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Patel MA, Fraser DD, Daley M, Cepinskas G, Veraldi N, Grazioli S. The plasma proteome differentiates the multisystem inflammatory syndrome in children (MIS-C) from children with SARS-CoV-2 negative sepsis. Mol Med 2024; 30:51. [PMID: 38632526 PMCID: PMC11022403 DOI: 10.1186/s10020-024-00806-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The Multi-System Inflammatory Syndrome in Children (MIS-C) can develop several weeks after SARS-CoV-2 infection and requires a distinct treatment protocol. Distinguishing MIS-C from SARS-CoV-2 negative sepsis (SCNS) patients is important to quickly institute the correct therapies. We performed targeted proteomics and machine learning analysis to identify novel plasma proteins of MIS-C for early disease recognition. METHODS A case-control study comparing the expression of 2,870 unique blood proteins in MIS-C versus SCNS patients, measured using proximity extension assays. The 2,870 proteins were reduced in number with either feature selection alone or with a prior COMBAT-Seq batch effect adjustment. The leading proteins were correlated with demographic and clinical variables. Organ system and cell type expression patterns were analyzed with Natural Language Processing (NLP). RESULTS The cohorts were well-balanced for age and sex. Of the 2,870 unique blood proteins, 58 proteins were identified with feature selection (FDR-adjusted P < 0.005, P < 0.0001; accuracy = 0.96, AUC = 1.00, F1 = 0.95), and 15 proteins were identified with a COMBAT-Seq batch effect adjusted feature selection (FDR-adjusted P < 0.05, P < 0.0001; accuracy = 0.92, AUC = 1.00, F1 = 0.89). All of the latter 15 proteins were present in the former 58-protein model. Several proteins were correlated with illness severity scores, length of stay, and interventions (LTA4H, PTN, PPBP, and EGF; P < 0.001). NLP analysis highlighted the multi-system nature of MIS-C, with the 58-protein set expressed in all organ systems; the highest levels of expression were found in the digestive system. The cell types most involved included leukocytes not yet determined, lymphocytes, macrophages, and platelets. CONCLUSIONS The plasma proteome of MIS-C patients was distinct from that of SCNS. The key proteins demonstrated expression in all organ systems and most cell types. The unique proteomic signature identified in MIS-C patients could aid future diagnostic and therapeutic advancements, as well as predict hospital length of stays, interventions, and mortality risks.
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Affiliation(s)
- Maitray A Patel
- Epidemiology and Biostatistics, Western University, N6A 3K7, London, ON, Canada
| | - Douglas D Fraser
- Lawson Health Research Institute, N6C 2R5, London, ON, Canada.
- Children's Health Research Institute, N6C 4V3, London, ON, Canada.
- Pediatrics, Western University, N6A 3K7, London, ON, Canada.
- Clinical Neurological Sciences, Western University, N6A 3K7, London, ON, Canada.
- Physiology & Pharmacology, Western University, N6A 3K7, London, ON, Canada.
- London Health Sciences Centre, Room C2-C82, 800 Commissioners Road East, N6A 5W9, London, ON, Canada.
