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Topic Name: UK Scientists Find Predisposition to Bronchiolitis in Some Babies

Category: Biomedical

Research persons: Dr Calum Semple

Location: Dept. of Health National Clinician Scientist, United Kingdom

Details

Scientists have found that a large proportion of infants who suffer from bronchiolitis have an inherent pre-disposition to the disease.

The disease is the most prevalent acute wheezing disorder in infants and is the most common cause of admission to hospital in the first year of life in the developed world. Around 25 in every 1,000 babies are admitted to hospital for bronchiolitis - needing oxygen and help with feeding - and of these, 10% need the support of a ventilator.

Bronchiolitis frequently develops in infants suffering from respiratory syncytial virus (RSV) infection. Although most infants infected with RSV have only mild symptoms such as a cough and wheeze some develop potentially life-threatening bronchiolitis. Babies born prematurely are particularly susceptible to the condition but what has puzzled scientists is that the majority of babies admitted to hospital are previously healthy and have not had an obvious reason for becoming so ill.

A new study by University of Liverpool scientists, based at Alder Hey Children’s Hospital, has found that previously healthy babies with severe disease have a different immune response to those with only mild symptoms. The study involved nearly 200 infants under two years old admitted to Alder Hey over a five-year period. On admission to hospital, those with severe disease were taking more than 50 breaths per minute and their blood oxygen levels were dangerously low.

The study found that those with severe bronchiolitis had lower levels of interferon-gamma and substance P in their airway secretions. Gamma interferon is an important substance made in the body which is used to fight viral infections. The role of substance P is less understood but is thought to be involved in the local inflammatory response in many parts of the body.

Dr Calum Semple, Senior Lecturer in Child Health at the University of Liverpool and Consultant Respiratory Paediatrician based at Alder Hey, said: “This work helps to explain a common observation about children who had bronchiolitis as babies. Parents often tell us that every time their child gets a cold ‘it goes straight to his chest’ and many parents and doctors believe that bronchiolitis in infancy is the cause of these chest problems in childhood.

“This study shows that it is the difference in the child’s ability to fight viruses that predisposes them to bronchiolitis in the first place. That poor ability to fight the condition is an innate feature of their immune system. Bronchiolitis just happens to be the commonest respiratory virus around and therefore the first virus a baby is likely to come across.

“Because the gamma interferon response is an important feature of the immune system in these children, they won’t handle subsequent respiratory viruses very well either. The association between bronchiolitis in babies and ‘chestiness’ in childhood is not causal or consequential but due to a common immune predisposition and is probably genetic.”

The research is funded by the Department of Health and published this week by the Public Library of Science (PLoS) in the journal PLoS One.

About Researcher:

Calum Semple BM BCh, PhD, PGC Med Ed, FHEA, MRCPEdin, FRCPCH

Dr Semple was the first paediatrician to be appointed as a National Clinician Scientist when the scheme sponsored by the Academy of Medical Sciences and the Department of Health was founded in 2001. Dr Semple is directly funded by the Department of Health as primary investigator to study the immunopathogenesis of respiratory syncytial virus bronchiolitis in infants. He is also investigating severe human metapneumovirus disease in infants. These clinical research projects are conducted in collaboration with the Divisions of Medical Microbiology and GU Medicine at The University of Liverpool.
Research Interests

Immunopathogenesis of Infantile Bronchiolitis. Human Respiratory Syncytial Virus and Human Metapneumovirus.

About Alder Hey Children's Hospital

Alder Hey Children's Hospital is a children's hospital in West Derby, Liverpool. It is run by the Royal Liverpool Children's NHS Trust as part of the UK National Health Service. The hospital forms a key part of the medical education at the University of Liverpool's Medical School curriculum.

The hospital was founded in 1914 and is one of the largest children's hospitals in Europe. The hospital acquired the prefix 'Royal' in 1985 and became an NHS Hospital Trust in 1991. It currently employs about 2,400 staff and treats over 200,000 children each year.

During the 1990s it was featured in the BBC television series 'Children's Hospital'.

A charity, 'imagine', raises funds to assist the hospital's work.

In 1999 an enquiry was instituted to investigate the hospital's practices in respect of removal and retention of human tissue. The enquiry had far-reaching effects throughout the UK hospital system (see Alder Hey organs scandal for more details).

About Department of Health (United Kingdom)

The Department of Health (DoH) is a department of the United Kingdom government. It is led by the Secretary of State for Health with two Ministers of State and three Parliamentary Under-Secretary of States.

It is responsible for government policy on health, social care and the National Health Service (NHS) in England (through the Strategic Health Authorities (SHAs)).

The DoH carries out some of its work through "arm's length bodies", including executive agencies such as the NHS Purchasing and Supply Agency (NHS PASA) and the Medicines and Healthcare products Regulatory Agency (MHRA).

In the rest of the United Kingdom, responsibility for health and the management of the NHS falls under the jurisdiction of the devolved governments of the other three constituent countries, namely:

the Department of Health, Social Services and Public Safety of the Northern Ireland Executive 
the Scottish Executive Health Department 
the Welsh Assembly Government.