Abstract In patients with asthma, respiratory syncytial virus (RSV) infections can cause disease exacerbations by infecting the epithelial layer of the airways, inducing an innate and adaptive immune response. The type-I interferon antiviral response of epithelial cells upon RSV infection is found to be reduced in asthma in most -but not all-studies. Moreover, the molecular mechanisms that cause the differences in the asthmatic bronchial epithelium in response to viral infection are poorly understood. Here, we investigated the transcriptional response to RSV infection of primary bronchial epithelial cells (pBECs) from asthma patients(n=8) and healthy donors(n=8). The pBECs obtained from bronchial brushes were differentiated in air-liquid interface conditions and infected with RSV. After three days, cells were processed for single-cell RNA sequencing. A strong antiviral response to RSV was observed for all cell types present, from both asthma patients and healthy donors. Most differentially regulated genes following RSV infection were found in cells transitioning from basal to secretory. Goblet cells from asthma patients showed lower expression of genes involved in the interferon response. In multiciliated cells, an impairment of the signaling pathways involved in the response to RSV in asthma was observed, including no enrichment of the type-III interferon response. Our results highlight that the response to RSV infection of the bronchial epithelium in asthma and healthy airways was largely similar. However, in asthma, the response of goblet and the multiciliated cells was impaired, highlighting the need for studying airway epithelial cells at high resolution in the context of asthma exacerbations. What is already know on this topic The airway epithelium response to RSV is altered in asthma. However, literature remains conflicted about the exact changes in the antiviral response, and the mechanisms causing these changes are yet to be found. What this study adds This study describes extensively the response of the bronchial epithelial cells (BECs) to RSV for both healthy subjects and asthma patients, at a single-cell resolution. It highlights the major overlap between healthy and asthma in the antiviral response to RSV. It allows the identification of specific genes and cell types that show a different behavior in response to RSV in asthma compared to healthy. How this study might affect research, practice or policy Our study indicates that goblet and multiciliated cells are the most relevant BECs to further investigate in the context of drug development for RSV-induced asthma exacerbation. It also suggests that focusing research on the cross-talk between the epithelial and the immune cells, or into investigating a potential delayed response in asthma would be the best way forward into understanding the mechanisms involved in the asthma response to RSV.

Airway epithelial response to RSV is impaired in multiciliated and goblet cells in asthma