Recent observations regarding the pathogenesis of recurrent respiratory syncytial virus infections: implications for vaccine development

The continuing need for therapeutic agents for respiratory syncytial virus infection

Respiratory syncytial virus infections recur throughout life despite induction of immunity by the first natural infection. An effective vaccine has long been sought but no vaccine is currently licensed, although promising candidates are currently being developed based on greater knowledge of the virus properties. However, there are significant populations that may not be protected adequately by a vaccine or are unable to be vaccinated. Thus, there is a continued need for effective therapeutic agents to treat the infection, especially in higher-risk individuals, a perspective presented in this article.

Respiratory syncytial virus suppression of the antiviral immune response: Implications for evaluation of candidate vaccines

Respiratory syncytial virus infections recur throughout life despite induction of immunity by the first natural infection. Results of an extensive series of studies indicate that the virus adversely affects the human antiviral recall response to challenge, although subsequent infections are less severe than the initial illness. The observations suggest that candidate vaccines for respiratory syncytial virus should not be expected to prevent clinical illness upon subsequent exposure. Candidate vaccines may be considered effective if they render a subsequent natural infection less severe. This is what would be expected from an initial and commonly more severe natural infection and sensitization.

Reduced activation and proliferation of human lymphocytes exposed to respiratory syncytial virus compared to cells exposed to influenza virus

Both respiratory syncytial virus (RSV) and influenza A virus (IAV) may infect human peripheral blood mononuclear leukocytes (PBMC) during the immune response to viral challenge as the cells are recruited to the respiratory tract. The current studies demonstrated differences in PBMC responses to the two viruses very early after exposure, including reduced fos protein and CD69 expression and IL-2 production by RSV-exposed T lymphocytes. Exposure to RSV resulted in reduced lymphocyte proliferation despite evidence of a virus-specific T lymphocyte frequency equivalent to that for influenza virus. Reduced RSV-induced proliferation was not due to apoptosis, which was itself reduced relative to that of influenza virus-exposed T lymphocytes. The data indicate that differential immune responses to RSV and influenza virus are determined early after exposure of human PBMC and support the concept that the anamnestic immune response that might prevent clinically evident reinfection is attenuated very soon after exposure to RSV. Thus, candidate RSV vaccines should be expected to reduce but not prevent clinical illness upon subsequent infection by RSV. Furthermore, effective therapeutic agents for RSV are likely to be needed, especially for high-risk populations, even after vaccine development.

Immunoregulatory role of secreted glycoprotein G from respiratory syncytial virus

The secretory glycoprotein (Gs) of respiratory syncytial virus (RSV) was enriched and investigated for its effects on T cells specific for RSV and unrelated antigens. Gs exhibited a dose dependent suppression of lymphoproliferative responses in peripheral blood mononuclear cells (PBMCs), specific for mycobacterial lysates or tetanus toxoid. However, Gs did not inhibit live RSV specific T cell responses. These results suggest that Gs may suppress immune response to unrelated antigens, but should not interfere with the overall development of RSV specific immunity.

Reduced interferon-gamma expression in peripheral blood mononuclear cells of infants with severe respiratory syncytial virus disease

We examined the in vivo cell-mediated immune response in infants with respiratory syncytial virus (RSV) infection in order to gain information about the pathogenesis of severe RSV disease in infancy. Semiquantitative reverse transcription-polymerase chain reaction and three-color flow cytometry were used to determine the levels of messenger RNA (mRNA) for interferon (IFN)-gamma in peripheral blood mononuclear cells, and the distribution of lymphocyte subsets in infants with acute RSV infection. The findings were correlated with the severity of the patients' illness and the production of RSV-specific IgE antibodies (RSV-IgE). Significantly lower IFN-gamma levels and T-lymphocyte counts in the acute phase of illness were observed in infants with severe RSV disease than in those with a milder clinical course of illness. The induction of RSV-IgE was not related to IFN-gamma levels in the acute phase of illness, but rather correlated with IFN-gamma expression during convalescence. The data indicate that reduced IFN-gamma expression may be an important factor in the pathogenesis of severe RSV disease in infancy.