| | - Mark Daley
- Epidemiology and Biostatistics, Western University, N6A 3K7, London, ON, Canada
- Computer Science, Western University, N6A 3K7, London, ON, Canada
| | - Gediminas Cepinskas
- Lawson Health Research Institute, N6C 2R5, London, ON, Canada
- Medical Biophysics, Western University, N6A 3K7, London, ON, Canada
| | - Noemi Veraldi
- Department of Pediatrics, Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Serge Grazioli
- Department of Pediatrics, Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Neonatal and Pediatric Intensive Care, Department of Child, Woman, and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland
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Almeida FJ, Jarovsky D, Almeida Farias CG, Ramos Nantes de Castilho TR, Gara Caetano T, Manzoni Ribeiro Borsetto CC, Simões Aguiar A, Serafini de Araújo C, Badue Pereira MF, de Sousa Marques HH, Silva CA, Ribeiro de Matos Tannure A, Prado R, Becker Mau L, Andrade Alvares P, de Siqueira AC, Paro Scremin G, Otsuka M, Volpe Arnoni M, Machado Rissoni Laporte R, Altruda de Moraes Costa Carlesse F, Ejzenberg F, Naaman Berezin E, Palazzi Sáfadi MA. High Fatality Rates in Pediatric Multisystem Inflammatory Syndrome: A Multicenter Experience From the Epicenter of Brazil's Coronavirus Pandemic. Pediatr Infect Dis J 2024; 43:109-116. [PMID: 37991363 DOI: 10.1097/inf.0000000000004164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Brazil´s case fatality rate (CFR) of pediatric multisystem inflammatory syndrome in children and adolescents (MIS-C) is among the highest worldwide. Despite these concerns, limited hospital-based and comprehensive pediatric data have been published on MIS-C in Brazilian children. METHODS We performed a descriptive analysis of the MIS-C scores in 16 public and private hospitals providing secondary and tertiary care in the metropolitan area of São Paulo, Brazil. Clinical and demographic information were systematically extracted from the electronic medical records of each patient. Logistic regression analysis was performed to identify the combined effects of MIS-C phenotype, disease severity and comorbidity as dependent variables. RESULTS A total of 101 patients met the MIS-C criteria and were evaluated. The median age was 67 months, 60% were male, 28.7% were black or afrodescendant and 62.3% were admitted to public hospitals. Underlying medical conditions were observed in 16.8% of patients and were associated with a longer duration of hospitalization. A Kawasaki disease-like phenotype was observed in 43.5% of patients, and they demonstrated a trend of lower median age. Children with severe MIS-C were older (median age 91 months vs. 36 months) and had a nonspecific phenotype, more cardiovascular and respiratory involvement and kidney injury; 73.3% required intensive care, 20.8% required mechanical ventilation and 35.6% required inotropic support. Four deaths occurred (CFR = 3.9%), three of which were in healthy participants. CONCLUSION We identified a lower median age, particularly among children with Kawasaki disease-like phenotypes, those with a significant need for intensive care, and a high CFR in MIS-C. Our findings confirmed the increased severity of the disease in the selected Brazilian population.
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Affiliation(s)
- Flávia Jacqueline Almeida
- From the Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
- Department of Pediatrics, Hospital Infantil Sabará, São Paulo, Brazil
| | - Daniel Jarovsky
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
- Department of Pediatrics, Hospital Infantil Sabará, São Paulo, Brazil
- Department of Pediatrics, Hospital Infantil Cândido Fontoura, São Paulo, Brazil
| | - Camila Giuliana Almeida Farias
- Department of Pediatrics, Hospital Infantil Sabará, São Paulo, Brazil
- Department of Pediatrics, Hospital e Maternidade São Luiz Anália Franco, São Paulo, Brazil
- Department of Pediatrics, Hospital e Maternidade São Luiz São Caetano, São Caetano, Brazil
| | | | - Thiago Gara Caetano
- Department of Pediatrics, Hospital e Maternidade São Luiz São Caetano, São Caetano, Brazil
| | | | - Andressa Simões Aguiar
- Department of Pediatrics, Hospital São Luiz Gonzaga, São Paulo, Brazil
- Department of Pediatrics, Hospital Infantil Cândido Fontoura, São Paulo, Brazil
| | | | - Maria Fernanda Badue Pereira
- Department of Pediatrics, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Heloisa Helena de Sousa Marques
- Department of Pediatrics, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Clovis Artur Silva
- Department of Pediatrics, Instituto da Criança e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | | | - Rogério Prado
- Department of Pediatrics, Hospital Municipal do Tatuapé - Dr. Cármino Caricchio, São Paulo, Brazil
| | - Luciana Becker Mau
- Department of Pediatrics, Hospital Municipal Infantil Menino Jesus, São Paulo, Brazil
| | - Paula Andrade Alvares
- Department of Pediatrics, Hospital Municipal da Criança e do Adolescente de Guarulhos, Guarulhos, Brazil
| | | | | | - Marcelo Otsuka
- Department of Pediatrics, Hospital Infantil Darcy Vargas, São Paulo, Brazil
| | | | | | | | - Fernanda Ejzenberg
- Department of Pediatrics, Hospital Municipal M´Boi Mirim - Dr. Moysés Deutsch, São Paulo, Brazil
| | - Eitan Naaman Berezin
- From the Department of Pediatrics, Santa Casa de São Paulo, São Paulo, Brazil
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Marco Aurélio Palazzi Sáfadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
- Department of Pediatrics, Hospital Infantil Sabará, São Paulo, Brazil
