We read with interest the paper by BERGAUER et al. [1] on innate immune responses to viral infection in paediatric asthma. The paper confirms previous reports on impaired interferon responses in stable asthma [2-4], but describes a hyperactive interferon production during asthma exacerbations associated with rhinovirus infection. The authors conclude that, despite impaired immune condition at stable state, the ability to upregulate type I interferons during the acute phase is preserved in asthmatic children. However, what is lacking from this study is the information on interferon production during acute rhinovirus infection in an age-matched group of non-asthmatics. Thus, how can it be conclusively excluded that the production of interferon is impaired during the rhinovirus-induced acute phase of asthma in the absence of such a comparative control group? A study which examined nasal washes of children during acute episodes of wheezing or rhinitis, reported lower levels of IFN-λ in children with wheezing than in those with acute rhinitis, even if the differences were not statistically significant [5]. The fact that asthmatic patients, once infected, have more severe manifestations of the infectious diseases [6] could possibly suggest an impaired response also in the acute phase, but conclusive data are lacking.

The PreDicta cohort presented no differences in non-asthma related measures; however, it is well balanced regarding key phenotypic characteristics representative of "preschool asthma".

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The Blood-Brain Barrier (BBB) permeability is an important factor governing a drug’s ability to act upon the Central Nervous System. The measure of the BBB permeability used throughout this study is the log BB (the blood/brain partitioning coefficient) measured in vivo or calculated. Useful yet simple models of the BBB permeability were developed by Stepwise Multiple Regression Analysis based on the chromatographic parameters Rf and Rf/PSA obtained by RP-18 TLC with acetonitrile - pH 7.4 phosphate buffered saline 70:30 (v/v) as mobile phase, combined with descriptors - the number of H-bond donors (HD), the number of H-bond acceptors (HA), energy of the highest occupied molecular orbital – (eH), energy of the lowest unoccupied molecular orbital (eL). The ability of the solutes to cross the BBB has been studied qualitatively using Discriminant Function Analysis. Almost all compounds with the known BB vivo parameter were correctly classified as CNS+/-. The classification functions based on Rf/PSA have been verified using an external group. The results of the chromatographic analysis proposed in this study (RP-18 TLC) are a source of valuable information on the BBB permeability of compounds available even on a very small scale.

We analysed the influence of rhinovirus (RV) in nasopharyngeal fluid (NPF) on type I and III interferon (IFN) responses (e.g. IFN-α and IFN -: λ) and their signal transduction, at baseline and during disease exacerbation, in cohorts of pre-school children with and without asthma.At the time of recruitment into the Europe-wide study PreDicta, and during symptoms, NPF was collected and the local RV colonisation was analysed. Peripheral blood mononuclear cells (PBMCs) were challenged in vitro with RV or not. RNA was analysed by quantitative real-time PCR and gene arrays. Serum was analysed with ELISA for IFNs and C-reactive protein.We found that PBMCs from asthmatic children infected in vitro with the RV1b serotype upregulated MYD88, IRF1, STAT1 and STAT2 mRNA, whereas MYD88, IRF1, STAT1 and IRF9 were predominantly induced in control children. Moreover, during symptomatic visits because of disease exacerbation associated with RV detection in NPF, IFN-α production was found increased, while IFN-λ secretion was already induced by RV in asthmatic children at baseline.During asthma exacerbations associated with RV, asthmatic children can induce IFN-α secretion, indicating a hyperactive immune response to repeated respiratory virus infection.

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Background: Investigation of preschool asthma is important since not all children outgrow their illness during this age. Data are scarce on the role of rhinovirus (RV) infections in this patient group. Objectives: To investigate the role of RV infections in preschool asthma: (i) susceptibility factors, (ii) clinical course, and (iii) medium-term outcome. Methods: A total of 130 asthmatic children aged 4-6 years from the multinational PreDicta cohort were prospectively followed for a 12-month period. Allergy tests and a standard health questionnaire were carried out at study entry. Respiratory virus presence in nasopharyngeal washes was studied at illness visits and at 3 scheduled visits. Results: At study entry, mean age of the children was 5.3 years. Of 571 visits, 54% were positive for any virus and 39% for RV. Patient characteristics were only assessed with RV infection due to low number of other viruses. The use of supplementary vitamin D was inversely associated with RV infection (P < .05). RV infection was associated with more severe course of acute illness in terms of more severe nighttime coughing, more sleep disturbances, and more days with runny nose (all P < .05). RV infection was also associated with more severe disease course during the 12-month This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

We agree about the importance of rhinovirus-C in asthma pathogenesis. In fact, rhinovirus genotyping is currently underway and the results of all Predicta cohorts will be published in a separate manuscript. Moreover, we agree with C. Scagnolari and co-workers that IFN-λ and IFN-λR distribution in the airways are relevant to asthma, so they require separate study. Moreover, beside epithelial cells, we have recently reported that IFN-λR is also expressed in pulmonary CD11c+ dendritic cells [1]. In our original manuscript we analysed IFN-λ in the serum of preschool children with and without asthma considering the presence of respiratory viruses in their airways [2], and detected higher levels of IFN-λ in serum in association with rhinovirus in the airways. This indicates the importance of evaluating systemic IFN-λ, especially during exacerbation of the disease, without diminishing its relevance in the airways. In conclusion, we thank C. Scagnolari and co-workers for their analysis of our work and we absolutely agree that the complex puzzle of childhood asthma regarding rhinovirus and type I and III interferons is still far from being completed and thus needs further investigations.