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Immune profile of children diagnosed with multisystem inflammatory syndrome associated with SARS-CoV-2 infection
Ewelina Gowin1, Grzegorz Dworacki2, Bartosz Siewert1
1Health Promotion Department, Poznan University of Medical Sciences, Poland.
Insights
Multisystem inflammatory syndrome in children (MIS-C) involves prolonged lymphopenia, a potential marker for early detection. This immune profile differs from Kawasaki disease but resembles severe COVID-19 in adults.
Area of Science:
- Pediatric Immunology
- Infectious Diseases
- COVID-19 Research
Background:
- The pathophysiology of multisystem inflammatory syndrome in children (MIS-C) linked to SARS-CoV-2 infection is not well understood.
- Defining peripheral blood immune features in MIS-C patients is crucial for understanding disease mechanisms.
Purpose of the Study:
- To investigate the peripheral blood immune cell profile in children diagnosed with MIS-C.
- To compare the immune characteristics of MIS-C in children with other conditions like COVID-19 in adults and Kawasaki disease in children.
Main Methods:
- Analysis of seven pediatric patients diagnosed with MIS-C.
- Evaluation of immune markers including T cell subsets (CD4+, CD8+), B cells, and inflammatory markers.
- Comparison of patient immune profiles with data from adults with severe COVID-19 and children with Kawasaki disease.
Main Results:
- MIS-C patients exhibited elevated inflammatory markers, SARS-CoV-2 IgG antibodies, and significant lymphopenia with decreased CD4+ and CD8+ T cells.
- A majority of CD4+ T cells were naive, and most patients showed an elevated CD4+/CD8+ T cell ratio.
- B cell counts were normal, with a predominance of non-memory B cells.
Conclusions:
- The immune profile in children with MIS-C resembles that of adults with severe COVID-19, not children with Kawasaki disease.
- Prolonged lymphopenia post-SARS-CoV-2 infection in children may serve as a practical alert for potential MIS-C development.
- Further research is needed to explore screening, prevention, and the potential role of steroid treatment in managing prolonged lymphopenia and preventing MIS-C.
Introduction:
The pathophysiology of multisystem inflammatory syndrome associated with SARS-CoV-2 infection (MIS-C) remains poorly understood. This study aimed to define peripheral blood immune features in patients with MIS-C.
Material And Methods:
We analyzed seven children diagnosed with MIS-C between April 1 and May 15, 2021, in St. Joseph's Children's Hospital in Poznan (Poland).
Results:
All patients had elevated inflammatory markers, IgG antibodies against SARS-CoV-2, and lymphopenia with a marked decrease in CD4+ and CD8+ T cells. The majority of CD4+ T cells were naive cells. Almost all (6/7) of the analyzed patients had a higher CD4+/CD8+ T cell ratio than average values. B cells were within the normal range - the majority were non-memory cells.
Conclusions:
Children with MIS-C do not resemble adults during COVID-19 recovery. The immune profile of the studied patients differs from that of children with Kawasaki disease (KD), but it is similar to that of adults with severe COVID-19. The proposed explanation is a profound lymphopenia caused by SARS-CoV-2 infection - which persists for weeks - as a result leading to uncontrolled inflammation. In COVID-19 patients the T cell level returns to normal after the second week of the disease. Our data suggest that in children prolonged lymphopenia after COVID-19 can be a practical marker for possible MIS-C alert. If there is a continuum from lymphopenia to MIS-C, there is room for screening and prevention. Further studies are needed to determine whether steroid treatment introduced in a child with prolonged lymphopenia could stop the inflammatory process.
