Classification andnomenclature system for Human Alphapapillomavirus variants: general features, nucleotide landmarks andassignment of HPV6 and HPV11 isolates to variant lineages R. D. Burk, Z. Chen, A. Harari, B. C. Smith, B. J. Kocjan, P. J. Maver, M. Poljak K E WOR Y D S human alpha-PV, HPV6, HPV11, HPV variants, classification -Abstract Background: Papillomaviruses constitute a family of viruses that can be classified into genera, species and types based on their viral genome heterogeneity. Currently circulating infectious human Alphapapillomaviruses (alpha-PVs) constitute a set of viral genomes that have evolved from archaic times and display features of host co-speciation. Viral variants are more recently evolved genomes that require a standardized classification and nomenclature. Objectives: To describe a system for the classification and nomenclature of HPV viral variants and provide landmarks for the numbering of nucleotide positions. Methods: The complete 8 kb genomes of the alpha-9 species group and HPV6 and 11 types, collected from isolates throughout the world were obtained from published reports and GenBank. Complete genomes for each HPV type were aligned using the E1 start codon and sequence divergence was calculated by global and pairwise alignments using the MUSCLE program. Phylogenetic trees were constructed from the aligned sequences using a maximum likelihood method (RAxML). Results: Pairwise comparisons of nucleotide differences between complete genomes of each type from alpha-9 HPV isolates (HPV16, 31, 33, 35, 52, 58 and 67) revealed a trimodal distribution. Maximum heterogeneity for variants within a type varied from 0.6%-2.3%. Nucleotide differences of approximately 1.0%-10.0% and 0.5%-1.0% of the complete genomes were used to define variant lineages and sublineages, respectively. Analysis of 43 HPV6 complete genomes indicated the presence of 2 variant lineages, whereas 32 HPV11 isolates were highly similar and clustered into 2 sublineages. A table was constructed of the human alpha-PV landmark nucleotide sequences for future reference and alignments. Conclusions: A proposed nomenclature system for viral variants and coordination of nucleotide positions will facilitate the comparison of variants across geographic regions and amongst different populations. In addition, this system will facilitate study of pathogenic, tissue tropism and functional differences amongst variant lineages of and polymorphisms within HPV variants. Introduction Papillomaviruses are small closed circular double-stranded DNA viruses. They are highly species specific and preferentially infect cutaneous or mucocutaneous epithelium. Papillomavirus genomes have been isolated and characterized from reptiles (1), birds (2), marsupials (3) and multiple other mammalian species (for recent review see (4)) suggesting an evolutionary history spanningmore than 300 million years (1). Papillomaviruses replicate their genomes using the host enzymatic machinery, ensuring a high degree of proof reading with low mutation rates (5). Their evolution has been exclusively asexual, although extremely rare recombination events cannot be excluded. This implies that multiple mutations/variations occurring in papillomavirus genomes are not related to genetic distance as in recombining genomes, i.e., linkage disequilibrium, but to sequential accumulation of genetic changes through genetic drift. We have termed this process of speciation through genetic drift and subsequent natural selection, lineage fixation (6). That is, groups of single nucleotide polymorphisms and/ or insertions/deletions (indels) tend to become fixed within viral lineages. As time goes on, the quantity of