Daily Respiratory Research Analysis
A prospective community cohort identified baseline RSV prefusion F–binding antibodies as correlates of reduced RSV infection risk, informing vaccine development. ERS and ATS jointly issued unified evidence-based guidelines for primary ciliary dyskinesia diagnosis, recommending HSVM, IF, and nNO as adjuncts to TEM/genetics. A genomic-epidemiologic study from Guangzhou documented the rise of macrolide-resistant Bordetella pertussis (ptxP3/prn150) with 23S rRNA A2047G, guiding local treatment and s
Summary
A prospective community cohort identified baseline RSV prefusion F–binding antibodies as correlates of reduced RSV infection risk, informing vaccine development. ERS and ATS jointly issued unified evidence-based guidelines for primary ciliary dyskinesia diagnosis, recommending HSVM, IF, and nNO as adjuncts to TEM/genetics. A genomic-epidemiologic study from Guangzhou documented the rise of macrolide-resistant Bordetella pertussis (ptxP3/prn150) with 23S rRNA A2047G, guiding local treatment and surveillance.
Research Themes
- Correlates of protection and vaccine design for RSV
- Standardized diagnostic pathways for primary ciliary dyskinesia
- Antimicrobial resistance evolution in respiratory pathogens
Selected Articles
1. High expression of Rex-orf-I and HBZ mRNAs and bronchiectasis in lung of HTLV-1A/C infected macaques.
In a nonhuman primate model using a chimeric HTLV-1A/C virus, investigators observed bronchiectasis and high expression of viral transcripts (Rex-orf-I and HBZ) in lung tissue. The work implicates viral genetic determinants in the pathogenesis of HTLV-1C–associated respiratory disease and provides a mechanistic basis for the differential lung morbidity between HTLV-1 types.
Impact: This mechanistic in vivo study links specific viral gene expression to bronchiectasis, advancing understanding of HTLV-1C–related lung disease and informing surveillance in endemic regions.
Clinical Implications: Findings support heightened respiratory monitoring (e.g., bronchiectasis screening) in populations with HTLV-1C and highlight viral targets that could guide future diagnostics or therapeutics.
Key Findings
- Nonhuman primates infected with a chimeric HTLV-1A/C developed bronchiectasis.
- Lung tissues showed high expression of viral Rex-orf-I and HBZ mRNAs.
- Data indicate viral genetic determinants underpin HTLV-1C–associated lung morbidity compared to HTLV-1A.
Methodological Strengths
- Mechanistic in vivo model in nonhuman primates enabling causal inference.
- Molecular characterization of viral gene expression in affected lung tissue.
Limitations
- Animal model data may not fully generalize to human disease.
- Sample size and detailed experimental numbers were not specified in the abstract.
Future Directions: Validate findings in human cohorts from HTLV-1C–endemic regions, define how Rex-orf-I/HBZ drive lung pathology, and explore targeted antiviral or immunomodulatory strategies.
HTLV-1 type-A rarely causes lung disease in humans, whereas HTLV-1 type-C is more frequently associated with respiratory failure and premature death. We investigated the genetic basis of HTLV-1C morbidity by constructing a chimeric HTLV-1A/C
2. Correlates of risk of respiratory syncytial virus disease: a prospective cohort study.
In a community-based cohort (n=3237) with weekly active surveillance, higher baseline anti–prefusion F IgG levels were associated with reduced RSV risk in children. These findings provide human correlates of protection to inform immunization strategies and vaccine evaluation.
Impact: Defines antibody-based correlates of risk using robust prospective surveillance, directly informing RSV vaccine targets and schedules.
Clinical Implications: Supports leveraging prefusion F–targeted immunity in vaccine design and may guide prioritization (e.g., maternal or pediatric immunization timing) based on antibody levels.
Key Findings
- Among 3237 participants, 305 RSV illnesses were detected with weekly RT-qPCR testing.
- Higher baseline RSV prefusion F–binding IgG was associated with lower hazard of RSV in pediatric participants (HR≈0.66 per log unit).
- Prospective, symptom-independent swabbing enabled unbiased estimation of correlates of risk.
