Macronutrients during Pregnancy and Life-Threatening Respiratory Syncytial Virus Infections in Children

Ferolla, Fausto M; Hijano, Diego R.; Acosta, Patricio L.; Rodríguez, Andrea; Dueñas, Karina; Sancilio, Andrea; Barboza, Edgar; Caría, Adriana; Gago, Guadalupe Fernández; Almeida, Rodrigo Egües; Castro, Laura; Pozzolo, Cecilia; Martínez, María Vanina; Grimaldi, Luciano Alva; Rebec, Beatriz; Calvo, M. Fernanda Arce; Henrichsen, Julieta; Nocito, Celina; González, Mariela; Barbero, Guillermo; Losada, Juan Ves; Caballero, Mauricio T.; Zurankovas, Valeria; Raggio, Mirta; Schavlovsky, Graciela; Kobylarz, Alicia; Wimmenauer, Vera; Bugna, Jimena; Williams, John V.; Sastre, Gustavo; Flamenco, Edgardo; Pérez, Alberto Rodríguez; Ferrero, Fernando; Libster, Romina; Grijalva, Carlos G.; Polack, Fernando P.

doi:10.1164/rccm.201301-0016oc

Cited by 58 publications

(86 citation statements)

References 27 publications

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“…Moreover, 89.5% of North American premature infants hospitalized with RSV LRI in an earlier study were found to be TLR4 +/-, while the rate of heterozygosity in the general population was 10.5% (50). Should additional studies in TLR4 +/-infants confirm our observations, pre- Previously healthy full-term infants under 1 year of age and born after September 15 of the previous year, 15 days after the end of the RSV season in Buenos Aires (3,43), with signs and symptoms of bronchiolitis for the first time in their lives, were invited to participate. Bronchiolitis was defined as a constellation of clinical signs including wheezing with or without cough, rales, dyspnea, and increased respiratory rate and retractions of the respiratory muscles.…”

Section: Discussionsupporting

confidence: 58%

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TLR4 genotype and environmental LPS mediate RSV bronchiolitis through Th2 polarization

Caballero¹,

Serra²,

Acosta³

et al. 2015

J. Clin. Invest.

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106

126

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Section: Discussionsupporting

confidence: 58%

“…An estimated 30%-70% of infants develop bronchiolitis upon primary RSV infection, 1%-3% of whom are hospitalized (1)(2)(3). Even though risk factors for hospitalization have been identified (2,4), the mechanism of severe RSV bronchiolitis is not well understood.…”

Section: Introductionmentioning

confidence: 99%

TLR4 genotype and environmental LPS mediate RSV bronchiolitis through Th2 polarization

Caballero¹,

Serra²,

Acosta³

et al. 2015

J. Clin. Invest.

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106

126

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“…The study was conducted between 2011 and 2013 in a catchment population of 28,280 infants younger than 12 months without medical insurance in the southern Region VI of the state of Buenos Aires in Argentina, and was nested in a larger program investigating severe respiratory infections in children under two years 7 . Details of the program are described in previous reports studying the role of macronutrients and alcohol ingestion during pregnancy in childhood respiratory infections 7,8 Eligible patients were hospitalized due to severe LRTI in our network of public hospitals 7 . Severe LRTI was defined as the sudden onset of cough, tachypnea, wheezing, retractions and/or crackles with or without fever, and either an oxygen saturation (SpO2)<93% at rest when breathing room air or arriving to the emergency room receiving oxygen supplementation due to acute symptoms.…”

Section: Study Populationmentioning

confidence: 99%

“…We obtained nasopharyngeal secretions from infants with severe LRTI on admission to the hospitals during the RSV season (see definition below) and tested in duplicate by real-time RT-PCR for RSV as previously described 7,10 .…”

Section: Viral Detectionmentioning

confidence: 99%

Mortality due to Respiratory Syncytial Virus. Burden and Risk Factors

Geoghegan

Erviti

Caballero

et al. 2017

Am J Respir Crit Care Med

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140

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RSV was the most frequent cause of mortality in low-income postneonatal infants. RF and death due to RSV LRTI, almost exclusively associated with prematurity and cardiopulmonary diseases in industrialized countries, primarily affect term infants in a developing world environment. Poor outcomes at hospitals are frequent and associated with the cooccurrence of bacterial sepsis and clinically significant pneumothoraxes.

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“…Maternal smoking and diet are independent risk factors for the development of bronchiolitis (20, 21) and low cord blood vitamin D in otherwise healthy infants is associated with a sixfold increased risk of developing RSV LRTI in the first year of life (22) consistent with a linkage of bronchiolitis with polymorphisms in the vitamin D receptor (23). In utero influences on infant immune responses and the outcome of RSV infection is an area that deserves further study.…”

Section: Clinical Disease and Treatmentmentioning

confidence: 99%

Immunity to RSV in Early-Life

et al. 2014

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Respiratory Syncytial Virus (RSV) is the commonest cause of severe respiratory infection in infants, leading to over 3 million hospitalizations and around 66,000 deaths worldwide each year. RSV bronchiolitis predominantly strikes apparently healthy infants, with age as the principal risk factor for severe disease. The differences in the immune response to RSV in the very young are likely to be key to determining the clinical outcome of this common infection. Remarkable age-related differences in innate cytokine responses follow recognition of RSV by numerous pattern recognition receptors, and the importance of this early response is supported by polymorphisms in many early innate genes, which associate with bronchiolitis. In the absence of strong, Th1 polarizing signals, infants develop T cell responses that can be biased away from protective Th1 and cytotoxic T cell immunity toward dysregulated, Th2 and Th17 polarization. This may contribute not only to the initial inflammation in bronchiolitis, but also to the long-term increased risk of developing wheeze and asthma later in life. An early-life vaccine for RSV will need to overcome the difficulties of generating a protective response in infants, and the proven risks associated with generating an inappropriate response. Infantile T follicular helper and B cell responses are immature, but maternal antibodies can afford some protection. Thus, maternal vaccination is a promising alternative approach. However, even in adults adaptive immunity following natural infection is poorly protective, allowing re-infection even with the same strain of RSV. This gives us few clues as to how effective vaccination could be achieved. Challenges remain in understanding how respiratory immunity matures with age, and the external factors influencing its development. Determining why some infants develop bronchiolitis should lead to new therapies to lessen the clinical impact of RSV and aid the rational design of protective vaccines.

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Macronutrients during Pregnancy and Life-Threatening Respiratory Syncytial Virus Infections in Children

Abstract: Life-threatening and fatal RSV infections are a heavy burden on infants in the developing world. Diets rich in carbohydrates during pregnancy are associated with these severe outcomes.

Cited by 58 publications

References 27 publications

TLR4 genotype and environmental LPS mediate RSV bronchiolitis through Th2 polarization

TLR4 genotype and environmental LPS mediate RSV bronchiolitis through Th2 polarization

Mortality due to Respiratory Syncytial Virus. Burden and Risk Factors

Immunity to RSV in Early-Life

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