these lineage-defining variations grows eventually leading to speciation. A distinct human papillomavirus (HPV) "type" is established when the DNA sequence of the LI open reading frame (ORF) of the cloned viral genome differs from that of any other characterized type by at least 10% (4, 7). Within the PV research community, isolates of the same HPV type are referred to as variants or subtypes when the nucleotide sequences differ by less than 10%. The criterion for HPV types have proven extremely stable and useful for basic researchers, clinicians, epidemiologists and vaccinologists. Nevertheless, the development of a common nomenclature for HPV variants for the multiplicity of HPV types has lagged behind, but is currently being implemented (8). Over 150 HPV types have been fully characterized; approximately 60 of these are predominantly detected in mucosal epithelia and sort to the Alphapapil-lomavirus (alpha-PV) genus (4, 7). Human alpha-PV infections are involved in the development of both benign and malignant disease, e.g., condylomata acuminata, respiratory papillomatosis and cervical cancer, respectively. Genital warts, one of the most frequent sexually transmitted infections (STIs) (9), and respira-tory/laryngeal papillomas are predominantly caused by HPV6 and HPV11 of the alpha-10 species group (7). Cervical cancer is the most common gynecologic malignancy and one of the leading causes of cancer mortality in women worldwide (10). Most oncogenic or high-risk (HR) types associated with invasive cervical cancer (11-13) are clustered in the HPV alpha-9 species group (14) and account for —75% of all cervical cancers worldwide (12, 13). Despite phylogenetic relatedness, HPV variants can differ in pathogenicity. For instance, there is a greater risk of cervical cancer for non-European HPV16 variants compared to European variants (15-17). The establishment of a coherent classification and nomenclature system for HPV variant lineages will facilitate comparison amongst studies that directly determine HPV sequences, as is becoming more common with application of next-generation sequencing methods (18). Moreover, specific variants occur on lineages that are stable and have correlated changes and diagnostic polymorphisms throughout the genome (6, 19). Without a system for naming variant lineages, investigators have had to rely on referring to specific changes at nucleotide positions. This is further complicated by the difficulty in the lack of a system for namingnucleotide positions in each genome. In this report, we review the evidence for the characterization of variant lineages and sublineages using the largest dataset of complete viral genomes from the medically relevant alpha-9 species group that includes: HPV16, 31, 33, 35, 52, 58 and 67. We extend this nomenclature system to HPV6 and HPV11 that are the main cause of genital warts and laryngeal papillomas. In addition, we present a table of nucleotide landmarks for the human alpha-PV types to facilitate the future description of variants and genotype-phe-notype associations. Materials and Methods HPV Genome sequences The DNA sequences for the alpha-9 HPV types were used as reported in previous studies (8, 20). This set of alpha-9 genomes includes 62 complete genomes (CGs) for HPV16, 23 CGs for HPV31, 21 CGs for HPV33, 24 CGs for HPV35, 23 CGs for HPV52, 37 CGs for HPV58 and 8 CGs for HPV67. There were 43 CG sequences for HPV6 and 32 CGs for HPV11. These genomes are accessible through GenBank with the listed names in Figures 2 and 3. Evolutionary analyses andphykgenetic tree construction The nucleotide sequences of the complete circular genomes were linearized at the first ATG of the El open reading