title: Increased expression of the glucocorticoid receptor β in infants with RSV bronchiolitis.
abstract: OBJECTIVE
  The majority of studies on glucocorticoid treatment in respiratory syncytial virus (RSV) bronchiolitis concluded that there are no beneficial effects. We hypothesized that RSV-infected patients may have an increased glucocorticoid receptor (GR) β expression, the isoform that is unable to bind cortisol and exert an antiinflammatory action.
  
  
  METHODS
  By using real-time polymerase chain reaction, we studied the expression of α and β GR in the peripheral blood mononuclear cells obtained from 49 RSV-infected infants (<1 year of age) with severe (n = 29) and mild to moderate (n = 20) illness. In plasma, we analyzed the level of cortisol by radioimmunoassay and inflammatory cytokines interleukin (IL)-10, IL-6, tumor necrosis factor-α, IL-1β, IL-8, IL-12p70, IL-2, IL-4, IL-5, interferon-γ, and IL-17 by cytometric beads assay. Statistical analysis was performed by nonparametric analysis of variance.
  
  
  RESULTS
  We found a significant increase of β GR expression in patients with severe illness compared with those with mild disease (P < .001) and with a group of healthy controls (P < .01). The α:β GR ratio decreased significantly in infants with severe disease compared with those with mild illness (P < .01) and with normal controls (P < .001). The expression of β GR was positively correlated with the clinical score of severity (r = .54; P < .0001).
  
  
  CONCLUSIONS
  The decrease of the α:β GR ratio by an increase of β receptors expression is related to illness severity and may partly explain the insensitivity to corticoid treatment in RSV-infected infants. The increased expression of β GR could be a marker of disease severity.
authors.affiliation: Pathophysiology Program, Instituto de Ciencias Biomédicas, Faculty of Medicine, University of Chile, Avda Salvador 486, Chile. pdiaz@med.uchile.cl
authors.forename: Patricia V
authors.initials: PV
authors.lastname: Diaz
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Pinto
authors.forename: Rossana
authors.initials: R
authors.lastname: Mamani
authors.forename: Paola A
authors.initials: PA
authors.lastname: Uasapud
authors.forename: Maria R
authors.initials: MR
authors.lastname: Bono
authors.forename: Aldo A
authors.initials: AA
authors.lastname: Gaggero
authors.forename: Julia
authors.initials: J
authors.lastname: Guerrero
authors.forename: Annelise
authors.initials: A
authors.lastname: Goecke
mesh_terms: D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001990:Bronchiolitis, Viral / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood; D004351:Drug Resistance; D005260:Female; D005434:Flow Cytometry; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D011863:Radioimmunoassay; D060888:Real-Time Polymerase Chain Reaction; D011965:Receptors, Glucocorticoid / Q000097:blood*; D018357:Respiratory Syncytial Virus Infections / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D016207:Cytokines; D005938:Glucocorticoids; D011965:Receptors, Glucocorticoid; C411470:glucocorticoid receptor alpha; C121943:glucocorticoid receptor beta; D006854:Hydrocortisone