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Differential expression of ovine innate immune genes by preterm and neonatal lung epithelia infected with respiratory syncytial virus.

Preterm infants have increased susceptibility to severe manifestations of respiratory syncytial virus (RSV) infection. The cause(s) for this age-dependent vulnerability is/are not well-defined, but alterations in innate immune products have been implicated. In sheep, RSV disease severity has similar age-dependent characteristics and sheep have several related innate molecules for study during pulmonary infection including surfactant protein A (SP-A), surfactant protein D (SP-D), sheep beta defensin 1 (SBD1), monocyte chemotactic protein 1 (MCP1), and Toll-like receptor 4 (TLR4). However, the in vivo cellular gene expression as a response to RSV infection is poorly understood. In this study, the effect of RSV infection on expression of these innate immune genes was determined for bovine RSV-infected (bRSV+ fluorescence) epithelial cells, adjacent cells lacking bRSV antigen (adjoining cells lacking fluorescence), and control cells from non-infected lung using laser capture microdissection (LCM) and real-time RT-PCR. Control lambs had increased expression of innate immune molecules in full term (term) compared to preterm epithelia with statistical significance in SBD1, SP-D, and TLR4 mRNA. Infected cells (bRSV+ fluorescent cells) had consistently higher mRNA levels of SP-A (preterm and term), MCP1 (preterm and term), and SP-D (preterm). Interestingly, bRSV- cells of infected term lambs had significantly reduced SP-D mRNA expression compared to bRSV+ and control epithelia, suggesting that RSV infected cells may regulate the adjacent epithelial SP-D expression. This study defines specific innate immune components (e.g., SBD1, SP-D, and TLR4) that have differential age-dependent expression in the airway epithelia. Furthermore, cellular bRSV infection enhanced certain innate immune components while suppressing adjacent cellular SP-D expression in term animals. These in vivo gene expression results provide a framework for future studies on age-dependent susceptibility to RSV and RSV pathogenesis.

Animals↗

T cell responses to respiratory syncytial virus fusion and attachment proteins in human peripheral blood mononuclear cells.

The cellular immune response to respiratory syncytial virus (RSV) is considered important in both protection and immunopathogenesis. We have studied the HLA class I- and class II-restricted T cell responses to RSV fusion (F) and attachment (G) proteins in peripheral blood mononuclear cells (PBMCs) obtained from healthy young adults. PBMCs were stimulated with autologous cells infected with recombinant modified vaccinia virus Ankara (rMVA) expressing RSV F (rMVA-F) or G (rMVA-G). In rMVA-F-stimulated bulk cultures F-specific CD4(+) and CD8(+) T cell responses were demonstrated, whereas in rMVA-G-stimulated cultures only G-specific CD4(+) T cell responses were detected. Using a set of overlapping peptides spanning the F protein, a number of the F-specific T cell responses could be mapped to different antigenic regions, whereas for the G protein only CD4(+) T cell responses recognizing the central conserved domain could be detected. These results suggest that the RSV glycoprotein-specific T cell response is directed to a number of different epitopes. Further studies must be performed to confirm the apparent inability of the RSV G protein to induce CD8(+) T cell responses. The rMVA-based in vitro stimulation protocol will be useful to define protein-specific T cell responses in different viral systems.

Adult↗

The pathogenesis of respiratory syncytial virus disease in childhood.

Respiratory syncytial virus (RSV) is a leading cause of severe respiratory infection in infants and children. RSV is an RNA virus whose genome encodes 10 proteins. The G protein is responsible for viral attachment to cells whilst the F protein promotes syncytia formation. These proteins are also important in the immune response to RSV. Both the innate and adaptive arms of the cellular immune system are involved in the immunological response to RSV. The cytopathic effects of the virus explain many of the pathological findings in RSV disease. However, there is compelling evidence to suggest that the host cell immune response also has a prominent role in disease pathogenesis. Non-immunological factors may also be important.

Eosinophils↗

Respiratory syncytial virus pneumonia in hospitalized adult patients with leukemia.

Respiratory syncytial virus (RSV) has been demonstrated to be an important cause of life-threatening pneumonia in adult bone marrow transplant recipients; however, its role in other immunocompromised adults has not been defined. We prospectively studied all adult patients with leukemia who were hospitalized at M. D. Anderson Cancer Center (Houston) during a 1-year period (November 1993 through October 1994). During a 19-week period when RSV was prevalent in the community, it was isolated from 9 (10%) of 87 patients with leukemia who developed an acute respiratory illness. In 6 (75%) of 8 patients with profound chemotherapy-induced myelosuppression, the RSV infection was complicated by pneumonia, with an 83% mortality rate. RSV appears to be an important cause of severe and often fatal pneumonia in myelosuppressed patients with leukemia.