frame (ORF) (see Table 1) and globally aligned using the program MUSCLE (21). The p-dis-tance method in MEGA5 (22) was used to calculate pairwise differences comparing each isolate to all oth- Table 1. Nucleotide landmarks of human Alphapapillomavirus type genomes. Species Group Type GenBank # Genome Size Position of 1st E6 ATG E6 1st 8bp 1st 8bp of Genome Sequence Position of 1st E1 ATG E1 1st 8bp alpha-1 HPV32* X74475 7961 102 ATGGCAAG TAATCTTT 850 ATGGCGGA alpha-1 HPV42* M73236 7917 114 ATGTCAGG CTTATTAT 829 ATGGCGGA alpha-2 HPV3* X74462 7820 102 ATGGCAGT TCTAACTA 806 ATGGATGA alpha-2 HPV10* X74465 7919 102 ATGTCCAT TTATAAAC 791 ATGGACGA alpha-2 HPV28* U31783 7959 102 ATGGATGA TAAATAAT 788 ATGGATGA alpha-2 HPV29* U31784 7916 102 ATGTCCAG TATAAACT 803 ATGGCCGA alpha-2 HPV77* Y15175 7887 102 ATGTCTAC TATAAACT 803 ATGGCTGA alpha-2 HPV94* AJ620211 7881 93 ATGTCTAT TAATGTAG 785 ATGGACGA alpha-2 HPV117* GQ246950 7895 103 ATGTCTAT TTATAAAC 795 ATGGACGA alpha-2 HPV125A# FN547152 7809 1 ATGTCTAT ATGTCTAT 693 ATGGCTGA alpha-3 HPV61* U31793 7989 102 ATGGGACC TAACAATC 811 ATGGCTGA alpha-3 HPV62A* AY395706 8092 1 ATGACTGC ATGACTGC 719 ATGGCCGA alpha-3 HPV72* X94164 7988 102 ATGCCTAT ATTACTAA 832 ATGGCCAA alpha-3 HPV81* AJ620209 8070 102 ATGGTCAG CTTCCTTT 844 ATGGCTGA alpha-3 HPV83A* AF151983 8104 1 ATGTCAGG ATGTCAGG 718 ATGGCGGA alpha-3 HPV84A* AF293960 7948 1 ATGCCCAA ATGCCCAA 715 ATGGCAGA alpha-3 HPV86A* AF349909 7983 1 ATGCCCAG ATGCCCAG 709 ATGGCAGA alpha-3 HPV87* AJ400628 7998 87 ATGTGCAA CAACAATC 890 ATGGTACA alpha-3 HPV89A* AF436128 8078 1 ATGCCCGG ATGCCCGG 721 ATGGCAGA alpha-3 HPV102A* DQ080083 8078 1 ATGTCAAG ATGTCAAG 715 ATGGCACA alpha-3 HPV114* GQ244463 8069 213 ATGCCCAC TGGCTGCG 998 ATGGTACA alpha-4 HPV2* X55964 7860 89 ATGCACAC ATAATGTA 812 ATGGAGGA alpha-4 HPV27* X74473 7823 99 ATGCGCAC TATGTGGT 822 ATGGAGGA alpha-4 HPV57* X55965 7861 105 ATGTCTGA TAATATAT 810 ATGGAGGA alpha-5 HPV26* X74472 7855 97 ATGTTCGA TAACAATT 878 ATGGACTG alpha-5 HPV51* M62877 7808 97 ATGTTCGA AACAATTA 874 ATGGACTG alpha-5 HPV69* AB027020 7700 102 ATGTTTCA CTTTTAAC 886 ATGGACTG alpha-5 HPV82* AB027021 7871 102 ATGTTTGA ATACTTTA 876 ATGGACAG alpha-6 HPV30* X74474 7852 102 ATGGCTTT TGAAAGTT 890 ATGGCGTC alpha-6 HPV53* X74482 7856 102 ATGGATCG GAAAGTAA 892 ATGGCGTC alpha-6 HPV56* X74483 7845 102 ATGGAGCC GAAAGTTT 895 ATGGCGTC alpha-6 HPV66* U31794 7824 102 ATGGATTC GAAAGTTT 895 ATGGCATC alpha-7 HPV18* X05015 7857 105 ATGGCGCG ATTAATAC 914 ATGGCTGA alpha-7 HPV39* M62849 7833 107 ATGGCGCG CTTATAAC 928 ATGGCCAA alpha-7 HPV45* X74479 7858 102 ATGGCGCG AATACTTT 914 ATGGCGGA alpha-7 HPV59* X77858 7896 55 ATGGCACG GTTAAGAC 872 ATGGCCGA alpha-7 HPV68A* DQ080079 7822 1 ATGGCGCT ATGGCGCT 823 ATGGCCAA alpha-7 HPV70* U21941 7905 107 ATGGCGCG CTTATAAC 928 ATGGCCAA alpha-7 HPV85* AF131950 7812 105 ATGGCTGA CTTATACT 920 ATGGCCGA alpha-7 HPV97A* DQ080080 7843 1 ATGGCGCG ATGGCGCG 813 ATGGAAGA alpha-8 HPV7* X74463 8027 102 ATGTCTGC TGTTTAAT 868 ATGGCAGA alpha-8 HPV40* X74478 7909 102 ATGTCTGC TTAATAAC 868 ATGGCAGA alpha-8 HPV43* AJ620205 7975 102 ATGACTGC CTAACAAT 835 ATGGCTGA alpha-8 HPV91A* AF419318 7966 1 ATGAGTAA ATGAGTAA 908 ATGGCTGA alpha-9 HPV16* K02718 7904 83 ATGCACCA ACTACAAT 865 ATGGCTGA alpha-9 HPV16R 7906 83 ATGCACCA ACTACAAT 865 ATGGCTGA alpha-9 HPV31* J04353 7912 108 ATGTTCAA TAATAATA 862 ATGGCTGA alpha-9 HPV33* M12732 7909 109 ATGTTTCA GTAAACTA 879 ATGGCCGA alpha-9 HPV35* M74117 7851 110 ATGTTTCA CCCTATAA 868 ATGGCTGA alpha-9 HPV52* X74481 7942 102 ATGTTTGA TAAATTAT 864 ATGGAGGA alpha-9 HPV58* D90400 7824 110 ATGTTCCA CTAAACTA 883 ATGGATGA alpha-9 HPV67* D21208 7801 102 ATGTTTCA TTATAATC 875 ATGGAGGA alpha-10 HPV6* X00203 7902 102 ATGGAAAG GTTAATAA 832 ATGGCGGA alpha-10 