Author: Esteve-Sole, Ana; Anton, Jordi; Pino-RamÃrez, Rosa Maria; Sanchez-Manubens, Judith; Fumadó, Victoria; Fortuny, Clà udia; Rios-Barnes, MarÃa; Sanchez-de-Toledo, Joan; Girona-Alarcón, Mónica; Mosquera, Juan M; Ricart, Silvia; Launes, Cristian; de Sevilla, Mariona Fernández; Jou, Cristina; Muñoz-Almagro, Carmen; González-Roca, Eva; Vergara, Andrea; Carrillo, Jorge; Juan, Manel; Cuadras, Daniel; Noguera-Julian, Antoni; Jordan, Iolanda; Alsina, Laia
Title: Similarities and differences between the immunopathogenesis of COVID-19-related pediatric inflammatory multisystem syndrome and Kawasaki disease. Cord-id: 3h2dglkj Document date: 2021_1_26
ID: 3h2dglkj
Snippet: Multisystem inflammatory syndrome associated with the SARS-CoV-2 pandemic has recently been described in children (MIS-C), partially overlapping with Kawasaki disease (KD). We hypothesized that: 1) MIS-C and pre-pandemic KD cytokine profiles may be unique and justify the clinical differences observed; 2) SARS-CoV-2-specific immune complexes (IC) may explain the immunopathology of MIS-C. Seventy-four children were included: 14 MIS-C; 9 patients with positive SARS-CoV-2-PCR without MIS-C (COVID);
Document: Multisystem inflammatory syndrome associated with the SARS-CoV-2 pandemic has recently been described in children (MIS-C), partially overlapping with Kawasaki disease (KD). We hypothesized that: 1) MIS-C and pre-pandemic KD cytokine profiles may be unique and justify the clinical differences observed; 2) SARS-CoV-2-specific immune complexes (IC) may explain the immunopathology of MIS-C. Seventy-four children were included: 14 MIS-C; 9 patients with positive SARS-CoV-2-PCR without MIS-C (COVID); 14 pre-pandemic KD and 37 healthy controls (HC). Thirty-four circulating cytokines were quantified in pre-treatment serum or plasma samples and the presence of circulating SARS-CoV-2 IC was evaluated in MIS-C patients. Compared to HC, MIS-C and KD groups showed most cytokines to be significantly elevated, with IFN-γ-induced response markers (including IFN-γ, IL-18, IP-10) and inflammatory monocytes activation markers (including MCP-1, IL-1α, IL-1RA) being the main triggers of inflammation. With linear discriminant analysis, MIS-C and KD profiles overlapped; however, a subgroup of MIS-C patients (MIS-Cplus) differentiated from the remaining MIS-C patients in IFN-γ, IL-18, GM-CSF, RANTES, IP-10, IL-1α and SDF-1 and incipient signs of macrophagic activation syndrome. Circulating SARS-CoV-2-IC were not detected in MIS-C patients. Our findings suggest a major role of IFN-γ in the pathogenesis of MIS-C, which may be relevant for therapeutic management.
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