loading page

Upregulation of neuropeptides and infant obstructive airway disorder in post-RSV wheezing and NEHI
  • +2
  • Bin Wang,
  • Monica Cardenas,
  • Mariana Bedoya,
  • Giovanni Rossi,
  • Andrew Colin
Bin Wang
Jackson Memorial Hospital
Author Profile
Monica Cardenas
University of Miami
Author Profile
Mariana Bedoya
University of Miami
Author Profile
Giovanni Rossi
G. Gaslini Institute
Author Profile
Andrew Colin
Director, Division of Pediatric Pulmonology
Author Profile

Abstract

Obstructive airway disorders are common in infancy and early childhood. The leading example of such disorder is post-viral wheezing, predominantly the well characterized disorder that follows respiratory syncytial virus (RSV) infection and leads to intermittent, long-term wheezing. The underlying mechanisms of the airway reactivity related to RSV infection have been extensively studies and are associated with dysregulation of the nonadrenergic-noncholinergic (NANC) system, via upregulation of neurotransmitters, typically Substance P. Neuroendocrine hyperplasia of infancy (NEHI), while a less common entity, is a disorder of infancy characterized by more severe and long-term obstructive airway disease. NEHI is pathophysiologically characterized by abundance of neuroendocrine cells in the airways containing the neuroimmune mediator bombesin, the release of which is presumed to be the driver of the persistent small airway obstruction and functional air-trapping. Here we review the NANC and NEC neurotransmitter systems and their studied roles in pulmonary diseases with a focus on their role in lung development, and subsequent various pediatric lung diseases. We focus on the juxtaposition of the separate neuroimmune mechanisms underlying the pathogenesis of post-RSV recurrent wheezing and NEHI persistent small airway obstruction. We finally raise the question whether substance P is indeed specific to post-RSV infection and bombesin to NEHI and then propose a unifying concept of post-viral spectrum of respiratory disorders that may encompass these two entities and possibly others.

Peer review status:IN REVISION

29 Jul 2020Submitted to Pediatric Pulmonology
30 Jul 2020Assigned to Editor
30 Jul 2020Submission Checks Completed
31 Jul 2020Reviewer(s) Assigned
26 Aug 2020Review(s) Completed, Editorial Evaluation Pending
27 Aug 2020Editorial Decision: Revise Major