteins, the viral E6/E7 region is invariably retained in integrated viral genomes in cervical cancers. The QIAscreen HPV PCR Test targets a conserved region within the E7 gene.

HPV genes detection using real-time PCR is both a screening and confirmatory test of Human papillomaviruses that is responsible for malignant transformation of the host cell. The human papillomaviruses (HPV) nucleic acid test kit is a multiplex, real-time PCR test intended for the qualitative detection of nucleic acid from the human papillomaviruses in the specimens such as a cervical specimen(scrape) sample or self-collected vaginal brush specimens or self-collected cervicovaginal lavage specimens in respective preservative solutions of HPV 16 gene, HPV 18, HPV Others and human housekeeping gene β-globin.

Cervical specimen for Human Papillomavirus (HPV) detection
Fig. Cervical specimen for Human Papillomavirus (HPV) detection

Principle of Human Papillomavirus (HPV) Genes Detection Using Real-Time PCR

The QIAscreen Human Papillomavirus (HPV) PCR Test is a multiplex, real-time PCR-based test and it is directed against the E7 gene of 15 hrHPV types that uses fluorescent probes for the detection of one or more accumulating PCR products/ amplicons. During each PCR cycle, the fluorescent signal increases in a logarithmic manner, causing an amplification curve. After completion of the reaction, the result will be determined through analysis of the cycle threshold  (Ct) of each channel. The multiplex format permits the simultaneous detection of four different fluorescent dyes per reaction, with each fluorescent dye representing different targets. HPV 16, HPV 18, 13 other hrHPV types (as a pool), and the human β-globin gene are the four different targets.

This assay separately detects HPV 16, HPV 18, and the pool of 13 other hrHPV genotypes. Moreover, the kit is designed with the human β-globin gene is a housekeeping gene and it is used for monitoring sampling, extraction, specimen addition, amplification, and other related processes as an internal standard to effectively prevent false positive and false negative results, so as to ensure the specificity and accuracy of the test results.

Requirements for Human Papillomavirus (HPV) Genes Detection Using Real-Time PCR

  • Extracted DNA/template from the specimen-The specimen may be either a cervical specimen(scrape) sample or self-collected vaginal brush specimens or self-collected cervicovaginal lavage specimens in respective preservative solutions.
DNA Extraction Kit for Human Papillomavirus (HPV)
Image: DNA Extraction Kit for Human Papillomavirus (HPV)
  • The Human Papillomavirus (HPV) nucleic acid test kit contains-
  • Master Mix
  • Human Papillomavirus (HPV) positive quality control
  • Negative quality control

Extra we need-

  • Lab coat (apron), disposable gloves, and protective goggles.
  • Dedicated pipets (adjustable) for PCR (1–10 µl; 10–100 µl)
  • Dedicated filter-plugged sterile DNAse-free pipette-tips
  • Disposable gloves
  • Benchtop centrifuge
  • Vortex mixer
  • Refrigerators
  • Thermocycler (PCR machine)
  • PCR cabinet
  • PCR tubes with cap (0.1 ml Strip Tubes and Caps)
  • PCR tube holder

Procedure of Human Papillomavirus (HPV) Genes Detection

Human Papillomavirus (HPV) PCR Test
Fig. Human Papillomavirus (HPV) PCR Test Kit

All reagents must be thawed completely before use. After mixing centrifuge them at 6000 rpm for a few seconds before use.

Nucleic acid (DNA) Extraction


The nucleic acid extraction kit will be used for specimen extraction. The extracted nucleic acid /template will be tested immediately, or it shall be stored at -20 °C. No extraction is required for this test kit (Qiagen) for positive and negative controls. Use recommended commercial nucleic acid extraction kit.

Mater Mix Preparation

The volume of master mix per reaction is multiplied by the number of samples, which includes the number of the control and samples prepared. For reasons of unprecise pipetting, always add an extra virtual sample. Mix completely and then spin down briefly with a centrifuge/short spinner.

Number of ReactionTotal Volume per Reaction
QIAscreen Master Mix15 µl
Table: Master mix preparation

Template Addition 

Pipet 15 µl Master mix with micropipette of sterile tips to each of the Real-Time PCR reaction plates /tubes. Separately add a 5 µl template (negative control and nucleic acid extracted from specimen, positive control) to different reaction plates /tubes. Immediately close the plates/tubes to avoid contamination, centrifuge the mixture instantaneously in order to collect the Master Mix in the bottom of the reaction tubes.

Component NameDosage for a patient
Master Mix15 µl
Extracted DNA/Template5 µl
Total Volume20 µl
Table: Template addition

Real-Time PCR Amplification

Put the complete PCR reaction tube into the fluorescent quantitative PCR analyzer (thermocycler-Rotor-Gene Q MDx 5plex HRM (CA) or Rotor-Gene Q bur here used QuantStudio 5 Real-Time PCR), set the positive quality control detection hole,  and set the specimen name.

Total reaction system: 20 µl

The cycle parameter setting is shown in the table.

StageTemperatureDurationCycle NumberFluorescence Collection
Hold (Predegeneration)95°C2 Min1No
Degeneration inside cycle95°C5 Sec1No
Annealing and extension inside the cycle60 °C30 Sec40Yes
Table: A cycle parameter setting


Note-
There is no reference fluorescence for the kit, and select “None” for the quencher; save the file after setting, and run the reaction program.

