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Pro- and anti-inflammatory responses in respiratory syncytial virus bronchiolitis

¹ Dept of Child Health, University of Liverpool, Institute of Child Health, and ⁴ Paediatric Intensive Care Unit, Alder Hey Children's Hospital, and Depts of ² Medical Microbiology and ³ Immunology, University of Liverpool, Liverpool, UK

CORRESPONDENCE: P.S. McNamara, Institute of Child Health, University of Liverpool, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK. Fax: 44 1512525456. E-mail: mcnamp@liv.ac.uk

Keywords: bronchiolitis, bronchoalveolar lavage, interleukin-6, premature, respiratory syncytial virus, tumour necrosis factor

Received: May 1, 2003
Accepted August 21, 2003

This work was supported by grants from Action Research (Grant Ref. SP3814) and the Charterhouse Charitable Trust, UK.

Respiratory syncytial virus (RSV) bronchiolitis is an important cause of severe respiratory disease in infants. This study aimed to characterise changes in pulmonary pro- and anti-inflammatory responses in infants with RSV bronchiolitis over the course of the illness.

On the day of intubation (Day 1) and the day of extubation (Day X), nonbronchoscopic bronchoalveolar lavage was performed on term and preterm infants ventilated for RSV bronchiolitis and on control infants on Day 1. Tumour necrosis factor (TNF)-, soluble TNF receptor (sTNFR) and interleukin (IL)-6 messenger ribonucleic acid (mRNA) and protein were measured.

Twenty-four infants, born at term and 23 infants born preterm with RSV bronchiolitis and 10 controls were recruited. TNF- and IL-6 mRNA and protein in infants with bronchiolitis were greater than the control group on Day 1. In preterm infants, who were ventilated for longer than term infants, TNF- and IL-6 proteins decreased between Day 1 and Day X. Concentrations of sTNFRs differed between groups on Day 1, but levels did not change between Day 1 and Day X.

Large amounts of tumour necrosis factor- and interleukin-6 in the respiratory syncytial virus-infected lung suggest important roles for these cytokines in the pathogenesis of respiratory syncytial virus bronchiolitis. The decrease in tumour necrosis factor- and interleukin-6 protein in preterm infants may reflect the prolonged clinical course seen in these infants.

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