Mark Rusznak

Mark Rusznak

PI: Stokes Peebles, MD, Department of Allergy, Pulmonary, and Critical Care Medicine

Glucagon-like peptide-1 receptor signaling attenuates RSV-induced type 2 responses and immunopathology

Glucagon-like peptide-1 receptor (GLP-1R) agonists are a well-accepted and safe 
treatment for Type II diabetes. Recent evidence suggests that GLP-1R signaling also has anti-
inflammatory effects. Severe acute bronchiolitis can be caused by infection with respiratory syncytial virus (RSV) and is characterized by significant immunopathology including mucus production and airway dysfunction. We determined the effect of GLP-1R signaling on RSV-induced type 2 immune responses and 
immunopathology. To test this, BALB/c mice were infected with RSV strain 12/12-6 or mock preparation and 
treated with GLP-1R agonist or vehicle. GLP-1R agonist treatment attenuated airway inflammation, airway responsiveness, 
and airway mucus in RSV 12/12-6-infected mice. The GLP-1R agonist decreased total lung IL-
13 and IL-33 protein expression, with concurrent decreases in IL-13+ group 2 innate lymphoid 
cells (ILC2), CD4+ type 2 helper T cells, and basophils as well as IL-33+ epithelial cells. GLP-1R agonist 
treatment prevented airway inflammation, and did not increase viral load or decrease anti-viral 
interferon and antibody production during secondary RSV infection. A Phenome-wide association study (PheWAS) was performed to assess the association between GLP-1R signaling and human disease. The PheWAS identified a statistically significant link between GLP-1R signaling and acute bronchiolitis. 
Taken together, these data suggest that GLP-1R signaling protects against type 2-mediated immunopathology during RSV 
infection and that GLP-1R signaling is associated with acute bronchiolitis in humans. GLP-1R 
agonists, drugs that are currently FDA-approved for type 2 diabetes, are the first known agents 
to inhibit IL-33 protein expression and may represent a novel treatment strategy for RSV 
bronchiolitis.