الفهرس 
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Abstract
Human papillomaviruses (HPVs) are a large family of small, non-enveloped, double-stranded DNA viruses that are the cause of benign epithelial proliferations or warts. These viruses have two central biological properties; they have a tightly restricted host range and exquisite tissue tropism in which infection and productive virus growth are confined to the squamous epithelia of humans. HPVs are not classified as serotypes but as genotypes on the basis of DNA sequence.
Despite the best efforts of the virus to evade host defenses, at least 80–90 % of both genital and cutaneous lesions resolve with time Immunohistochemical studies show that regression of cutaneous, oral and genital warts in humans is characterised by a massive local infiltration into the lesion of mononuclear cells (CD4+, CD8+, CD56+cells and macrophages) and the expression of Th1 cytokines.
Granulysin is expressed by activated cytotoxic T lymphocytes (CTL), mainly by CD8-positive T lymphocytes and some CD4-positive T lymphocytes; it is also expressed by NK cells and γδT cells constitutively. B cells and granular leukocytes do not express granulysin, but monocytes may express granulysin when activated. There is also a report indicating that granulysin was expressed in a megakaryocyte cell line, but whether it is expressed in platelets remains unclear.
Levels of granulysin gradually increase with aging and are extremely low in umbilical cord blood. These levels reflect the levels of constitutively secreted granulysin and can be correlated either with NK cell activity or the number of NK cells and γδT cells, which constitutively express granulysin. NK activity increases with ageing until the age of 40 and decreases thereafter. The discrepancy between granulysin level and NK activity after the age of 40-50 is not well explained. One possibility is that the ratio of conversion from 15-kDa to 9-kDa changesafter the age of 40.
Based on this information we established this study to evaluate the serum level of granulysin in cutaneous resistant warts patients (Patients who are not responding to previous treatment lines for more than 6 months and stopped treatment for at least two months before the start of the study).
This study evaluated serum level of granulysin among 80 subjects, 50 patients clinically diagnosed with different types of viral warts fulfilling study criteria will be included in the study (group A). 30 apparently healthy subjects included as control group (group B).
As shown from the results there was a statistically significant difference between patients and the control group so accordingly it has been imminent that the serum granulysin level decreased in patients with resistant warts.
Ther was no statistically significant difference either between serum level demographic data nor family history, or history of psychologic stress or previous treatment for cutaneous warts.
On the other hand, The results also show that there was a statistically significant correlation between serum granulysin level and the duration so grnulysin level inversely proportional with the duration.
About the relation between the serum granulysin level and the number of warts it was statistically significant. The number was inversely proportional with the granulysin level.