Alarmins and innate lymphoid cells 2 activation: A common pathogenetic link connecting respiratory syncytial virus bronchiolitis and later wheezing/asthma?

Severe respiratory syncytial virus (RSV) infection in infancy is associated with increased risk of recurrent wheezing in childhood. Both acute and long‐term alterations in airway functions are thought to be related to inefficient antiviral immune response. The airway epithelium, the first target of RSV, normally acts as an immunological barrier able to elicit an effective immune reaction but may also be programmed to directly promote a Th2 response, independently from Th2 lymphocyte involvement. Recognition of RSV transcripts and viral replication intermediates by bronchial epithelial cells brings about release of TSLP, IL‐33, HMGB1, and IL‐25, dubbed “alarmins.” These epithelial cell‐derived proteins are particularly effective in stimulating innate lymphoid cells 2 (ILC2) to release IL‐4, IL‐5, and IL‐13. ILC2, reflect the innate counterparts of Th2 cells and, when activate, are potent promoters of airway inflammation and hyperresponsiveness in RSV bronchiolitis and childhood wheezing/asthma. Long‐term epithelial progenitors or persistent epigenetic modifications of the airway epithelium following RSV infection may play a pathogenetic role in the short‐ and long‐term increased susceptibility to obstructive lung diseases in response to RSV in the young. Additionally, ILC2 function may be further regulated by RSV‐induced changes in gut microbiota community composition that can be associated with disease severity in infants. A better understanding of the alarmin‐ILC interactions in childhood might provide insights into the mechanisms characterizing these immune‐mediated diseases and indicate new targets for prevention and therapeutic interventions.