HPV11* M14119 7931 102 ATGGAAAG CTTAATAA 832 ATGGCGGA alpha-10 HPV13* X62843 7880 104 ATGGAAAG GTTTCTAA 843 ATGGCAGA alpha-10 HPV44* U31788 7833 105 ATGGAAAG TTAATAAT 832 ATGGCTGA alpha-10 HPV74A* AF436130 7887 1 ATGGAAAG ATGGAAAG 721 ATGGCGGA alpha-11 HPV34* X74476 7723 102 ATGTTTTT ACTATAAT 851 ATGGCTGA alpha-11 HPV73* X94165 7700 102 ATGCTGTT ACTATAAT 850 ATGGCTGA alpha-13 HPV54* U37488 7759 12§ ATGATTTA TAACTACA 828 ATGGCGGA alpha-14 HPV71* AB040456 8017 102 ATGCTTGG TTGTTCTA 838 ATGGCCGA alpha-14 HPV90A* AY057438 8033 1 ATGACCAA ATGACCAA 725 ATGGCCGA alpha-14 HPV106A* DQ080082 8035 1 ATGGGTAC ATGGGTAC 761 ATGGCCGA A Corresponds to reference sequence with "A" ofthe first E6 ATG as position 1 *Nucleotide positions based on genome reference sequence from PaVE (http://pave.niaid.nih.gov) # Nucleotide positions based on genome sequence available from GenBank (http://www.ncbi.nim.nih.gov) § Denotes disagreement between reference genome positions in PaVE and GenBank, PaVE positions are shown 31HPV16R is a revised "virtual" sequence as discussed on page ill-117, 1997 HPV Compendium (http://pave.niaid.nih.gOv/iani-archives/compendium/97PDF/3/ Meissner.pdf) er variants of the same type based on the global alignment. The assignment of position numbers for each nucleotide is based on the nucleotide numbering of the prototype reference sequence as shown in Table 1. Maximum likelihood trees for HPV6 and HPV11 aligned genomes were constructed using RAxML MPI v7.2.8 (23). The GTR + gamma model was set for among-site rate variation and allowed substitution rates of aligned sequences to be different. Human apha-PV nucleotide landmarks The complete genome sequences of 62 reference or prototype human Alphapapillomavirus types were obtained from GenBank or the PaVE website. The circular viral genomes were linearized and aligned based on the 1st ATG site of the El ORF using the global alignment software MUSCLE (21). The position of the 1st nucleotide of the El ORF start codon, ATG, is given for the prototype reference sequence for each type grouped by species (see Table 1, "Position of 1st El ATG"). The genomic position of the 1st nucleotide of the E6 ORF ATG for each of the 62 human alpha-PV types is displayed in Table 1 and the first 8 nucleotides 3' to this site are listed in the neighboring column, "E6 1st 8 bp". Also listed are the first 8 bp of the reference/prototype genomes from the published reports. Results HPVvariantlineage classification andnomenclature To establish an unbiased distribution of the related-ness of variant genomes within a given type, we have used the dataset for HPV isolates (HPV16, HPV31, HPV33, HPV35, HPV52, HPV58 and HPV67) from the alpha-9 species group as an example (8, 20). The distribution of percent differences between variants revealed a trimodal pattern (Figure 1A). This tri-modal distribution of pairwise comparisons indicates that some variants are more closely related to one another than others, thus supporting a grouping of lineages for each type. Previous examination of phy-logenies for each of the alpha-9 types combined with an approximate cut-off of 1.0% difference between genomes was used to define major variant lineages (6, 8). Each major lineage was named using an alphanumeric, with the "A" clade always containing the reference genome for each type. Support for this distinction between variants was examined by viewing the distribution of pairwise comparisons within each variant lineage (i.e., intra-lineage) or between variant lineages for each of the seven HPV types (i.e., inter-lineage), again this analysis only compares isolate genomes within a specific type and summarizes the data for all the individual types (Figure