Title: Determinants of disease severity in rhinovirus: importance of the host
Abstract: Human rhinoviruses are the most common respiratory viruses detected in adult and pediatric populations, and can be associated with severe disease in both otherwise healthy and vulnerable populations. In hematopoietic cell transplant (HCT) recipients, rhinoviruses cause significant morbidity; mortality rates following rhinovirus pneumonia similar to those seen with respiratory syncytial virus, influenza virus, and parainfluenza virus. My research program is focused on defining the determinants of disease severity in HCT recipients with rhinovirus infection. We have demonstrated that clinical risk factors, including cytopenias and steroid use, are associated with progression from upper to lower respiratory tract infection. However, up to 70% of patients with high clinical risk scores do not progress, suggesting a significant role of thus far unknown immunologic factors in determining disease progression in HCT recipients. I will describe recent studies exploring how host transcriptomics can be used to predict disease severity and to identify specific pathways for intervention in immunocompromised and other populations. Identification and validation of risk factors has the potential to allow patient risk stratification and to provide the critical basis for rational prevention and treatment strategies for rhinovirus in vulnerable populations.