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Complement Inhibition in Severe COVID-19 Acute Respiratory Distress Syndrome

Sharmila Raghunandan1,2, Cassandra D Josephson2,3, Hans Verkerke3

  • 1Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.

Frontiers in Pediatrics
|January 15, 2021
PubMed

Insights

Most children with COVID-19 experience mild illness, but severe cases can cause acute respiratory distress syndrome (ARDS). Complement-mediated lung injury may play a role, as suggested by a case treated with convalescent plasma and eculizumab.

Area of Science:

  • Pediatric critical care medicine
  • Immunology
  • Infectious diseases

Background:

  • COVID-19 in children often presents as mild or asymptomatic illness.
  • Critically ill children with COVID-19 may develop acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI).
  • Lung function deterioration in COVID-19 is associated with microangiopathic and immune-mediated processes, potentially involving complement activation.

Observation:

  • The role of complement-mediated acute lung injury is supported by animal models, human autopsy data, and therapeutic responses.
  • A case of a child with severe COVID-19 treated with convalescent plasma and eculizumab is presented.
  • Detailed evaluation of inflammatory pathways in this case is provided.

Findings:

  • Complement inhibition may be a therapeutic target for severe COVID-19 ARDS.
  • Understanding inflammatory pathways is crucial for managing critical illness in children.
  • Convalescent plasma and eculizumab were used in a pediatric case of severe COVID-19.

Implications:

  • This case highlights the potential role of complement in pediatric COVID-19 lung injury.
  • Further research into complement-targeted therapies for severe COVID-19 in children is warranted.
  • Insights into inflammatory pathways can inform treatment strategies for critical COVID-19.

Keywords:
COVID - 19SARS-CoV-2acute respiratory distress syndrome (ARDS)childrencomplementeculizumabpediatric

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