T cell redistribution kinetics after secondary infection of BALB/c mice with respiratory syncytial virus

Advances in and the potential of vaccines for respiratory syncytial virus

Respiratory syncytial virus (RSV) is the leading cause of serious lower respiratory track illness causing bronchiolitis and some mortality in infants and the elderly. Despite decades of research there is no licensed RSV vaccine. To enable the development of RSV vaccines, several major obstacles must be overcome including immature and waning immunity to RSV infection, the capacity of RSV to evade immunity and the failure of RSV infection to induce robust enduring immunity. Since the failure of the formalin-inactivated RSV vaccine trial, more cautious and deliberate progress has been made toward RSV vaccine development using a variety of experimental approaches. The scientific rational and the state of development of these approaches are reviewed in this article.

The host response and molecular pathogenesis associated with respiratory syncytial virus infection

Since the isolation of respiratory syncytial virus (RSV) in 1956, its significance as an important human pathogen in infants, the elderly and the immunocompromised has been established. Many important mechanisms contributing to RSV infection, replication and disease pathogenesis have been uncovered; however, there is still insufficient knowledge in these and related areas, which must be addressed to facilitate the development of safe and effective vaccines and therapeutic treatments. A better understanding of the molecular pathogenesis of RSV infection, particularly the host-cell response and transcription profiles to RSV infection, is required to advance disease intervention strategies. Substantial information is accumulating regarding how RSV proteins modulate molecular signaling and regulation of cytokine and chemokine responses to infection, molecular signals regulating programmed cell death, and innate and adaptive immune responses to infection. This review discusses RSV manipulation of the host response to infection and related disease pathogenesis.

Bronchoalveolar lavage cellularity in infants with severe respiratory syncytial virus bronchiolitis

AIM

To examine over time, the cellular response within the lungs of infants ventilated with respiratory syncytial virus (RSV) bronchiolitis and to compare this response in infants born at term with those born preterm.

METHODS

Non-bronchoscopic bronchoalveolar lavage (BAL) samples were taken from 47 infants (24 born at term and 23 born preterm) who were ventilated for RSV positive bronchiolitis and 10 control infants. BAL cellularity and differential cell counts were calculated using standard techniques.

RESULTS

Total cellularity in BAL over the first four days of ventilation in infants with RSV bronchiolitis was greater in term infants (median 2.2 (IQR 4.27) x 10(6) cells/ml) compared with preterm infants (0.58 (1.28) x 10(6) cells/ml). The magnitude of the cellular response in preterm infants with bronchiolitis was similar to that in the control group measured on day 1 (0.62 (0.77) x 10(6) cells/ml). BAL cellularity decreased progressively from the time of intubation in term infants, but remained relatively constant in preterm infants up to seven days after intubation.

CONCLUSIONS

There are differences in the magnitude and type of pulmonary cellular response in term and preterm infants ventilated with RSV bronchiolitis. The cellular response in term infants with bronchiolitis differs from that in a control group of infants. These differences may reflect variations in cellular recruitment in the lung and/or variations in airway calibre.

Long-term persistence and reactivation of T cell memory in the lung of mice infected with respiratory syncytial virus

In mice acutely infected with respiratory syncytial virus (RSV), more than 20% of pulmonary CD8(+) T cells, but only 2-3% of CD8(+) T cells in the draining lymph node secreted interferon-gamma in response to a single peptide. Surprisingly, the percentage of virus-specific T cells in the lung remained at these high levels long after the acute infection. Pulmonary memory T cells were further studied in a sensitive adoptive transfer system, which allows visualizing polyclonal CD4(+) and CD8(+) virus-specific memory T cell responses. Fifty days after infection, persisting RSV-specific pulmonary T cells remained CD69(hi) CD62L(lo), but had returned to a resting memory state according to functional criteria. In the absence of neutralizing antibodies reinfection first induced cell division among virus-specific memory T cells 3 days after infection predominantly in the local lymph node. However, divided cells then rapidly accumulated in the lung without significantly increasing in the lymph node. These results suggest rapid export of reactivated cells from the lymph node to the target organ. Thus, although memory T cells can be maintained in the infected organ after a localized virus infection, amplification of a recall response appears to be most effective in organized lymphoid tissue.

