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Cytokine and Whole-Genome Sequence Analysis in Korean Patients With Multisystem Inflammatory Syndrome in Children
Hwanhee Park1, Hye-Kyung Cho2, Doo Ri Kim3
1Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea.
Insights
This study monitored Multisystem Inflammatory Syndrome in Children (MIS-C) in South Korea, confirming 55 cases and analyzing clinical features and biomarkers. Findings highlight the need for ongoing surveillance and research into MIS-C pathogenesis.
Area of Science:
- Pediatric infectious diseases
- Immunology
- Genetics
Background:
- Multisystem Inflammatory Syndrome in Children (MIS-C) is a serious complication of COVID-19.
- National surveillance of MIS-C in South Korea was conducted from May 2020 to March 2023.
- The second phase of surveillance (August 2022-March 2023) enhanced reporting and included analysis of cytokine changes and genetic factors.
Purpose of the Study:
- To monitor epidemiological and clinical characteristics of MIS-C cases in South Korea.
- To analyze serum cytokine profiles and genetic factors in MIS-C patients.
- To evaluate an enhanced web-based reporting system for MIS-C surveillance.
Main Methods:
- Implemented a user-friendly web-based electronic case report form (e-CRF) for enhanced reporting.
- Reviewed cases from August 2022 to March 2023 and unclassified cases from the prior period.
- Conducted serum cytokine measurements and whole-genome sequencing on consenting patients.
Main Results:
- Confirmed 55 MIS-C cases, with a median age of 7.8 years; 54.5% were male.
- Clinical findings included abnormal echocardiography (27%) and ICU care (9.1%); 81.8% received steroids and 83.6% received IVIG.
- Elevated serum cytokines (IL-6, IL-17, IL-10, CXCL10) decreased post-treatment; no known MIS-C genetic variants were found.
Conclusions:
- Continuous MIS-C surveillance is crucial due to potential serious complications.
- Clinicians must remain vigilant in diagnosing MIS-C.
- Further research is required to understand the pathogenesis of MIS-C.
Background:
Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious complication after coronavirus disease 2019. In South Korea, the Korea Disease Control and Prevention Agency has conducted national surveillance of MIS-C from May 2020 to March 2023. This project was carried out during the second phase of the surveillance, which included enhancements to the reporting system starting in August 2022. In addition to monitoring the epidemiological and clinical characteristics, we analyzed cytokine changes and genetic factors.
Methods:
A user-friendly web-based reporting system using an electronic case report form (e-CRF) was established to provide clinicians in the field with easy access to reports. Cases collected from August 2022 to March 2023 were evaluated to confirm diagnoses, and unclassified cases from the prior research period were also reviewed. For patients who provided consent, serum cytokine measurements and whole-genome sequence analyses were conducted.
Results:
In this study, 55 cases were confirmed as MIS-C. Of the 32 cases reported via e-CRF in the second period, 28 were confirmed as MIS-C. Among 31 cases reported but unclassified in the first period, 27 were subsequently confirmed as MIS-C. The median patient age was 7.8 years (range: 2 months to 16 years), with 54.5% (30/55) male. Clinically, 15 patients (27%) had abnormal echocardiography findings, and 5 (9.1%) required intensive care unit care. Steroids were administered to 45 patients (81.8%) and intravenous immunoglobulin to 46 (83.6%). No mortality occurred. In two patients, 17 serum cytokines were measured pre- and post-treatment, with interleukin (IL)-6, IL-17/IL-17A, IL-1ra/IL-1F3, IL-10, and CXC motif chemokine ligand 10 (CXCL10)/inducible protein 10 kDa (IP-10) peaking before treatment and decreasing afterward. Whole-genome sequencing in 6 patients revealed no previously reported MIS-C-associated genetic variants.
Conclusion:
Continuous monitoring of MIS-C cases is essential, as some may develop serious complications. Clinicians should remain vigilant in diagnosing MIS-C, and further research is needed to elucidate its pathogenesis.