Acute Disease↗

Respiratory syncytial virus lung infection in infants: immunoregulatory role of infected alveolar macrophages.

Thirteen previously healthy children with acute onset of severe lower respiratory tract signs and symptoms underwent bronchoscopy and bronchoalveolar lavage (BAL) for diagnostic purposes. BAL samples were assessed for viral, bacterial, mycobacterial, and fungal cultures. Cytospin preparations of BAL cells were assessed for expression of respiratory syncytial virus (RSV), HLA-DR, interleukin-1 beta, and tumor necrosis factor proteins. Purified alveolar macrophages from 2 RSV-infected children were assessed for viral replication. Three children had bacterial pneumonia and 6 were infected with RSV. BAL cells from RSV-infected children demonstrated viral protein expression. Alveolar macrophages were the predominant cell type recovered by BAL and demonstrated coexpression of RSV, HLA-DR, interleukin-1 beta, and tumor necrosis factor proteins. Purified alveolar macrophages from 2 RSV-infected children replicated RSV by infectious center assays. Thus, alveolar macrophages are infected by RSV in vivo and coexpress potent immunomodulatory molecules that potentially regulate the local immune response or lung injury due to this virus.

Bronchoalveolar Lavage Fluid↗

Comparison of antibody concentrations and protective activity of respiratory syncytial virus immune globulin and conventional immune globulin.

Relative to conventional immune globulins (IG, 13 lots), IGs prepared from donors with high activity by microneutralization assay to respiratory syncytial virus (RSVIG, 8 lots) had significantly higher neutralizing antibodies to 6 RSV strains (mean enrichment, 5.2-fold; range, 2.6- to 10.0-fold). In contrast, IgG antibody concentrations to whole RSV, fusion protein, or glycoproteins of A and B strains were similar in RSVIG and IG. Treatment of cotton rats with RSVIG at 0.5 g/kg 24 h before RSV challenge reduced RSV by 99% in the lungs (P < .001). RSVIG at 5.0 g/kg reduced RSV by 99% in the nose. IG at 5.0 g/kg had efficacy similar to that of RSVIG at 0.5 g/kg. Serum plaque-reduction neutralization titers of 1/390 resulted in 99% reduction of lung RSV and titers of 1/3500 resulted in 99% reduction in nose RSV. Relative to IG, RSVIG is enriched selectively in RSV neutralizing antibodies and has approximately 10 times greater protective activity in cotton rats.

Animals↗

Humoral, mucosal, and cellular immune response to topical immunization with a subunit respiratory syncytial virus vaccine.

The efficacy of topical immunization with the respiratory syncytial virus (RSV) fusion (F) protein was tested in mice using cholera toxin B chain (CTB) as an adjuvant. The dose of CTB required for the adjuvant effect (as measured by local and systemic antibody stimulation) and protection from viral challenge was > or = 5 micrograms. With this dose, mice immunized intranasally with CTB plus F protein were highly protected from viral replication in the upper and lower respiratory tract. This protection was associated with the induction of mucosal IgA and serum IgG and neutralizing antibody. Addition of parenteral immunization with F protein to the topical vaccination provided protection from viral challenge nearly equivalent to immunization with live RSV intranasally. Topical and parenteral immunization with F protein was not associated with induction of splenic cytotoxic T cells, in contrast to live virus given intranasally.

Adjuvants, Immunologic↗

Respiratory syncytial virus-specific cell-mediated immune responses after vaccination with a purified fusion protein subunit vaccine.

Vaccination with a respiratory syncytial virus (RSV) fusion protein subunit vaccine (PFP-2) was done to determine if this vaccine induced evidence of cell-mediated immunity to RSV and if cell-mediated immunity prevented RSV reinfection. Healthy children 12-18 months old received 50 micrograms of PFP-2 or a saline control. Lymphocyte transformation (LTF) responses were determined before and 1 and 6 months after vaccination. PFP-2 induced positive LTF responses in 5 (83%) of 6 subjects whose prevaccination samples lacked evidence of cell-mediated immunity. Positive LTF responses in prevaccination samples were not boosted but were more persistent in vaccinees than in controls. Positive LTF responses were not associated with protection against subsequent infection. Immunization with PFP-2 induces correlates of cell-mediated immunity, but this immunity does not appear to be a critical component of protection.

Double-Blind Method↗

National surveillance for respiratory syncytial virus, United States, 1985-1990.

Respiratory syncytial virus (RSV) causes pneumonia and bronchiolitis in infants and young children and serious disease in the elderly and persons with compromised immune systems. To determine the temporal and geographic patterns of RSV outbreaks in the United States, monthly reports from 74 laboratories were analyzed for July 1985 through June 1990. RSV outbreaks were identified in 197 (93%) of the 211 laboratory years analyzed, with widespread activity beginning each fall, peaking in winter, and returning to baseline in April or May. Each year, the timing of outbreaks did not differ significantly between most regions; the few differences were small, and no region consistently had early or late outbreaks. These findings are consistent with RSV transmission within communities rather than between communities or regions. Health care personnel should consider the possibility of RSV infection in their treatment and prevention efforts from November through April each year in the United States.

