Mejías A, Chávez-Bueno S, Ríos A María, Fonseca-Aten M, Gómez A María, Jafri H S, Ramilo O
Division of Infectious Diseases, Department of Pediatrics, The University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas, USA.
An Pediatr (Barc). 2004 Sep;61(3):252-60. doi: 10.1016/s1695-4033(04)78805-0.
Numerous studies have described an association between respiratory sincticial virus (RSV) infection in infancy and the subsequent development of airway hyperresponsiveness (AHR). Besides the exaggerated immune response and the abnormal neurogenic mechanisms induced by RSV, recent studies have correlated the "persistence" of RSV in the lower respiratory tract with the development of AHR. Several investigators have evaluated whether treatment with antiviral or immunosuppressive agents could decrease the long term respiratory abnormalities induced by RSV. The RSV murine model has allowed us to study the immunopathogenesis of RSV-induced AHR. Once the airway obstruction, typical of acute disease, is resolved and no virus is longer detected by cell cultures, mice progress into a chronic phase characterized by AHR and persistent airway inflammation. The use of polymerase chain reaction assay for RSV quantitation has demonstrated, quite unexpectedly, the presence of RSV RNA in the lower respiratory tract of mice during the chronic phase of the disease. As an example of intervention, the administration of an anti-RSV neutralizing antibody (palivizumab) was associated with a significant reduction in viral replication, pulmonary inflammation and inflammatory cytokines, as well as a significant improvement in the pulmonary function both in the acute and chronic phases of the disease. Future clinical studies to determine whether therapy with palivizumab can prevent the long-term morbidity associated with RSV in children are warranted.
大量研究描述了婴儿期呼吸道合胞病毒（RSV）感染与随后气道高反应性（AHR）发展之间的关联。除了RSV诱导的过度免疫反应和异常神经源性机制外，最近的研究已将RSV在下呼吸道的“持续存在”与AHR的发展联系起来。几位研究人员评估了抗病毒或免疫抑制剂治疗是否能减少RSV诱导的长期呼吸异常。RSV小鼠模型使我们能够研究RSV诱导的AHR的免疫发病机制。一旦典型的急性疾病气道阻塞得到缓解且细胞培养不再检测到病毒，小鼠就会进入以AHR和持续性气道炎症为特征的慢性期。用于RSV定量的聚合酶链反应检测的使用非常意外地证明，在疾病的慢性期小鼠下呼吸道中存在RSV RNA。作为干预的一个例子，给予抗RSV中和抗体（帕利珠单抗）与病毒复制、肺部炎症和炎性细胞因子的显著减少以及疾病急性和慢性期肺功能的显著改善相关。有必要进行未来的临床研究以确定帕利珠单抗治疗是否能预防儿童与RSV相关的长期发病。