IB). Although there is a bimodal distribution seen within the inter-lineage comparisons driven by the deeper nodes separating HPV16 (European vs. non-European lineages) (20) and HPV52 (A,B,C vs. D lineages) variants (8), we have not made a distinction at this level of variant divergence. The overlap between the inter- and intra-lineage distributions (0.7%-0.9%) indicates a fixed value cannot be used to distinguish variant lineages. We conservatively suggest a 1.0% divergence, with the caveat that no classification system can exactly categorize the process of evolution. Two distributions were discernable between and within the genome comparisons of sublineages for each HPV type (Figure 1C). Differences between genomes in the 0.5%-l% range were designated as sublineages (e.g., Al, A2, etc.). We have used these criteria to classify HPV6 and HPV11 based on the available genomes (24, 25). Nomenclature of HPV6 variant Solates Forty-three HPV6 complete genome sequences were available for analyses. These genomes were characterized from seven isolates from laryngeal papillomas (LP5, LP26, LP130, LP98(131), LP137, LP96(175) and LP11) and 11 isolates from condyloma acuminatum lesions (CAC377, CAC26, CAC251c, CAC306, CAC11, CAC23z, CAC231, CAC96, CAC331, CAC301 and CAC56) obtained from a study of Kocjan et al. (GenBank Accession Numbers: FR751320 - FR751338) (24), and from three previously characterized HPV6 isolates, including prototype HPV6b (X00203), HPV-6vc (AF092932), and HPV6a (L42216). The rest of the HPV6 isolates were obtained from the ongoing research of the HPV6 genomic diversity in Slovenia. As shown in Figure 2, the topology of the tree constructed with HPV6 variants revealed two distinct lineages, termed A and B. The isolates sorting to the A lineage were highly related, although two clades were present differing by ~ 0.2% (Figure 2, right panel). Lineage B was more variable and was further divided into three sublineages Bl, B2 and B3, with inter-sublineage differences of 0.4% - 0.7%. These three sublineages were equally distant from the A lineage, with a difference of approximately 1.5% of nucleotide sequences (Figure 2, right panel). Nomenclature of HPV11 variant isobtes Complete genome sequences were available for 32 HPV11 isolates representing a heterogeneous set of 10 isolates from Slovenian patients with exophytic genital lesions, laryngeal papillomatosis and cervical samples (CS20, A86, A346, CAC86, LP12, CAC246, A48, LP13, A47 and A260) obtained from a study of Maver et al. (GenBank Acc. Nos: FN870021, FN870022 and FN907957 - FN907964) (25). In addition, genomes of six Hungarian HPV11 isolates from recurrent respiratory papillomatosis (HUNG1, RRP1 to RRP5; GenBank Acc. Nos: FR872717 and HE574701 -HE574705), as well as two previously deposited genomes (prototype HPV11 (M14119) and LZod45-ll from a cervical swab (EU918768) were also avail- able in sequence repositories (26, 27). The rest of the HPV11 isolates were from the ongoing research of the HPV11 genomic diversity in Slovenia. (Figure 3). Nevertheless, all variants were highly conserved; the maximum pairwise difference was approximately 0.4% (Figure 3). Based on the nucleotide difference of the aligned complete genomes and the topology of the phylogenetic tree, we have designated two clades as sublineages Al and A2. Figure 1. Distribution of pairwise differences between nucleotide sequences of alpha-9 type genomes. The genome nucleotide sequences of types 16, 31, 33, 35, 52, 58 and 67, previously reported (8, 20), were globally aligned using the program MUSCLE (21). The p-distance method in MEGA5 (22) was used to calculate the percent differences for each isolate compared to all other