2020
DOI: 10.1016/j.cell.2020.09.016
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The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19

Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is typically very mild and often asymptomatic in children. A complication is the rare multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, presenting 4–6 weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation. The pathogenesis is unclear but has overlapping features with Kawasaki disease suggestive of vasculitis and a likely autoimmune etiology. We apply systems-level… Show more

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Cited by 786 publications
(1,100 citation statements)
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“…The sudden and widespread emergence of SARS-CoV-2 as a new pathogen enables the study of primary immune responses across all ages. The reduced respiratory symptoms and low incidence of ARDS in the pediatric population 2 suggest a distinct infection course, possibly due to lower expression of the viral receptor (angiotensin-converting enzyme 2 (ACE2)) in pediatric airway epithelial cells 27 or a more robust innate immune response in children [28][29][30] . A milder infection course in the pediatric groups is further consistent with the lower abundance of anti-N-specific antibodies identified in this study since release of N proteins requires lysis of virally infected cells.…”
Section: Nature Immunologymentioning
confidence: 99%
See 1 more Smart Citation
“…The sudden and widespread emergence of SARS-CoV-2 as a new pathogen enables the study of primary immune responses across all ages. The reduced respiratory symptoms and low incidence of ARDS in the pediatric population 2 suggest a distinct infection course, possibly due to lower expression of the viral receptor (angiotensin-converting enzyme 2 (ACE2)) in pediatric airway epithelial cells 27 or a more robust innate immune response in children [28][29][30] . A milder infection course in the pediatric groups is further consistent with the lower abundance of anti-N-specific antibodies identified in this study since release of N proteins requires lysis of virally infected cells.…”
Section: Nature Immunologymentioning
confidence: 99%
“…38 ). Additionally, autoreactive antibodies recently identified in children with MIS-C may promote aberrant immune responses leading to systemic inflammation 29,30 . Further studies delineating the differences in adult and pediatric immune responses to SARS-CoV-2 are warranted to define how protection or pathology is mediated in response to this pathogen.…”
Section: Nature Immunologymentioning
confidence: 99%
“…1 B). However, there are now clinical, microbiological and immunological data describing PIMS-TS as a novel immunopathogenic illness [5,9,10]. Similarities between PIMS-TS and KD include ubiquity of fever and high prevalence of oral mucositis, conjunctivitis and rash.…”
Section: What Are the Differential Diagnoses Of Pims-ts?mentioning
confidence: 99%
“…However, we have few data on the role of anti-viral interferons (alpha, beta and lambda) in viral clearance. Alternatively, antibody-dependent enhancement (ADE), with invasion of host cells augmented by antibody, serum proteases, or auto-antibody mediated disease [10], have been suggested. However, PIMS-TS appears to affect only children and young adults, and ADE would be expected in older adults (with more prevalent prior exposure to other coronaviruses).…”
Section: What Is the Pathobiology Of Pims-ts?mentioning
confidence: 99%
“…В другом исследовании было показано, что спектр биомаркеров «гипервоспаления» у пациентов с MIS-C отличается от нарушений, выявляемых при COVID-19 у взрослых и у детей с БК, в первую очередь в отношении преобладания Th17-типа иммунного ответа при БК [57]. Предварительные данные об особенностях профиля гиперпродукции цитокинов у пациентов MIS-C, БК, CАМ и синдромом «цитокинового шторма» при COVID-19 получены другими авторами [58,59].…”
Section: иммунопатологические механизмыunclassified