2
|
Tulling AJ, Holierhoek MG, Jansen-Hoogendijk AM, Hoste L, Haerynck F, Tavernier SJ, Oostenbrink R, Buysse CMP, Bannier MAGE, Bekhof J, Breukels M, Hammer SC, Jacobs MAM, Kamps AWA, van der Linden JW, Lebon A, Oudshoorn JH, Tramper-Stranders GA, Vastert SJ, Wieringa JW, Terheggen-Lagro SWJ, Wildenbeest JG, von Asmuth EGJ, van den Akker EB, van Gijn ME, Lugthart G, Buddingh EP. Serum proteomics reveals hemophagocytic lymphohistiocytosis-like phenotype in a subset of patients with multisystem inflammatory syndrome in children. Clin Immunol 2024; 264:110252. [PMID: 38744408 DOI: 10.1016/j.clim.2024.110252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
Children with Multisystem Inflammatory Syndrome in Children (MIS-C) can present with thrombocytopenia, which is a key feature of hemophagocytic lymphohistiocytosis (HLH). We hypothesized that thrombocytopenic MIS-C patients have more features of HLH. Clinical characteristics and routine laboratory parameters were collected from 228 MIS-C patients, of whom 85 (37%) were thrombocytopenic. Thrombocytopenic patients had increased ferritin levels; reduced leukocyte subsets; and elevated levels of ASAT and ALAT. Soluble IL-2RA was higher in thrombocytopenic children than in non-thrombocytopenic children. T-cell activation, TNF-alpha and IFN-gamma signaling markers were inversely correlated with thrombocyte levels, consistent with a more pronounced cytokine storm syndrome. Thrombocytopenia was not associated with severity of MIS-C and no pathogenic variants were identified in HLH-related genes. This suggests that thrombocytopenia in MIS-C is not a feature of a more severe disease phenotype, but the consequence of a distinct hyperinflammatory immunopathological process in a subset of children.
Collapse
Affiliation(s)
- Adam J Tulling
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Marloes G Holierhoek
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Levi Hoste
- Primary Immunodeficiency Research Lab (PIRL), Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Center for Primary Immunodeficiency, Jeffrey Modell Diagnosis and Research Center, Ghent University Hospital, Ghent, Belgium
| | - Filomeen Haerynck
- Primary Immunodeficiency Research Lab (PIRL), Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Center for Primary Immunodeficiency, Jeffrey Modell Diagnosis and Research Center, Ghent University Hospital, Ghent, Belgium
| | - Simon J Tavernier
- Primary Immunodeficiency Research Lab (PIRL), Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Center for Primary Immunodeficiency, Jeffrey Modell Diagnosis and Research Center, Ghent University Hospital, Ghent, Belgium
| | - Rianne Oostenbrink
- Department of General Pediatrics, Sophia Children's Hospital, Erasmus MC, Rotterdam, the Netherlands
| | - Corinne M P Buysse
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Michiel A G E Bannier
- Department of Pediatrics, MosaKids Children's Hospital, University Medical Center Maastricht, Maastricht, the Netherlands
| | - Jolita Bekhof
- Department of Pediatrics, Isala Hospital, Zwolle, the Netherlands
| | - Mijke Breukels
- Department of Pediatrics, Elkerliek Hospital, Helmond, the Netherlands
| | - Sanne C Hammer
- Department of Pediatrics, Amphia Hospital, Breda, the Netherlands
| | - Monique A M Jacobs
- Department of Pediatrics, Slingeland Hospital, Doetinchem, the Netherlands
| | - Arvid W A Kamps
- Department of Pediatrics, Martini Hospital, Groningen, the Netherlands
| | | | - Ankie Lebon
- Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | | | - Sebastiaan J Vastert
- Department of Pediatric Rheumatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jantien W Wieringa
- Department of Pediatrics, Haaglanden Medical Center, the Hague, the Netherlands
| | - Suzanne W J Terheggen-Lagro
- Department of Pediatric Pulmonology and Allergy, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Joanne G Wildenbeest
- Department of Pediatric Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Erik G J von Asmuth
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik B van den Akker
- Leiden Computational Biology Center, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; The Delft Bioinformatics Lab, Pattern Recognition & Bioinformatics, Delft University of Technology, Delft, the Netherlands
| | - Marielle E van Gijn
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gertjan Lugthart
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Emilie P Buddingh
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands.