isolates of the same type based on a global alignment. The Y-axis represents the number of comparisons. The X-axis shows the percent nucleotide pairwise differences. (A) Comparison of each isolate to all other isolates of the same type, resulting in a total of 3577 assessments; (B) Inter- and intra-lineage pairwise differences. Inter-lineage: comparisons of isolates within different lineages of the same type (2213 comparisons). Intra-lineage: comparisons of isolates within the same lineage (1362 comparisons); (C) Inter-and intra-sublineage pairwise differences. Inter-sublineage: comparisons of isolates within different sublineages of the same lineage (578 comparisons). Intra-sublineage: comparisons of isolates within the same sublineage (784 comparisons). Phykgenetic tree of apha-10 pecies group HPV types and variant Images To view the relationship between the HPV members of the alpha-10 species group, a ML phylogenetic tree was constructed using representative complete genomes (Figure 4). HPV6 and HPV11 genomes form a clade and the topology indicates they shared a most recent common ancestor (MRCA). Discussion This is the first report describing a nomenclature for HPV6 and HPV11 variants based on complete genome analyses. HPV6 could be classified into two lineages, with the B lineage consisting of 3 sublineages (see Figure 2). HPV11 isolates were not highly variable and were classified into two sublineages (see Figure 3). The classification of variant genomes is based on a set of complete genomes, whereas the classification ofHPV types is based on the LI nucleotide sequences (4, 7). The use of full genome sequences for variant Figure 2. HPV6 variant tree topology and pairwise comparisons of individual complete genomes. A maximum likelihood (ML) tree was inferred from a global alignment of 43 complete genome nucleotide sequences of HPV6 using RAxML HPC v7.2.8 (23). Distinct variant lineages (i.e., termed A and B) and sublineages (i.e., termed B1, B2 and B3) are classified according to the topology and nucleotide sequence differences from > 1% to < 10%, and > 0.5% to < 1% ranges (4, 8). The percent nucleotide sequence differences were calculated for each isolate compared to all other isolates of the same type based on the complete genome nucleotide sequences and are shown in the panel to the right of the phylogeny. Values for each comparison of a given isolate are connected by lines and the comparison to self is indicated by the 0% difference point. classification is derived from the fact that isolates of the same type are closely related and the full extent of the sequence heterogeneity is best summed across the whole genome; recently evolved variant genomes have changes that are not always evenly distributed throughout the genome. Nevertheless, to define distinct variant lineages, we used a nucleotide sequence difference of approximately 1.0% between two or more variants of the same type. This value was derived from empiric data on the distribution of differences between genomes of the same type from the alpha-9 species group (see Figure 1). Similarly, differences across the genome of 0.5%-1.0% were used to identify sublineages. Each variant lineage was classified and named with an alphanumeric value. The prototype or reference sequence (i.e., the cloned genome designated as the original type) is always designated variant lineage A and/or sublineage A1 (8, 28). There- fore, after the classification of variants is established based on full genome sequences, it is then possible to characterize and name isolates by the use of lineage-specific diagnostic single nucleotide polymorphisms (SNPs) or lineage-specific indels found in short sequence reads. To