Chlamydia coinfection inhibits HPV-induced safeguards of the cellular and genomic integrity in patient-derived ectocervical organoids

Cervical mucosa is continually confronted by coinfections with pathogenic microbes. In addition to human papillomavirus, coinfections with Chlamydia trachomatis have been associated with an increased risk of cervical cancer. However, the dynamics of coinfections, their impact on the epithelia, and their contribution to pathogenesis remain obscure. Using a novel human ectocervical squamous stratified epithelial organoids, we recapitulated the natural infections of the cervix by Chlamydia, HPV, and their coinfections. Towards this, we genetically manipulated the healthy organoids to mimic in vivo HPV persistence by introducing E6E7 oncogenes into the host genome. HPV persistent organoids show enhanced tissue regeneration, increased proliferation and differentiation of stem cells, and nuclear atypia resembling cervical intraepithelial neoplasia grade 1. We found that HPV interferes with normal Chlamydia development. Further, a unique transcriptional host response induced by Chlamydia and HPV leads to distinct reprogramming of host cell processes. Strikingly, in coinfections, Chlamydia impedes HPV-induced mechanisms that maintain cellular and genome integrity, including mismatch repair (MMR). Distinct post-translational proteasomal-degradation and E2F-mediated transcriptional regulation delineate the inverse regulation of MMR during coinfections. Our study employing organoids demonstrates the jeopardy of multiple sequential infection processes and the unique cellular microenvironment they create, accelerating neoplastic progression.