- Department of Pediatrics, Hospital Infantil Cândido Fontoura, São Paulo, Brazil
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Pavan Kumar N, Abbas KM, Renji RM, Venkataraman A, Nancy A, Varadarjan P, Selladurai E, Sangaralingam T, Selvam R, Thimmaiah A, Natarajan S, Ramasamy G, Hissar S, Ranganathan UD, Nutman TB, Babu S. Multisystem inflammatory syndrome in children characterized by enhanced antigen-specific T-cell expression of cytokines and its reversal following recovery. Front Pediatr 2023; 11:1235342. [PMID: 38116577 PMCID: PMC10728284 DOI: 10.3389/fped.2023.1235342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023] Open
Abstract
Background Multisystem inflammatory syndrome (MIS) in children is considered to be a post-infectious complication of COVID-19. T-cell responses in children with this condition have not been well-studied. Methods We aimed to study the immune responses in children with MIS in comparison to children with acute COVID-19 and children with other infections. Whole blood was stimulated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-specific antigens and flow cytometry was performed to examine CD4+ and CD8+ T-cell responses. Results Children with MIS had higher frequencies of CD4+ and CD8+ T cells expressing cytokines at baseline and upon SARS-CoV-2 antigen-specific stimulation in comparison to children with COVID-19 and/or other infections. Children with COVID-19 also exhibited higher frequencies of CD4+ and CD8+ T cells expressing cytokines at baseline and upon SARS-CoV-2 antigen-specific stimulation in comparison to children with other infections. At 6-9 months following treatment and recovery, this enhanced response against SARS-CoV-2 antigens was down modulated in children with MIS. Conclusion Our study, therefore, provides evidence of enhanced activation of CD4+ and CD8+ T-cell responses in children with MIS and reversal following recovery.
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Affiliation(s)
- Nathella Pavan Kumar
- Department of Immunology, ICMR—National Institute for Research in Tuberculosis, Chennai, India
| | - Kadar M. Abbas
- National Institutes of Health—International Center for Excellence in Research, Chennai, India
| | - Rachel M. Renji
- National Institutes of Health—International Center for Excellence in Research, Chennai, India
| | - Aishwarya Venkataraman
- Department of Clinical Research, ICMR—National Institute for Research in Tuberculosis, Chennai, India
| | - Arul Nancy
- National Institutes of Health—International Center for Excellence in Research, Chennai, India
| | - Poovazhagi Varadarjan
- Department of Pulmonology, Institute of Child Health and Hospital for Children, Chennai, India
| | - Elilarasi Selladurai
- Department of Pulmonology, Institute of Child Health and Hospital for Children, Chennai, India
| | | | - Ramya Selvam
- General Pediatrics, Dr. Mehta’s Children’s Hospital, Chennai, India
| | | | | | - Ganesh Ramasamy
- General Pediatrics, Rainbow Children’s Hospital, Chennai, India
| | - Syed Hissar
- Department of Clinical Research, ICMR—National Institute for Research in Tuberculosis, Chennai, India
| | - Uma Devi Ranganathan
- Department of Immunology, ICMR—National Institute for Research in Tuberculosis, Chennai, India
| | - Thomas B. Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Subash Babu
- National Institutes of Health—International Center for Excellence in Research, Chennai, India
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
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Reis BCSD, Soares Faccion R, de Carvalho FAA, Moore DCBC, Zuma MCC, Plaça DR, Salerno Filgueiras I, Leandro Mathias Fonseca D, Cabral-Marques O, Bonomo AC, Savino W, Freitas FCDP, Faoro H, Passetti F, Robaina JR, de Oliveira FRC, Novaes Bellinat AP, Zeitel RDS, Salú MDS, de Oliveira MBG, Rodrigues-Santos G, Prata-Barbosa A, de Vasconcelos ZFM. Rare genetic variants involved in multisystem inflammatory syndrome in children: a multicenter Brazilian cohort study. Front Cell Infect Microbiol 2023; 13:1182257. [PMID: 37588055 PMCID: PMC10426286 DOI: 10.3389/fcimb.2023.1182257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/23/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Despite the existing data on the Multisystem Inflammatory Syndrome in Children (MIS-C), the factors that determine these patients evolution remain elusive. Answers may lie, at least in part, in genetics. It is currently under investigation that MIS-C patients may have an underlying innate error of immunity (IEI), whether of monogenic, digenic, or even oligogenic origin. Methods To further investigate this hypothesis, 30 patients with MIS-C were submitted to whole exome sequencing. Results Analyses of genes associated with MIS-C, MIS-A, severe covid-19, and Kawasaki disease identified twenty-nine patients with rare potentially damaging variants (50 variants were identified in 38 different genes), including those previously described in IFNA21 and IFIH1 genes, new variants in genes previously described in MIS-C patients (KMT2D, CFB, and PRF1), and variants in genes newly associated to MIS-C such as APOL1, TNFRSF13B, and G6PD. In addition, gene ontology enrichment pointed to the involvement of thirteen major pathways, including complement system, hematopoiesis, immune system development, and type II interferon signaling, that were not yet reported in MIS-C. Discussion These data strongly indicate that different gene families may favor MIS- C development. Larger cohort studies with healthy controls and other omics approaches, such as proteomics and RNAseq, will be precious to better understanding the disease dynamics.
