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Thorax ; 72(7): 620-627, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-27531529

RESUMO

RATIONALE: The pathogenesis of respiratory syncytial virus (RSV) bronchiolitis in infants remains poorly understood. Mouse models implicate pulmonary T cells in the development of RSV disease. T cell responses are initiated by dendritic cells (DCs), which accumulate in lungs of RSV-infected mice. In infants with RSV bronchiolitis, previous reports have shown that DCs are mobilised to the nasal mucosa, but data on lower airway DC responses are lacking. OBJECTIVE: To determine the presence and phenotype of DCs and associated immune cells in bronchoalveolar lavage (BAL) and peripheral blood samples from infants with RSV bronchiolitis. METHODS: Infants intubated and ventilated due to severe RSV bronchiolitis or for planned surgery (controls with healthy lungs) underwent non-bronchoscopic BAL. Immune cells in BAL and blood samples were characterised by flow cytometry and cytokines measured by Human V-Plex Pro-inflammatory Panel 1 MSD kit. MEASUREMENTS AND MAIN RESULTS: In RSV cases, BAL conventional DCs (cDCs), NK T cells, NK cells and pro-inflammatory cytokines accumulated, plasmacytoid DCs (pDCs) and T cells were present, and blood cDCs increased activation marker expression. When stratifying RSV cases by risk group, preterm and older (≥4 months) infants had fewer BAL pDCs than term born and younger (<4 months) infants, respectively. CONCLUSIONS: cDCs accumulate in the lower airways during RSV bronchiolitis, are activated systemically and may, through activation of T cells, NK T cells and NK cells, contribute to RSV-induced inflammation and disease. In addition, the small population of airway pDCs in preterm and older infants may reveal a distinct endotype of RSV bronchiolitis with weak antiviral pDC responses.


Assuntos
Bronquiolite Viral/imunologia , Líquido da Lavagem Broncoalveolar/citologia , Líquido da Lavagem Broncoalveolar/imunologia , Citocinas/análise , Células Dendríticas/imunologia , Infecções por Vírus Respiratório Sincicial/complicações , Fatores Etários , Antígenos CD/sangue , Bronquiolite Viral/sangue , Bronquiolite Viral/virologia , Líquido da Lavagem Broncoalveolar/química , Linfócitos T CD4-Positivos , Antígenos CD40/sangue , Linfócitos T CD8-Positivos , Estudos de Casos e Controles , Contagem de Células , Citocinas/sangue , Feminino , Humanos , Imunoglobulinas/sangue , Lactente , Recém-Nascido , Células Matadoras Naturais , Macrófagos , Masculino , Glicoproteínas de Membrana/sangue , Monócitos , Células T Matadoras Naturais , Fenótipo , Nascimento Prematuro/imunologia , Nascimento a Termo/imunologia , Antígeno CD83
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