Aged↗

Protective and disease-enhancing immune responses to respiratory syncytial virus.

The National Institutes of Health, Centers for Disease Control and Prevention, and World Health Organization jointly sponsored a workshop on protective and disease-enhancing immune responses to respiratory syncytial virus (RSV). The primary purpose of the meeting was to discuss protective and disease-enhancing immune responses to RSV in the context of opportunities and barriers to the development of RSV vaccines. Although both live attenuated and subunit vaccines have been developed, it is not yet clear if any of these vaccines will be safe and effective. The fact that neither the disease-enhancing nor the protective immune response to RSV is well understood or well characterized is an important barrier to development of these vaccines. Studies in animal model systems and newly developed immunologic tools, however, provide hope that these barriers can be overcome and a safe and effective RSV vaccine can be developed.

Animals↗

Systemic immunoprophylaxis of nasal respiratory syncytial virus infection in cotton rats.

The cotton rat model was used to test whether systemically administered immunoglobulin could protect nasal tissues against low challenge doses of respiratory syncytial virus (RSV). Animals were pretreated by intraperitoneal injection of human immunoglobulin with moderate (1:2226) or high (1:15,000) neutralizing antibody titers to RSV (day 0), challenged intranasally with RSV Long at doses ranging from 10(1) to 10(5) pfu (day 1), and sacrificed for virus titration (day 5). Pretreatment with moderate-titer immunoglobulin effected complete or near complete nasal protection against low to moderate (10(1)-10(3) pfu) RSV challenge doses and a significant reduction in nasal RSV titers at high (10(4)-10(5) pfu) challenge doses. Pretreatment with high-titer immunoglobulin effected near complete nasal protection at an RSV challenge dose of 10(3) pfu and highly significant and significant reductions in nasal RSV titers at challenge doses of 10(4) and 10(5) pfu, respectively. Immunoprophylaxis effected complete or near complete pulmonary protection at all RSV challenge doses.

Animals↗

Topical immunoprophylaxis of respiratory syncytial virus (RSV)-challenged mice with RSV-specific immune globulin.

The modulatory effects of passive antibody on viral replication, illness, and immunity were investigated in a murine model of respiratory syncytial virus (RSV) infection. Nasally administered RSV-specific immune globulin (RSVIG) given prophylactically in a large volume (100 microL) reduced illness and RSV replication in lung after primary challenge. However, passive antibody treatment diminished the host antibody response to primary RSV infection. This resulted in greater susceptibility to reinfection and an alteration in the composition of the immune response after rechallenge. RSV infection of lung during primary infection was necessary for complete protection of lung from RSV rechallenge. Nasal infection alone during primary infection was not sufficient to protect against RSV rechallenge of lung, suggesting that the immune responses in the murine system are compartmentalized. The influence of compartmentalized immunity and modulation of immune responses will be important considerations as new approaches for topical immunoprophylaxis of RSV are developed.

Administration, Intranasal↗

Interleukin-12 treatment during immunization elicits a T helper cell type 1-like immune response in mice challenged with respiratory syncytial virus and improves vaccine immunogenicity.

Adjuvant effects of exogenous interleukin (IL)-12 on induction of immune responses against respiratory syncytial virus (RSV) infection in mice were evaluated. Giving recombinant IL-12 at the time of immunization with a formalin-inactivated alum-precipitated RSV preparation resulted in significant reduction of virus replication in lungs 4 days after RSV challenge. Intraperitoneal or intramuscular IL-12 was effective when given at the time of immunization but not at the time of challenge. IL-12 treatment resulted in increased interferon-gamma mRNA in lungs, increased IgG2a RSV-specific antibody isotype utilization, and increased endogenous IL-12 p40 mRNA expression. IL-12 treatment did not significantly affect clinical outcome or cytotoxic T lymphocyte activity. These data demonstrate that IL-12 has potent adjuvant effects that may be due to induction of T helper cell type 1-like immune responses.

Adjuvants, Immunologic↗

Live subgroup B respiratory syncytial virus vaccines that are attenuated, genetically stable, and immunogenic in rodents and nonhuman primates.