facilitate the consistent numbering of nucleotide positions, we constructed a table with the key landmark nucleotide positions that can be used as a reference to name specific nucleotide variations within human alpha-PV genomes. Nucleotide positions are based on the reference sequence for each type. At some point in the past, agreement arose within the PV community that the "A" of the first ATG in the E6 ORF should be designated position "1". However, as shown in the Table 1, few of the human alpha-PVs used this criterion in naming position "1". For instance, the sequence of HPV16 defines position "1" based on an Figure 3. HPV11 variant tree topologies and pairwise comparisons of individual complete genomes. A ML phylogenetic tree was constructed from 32 HPV11 aligned complete genomes as described in Figure 2. Distinct sublineages (i.e., termed A1 and A2) were inferred from the tree topology and nucleotide sequence differences in the range of ~ 0.5%. The percent nucleotide sequence differences were calculated for each HPV11 isolate compared to all other HPV11 isolates based on the complete genome nucleotide sequences and are shown in the panel to the right of the phylogeny. Values for each comparison of a given isolate are connected by lines and the comparison to self is indicated by the 0% difference point. Figure 4. Alpha-10 phylgenetic tree showing representative types and variant lineages/ sublineages. A maximum likelihood tree was constructed using RAxML HPC v7.2.8 (23) inferred from the global alignment of complete genome nucleotide sequences linearized at the first ATG of the E1 ORF. Representative alpha-8 HPVtypes, HPV7 (NCBI accession number NC_001595), HPV40 (NC_001589), HPV43 (NC_005349) and HPV91 (NC_004085), were set as the outgroup and are shown by grey dashed lines. The shaded areas represent groupings of lineages and sublineages of HPV6 and HPV11. The length of dashed and solid lines represent distance between clades, although the number of changes is different for these two lines; the scale is indicated in the upper left corner of the figure. The GenBank accession numbers of alpha-10 HPV types are listed in the brackets following each variant: HPV6|A (X00203), HPV6|B1 (FR751337), HPV6|B2 (FR751328), HPV6|B3 (L41216), HPV11|A1 (M14119), HPV11|A2 (FN907962), HPV13|A (X62843), HPV13|B (DQ344807), HPV44 (U31788), HPV44s (U31791), HPV74 (AF436130). 1-----1 0.050 changes per site 1-1 0.007 changes per site HPV44S HPV6|B2 HPV6|B1 \ HPV44 \ „ HPV61 B3 _ y / \ \ / s \ / / HPV6|A \ / / / / ✓ / / / ✓ HPV11|A1^PV11|A2 _l t 1 i ] ________HPV74 ✓ / ✓ -< \ \ \ \ \ \ \ \ \ \ V^- HPV131A HPV7/40/43/91 \ HPV13|B alignment with the first 60 bp of HPVla, HPV6b and BPV1 (29). Moreover, there were sequencing errors in some reference clones that have been corrected over time. For convenience, we list both the first 8 nucleotides of the reference genome and the potential E6 start codon. These 8 bp sequences can be used to search the genome to locate landmarks of interest. We recommend use of the El ORF ATG as a reasonably conserved site, at least, in the human alpha-PVs for multiple sequence alignments. Thus, we provide the location of the El ATG established from the reference sequence numbering and the 8 bp subsequent to the El ATG for quick identification by searching. Variants of HPV6 form at least two deeply separated clades suggesting codivergence of host and virus as different lineages diversified from their most recent common ancestors (MRCAs). HPV11 variants are highly conserved and did not meet criterion for classification into more than one lineage. This re- duced diversification probably represents a more recent divergence of HPV11 from