| |
Collapse
|
3
|
Ptak K, Olszewska M, Szymońska I, Olchawa-Czech A, Mól N, Rudek-Budzyńska A, Kukla K, Cisowska M, Sabat O, Grzyb A, Kwinta P. Should we be afraid of long-term cardiac consequences in children with multisystem inflammatory syndrome? Experience from subsequent waves of COVID-19. Eur J Pediatr 2024:10.1007/s00431-024-05528-0. [PMID: 38517518 DOI: 10.1007/s00431-024-05528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024]
Abstract
The purpose of the study was to assess and compare short- and long-term cardiac complications of the multisystem inflammatory syndrome in children (MIS-C) by predominant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants throughout the pandemic. The analysis of prospectively collected data comparing cardiac complications of MIS-C during and after hospitalization across the original/alpha, delta, and omicron waves. Cardiac complications were defined as cardiac failure with systolic function impairment or hypotension or abnormalities in echocardiographic findings (decrease in LVEF, FS, valvular insufficiency, pericardial effusion, or coronary artery abnormalities). A total of 120 patients with MIS-C admitted to the Children's Hospital of Krakow between November 1, 2020, and May 5, 2023, were included in the study (74 during original/alpha dominance, 31 delta, and 15 omicron). Patients in the omicron group were found to be younger than those in the alpha and delta groups (37 vs. 75 vs. 80 months, p = 0.03). The frequency of cardiac failure with systolic function impairment or hypotension was diagnosed more frequently in the original/alpha and delta groups than in the omicron group (44.59% vs. 41.94% vs. 13.33%, p = 0.08) also echocardiographic abnormalities changed, with rates of 60.8%, 35.5%, and 13.3% (p < 0.001) accordingly. The multivariable regression revealed an older age (OR = 1.19, 95% CI = 1.07-1.33, p = 0.002) as the only independent factors of cardiac failure with systolic function impairment or hypotension. In all patients, signs of cardiac failure resolved during the hospitalization. Moreover, in 98.3% of patients, all echocardiagraphic abnormalities resolved completely during the observation period. Conclusion: The cardiac complications of MIS-C appeared to advance less severely in younger children during the Omicron outbreak. In long-term observation, symptoms of cardiac failure resolve completely. Similarly, also echocardiographic abnormalities normalize in the vast majority of patients. What is Known: • Knowledge about the long-term cardiac complications of MIS-C is still evolving and uncertain. • The greatest concern of MIS-C is cardiac complications, including cardiac failure and coronary artery dilatation. What is New: • Long-term observations revealed complete resolution of cardiac complications in the vast majority of patients with MIS-C, irrespective of the dominant variant. • Cardiac complications of MIS-C were less common in younger children during subsequent pandemic waves in our patient population.
Collapse
Affiliation(s)
- Katarzyna Ptak
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
| | - Marta Olszewska
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Izabela Szymońska
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Olchawa-Czech
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Nina Mól
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | | | - Kornelia Kukla
- Department of Pediatrics, University Children's Hospital, Krakow, Poland
| | - Marta Cisowska
- Department of Pediatrics, University Children's Hospital, Krakow, Poland
| | - Oliwia Sabat
- Department of Pediatrics, Jagiellonian University Medical College, Students' Scientific Group, Krakow, Poland
| | - Aleksandra Grzyb
- Department of Pediatrics, Jagiellonian University Medical College, Students' Scientific Group, Krakow, Poland
| | - Przemko Kwinta
- Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
4
|
Demirhan S, Goldman DL, Herold BC. Differences in the Clinical Manifestations and Host Immune Responses to SARS-CoV-2 Variants in Children Compared to Adults. J Clin Med 2023; 13:128. [PMID: 38202135 PMCID: PMC10780117 DOI: 10.3390/jcm13010128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
The COVID-19 pandemic challenged the medical field to rapidly identify and implement new approaches to the diagnosis, treatment and prevention of SARS-CoV-2 infections. The scientific community also needed to rapidly initiate basic, translational, clinical and epidemiological studies to understand the pathophysiology of this new family of viruses, which continues to evolve with the emergence of new genetic variants. One of the earliest clinical observations that provided a framework for the research was the finding that, in contrast to most other respiratory viruses, children developed less severe acute and post-acute disease compared to adults. Although the clinical manifestations of SARS-CoV-2 infection changed with each new wave of the pandemic, which was dominated by evolving viral variants, the differences in severity between children and adults persisted. Comparative immunologic studies have shown that children mount a more vigorous local innate response characterized by the activation of interferon pathways and recruitment of innate cells to the mucosa, which may mitigate against the hyperinflammatory adaptive response and systemic cytokine release that likely contributed to more severe outcomes including acute respiratory distress syndrome in adults. In this review, the clinical manifestations and immunologic responses in children during the different waves of COVID-19 are discussed.
Collapse
Affiliation(s)
| | | | - Betsy C. Herold
- Department of Pediatrics, Division of Infectious Diseases, Albert Einstein College of Medicine, The Children’s Hospital at Montefiore, 1225 Morris Park Avenue, Bronx, NY 10461, USA; (S.D.); (D.L.G.)
| |
Collapse
|