Differential lower airway dendritic cell patterns may reveal distinct endotypes of RSV bronchiolitis

Aoife Kerrin, Paul Fitch, Claire Errington, Dennis Kerr, Liz Waxman, Kay Riding, Jon McCormack, Felicity Mehendale, Henry McSorley, Karen Mackenzie, Sabine Wronski, Armin Braun, Richard Leven, Ulf Theilen, Jurgen Schwarze

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output


The pathogenesis of respiratory syncytial virus (RSV) bronchiolitis in infants remains poorly understood. Mouse models implicate pulmonary T cells in the development of RSV disease. T cell responses are initiated by dendritic cells (DCs), which accumulate in lungs of RSV-infected mice. In infants with RSV bronchiolitis, previous reports have shown that DCs are mobilised to the nasal mucosa, but data on lower airway DC responses are lacking.


To determine the presence and phenotype of DCs and associated immune cells in bronchoalveolar lavage (BAL) and peripheral blood samples from infants with RSV bronchiolitis.


Infants intubated and ventilated due to severe RSV bronchiolitis or for planned surgery (controls with healthy lungs) underwent non-bronchoscopic BAL. Immune cells in BAL and blood samples were characterised by flow cytometry and cytokines measured by Human V-Plex Pro-inflammatory Panel 1 MSD kit.

Measurements and main results 

In RSV cases, BAL conventional DCs (cDCs), NK T cells, NK cells and pro-inflammatory cytokines accumulated, plasmacytoid DCs (pDCs) and T cells were present, and blood cDCs increased activation marker expression. When stratifying RSV cases by risk group, preterm and older (≥4 months) infants had fewer BAL pDCs than term born and younger (<4 months) infants, respectively.


cDCs accumulate in the lower airways during RSV bronchiolitis, are activated systemically and may, through activation of T cells, NK T cells and NK cells, contribute to RSV-induced inflammation and disease. In addition, the small population of airway pDCs in preterm and older infants may reveal a distinct endotype of RSV bronchiolitis with weak antiviral pDC responses. 

Original languageEnglish
Pages (from-to)620-627
Issue number7
Early online date16 Aug 2016
Publication statusPublished - 16 Jun 2017


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