Mohammed El Mzibri

Association between Gene Promoter Methylation and Cervical Cancer Development: Global Distribution and A Meta-analysis

Abstract DNA methylation is the main epigenetic event for gene silencing and is associated with carcinogenesis. In this meta-analysis, we evaluated the association between the methylation of the promoter regions of APC, CADM1, CCNA1, CDH1, DAPK, FHIT, HIC1, MAL, MGMT, hMLH1, P16, PAX1, RAR-β, and RASSF1 genes and the risk of cervical cancer development and progression. Overall, 194 eligible studies were identified assessing the associations of promoter methylation status of aforementioned genes with low- and high-grade squamous intraepithelial lesions (LSIL and HSIL) and cervical cancer development. The majority of studies were conducted on Caucasian and Asian populations, whereas rare studies were available on the African population. Promoter methylation frequencies were shown to be significantly higher in LSIL and HSIL cervical cancer cases as compared to control specimens for CADM1, CCNA1, CDH1, DAPK1, FHIT, MAL, P16, PAX1, RAR-β, and RASSF1 genes. A moderate association was found between HIC promoter methylation, whereas APC, MGMT, and hMLH1 promoter methylation was not correlated with cervical cancer development. Promoter methylation could be considered as a noninvasive biomarker for early cervical lesions, making them highly promising targets for a personalized therapeutic approach.

Evaluating the performance of the Xpert HPV assay in detecting HPV positive cases in Morocco

Recently, the World Health Organization recommended integrating HPV testing into cervical cancer screening programs globally. This study aimed to compare the GeneXpert assay with PCR-sequencing for HPV detection and genotyping to assess the feasibility of incorporating HPV molecular testing into cervical cancer screening. A total of 1000 women aged 30 or 40 from rural and urban areas across four regions in Morocco with high sexually transmitted infection prevalence were recruited. After excluding 21 invalid tests, DNA testing on the remaining 979 samples showed an HPV prevalence of 4.0 % (39/979) by PCR and 5.0 % (49/979) by Xpert, with an overall prevalence of 5.7 % (56/979) when combining both techniques. The concordance rate between the tests was 97.5 %. Notably, the Xpert HPV assay was highly efficient in detecting HPV, with nearly all identified HPVs being high-risk oncogenic types, predominantly HPV16, 18, 31, 35, and 45. The Xpert HPV assay has demonstrated excellent analytical performance, making it a reliable option for HPV detection in vaginal and cervical swabs. Its integration into primary cervical cancer screening programs could significantly enhance the early detection of HPV-positive cases, thereby strengthening the screening framework and potentially reducing both the incidence and mortality of cervical cancer. Future studies should focus on confirming these results and exploring the utility of this method in conjunction with other diagnostic tools such as visual inspection with acetic acid (VIA) for a comprehensive assessment of its effectiveness in real-world settings.

HPV Self-Sampling for Cervical Cancer Screening in Morocco: A Cross-Sectional Study

Morocco is currently planning to introduce HPV testing as the primary screening method in routine cervical cancer screening. Accordingly, HPV self-sampling offers a potential solution to increase participation rates, particularly in underserved regions. Therefore, this study was designed to assess the feasibility and acceptability of HPV self-sampling using the GeneXpert assay as an alternative to clinician-administered screenings in Morocco. A cross-sectional study was conducted among 997 women aged 30 or 40 years from four Moroccan provinces. Participants were offered the choice of clinician-collected sampling, supervised self-sampling, or unsupervised self-sampling. Socioeconomic and clinical data were collected using structured questionnaires, and HPV detection and genotyping were performed using the GeneXpert HPV assay. Overall, 13% of participants opted for self-sampling, including 4.8% who chose unsupervised, and 8.2% supervised self-sampling. Women living in urban areas, younger participants (30 years old), and those with higher education and income levels were more likely to select self-sampling. Satisfaction was high: 92.2% found the procedure easy to perform, all participants reported comfort using the cytobrush, and all indicated willingness to recommend the test to relatives or friends. Additionally, the diagnostic performance of high-risk HPV (hrHPV) testing was comparable between self-collected and clinician-collected samples, demonstrating no effect of sampling method on HPV detection. HPV self-sampling is feasible and highly acceptable among Moroccan women. However, the low uptake, particularly in rural settings, highlights the need for targeted education and awareness efforts. Integrating self-sampling into national screening programs may improve participation and contribute to reducing cervical cancer incidence in Morocco.