Advancing our understanding of infant bronchiolitis through phenotyping and endotyping: clinical and molecular approaches

ABSTRACT

Introduction: Bronchiolitis is a major public health problem worldwide. However, no effective treatment strategies are available, other than supportive care.

Areas covered: Although bronchiolitis has been considered a single disease diagnosed based on clinical characteristics, emerging evidence supports both clinical and pathobiological heterogeneity. The characterization of this heterogeneity supports the concept that bronchiolitis consists of multiple phenotypes or consistent grouping of characteristics.

Expert commentary: Using unbiased statistical approaches, multidimentional clinical characteristics will derive bronchiolitis phenotypes. Furthermore, molecular and systems biology approaches will, by linking pathobiology to phenotype, identify endotypes. Large cohort studies of bronchiolitis with comprehensive clinical characterization and system-wide profiling of the ‘-omics’ data (e.g., host genome, transcriptome, epigenome, viral genome, microbiome, metabolome) should enhance our ability to molecularly understand these phenotypes and lead to more targeted and personalized approaches to bronchiolitis treatment.

KEYWORDS:

• Bronchiolitis
• lower respiratory infection
• infants
• phenotypes
• endotypes
• immune response
• genome
• transcriptome
• microbiome
• systems biology

Declaration of interest

This study was supported by the grants U01 AI-087881, R01 AI-114552, R21 HL-129909, U19 AI-095227, and K24 AI-077930 from the National Institutes of Health (Bethesda, MD). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.