Fluorescence detection channel selection: FAM, CY5, VIC, and ROX channels are selected for detection: FAM is the HPV 16 gene indicator channel, CY5  is the HPV 18, VIC is the HPV Others indicator channel, and ROX is the internal control β-globin indicator channel.

Target and channel settings

TargetDetection Control
β-globin Orange (ROX)
HPV 16Green (FAM)
HPV 18 Red (CY5)
HPV OtherYellow (VIC)
Table: Target genes and their respective fluorochromes

Result Analysis for Human Papillomavirus (HPV) Genes Detection 

After the reaction is completed, the system saves the results automatically, and the baseline and the threshold of each detection are adjusted according to the image after analysis. Click Analysis for the analysis and make the parameters meet the requirements in quality control and then check the result of each unknown specimen.

Quality Control

Negative quality control: No exponential increase in any channel amplification plot or Ct≥40.

Positive control: The amplification plots of the fours channels, i.e FAM (Ct<30), CY5 (<30), VIC (<32), and β-globin (<29). Note-The above two items must be satisfied in the same test at the same time, or the test is deemed invalid and the detection will be carried out again.

Cut–off (CO ) Value or Reference Interval 

Based on the clinical specimen test results the ROC (receiver operating characteristic) curve method is adopted to determine the cut-off ( CO) value of these kits as follows.

  1. It is FAM positive if the FAM channel amplification plot shows an exponential increase with Ct <36.
  2. It is CY5 positive if the CY5 channel amplification plot an exponential increase with Ct<36.
  3. It is VIC positive if the VIC channel amplification plot an exponential increase with Ct<33.5.

Interpretation of Test Results for Human Papillomavirus (HPV) Genes Detection 

Interpretation of Test Results for Human Papillomavirus (HPV) Genes Detection 
Fig. Interpretation of Test Results for Human Papillomavirus (HPV) Genes Detection 
  1. In each experiment, it’s necessary to test negative quality control and HPV positive quality control, and the results can only be determined when the results meet the quality control requirements.
  2. The criterion for a positive specimen: It can be reported as a positive specimen when the FAM, CY5, VIC, and also β-globin channels are positive.
  3. The criterion for a negative specimen: It can be reported as a negative specimen when the channel β-globin is positive while FAM, CY5, and VIC channels are negative.
  4. When the β-channel is negative, the test results of the specimen are invalid. It may be caused by sampling, extraction, specimen addition, amplification, and other processes. It is recommended to conduct the test after pre-extraction or after re-sampling.

Result Interpretation Table

Ct value HPV target(s)Ct
value
βglobin
Interpretation
HPV 16 and/or HPV 18 <36
and/or HPV Other <33.5
≤30HPV positive
HPV 16 and HPV 18 ≥36 or not
defined and HPV Other ≥33.5 or
not defined
≤30HPV negative
HPV 16 and HPV 18 ≥36 or not
defined and HPV Other ≥33.5 or
not defined
>30Test Invalid
Table: Result Interpretation

Keynotes on Human Papillomavirus (HPV)

  • The storage time shall not exceed three days, and repeated freeze-thaw cycles shall be avoided.
  • The human housekeeping gene (β-globin/RNaseP) is used as the sample control determining both the quality of the sample DNA and the presence of potential inhibitory substances.
  • Reporting format of HPV DNA Detection is as follows-
Patient Name: …Age/Sex: …
Specimen Type: Cervical swabDate of Sample Collection:…
Date of the sample received: …
Reported Date: …
Referred by:…
Table: Patient details

Human Papillomavirus (HPV) DNA PCR and Genotyping

HPV High Carcinogenic Risk GenotypingFinding
HPV Genotype 16Not Detected
HPV Genotype 18Not Detected
Other types HPV (26,31,33,35,39,45,51,52,53,56,58,59,66,68,73 and 82)Not Detected
Table: Result Interpretation
TestResult
HPV DNA DetectionNegative
Table : Test Result

Interpretation

  • A positive result indicates the presence of Human Papillomavirus (HPV).
  • A negative result indicates the viral concentration in the sample is lower than the detection limit of the kit, in this scenario, the infection can not be excluded.
  • Improper collection of specimen handling, transportation, and storage may result in a false negative.
  • The PCR reaction targets the L1 loci of the HPV genome that is highly specific and common in all types of Human Papillomavirus (HPV),
  • The results are only for clinical reference and they should be analyzed in combination with clinical signs and symptoms, medical history, treatment response, and results of other laboratory examinations.
  • These results are based on the real-time PCR amplification by QuantStudio 5 Real-Time PCR system.

Note: The report should be on the organization sheet with signature/s and NMC/NHPC registration number of laboratory personnel who are involved in testing and reporting.

Human Papillomavirus (HPV) -Positive-Genotype-58
Report: Human Papillomavirus (HPV) -Positive-Genotype-58

Further Reading

  • https://www.cdc.gov/std/hpv/stdfact-hpv.htm
  • https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
  • QIAscreen HPV PCR Test Instructions for Use (Handbook)
  • https://www.mayoclinic.org/diseases-conditions/hpv-infection/symptoms-causes/syc-20351596
  • https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet
  • https://www.journals.elsevier.com/papillomavirus-research/recent-articles

139 thoughts on “Human Papillomavirus (HPV) Genes detection using Real-Time PCR: Introduction, Principle, Test Requirements, Procedure, Result Interpretation and Keynotes”

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