Abstract

BackgroundA broad variety of natural environmental stimuli, genotypic influences and timing all contribute to expression of protective versus maladaptive immune responses and the resulting clinical outcomes in humans. The role of commonly co-segregating Toll-like receptor 4 (TLR4) non-synonymous single nucleotide polymorphisms Asp299Gly and Thr399Ile in this process remains highly controversial. Moreover, what differential impact these polymorphisms might have in at risk populations with respiratory dysfunction, such as current asthma or a history of infantile bronchiolitis, has never been examined. Here we determine the importance of these polymorphisms in modulating LPS and respiratory syncytial virus (RSV) - driven cytokine responses. We focus on both healthy children and those with clinically relevant respiratory dysfunction.MethodologyTo elucidate the impact of TLR4 Asp299Gly and Thr399Ile on cytokine production, we assessed multiple immune parameters in over 200 pediatric subjects aged 7–9. Genotyping was followed by quantification of pro- and anti-inflammatory cytokine responses by fresh peripheral blood mononuclear cells upon acute exposure to LPS or RSV.Principal FindingsIn contrast to early reports, neither SNP influenced immune responses evoked by LPS exposure or RSV infection, as measured by the intermediate phenotype of pro- and anti-inflammatory cytokine responses to these ubiquitous agents. There is no evidence of altered sensitivity in populations with “at risk” clinical phenotypes.Conclusions/SignificanceGenomic medicine seeks to inform clinical practice. Determination of the TLR4 Asp299Gly/Thr399Ile haplotype is of no clinical benefit in predicting the nature or intensity of cytokine production in children whether currently healthy or among specific at-risk groups characterized by prior infantile broncholitis or current asthma.

Highlights

  • Genomic medicine seeks to inform clinical practice

  • Results obtained from fresh primary peripheral blood mononuclear cells (PBMC) culture derived from the 207 children examined in this cohort demonstrate that the intensity or nature of anti-viral immune responses driven by respiratory syncytial virus (RSV) infection are not influenced by the Toll-like receptor 4 (TLR4) haplotype (Figure 4)

  • The role of the haplotype comprised of TLR4 Asp299Gly and Thr399Ile polymorphisms in shaping immune activation and subsequent clinical outcomes in humans remains highly controversial

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Summary

Introduction

Genomic medicine seeks to inform clinical practice. It is widely anticipated that identifying specific components of an individual’s genome will help determine the optimal approach to health care; for example, by facilitating the prediction and prevention of diseases such as asthma [1], or by identifying optimal pharmacologic agents for therapy [2,3]. The study of susceptibility to respiratory syncytial virus (RSV), led to much attention focused on genes that encode proteins of the innate immune system. Kurt-Jones et al initially reported that TLR4 is key in initiating innate immune responses of monocytes to the fusion (F) protein of RSV [8] These early human data were supported by experimental animal studies in which RSV was found to persist longer in the lungs of TLR4-deficient mice compared to TLR4expressing controls [9]. We determine the importance of these polymorphisms in modulating LPS and respiratory syncytial virus (RSV) - driven cytokine responses. We focus on both healthy children and those with clinically relevant respiratory dysfunction

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