the HPV6/11 MRCA (Figure 4). Alternatively, divergent isolates ofHPVll might exist in a remote and/or unsampled population or could have disappeared by genetic isolation and/or host demise. Another possibility is that a reduced viral population may have limited the capacity for diversification over time. In addition, previous work analyzing 62 isolates from around the world neither found a geographical association between HPV6 or HPV11 variants, nor an association with disease type (30). A common nomenclature will allow HPV researchers to discuss the properties of HPV variant lineages without having to describe sets of nucleotide changes to define a group ofHPV variants. This will be particularly useful for future studies of the alpha-10 species group of HPVs that exhibit a broad tissue tropism and have the ability to infect and cause exophytic lesions of the anogenital area, the larynx/ respiratory tract and the cervix. If we include HPV13 that causes oral focal hyperplasia, the tissue tropism of the alpha-10 species group expands to include benign infections of the oral cavity (31). To facilitate better characterization of HPV6 and HPV11 variants, different regions of the viral genome can be sequenced and the changes related back to specific lineages using the data provided in Figure 1 of Kocjan et al. (24), as they list the isolate name that corresponds to the genome sequences shown in Figure 2. To maintain a consistent nomenclature for all HPV types, we propose calling the lineage containing the original reference sequence HPV6b (32) as the "A" lineage. The other HPV6 genomes termed HPV6vc (33) and HPV6a (34) sort to sublineages "Bl" and "B3", respectively. In summary, we present a nomenclature for variants of HPV6 and HPV11. We provide a taxonomy and nomenclature of these variants that should be useful References - for detailed studies addressing the genetic basis of the pathogenesis of these protean HPVs that commonly cause genital warts, and/or laryngeal papillomas. 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Human papillomavirus type 6: classification of clinical isolates and functional analysis ofE2 proteins. J Gen Virol 1999; 80 (Pt 9): 2445-51. 34. Hofmann KJ, Cook JC, Joyce JG, Brown DR, Schultz LD, George HA, Rosolowsky M, Fife KH, Jansen KU. Sequence determination of human papillomavirus type 6a and assembly of virus-like particles in Saccharomyces cerevisiae. Virology 1995; 209:506-18. authors' Prof. Robert D. Burk, MD, Departments Pediatrics, Microbiology and addresses Immunology, Epidemiology and Population Health, and Obstetrics, Gynecology and Woman's Health, Albert Einstein College of Medicine, 1300MorrisParkAve., Bronx, New York, 10461, UnitedStatesof America. Correspondingauthor. E-mail: robert.burk@einstein.yu.edu Zigui Chen, PhD, Department of Pediatrics, Albert Einstein College of Medicine, same address. E-mail: zigui.chen@einstein.yu.edu Ariana Harari, BA, Department of Microbiology and Immunology, Albert Einstein College ofMedicine, same address. E-mail: ariana.harari@phd. einstien.yu.edu Benjamin C. Smith, PhD, Department of Pediatrics, Albert Einstein College ofMedicine, same address. E-mail: benjamin.smith@einstein.yu.edu Boštjan J. Kocjan, PhD, University of Ljubljana, Institute of Microbiology andlmmunology, FacultyofMedicine, Zaloska4, 1105Ljubljana, Slovenia. E-mail: bostjan.kocjan@mf.uni-lj.si Polona J. Maver, MD, University of Ljubljana, Institute of Microbiology and Immunology, Faculty ofMedicine, same address. E-mail: polona.maver@ mf.uni-lj.si Prof. Mario Poljak, MD, PhD, University of Ljubljana, Institute of Microbiologyandlmmunology, FacultyofMedicine, same address. E-mail: mario.poljak@mf.uni-lj.si