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Affiliation(s)
- Bárbara Carvalho Santos Dos Reis
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Laboratório de Alta Complexidade (LACIFF), Unidade de Pesquisa Clínica, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Departamento de Imunologia, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Roberta Soares Faccion
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Laboratório de Alta Complexidade (LACIFF), Unidade de Pesquisa Clínica, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Flavia Amendola Anisio de Carvalho
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Departamento de Imunologia, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Daniella Campelo Batalha Cox Moore
- Unidade de Pacientes Graves, Departamento de Pediatria, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ, Brazil
| | - Maria Celia Chaves Zuma
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Laboratório de Alta Complexidade (LACIFF), Unidade de Pesquisa Clínica, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Desirée Rodrigues Plaça
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas (FCF), Universidade de São Paulo (USP), São Paulo, SP, Brazil
- Programa de Pós-Graduação em Farmácia (Fisiopatologia e Toxicologia), FCF, USP, São Paulo, SP, Brazil
| | - Igor Salerno Filgueiras
- Departamento de Imunologia, Instituto de Ciências Biomédicas (ICB), USP, São Paulo, SP, Brazil
| | - Dennyson Leandro Mathias Fonseca
- Programa Interunidades de Pós-graduação em Bioinformática, Instituto de Matemática e Estatística (IME), USP, São Paulo, SP, Brazil
| | - Otavio Cabral-Marques
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas (FCF), Universidade de São Paulo (USP), São Paulo, SP, Brazil
- Departamento de Imunologia, Instituto de Ciências Biomédicas (ICB), USP, São Paulo, SP, Brazil
- Programa Interunidades de Pós-graduação em Bioinformática, Instituto de Matemática e Estatística (IME), USP, São Paulo, SP, Brazil
- Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), São Paulo, Brazil
- Department of Medicine, Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, SP, Brazil
- Laboratory of Medical Investigation 29, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Adriana Cesar Bonomo
- Laboratoírio de Pesquisas Sobre o Timo, Instituto Oswaldo Cruz (IOC), FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Instituto National de Ciencia e Tecnologia em Neuroimunomodulação (INCT/NIM), IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Rede FAPERJ de Pesquisa em Neuroinflamação, IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Rede INOVA-IOC em Neuroimunomodulação, IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Wilson Savino
- Laboratoírio de Pesquisas Sobre o Timo, Instituto Oswaldo Cruz (IOC), FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Instituto National de Ciencia e Tecnologia em Neuroimunomodulação (INCT/NIM), IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Rede FAPERJ de Pesquisa em Neuroinflamação, IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Rede INOVA-IOC em Neuroimunomodulação, IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | | | - Helisson Faoro
- Laboratório de Regulação da Expressão Gênica, Instituto Carlos Chagas (ICC), FIOCRUZ, Curitiba, PR, Brazil
| | - Fabio Passetti
- Laboratório de Regulação da Expressão Gênica, Instituto Carlos Chagas (ICC), FIOCRUZ, Curitiba, PR, Brazil
| | | | | | | | - Raquel de Seixas Zeitel
- Pediatric Intensive Care Unit, Hospital Universitário Pedro Ernesto (HUPE), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Margarida dos Santos Salú
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Laboratório de Alta Complexidade (LACIFF), Unidade de Pesquisa Clínica, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Pediatric Intensive Care Unit, Hospital Martagão Gesteira, Salvador, BA, Brazil
| | | | | | - Arnaldo Prata-Barbosa
- Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
- Pediatric Intensive Care Unit, Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Cannon L, Campbell MJ, Wu EY. Multisystemic Inflammatory Syndrome in Children and Kawasaki Disease: Parallels in Pathogenesis and Treatment. Curr Allergy Asthma Rep 2023:10.1007/s11882-023-01083-0. [PMID: 37171672 PMCID: PMC10176315 DOI: 10.1007/s11882-023-01083-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE OF REVIEW Since it first appeared, multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been compared to Kawasaki disease (KD). Although there were early parallels between MIS-C and KD, key differences emerged over time. Here, we aim to compare the pathogenesis, clinical presentation, treatment, and outcomes of MIS-C and KD. RECENT FINDINGS In this article, we review and compare MIS-C and KD, highlighting differentiating features. We discuss the epidemiological and immunological factors along with clinical and laboratory features which discern MIS-C from KD. We also compare treatment and our understanding of long-term outcomes. Though parallels exist between MIS-C and KD, distinguishing the two is important for clinical management of patients, counseling about natural history, and determining long-term monitoring. While both MIS-C and KD are characterized by profound inflammation and inflammatory vasculopathy, further study is needed to determine whether they are distinct immunopathogenic disorders.
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Affiliation(s)
- Laura Cannon
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Jay Campbell
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Eveline Y Wu
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Division of Pediatric Allergy/Immunology, Department of Pediatrics, University of North Carolina at Chapel Hill, 030 MacNider Hall, CB #7231 Chapel Hill, NC, 27599-7231, Chapel Hill, USA.
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Bucciol G, Meyts I. Inherited and acquired errors of type I interferon immunity govern susceptibility to COVID-19 and multisystem inflammatory syndrome in children. J Allergy Clin Immunol 2023; 151:832-840. [PMID: 36841740 PMCID: PMC9951110 DOI: 10.1016/j.jaci.2023.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/02/2023] [Accepted: 02/01/2023] [Indexed: 02/27/2023]
Abstract
Since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/coronavirus disease 2019 (COVID-19) pandemic, global sequencing efforts have led in the field of inborn errors of immunity, and inspired particularly by previous research on life-threatening influenza, they have revealed that known and novel inborn errors affecting type I interferon immunity underlie critical COVID-19 in up to 5% of cases. In addition, neutralizing autoantibodies against type I interferons have been identified in up to 20% of patients with critical COVID-19 who are older than 80 years and 20% of fatal cases, with a higher prevalence in men and individuals older than 70 years. Also, inborn errors impairing regulation of type I interferon responses and RNA degradation have been found as causes of multisystem inflammatory syndrome in children, a life-threatening hyperinflammatory condition complicating otherwise mild initial SARS-CoV-2 infection in children and young adults. Better understanding of these immunologic mechanisms can aid in designing treatments for severe COVID-19, multisystem inflammatory syndrome in children, long COVID, and neuro-COVID.
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Affiliation(s)
- Giorgia Bucciol
- Laboratory of Inborn Errors of Immunity, Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium; Childhood Immunology, Department of Pediatrics, Leuven University Hospitals, Leuven, Belgium
| | - Isabelle Meyts
- Laboratory of Inborn Errors of Immunity, Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium; Childhood Immunology, Department of Pediatrics, Leuven University Hospitals, Leuven, Belgium.
