Case Report: Inflammation and Endothelial Injury Profiling of COVID-19 Pediatric Multisystem Inflammatory Syndrome (MIS-C)

Abstract

Introduction: COVID-19 is associated with a novel multi-system inflammatory syndrome that shares some characteristics with Kawasaki's Disease. The syndrome manifestation is delayed relative to COVID-19 onset, with a spectrum of clinical severity. Clinical signs may include persistent fever, gastrointestinal symptoms, cardiac inflammation and/or shock.Case Presentation: We measured 59 inflammatory and endothelial injury plasma analytes in an adolescent girl that presented with malaise, fever, cough, strawberry tongue and jaundice. Her COVID-19 status was positive with detection of 2 SARS-CoV-2 viral genes using polymerase chain reaction. She was treated with intravenous immunoglobulin prior to blood draw, but our plasma measurements suggested a unique analyte expression pattern associated with inflammation, endothelial injury and microvascular glycocalyx degradation.Conclusions: COVID-19 is associated with a multi-system inflammatory syndrome and a unique inflammatory and endothelial injury signature.Summary: Analyte markers of inflammation and endothelial cell injury might serve as putative biomarkers and/or be investigated further as potential therapeutic targets.

Critically Ill COVID-19 Patients Exhibit Anti-SARS-CoV-2 Serological Responses

“…Standard operating procedures were used to ensure all samples were treated rapidly and equally [ 5 , 6 , 7 , 15 , 22 , 23 , 39 ]. Daily blood was obtained from critically ill ICU patients via indwelling catheters using vacuum serum separator tubes and placed immediately on ice.…”

Endothelial contribution to COVID-19: an update on mechanisms and therapeutic implications

“…Besides, COVID-19 related endotheliitis and vasculitis in multiple organs including the lungs [ 3 , 4 , 25 ], intestine [ 3 , 26 , 27 ], heart [ 3 , 28 ], kidney [ 3 ], liver [ 3 ], and skin [ 29 ] have been reported. Moreover, elevated endothelial injury biomarkers in the blood [ [30] , [31] , [32] ], vascular occlusion [ 32 , 33 ], and altered vascular reactivity and stiffness [ 34 , 35 ] were observed in both mild and severe COVID-19 patients.…”

Targeting Arginine in COVID-19-Induced Immunopathology and Vasculopathy

“…Post-mortem studies on lung samples from patients with COVID-19 also uncovered substantial EC damage, with evidence of apoptosis and loss of junctional integrity [ 101 ]. Furthermore, biomarkers of endothelial dysfunction are detected in the blood of patients with COVID-19 and appear to have prognostic relevance, being associated with severe disease [ 114 , 115 , 116 ]. The von Willebrand factor, a molecular marker of endothelial dysfunction, is increased in association with the development of ARDS following SARS-CoV-2 infection [ 114 ].…”