Methodological Strengths
- Prospective community cohort with weekly, symptom-independent RT-qPCR testing.
- Baseline serology including prefusion F–binding antibodies and pediatric neutralization.
Limitations
- Single-season follow-up; durability of correlates across seasons not assessed.
- Neutralization assays were limited to pediatric participants; adult neutralization data not detailed in abstract.
Future Directions: Quantify protective thresholds, assess durability across seasons and variants, and integrate correlates into vaccine licensure endpoints.
Few population-based studies have evaluated the importance of pre-existing respiratory syncytial virus (RSV) antibody on RSV susceptibility among children and adults. We conducted a prospective, community-based cohort study among individuals aged 6 months-50 years in Oregon and Washington State, USA (June 2022-May 2023), with weekly symptom surveys and swab collection regardless of symptoms. Swabs were tested for RSV using RT-qPCR. Enrollment sera were tested for RSV prefusion F IgG binding (all participants) and neutralizing antibodies (pediatric participants). We detected 305 RSV illnesses among 3237 participants from 1188 households. Using proportional hazards regression, higher RSV binding antibody titers were associated with a lower estimated hazard of RSV among pediatric participants (hazard ratio=0.66 per 1-unit difference in log
3. European Respiratory Society and American Thoracic Society guidelines for the diagnosis of Primary Ciliary Dyskinesia.
ERS and ATS jointly recommend HSVM, IF, and nNO as adjuncts to TEM/genetics for PCD diagnosis, while emphasizing that no single test confirms or excludes PCD. The guideline standardizes test quality, advocates genetic diagnosis, and recommends referral to experienced centers and pretest probability–based interpretation.
Impact: Unifies diagnostic standards across two major societies, likely improving diagnostic accuracy and reducing variability in PCD workups.
Clinical Implications: Clinicians should combine HSVM, IF, and nNO with TEM/genetics, seek genetic confirmation when possible, and refer to specialized centers; results should be interpreted against pretest probability.
Key Findings
- Strong recommendation for HSVM, IF, and nNO as adjunct tests to TEM/genetics in PCD diagnosis.
- No single adjunct or reference test alone can confirm or exclude PCD.
- Call for standardized test quality, genetic diagnosis pursuit, specialty referral, and pretest probability–based interpretation.
Methodological Strengths
- Systematic literature review with GRADE and EtD frameworks.
- Joint consensus across ERS and ATS with PICO-structured questions.
Limitations
- Evidence base constrained by heterogeneous studies and lack of a single definitive reference standard.
- Implementation may be limited by access to specialized testing and centers.
Future Directions: Develop validated diagnostic algorithms incorporating Bayesian pretest probability, expand access and standardization of HSVM/IF/nNO, and refine genotype–phenotype correlations.
Primary ciliary dyskinesia (PCD) is caused by pathogenetic variants in >55 genes. PCD is associated with early-onset chronic wet cough and rhinosinusitis, laterality defects, middle ear disease, and reduced fertility. The clinical presentation is heterogeneous, and diagnosis often relies on multiple tests. The American Thoracic Society (ATS) and European Respiratory Society (ERS) have previously developed separate guidelines for diagnosis. Here, ERS and ATS members systematically reviewed the literature on diagnostic tools used in practice and developed unified evidence-based guidelines for PCD diagnosis using GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology, and a transparent process of decision-making using Evidence-to-Decision (EtD) frameworks. The Task Force panel formulated three PICO (Patients, Intervention, Comparison, Outcomes) questions and three narrative questions. The accuracies of high-speed video microscopy (HSVM), immunofluorescence (IF), and nasal nitric oxide (nNO) were compared to a reference test of transmission electron microscopy (TEM) and/or genetics. The panel gives strong recommendation for use of HSVM, IF, and nNO as adjunct tests to TEM and/or genetics for PCD diagnosis. However, no adjunct test is suitable as a standalone test to diagnose PCD and no single adjunct or reference test is suitable to exclude PCD. Pursuing a genetic diagnosis is encouraged due to the implication on management. The panel emphasizes that tests should meet a minimum standard and proposes evaluation of patients at a referral centre experienced in diagnosis. The pretest probability based on symptoms should be considered when interpreting results.