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Kopitar AN, Repas J, Janžič L, Bizjak M, Vesel TT, Emeršič N, Avramovič MZ, Ihan A, Avčin T, Pavlin M. Alterations in immunophenotype and metabolic profile of mononuclear cells during follow up in children with multisystem inflammatory syndrome (MIS-C). Front Immunol 2023; 14:1157702. [PMID: 37153551 PMCID: PMC10157053 DOI: 10.3389/fimmu.2023.1157702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Although children seem to be less susceptible to COVID-19, some of them develop a rare but serious hyperinflammatory condition called multisystem inflammatory syndrome in children (MIS-C). While several studies describe the clinical conditions of acute MIS-C, the status of convalescent patients in the months after acute MIS-C is still unclear, especially the question of persistence of changes in the specific subpopulations of immune cells in the convalescent phase of the disease. Methods We therefore analyzed peripheral blood of 14 children with MIS-C at the onset of the disease (acute phase) and 2 to 6 months after disease onset (post-acute convalescent phase) for lymphocyte subsets and antigen-presenting cell (APC) phenotype. The results were compared with six healthy age-matched controls. Results All major lymphocyte populations (B cells, CD4 + and CD8+ T cells, and NK cells) were decreased in the acute phase and normalized in the convalescent phase. T cell activation was increased in the acute phase, followed by an increased proportion of γ/δ-double-negative T cells (γ/δ DN Ts) in the convalescent phase. B cell differentiation was impaired in the acute phase with a decreased proportion of CD21 expressing, activated/memory, and class-switched memory B cells, which normalized in the convalescent phase. The proportion of plasmacytoid dendritic cells, conventional type 2 dendritic cells, and classical monocytes were decreased, while the proportion of conventional type 1 dendritic cells was increased in the acute phase. Importantly the population of plasmacytoid dendritic cells remained decreased in the convalescent phase, while other APC populations normalized. Immunometabolic analysis of peripheral blood mononuclear cells (PBMCs) in the convalescent MIS-C showed comparable mitochondrial respiration and glycolysis rates to healthy controls. Conclusions While both immunophenotyping and immunometabolic analyzes showed that immune cells in the convalescent MIS-C phase normalized in many parameters, we found lower percentage of plasmablasts, lower expression of T cell co-receptors (CD3, CD4, and CD8), an increased percentage of γ/δ DN Ts and increased metabolic activity of CD3/CD28-stimulated T cells. Overall, the results suggest that inflammation persists for months after the onset of MIS-C, with significant alterations in some immune system parameters, which may also impair immune defense against viral infections.
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Affiliation(s)
- Andreja Nataša Kopitar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jernej Repas
- Institute of Biophysics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Larisa Janžič
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maša Bizjak
- Department for Allergology, Rheumatology and Clinical Immunology, Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tina Tajnšek Vesel
- Department for Allergology, Rheumatology and Clinical Immunology, Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nina Emeršič
- Department for Allergology, Rheumatology and Clinical Immunology, Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mojca Zajc Avramovič
- Department for Allergology, Rheumatology and Clinical Immunology, Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alojz Ihan
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadej Avčin
- Department for Allergology, Rheumatology and Clinical Immunology, Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Department of Pediatrics, University of Ljubljana, Ljubljana, Slovenia
- *Correspondence: Tadej Avčin, ; Mojca Pavlin,
| | - Mojca Pavlin
- Institute of Biophysics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Group for Nano and Biotechnological Applications, Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
- *Correspondence: Tadej Avčin, ; Mojca Pavlin,
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Ferraresi A, Isidoro C. Will Omics Biotechnologies Save Us from Future Pandemics? Lessons from COVID-19 for Vaccinomics and Adversomics. Biomedicines 2022; 11:biomedicines11010052. [PMID: 36672560 PMCID: PMC9855897 DOI: 10.3390/biomedicines11010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
The COVID-19 pandemic had cross-cutting impacts on planetary health, quotidian life, and society. Mass vaccination with the current gene-based vaccines has helped control the pandemic but unfortunately it has not shown effectiveness in preventing the spread of the virus. In addition, not all individuals respond to these vaccines, while others develop adverse reactions that cannot be neglected. It is also a fact that some individuals are more susceptible to infection while others develop effective immunization post-infection. We note here that the person-to-person and population variations in vaccine efficacy and side effects have been studied in the field of vaccinomics long before the COVID-19 pandemic. Additionally, the field of adversomics examines the mechanisms of individual differences in the side effects of health interventions. In this review, we discuss the potential of a multi-omics approach for comprehensive profiling of the benefit/risk ratios of vaccines. Vaccinomics and adversomics stand to benefit planetary health and contribute to the prevention of future pandemics in the 21st century by offering precision guidance to clinical trials as well as promoting precision use of vaccines in ways that proactively respond to individual and population differences in their efficacy and safety. This vision of pandemic prevention based on personalized instead of mass vaccination also calls for equity in access to precision vaccines and diagnostics that support a vision and practice of vaccinomics and adversomics in planetary health.
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