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The immunopathogenesis of SARS-CoV-2 infection in children: diagnostics, treatment and prevention
Harsita Patel1, Andrew McArdle1, Eleanor Seaby1,2,3
1Department of Infectious Disease, Section of Paediatric Infectious Disease Imperial College London London UK.
Insights
Children exhibit distinct COVID-19 (coronavirus disease) responses compared to adults, with lower mortality. Understanding pediatric immune protection may reveal insights into adult disease severity and new therapies.
Area of Science:
- Immunology
- Infectious Diseases
- Pediatrics
Background:
- Paediatric COVID-19 (coronavirus disease) presents with significantly lower morbidity and mortality than adult cases.
- Age-related differences in innate and adaptive immune responses likely explain variations in disease severity.
- Severe outcomes in adults are driven by immunopathogenesis, offering potential insights from pediatric immunity.
Purpose of the Study:
- To review and compare immune responses to SARS-CoV-2 in children versus adults.
- To investigate pediatric immune features that may protect against severe COVID-19.
- To explore therapeutic strategies informed by pediatric immune responses.
Main Methods:
- Review of studies on pre-existing immunity, cytokine profiles, and immune cell responses (innate, B-cell, T-cell, antibody, vaccine) in children with acute COVID-19 and multisystem inflammation.
- Comparison of pediatric responses with those in COVID-19 adults and healthy controls.
- Analysis of clinical presentations including multisystem inflammatory syndrome in children (MIS-C).
Main Results:
- Children generally display milder acute COVID-19 symptoms but can develop delayed multisystem inflammation (MIS-C).
- Immune responses, including antibody and T-cell profiles, differ between pediatric and adult COVID-19.
- Kawasaki Disease-like presentations and cardiac involvement (coronary artery aneurysms) are noted in some pediatric cases.
Conclusions:
- Understanding pediatric immune responses to SARS-CoV-2 is critical for deciphering adult COVID-19 severity.
- Pediatric immune system characteristics may hold keys to novel therapeutic targets.
- Further research is needed to address knowledge gaps in pediatric COVID-19 immunology and treatment.
Abstract:
Symptoms and outcomes for paediatric COVID-19 differ vastly from those for adults, with much lower morbidity and mortality. Immunopathogenesis drives severe outcomes in adults, and it is likely that age-related differences in both the innate and specific immune responses underlie much of the variation. Understanding the protective features of the paediatric immune system may be crucial to better elucidate disease severity in adult COVID-19 and may pave the way for novel therapeutic approaches. However, as well as uncommon cases of severe paediatric acute COVID-19, there have been children who have presented with delayed multisystem inflammation, including cardiac, gastrointestinal, skin, mucosa and central nervous system involvement. The occurrence of coronary artery aneurysms has drawn comparisons with Kawasaki Disease, but similarities with the inflammatory phase of adult acute COVID-19 have also been drawn. In this review, we summarise findings from studies investigating pre-existing immunity, cytokine profiles, innate, B-cell, antibody, T-cell and vaccine responses in children with acute COVID-19 and multisystem inflammation, compared with COVID-19 adults and controls. We further consider the relevance to therapeutics in the context of limited evidence in children and highlight key questions to be answered about the immune response of children to SARS-CoV-2.
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