A distinct clinical presentation of respiratory syncytial virus (RSV) infection of humans is bronchiolitis, which has clinical features similar to those of asthma. Substance P (SP), a tachykinin neuropeptide, has been associated with neurogenic inflammation and asthma; therefore, we chose to examine SP-induced inflammation with RSV infection. In this study, we examined the production of pulmonary SP associated with RSV infection of BALB/c mice and the effect of anti-SP F(ab) 2 antibodies on the pulmonary inflammatory response. The peak production of pulmonary SP occurred between days 3 and 5 following primary RSV infection and day 1 after secondary infection. Treatment of RSV-infected mice with anti-SP F(ab) 2 antibodies suggested that SP may alter the natural killer cell response to primary and secondary infection. In mice challenged after formalin-inactivated RSV vaccination, SP appears to markedly enhance pulmonary eosinophilia as well as increase polymorphonuclear cell trafficking to the lung. Based on studies with a strain of RSV that lacks the G and SH genes, the SP response to RSV infection appears to be associated with G and/or SH protein expression. These data suggest that SP may be an important contributor to the inflammatory response to RSV infection and that anti-SP F(ab) 2 antibodies might be used to ameliorate RSV-associated disease.Respiratory syncytial virus (RSV) is one of most important respiratory pathogens of infants and young children worldwide (12,24,28,29,35). Acute bronchiolitis is the most distinctive feature of RSV infection in infants and young children, and RSV is the most important cause of bronchiolitis (26,51,66). Bronchiolitis is an acute inflammatory process of the respiratory bronchioles leading to symptoms of obstructive airway disease. The clinical presentation of bronchiolitis is similar to that of asthma (48,51,64). These similarities have led investigators to consider that the mechanisms underlying RSV bronchiolitis and asthma may be similar (46,48,56,65).Recent studies have raised the possibility that neurogenic factors, including tachykinins such as substance P (SP), may contribute to pulmonary inflammation associated with asthma (4,17,31,59). For example, SP is active at nanomolar concentrations and has diverse actions including induction of vascular extravasation of immune cells (15, 21), increased adhesion of polymorphonuclear cells and eosinophils to endothelium (36), and potentiation of immune functions of lymphocytes, macrophages, mast cells, and eosinophils (42). SP is thought to act primarily through the specific neurokinin 1 receptor (NK-1R) (3,9,10,43). It is possible that SP can also act in a receptorindependent fashion, because it is a small (11-amino-acid) amphiphilic/amphipathic molecule that can pass through the cellular membrane. The functional relevance of SP in pulmonary inflammation is indicated by studies of NK-1R knockout mice (11). In these studies, immune complexes, which induce vascular permeability and allow infiltration of inflammatory cells into...