Optimal immunization of neonates against disease caused by respiratory syncytial virus (RSV) probably will require multiple doses of a vaccine containing viruses of both subgroups A and B. Live subgroup B RSV mutants were generated containing multiple attenuating mutations, ts (temperature-sensitive) and non-ts (host range), that were introduced by prolonged passage in cell culture or by chemical mutagenesis. The cold-passaged (cp)-52 mutant was restricted in replication compared to wild type virus in rodents and nonhuman primates. In addition, the attenuation phenotype of cp-52 was stable after prolonged replication in immunosuppressed rodents. One or two ts mutations were then introduced into the cp-52 mutant to generate additional candidate vaccine strains that were more attenuated in vivo than the cp-52 parental virus. Tests in humans are being done to determine if one or more of the RSV B-1 mutants exhibit a satisfactory balance between attenuation and immunogenicity.

Animals↗

Intranasal monoclonal IgA antibody to respiratory syncytial virus protects rhesus monkeys against upper and lower respiratory tract infection.

Respiratory syncytial virus (RSV), the major cause of lower respiratory tract disease in infants, is thought to infect the upper airways before spreading to the lower respiratory tract. A rhesus monkey model of RSV infection after upper airway inoculation was used to test the protective effect of intranasal treatment with HNK20, a mouse monoclonal IgA antibody against RSV F glycoprotein. HNK20 was administered once daily for 2 days before RSV challenge and 4 days after challenge. Treatment with 0.5 mg/kg HNK20 reduced viral shedding in the nose, throat, and lungs by 3-4 log10/mL (P < or = .002). All monkeys developed RSV neutralizing antibody in serum, even in the absence of detectable viral replication. Neutralizing concentrations of monoclonal antibody remained in nasal secretions for > 1 day after treatment. These results suggest that nose-drop application of monoclonal antibody could provide convenient and effective protection against RSV infection in human infants at risk of severe lower respiratory tract disease.

Administration, Intranasal↗

The pharmacokinetics, antigenicity, and fusion-inhibition activity of RSHZ19, a humanized monoclonal antibody to respiratory syncytial virus, in healthy volunteers.

Single ascending doses of RSHZ19 (also known as SB 209763), a humanized monoclonal antibody (MAb) directed to the fusion protein of respiratory syncytial virus, were administered to healthy men to evaluate the safety, pharmacokinetics, antigenicity, and fusion inhibition (FI) activity of RSHZ19. Doses of RSHZ19 (0.025-10.0 mg/kg) or placebo were infused over 30 min, and subjects were followed for 10 weeks. Plasma concentrations of RSHZ19 and RSHZ19-specific antibodies were determined by ELISAs. FI titers were used to evaluate the ability of plasma to inhibit virus-induced fusion of VERO cells previously infected with RS Long strain virus. Twenty-six subjects, mean age 24, completed the study. RSHZ19 was safe and well tolerated, and no subject developed antibodies to RSHZ19 during follow-up. RSHZ19 had low plasma clearance and a half-life of approximately 23 days, similar to native IgG. Increases in FI titers relative to pretreatment levels were seen 24 h after MAb administration in all 4 subjects given 10 mg/kg and in 2 of 4 given 5 mg/kg.

Adolescent↗

Increase in CD23+ B cells in infants with bronchiolitis is accompanied by appearance of IgE and IgG4 antibodies specific for respiratory syncytial virus.

Infection with respiratory syncytial virus (RSV) may induce asthma-like symptoms and RSV-specific IgE in infected infants as a result of Th2-like response to RSV. The effect of RSV infection on the expression of B cell antigens CD21 and CD23, putative participants in Th2 responses, was investigated. Samples from bronchiolitic infants (n = 19) were tested by three-color immunofluorescence flow cytometry during the acute phase of infection and 4-6 weeks later. In 6 of 10 RSV-positive infants, the percentage of CD23+ B cells was higher than in 9 RSV-negative children and in controls. Both CD21+ and CD21- B cells exhibited a higher percentage of CD23. The group with increased expression of CD23 antigen had RSV-specific IgE and IgG4 antibodies. These findings corroborate the hypothesis that RSV could provoke a Th2-type response, but the relationship between CD23 antigen and RSV infection must be determined.

Antibodies, Viral↗

Inhibition of respiratory syncytial virus by RhoA-derived peptides: implications for the development of improved antiviral agents targeting heparin-binding viruses.

The respiratory syncytial virus (RSV) fusion glycoprotein (F) can interact with the small intracellular GTPase RhoA, and peptides derived from RhoA inhibit RSV replication. These observations initially suggested that RhoA-derived peptides might inhibit RSV replication by disrupting an in vivo interaction between RSV F and RhoA. However, recent data indicate that the antiviral activity of RhoA-derived peptides is not due to competitive inhibition of an hypothesized F-RhoA interaction, but is rather a function of the peptides' intrinsic biophysical properties. We summarize here what is known about the mechanism of RSV inhibition by these peptides and give our opinion regarding the potential implications of this work with regards to RSV biology, and to the development of antiviral agents targeting RSV and other enveloped viruses.

Antiviral Agents↗