Developing Strategies to Treat Asthma Exacerbations Caused by Rhinovirus

Rhinovirus (RV) accounts for 75 to 80% of virus-induced exacerbarelevant RV infections associated with asthma exacerbations that tions of asthma among children and young adults. A wide diversity of RV genotypes cause recurrent infections that lead to attacks of wheezing that begin in infancy. After 3 years of age, it is now clear that atopy and allergic airway inflammation are major risk factors for attacks of asthma provoked by RV (Heymann et al., 2004; Soto-Quiros et al., 2012). Together with efforts to understanding mechanisms underlying the role of RV in causing asthma exacerbations, current research has been focused on determining whether there are strains of RV that are more likely to induce an attack of asthma to guide the development of new treatments, including vaccines. A significant challenge for developing vaccines against RV is that well over 150 strains of RV have been identified. These strains belong to three genetically related groups; RV-A, B, and C. Recent investigations indicate that some strains may be more likely to provoke an asthma attack and may represent targets for an effective vaccine. In populationbased studies of children and adults experiencing an attack of asthma, group A and C strains have been detectedmore frequently. Recent studies from Australia and Costa Rica indicate that the group C strains may trigger exacerbations more often than group A strains (Soto-Quiros et al., 2012; Bizzintino et al., 2011); however, studies from the United States indicate that the group A viruses play an equally important role (Khetsuriani et al., 2008; Kennedy et al., 2014). Deciphering the pathogenic role of each RV strain in provoking asthma symptoms has also been challenging. PCR tests for RV are frequently positive in longitudinal studies designed to determine the rate of infections (e.g., approximately 0.4 to 0.6 infections/month in children) (Winther et al., 2006). However, many of these positive tests either represent sub-clinical infections, or identify recent, but not acute infections. Unfortunately, cultures underestimate the prevalence of RV infections, because the group C strains cannot be detected using currently available culture systems. For these reasons, the research paper in this issue of EBioMedicine by Niespodziana and colleagues addresses a very important problem (Niespodziana et al., 2015–in press). Their paper describes themeasurement RV group and strain specific antibody responses to recombinant RV related proteins and fragments. The results indicate that IgG1 isotype antibody responses specific for the N-terminal fragments of the VP1 coat protein may serve as serologic markers for clinically