A VIRUS that has come back for years, but which now, thanks to the Covid pandemic, has accelerated the times. Thus, the respiratory syncytial virus returned earlier this year: in October instead of January, as has always been the case. It has attacked thousands of children all over Italy, as well as many elderly people. “Bronchiolitis”, they define it in hospitals in front of apprehensive parents with their little son in their arms suffering from fever and breathing difficulties. Among those parents, in recent days, there were also the rapper Fedez with his entrepreneur wife and blogger Chiara Ferragni, mother and father of Vittoria, the second child affected by the respiratory syncytial virus and treated at the Buzzi hospital in Milan.
To study it and treat it at the same time, two parallel studies were launched: in both the protagonist is the San Matteo polyclinic in Pavia. In the first, the Pediatric clinic and the Virology laboratory of the polyclinic are conducting an in-depth examination of the virus, with the aim of “photographing” it and understanding how it moves; in the other, Pediatrics is studying a specific drug (which is now missing) by applying it to 5 small patients.
The virus of children
Respiratory syncytial virus (RSV) is an RNA virus, classified as a pneumovirus. Some subgroups have been identified: A1, A2, B1 and B2. It is ubiquitous, meaning it can be in different places at the same time, and almost all children are infected by the age of 4. Outbreaks occur with annual cycles in winter or early spring in temperate climates. Given that the immune response against the respiratory syncytial virus does not protect against reinfection, the percentage of contagion is about 40% taking into account all exposed subjects. However, respiratory syncytial virus antibodies reduce the severity of the disease. RSV is the most common cause of lower airway disease in infants and is responsible for more than 50,000 hospital admissions each year in the United States in children under the age of 5.
Respiratory syncytial virus epidemic in newborns, the alarm in Italian hospitals
It can also lead to severe forms
“We have several projects that include the study of this virus, we have been working on it for years – explains the professor Fausto Baldanti, head of the Molecular Virology Laboratory of the Pavia Polyclinic -. Because it gives pathology in children mainly due to the fact that they do not have immunity: it often occurs in a mild form, but can also lead to severe forms of bronchiolitis. However, it can also affect the elderly because, as they get older, they experience a decline in the immune system. Finally, it is particularly aggressive in the immunocompromised, and can lead to aggressive forms “.” For this virus there are no drugs, but monoclonal antibodies have been proposed for use on newborns “, concludes Baldanti.
The small patient study
Precisely to get to know him more in the mechanisms that allow him to replicate in space and time, a project is underway, funded by the Higher Institute of Health, which sees the San Matteo polyclinic (with Baldanti and the head of Pediatrics Gian Luigi Marseglia) coordinator for Northern Italy together with two other partners: the pediatric clinic of the Policlinico Umberto 1 in Rome, for central Italy and the pediatric clinic of Catania, for the south.
“Our project involves the observation of all infections that arrive in our centers, also with evaluation of the genome of the virus in question, to verify if there are variants that can amplify the severity of the disease or if it is a stable virus – Marseglia explains -. Soon this will allow us to photograph the national situation in three different latitudes. By next summer we will have all the data, which will be published precisely in order to learn more about a virus that is killing many victims and crowding First Aid and wards of small patients “.
First drug in trial
At the same time, the Pavia polyclinic, the only one in Italy, is also working on the first drug capable of blocking RSV. This is an experimental study, started in 2019, but then suspended due to Covid and now resumed worldwide. The US, Europe, Asia and Oceania participate in the experimentation. “For this virus there are no drugs, but monoclonal antibodies that are proposed to newborns – insists Baldanti -. In 2016 a work was published on Science in which our group of researchers, together with some colleagues from Bellinzona, identified a monoclonal antibody capable of covering all the variants of RSV. Secondly, we are experimenting with an innovative drug, a molecule capable of preventing the virus from attaching to its receptor: a kind of anchor in the respiratory mucosa to which it attaches in order to prevent it from entering the cells to cause infection. “.
Professor Marseglia’s team is administering it to 5 children in the Pediatric ward. “We are applying this new therapeutic strategy on a voluntary basis – underlines Marseglia – it is a syrup, therefore very well tolerated because it is administered by mouth and children consider it pleasant. It has few side effects and has, in fact, the aim of” unsettling “the virus”. Marseglia concludes: “Thanks to the data we will collect, we will probably be able, probably in a year, to take a world picture of the respiratory syncytial virus”.
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