Respiratory illnesses can be mild and relatively harmless, like the common cold, or they can prove to be dangerous – life-threatening, even – especially in older adults. The respiratory syncytial virus (RSV) is particularly problematic, accounting for approximately 14,000 deaths and 177,000 hospitalizations for U.S. adults over the age of 65.
A new study from The Ohio State University, however, is showing some preliminary promise in the battle against RSV using ibuprofen to build a more effective immune response against the virus. Part of the reason why RSV is such a deadly wintertime virus is that an initial infection doesn’t often generate a long-term immune response, unlike in younger adults.
The research showed that the older rats that had been given the ibuprofen before an initial RSV infection were able to expel the virus at a faster rate than those who weren’t given the drug. Published in the November 2021 issue of Virology, the study potentially showed the ability of ibuprofen to reduce inflammation related to aging, which could help the body clear RSV more effectively.
“For a long time, people have thought that certain immune cells get burned out and can’t function properly any longer,” said Stefan Niewiesk, DVM, PhD, senior study author. “And then we started treating against inflammation, and suddenly the old cells can do their job like young cells.”
The study evaluated younger, sexually mature cotton rats younger than 2 months old against geriatric ones that were 9 to 15 months old. Rats were chosen because, like humans, the virus can grow and thrive in the lungs as well as the nose.
In addition to clearing the initial virus, the ibuprofen-treated rats were also able to resist a second infection.
“It only works in old animals, and in older people we see a lot of inflammation and related chronic disease,” Niewiesk said. “When we think about what the pathways are to fix RSV infection in the elderly, this study opens a door to the possibilities.”
Researchers were quick to emphasize these study results should not lead older adults to preventively take ibuprofen to ward off a potential RSV infection, as long-term use has been shown to result in kidney damage and slow down the time it takes the blood to clot.
Boosting the body’s own immune response
While ibuprofen is not responsible for fighting the virus, the team believes its ability to lower inflammation gives the body more power to kill the virus on its own—specifically by stimulating production of the CD8+ T cells.
“If you take those inflammatory molecules away with ibuprofen, these immune cells would migrate normally and we’d have stimulated CD8+ T cells,” Niewiesk said. “We’re also asking what part of the inflammatory cascade does ibuprofen affect? How does inflammation look in these old animals—is it always there and then increased with infection? That’s where we’re looking at the moment.”
Niewiesk hopes the study will eventually lead to treatments in the future specifically for older adults that could provide the same immune-boosting effect the ibuprofen had on the rats but without the risk. While vaccines for RSV are currently being developed, older adults do not have any treatment options today.
“This isn’t a case where someone should take ibuprofen daily for the whole winter. There are too many side effects,” he said. “But if there was something to take post-infection, after you feel sick, that would be great.”
RSV vs. the flu
While influenza and its danger to seniors receives much of the attention each winter, RSV has proven to be just as deadly. Research has shown it contributes to longer hospital stays (as well as ICU admissions) and increases risk of pneumonia and death.
“The flu can be deadly, but if you survive you are less likely to have long-term negative outcomes than if you survive RSV infection,” said Bradley Ackerson, MD, a physician at Kaiser Permanente’s South Bay Medical Center in Harbor City. “In the short term, RSV is more likely than flu to be associated with the worsening of conditions like chronic obstructive pulmonary disease. Over the long term, RSV can be more deadly than flu.”
While RSV is often under-recognized by physicians, newer testing methods for respiratory viruses could prove to be valuable, Ackerson said.
“The importance of recognizing and detecting RSV infection will become even more important in the future if RSV becomes a preventable and treatable condition,” Dr. Ackerson said. “But first, we need to know that it is RSV.”
