Bronchiolitis and RSV infection

Each year, up to 20,000 babies and young children are admitted to UK hospitals with serious, sometimes life-threatening breathing problems after being infected by a virus called RSV.¹ We have no effective vaccine or treatment, and even diagnosis can be problematic. Researchers hope a deeper understanding of changes taking place within the bloodstream during RSV infection could help us design better ways to overcome this potentially deadly virus.

Contents

• What's the problem and who does it affect?
• What is the project trying to achieve?
• What are the researchers' credentials?
• Who stands to benefit from this research and how?
• References

What's the problem and who does it affect?

RSV infection can put vulnerable babies in intensive care

Infection by the Respiratory Syncytial Virus (RSV) is the leading cause of lung infections in babies and young children.¹ It causes bronchitis, bronchiolitis (inflammation of the lower airways) and pneumonia, being responsible for at least one in four cases of serious pneumonia in infants.¹

For most children, the illness is relatively mild, causing symptoms like a bad cold, often with wheezing and coughing. But a significant minority, mostly babies under six months of age, develop pneumonia and sometimes even respiratory failure. They can end up spending long periods in intensive care on mechanical ventilators.

Spending time away from home in an unfamiliar hospital environment, separated from parents and siblings, can be highly traumatic. The tests and procedures youngsters have to undergo can be uncomfortable and frightening.

While most children do recover, the physical and psychological impacts of their illness can be considerable. Sadly, for the most vulnerable, such as premature babies, RSV infection can be life-threatening. There is also a possible association between RSV infection in infancy and subsequent development of asthma.

What is the project trying to achieve?

Signatures in the blood

The researchers are using a cutting-edge technique, called proteomic fingerprinting, to increase our understanding of RSV infection. This technique profiles the many hundreds of proteins circulating in the blood of an infected person and then pulls out a distinctive pattern - a proteomic signature - from among them, which is characteristic of the particular disease.

The technique works on the principle that when we become ill with a viral infection, the combination of proteins in our blood changes. For example, a selection of viral proteins appear in the blood and, as the body tries to fight the infection, certain proteins from the immune system can increase or decrease in concentration.

The researchers are looking at the proteomic signature of RSV infection in babies. They are also investigating whether babies who develop severe, life-threatening RSV infections have a different proteomic signature to those who suffer milder symptoms.

The team is also beginning the process of identifying individual proteins that make up the proteomic signature.

What are the researchers' credentials?

The Project Leader, Dr Dan Agranoff, and his team are pioneers in applying the concept of proteomic fingerprinting to the diagnosis of infectious diseases. They have recently achieved very exciting results using this technique for other diseases, such as tuberculosis and 'sleeping sickness'.

Dr Agranoff's unit belongs to the UK's first Academic Health Sciences Centre, a model for a new type of partnership between academia and the NHS, integrating world-class research with healthcare delivery. The project team for this study is a multidisciplinary group, uniting experts in proteomics, mathematical biology and clinical paediatrics under the umbrella of the newly formed Pan-London RSV Research Group.

The researchers have access to state-of-the-art equipment, including machines called mass spectrometers, which can analyse tiny volumes of blood, and computers with artificial intelligence software. The study will involve the four major paediatric intensive care units in London (at Great Ormond Street, St George's, St Mary's and Guy's and St Thomas' hospitals).

Who stands to benefit from this research and how?

Working towards better diagnosis and treatment

The researchers aim to improve our fundamental understanding of RSV infection in infants. They believe their work will ultimately help in the design of new diagnostic tests and treatments. All babies and children with RSV infections may benefit in the future. RSV infection remains a serious global healthcare problem and a major economic burden.

The researchers believe future studies, which build on their work, may lead to the development of much better diagnostic tests for RSV infection, based on dipsticks. This type of test could be affordable, quick, easy to use, and practical in the clinical environment. The team envisages that these tests could enable us to better predict, at an earlier stage, which children will go on to develop more serious disease.

What's more, researchers believe further studies, which investigate the functional importance of individual proteins within the proteomic signature, may lead to new approaches to therapy. A successful new treatment could help stop babies with RSV infection from becoming seriously ill, so avoiding the trauma of hospital admissions and even saving lives.

References

1. Handforth J, Friedeland J.S, Sharland M. Basic epidemiology and immunopathology of RSV in children. Paediatric Respiratory Reviews (2000) 1, 210-214.