Bettie M. Steinberg, PhD speaks with colleagues. Imagine a virus that can trigger a lowly wart, or the growth of a tumor or a respiratory illness that takes your breath away. Meet the papillomavirus, a virus at the heart of a broiling controversy and a predator of the biggest order that is being studied by scientists at The Feinstein Institute for Medical Research. Bettie M. Steinberg, PhD, has spent much of her career staring down this virus, trying to figure out how it can do so many different things to so many people.

Human papillomavirus (HPV) is actually a family of viruses, which explains why some can trigger common skin warts and others will cause cervical cancer. Scientists have developed a vaccine against some members of this family of viruses. It must be given in the pre-sexual years of early adolescence. Once the virus has infected a person, the vaccine is rendered useless, Dr. Steinberg said. Its use can significantly reduce the prevalence of HPV infection, she added.

The goal of the research in Dr. Steinberg's laboratory is to develop better ways to treat HPV. While most people are exposed to the virus by adulthood, it is still not clear why some people's immune system keeps the virus at bay and others suffer the consequences of the virus. "We don't know why some people have a problem and others don't," said Dr. Steinberg, director of the laboratory of papillomavirus research. "We do know that it has to do with the immune system."

The team has identified a number of genetic variants of the immune system that put people at risk. Studies have shown that the virus triggers genital infections, respiratory infections, warts, papillomas (warts on the mucous membrane) and cervical cancer. An estimated one in 1,000 to one in 10,000 people with an HPV infection will develop cervical cancer, and the Feinstein team is trying to understand what puts those women at risk. Between 10 and 20 percent of people have airway HPV infection. The virus can sit dormant in the respiratory tract, or one in every 100,000 people will develop chronic respiratory papillomas that can block breathing and must be surgically removed.

"In some of these people, the immune system is just not able to handle this virus effectively," Dr. Steinberg explained. "It takes high amounts of virus to stimulate an immune response."

A few years ago, the researchers discovered that COX- 2 molecules induced the growth of papillomas, and it was natural that they would use available COX-2 inhibitors to test whether they could keep the virus at bay. Three patients were given a year on the potent anti-inflammatory and a year off. They have all remained free of respiratory papillomas and thus have not required any more surgery.

The work has led to funding for a larger trial of COX-2 inhibitors that is set to begin this fall.