Leucocyte populations in respiratory syncytial virus-induced bronchiolitis

OBJECTIVES

To enumerate the cellular composition of the airways in infants with acute bronchiolitis.

METHODOLOGY

Cells were obtained by airway lavage from the upper and lower airway and the peripheral blood of infants with respiratory syncytial virus (RSV)+ bronchiolitis, RSV- bronchiolitis and age-matched controls.

RESULTS

Neutrophils are the predominant cells present in the upper and lower airway. Neutrophils are present at a higher number/unit volume in the airway than in the peripheral blood.

CONCLUSIONS

Neutrophils, being the dominant cellular infiltrate into the airway, are likely to contribute to the pathophysiology of bronchiolitis. Therapies targeted at limiting neutrophil influx or neutrophil-mediated damage in the airway may have a therapeutic role.

T cell subset analysis in peripheral blood of children with RSV bronchiolitis

Respiratory syncytial virus (RSV) bronchiolitis is partially an immune-mediated disease in which RSV-specific T cells play a predominant role. The peripheral blood T cell response was studied in patients with RSV bronchiolitis in order to detect evidence for T cell redistribution during natural RSV infection and if so, which subsets are involved. 18 patients with RSV bronchiolitis and 13 control patients were studied. The white blood cell count, the number of T cells and T cell subsets in blood on admission and after 1 week were measured. The absolute count of natural killer cells and gamma delta + T cells on admission were significantly lower in RSV patients in comparison with the control group. During the course of RSV bronchiolitis CD8+ T cells and IL-2 receptor-positive T cells increased significantly. In the ventilated patients the total lymphocytes and the number of T cells and several T cell subsets with surface molecules compatible with an activation state of the cell were decreased in comparison with the non-ventilated RSV patients on admission. During RSV bronchiolitis, consistent shifts in T cell subsets can be demonstrated in the peripheral blood compatible with redistribution from the circulation probably towards the lungs. These findings are more pronounced in patients with severe disease.

Priming with live respiratory syncytial virus (RSV) prevents the enhanced pulmonary inflammatory response seen after RSV challenge in BALB/c mice immunized with formalin-inactivated RSV

To investigate enhanced disease associated with a formalin-inactivated (FI) respiratory syncytial virus (RSV) vaccine, we studied the pulmonary inflammatory response to RSV in BALB/c mice immunized with live RSV, FI-RSV, or combinations of the two. After RSV challenge, the number of granular cells, the ratio of CD4+/CD8+ lymphocytes, and the level of Th2-like cytokine mRNAs in the bronchoalveolar lavage specimens in mice immunized first with live RSV and then with FI-RSV were lower than that in FI-RSV-immunized mice and close to that in live RSV-immunized mice. These data suggest that prior live RSV infection prevents most of the enhanced inflammatory response seen in FI-RSV-immunized mice and might explain lack of enhanced disease in older FI-RSV-immunized children. A live RSV vaccine might similarly decrease the risk of enhanced disease with non-live RSV vaccines.

Mucosal T cells recovered from mice after infection with respiratory syncytial virus display a memory/activation phenotype

Pgp-1 expression was studied as a marker of memory/activation on systemic and mucosal T cells of BALB/c and C57BL/6 mice after infection with respiratory syncytial virus (RSV), using two-color dual fluorescence flow cytometry employing anti-L3T4 (CD4), anti-Ly2 (CD8), and anti-Pgp-1 (CD44) monoclonal antibodies. Pgp-1 was expressed in relatively low densities on T cells of C57BL/6 mice, allowing differentiation of a dual population of Pgp-1(10) and Pgp-1hi T cells after antigenic stimulation in vivo. On the contrary, T cells of BALB/c mice were uniformly Pgp-1hi, making this mouse strain less suitable for studies with this marker. In blood and spleen consistently more CD8+ than CD4+ T cells were Pgp-1hi, while in BAL more CD4+ than CD8+ T cells were Pgp-1hi. After primary but not after secondary infection, CD4+ Pgp-1hi T cells increased significantly in the blood and spleen. After secondary infection both CD4+ Pgp-1hi and CD8+ Pgp-1hi T cells increased in the BAL. It is hypothesized that after primary infection systemic RSV-specific T cells acquire an activation/memory phenotype as characterized by an enhanced expression of Pgp-1, resulting in a faster and stronger influx of these cells in the lungs after secondary infection.