Lactate dehydrogenase and caspase activity in nasopharyngeal secretions are predictors of bronchiolitis severity

Mehta, Reena; Scheffler, Margaret; Tapia, Lorena; Aideyan, Letisha; Patel, Kirtida D; Jewell, Alan M; Avadhanula, Vasanthi; Mei, Minghua; Garofalo, Roberto P; Piedra, Pedro A

In conclusion, NW-LDH, NW-caspase 3/7 and the NW-LDH/NW-caspase 3/7 ratio when used in combination can help predict outcome in children with bronchiolitis. Understanding the underlying relationship between LDH, caspase, and the innate immune response to respiratory viral pathogens will likely strengthen this predictive ability. Demographic variables and their interaction effects must also be considered when explaining the biomarkers of interest with respect to outcomes and disposition. The ratio of NW-LDH/NW-caspase 3/7 reflects the innate immune balance between necrosis and apoptosis in controlling disease severity in children presenting with bronchiolitis. Our observations support the hypothesis that during the early immune response to control acute viral respiratory tract infection, an excess of necrosis of epithelial cells from either direct viral replication or a secondary inflammatory response is detrimental to the host versus a regulated apoptotic, antiviral pro-inflammatory pathway of epithelial cells designed to inhibit viral replication and progression of airway injury. Biomarkers like NW-LDH and NW-caspase 3/ 7 that can help elucidate the pathogenesis of virally induced airway disease will likely serve as good predictive biomarkers in the clinical setting. Further study of LDH, caspase and other biomarkers may reveal novel targets for diagnostic tools that would aid clinicians in management and disposition of children with bronchiolitis.