The effects of bovine respiratory syncytial on normal ovine lymphocyte responses to mitogens or antigens in vitro

In the present study peripheral blod mononuclear cells (MNC) obtained from normal uninfected lambs were used to study the possible effects of bovine respiratory syncytial virus (BRSV) on lymphocyte responses to the mitogens, phytohaemagglutinin (PHA), concanavalin A (Con A) and pokeweed mitogen (PWM) in vitro. Live BRSV had a depressive effect on the proliferative responses of normal MNC to PHA, Con A and PWM. Inactivated BRSV and a commercial preparation of prostaglandin E2 were also found to depress the proliferative responses of normal ovine MNC to PHA but recombinant tumour necrosis factor-alpha (TNF-alpha) had no such effect. Serum samples obtained from BRSV-infected lambs contained substances inhibitory to PHA-driven lymphocyte blastogenesis. Memory blastogenic responses to border disease virus (BDV) of lymyphocytes obtained from lambs previously primed with BDV were significantly reduced when lymphocytes were exposed to infectious BRSV.

Vaccination with glutaraldehyde-fixed bovine respiratory syncytial virus (BRSV)-infected cells stimulates a better immune response in lambs than vaccination with heat-inactivated cell-free BRSV

The lamb model was used to investigate the possible protective effects of vaccination with inactivated viral antigens against experimental infection with bovine respiratory syncytial virus. Two groups of eight lambs were vaccinated with either glutaraldehyde-inactivated cell-associated virus or heat-inactivated cell-free virus and subsequently challenged with live virus, along with a group of naive lambs. The virus was shed for significantly longer periods, and the virus titres in nasal secretions were significantly higher in the group of naive lambs than in the two groups of vaccinated lambs. The period of virus-shedding in nasal secretions and virus titres was significantly lower (p < 0.01) in the group of lambs immunized with the cell-associated preparation. The same antigen stimulated better cellular immune responses as measured by virus-specific cytotoxicity or by virus-specific lymphocyte proliferation. However, priming with inactivated vaccines had no significant effect on lymphocyte responses to phytohaemagglutinin, which was found to be significantly reduced (p < 0.01) following challenge with live virus.

Antigens of bovine respiratory syncytial virus in peripheral blood lymphocytes of experimentally infected lambs

Eight lambs were experimentally infected with bovine respiratory syncytial virus (RSV) and the distribution of viral antigen in lymphocyte subpopulations studied by flow cytometry. Experimental infection with bovine RSV was characterised by significant changes in lymphocyte subpopulations. Infection was followed by a significant (P <0.001) reduction in the number of cells expressing the OvCD5 epitope (T cells), due to a fall in the number of cells expressing the OvCD4 epitope (helper) and those expressing the OvWC1 epitope (gamma/delta) 3-7 days post-inoculation. There was a significant increase in the number of OvCD5+ cells expressing the OvCD8 epitope (cytotoxic/suppressor) later. Flow cytometric analysis with bovine RSV-specific monoclonal antibodies revealed that viral antigens were present in all lymphocyte subpopulations but the main targets were T cells in general and OvCD4+ cells in particular. Challenge of primed lambs with bovine RSV had similar effects over a shorter period, followed by significant rises in the number of OvCD45+ (B) cells and OvCD5+ (T cells). Viral antigens were also present in lymphocytes subsets following challenge.

Replication of bovine respiratory syncytial virus in ovine peripheral blood lymphocytes and monocytes in vitro

Adherent and non-adherent mononuclear cells obtained from the peripheral blood of normal lambs supported the replication of bovine respiratory syncytial virus in vitro. Sequential treatment of monocytes with phorbol ester acetate (PMA) enhanced their ability to support viral replication. After exposure in vitro for 24 h, viral antigens were present in 47 +/- 4.5% of monocytes and 32 +/- 3% of lymphocytes. Treatment of monocytes with PMA resulted in the increase of the proportion of cells expressing viral antigen and in the titre of infectious virus.