Cited by 247Kawasaki Disease and Coronary ComplicationsCOVID-19 Clinical Research StudiesSARS-CoV-2 and COVID-19 Research

Immunopathological signatures in multisystem inflammatory syndrome in children and pediatric COVID-19

Open access
Sacco, Keith, Castagnoli, Riccardo, Vakkilainen, Svetlana, Liu, Can, Delmonte, Ottavia M., Oguz, Cihan, Kaplan, Ian M., Alehashemi, Sara +82 more·2022·Nature Medicine

Published version of a preprint

Abstract

Pediatric Coronavirus Disease 2019 (pCOVID-19) is rarely severe; however, a minority of children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might develop multisystem inflammatory syndrome in children (MIS-C), with substantial morbidity. In this longitudinal multi-institutional study, we applied multi-omics (analysis of soluble biomarkers, proteomics, single-cell gene expression and immune repertoire analysis) to profile children with COVID-19 (n = 110) and MIS-C (n = 76), along with pediatric healthy controls (pHCs; n = 76). pCOVID-19 was characterized by robust type I interferon (IFN) responses, whereas prominent type II IFN-dependent and NF-κB-dependent signatures, matrisome activation and increased levels of circulating spike protein were detected in MIS-C, with no correlation with SARS-CoV-2 PCR status around the time of admission. Transient expansion of TRBV11-2 T cell clonotypes in MIS-C was associated with signatures of inflammation and T cell activation. The association of MIS-C with the combination of HLA A*02, B*35 and C*04 alleles suggests genetic susceptibility. MIS-C B cells showed higher mutation load than pCOVID-19 and pHC. These results identify distinct immunopathological signatures in pCOVID-19 and MIS-C that might help better define the pathophysiology of these disorders and guide therapy.

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  • SASP-typical cytokines, extracellular matrix-active proteases, and SASP-related pro-coagulant and complement-activating factors are strongly elevated in the serum of COVID-19 patients compared with healthy controls.

    “were also strongly elevated in the serum of patients with COVID-19 compared to healthy controls28,52,67–70.”

    From COVID-19 and cellular senescence (2023) · cites this paper as [69]

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  1. [63]COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Accessed 28 June 2021. 34003615

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Authors
Sacco, K., Castagnoli, R., Vakkilainen, S., Liu, C., Delmonte, O. M., Oguz, C., Kaplan, I. M., Alehashemi, S., Burbelo, P. D., Bhuyan, F., de Jesus, A. A., Dobbs, K., Rosen, L. B., Cheng, A., Shaw, E., Vakkilainen, M. S., Pala, F., Lack, J., Zhang, Y., Fink, D. L., Oikonomou, V., Snow, A. L., Dalgard, C. L., Chen, J., Sellers, B. A., Montealegre Sanchez, G. A., Barron, K., Rey-Jurado, E., Vial, C., Poli, M. C., Licari, A., Montagna, D., Marseglia, G. L., Licciardi, F., Ramenghi, U., Discepolo, V., Lo Vecchio, A., Guarino, A., Eisenstein, E. M., Imberti, L., Sottini, A., Biondi, A., Mató, S., Gerstbacher, D., Truong, M., Stack, M. A., Magliocco, M., Bosticardo, M., Kawai, T., Danielson, J. J., Hulett, T., Askenazi, M., Hu, S., NIAID Immune Response to COVID Group, Barnett, J., Cheng, X., Kaladi, K., Kuram, V., Mackey, J., Bansal, N. M., Martins, A. J., Palterer, B., Matthews, H., Mudunuri, U., Nambiar, M., Oler, A. J., Rastegar, A., Samuel, S., Shyu, C., Waingankar, V., Weber, S., Xirasagar, S., Chile MIS-C Group, Espinosa, Y., Astudillo, C., Piñera, C., González, R., Pavia Pediatric COVID-19 Group, De Filippo, M., Votto, M., Montagna, L., Cohen, J. I., Su, H. C., Kuhns, D. B., Lionakis, M. S., Snyder, T. M., Holland, S. M., Goldbach-Mansky, R., Tsang, J. S., & Notarangelo, L. D.
Affiliations
  • National Institutes of Health (US)
  • Adaptive Biotechnologies (United States) (US)
  • Aalto University (FI)
  • Frederick National Laboratory for Cancer Research (US)
  • Uniformed Services University of the Health Sciences (US)
  • Clínica Alemana (CL)
  • University of Pavia (IT)
  • Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
  • University of Naples Federico II (IT)
  • Hadassah Medical Center (IL)
  • Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
  • Azienda Ospedaliera San Gerardo (IT)
  • Legacy Emanuel Medical Center (US)
  • Stanford Medicine (US)
  • National Institute of Allergy and Infectious Diseases (US)
  • Hospital Roberto del Rio (CL)
Corresponding author
Notarangelo, Luigi D.
Venue
Nature Medicine
Published
2022-02-17
Volume
28
Issue
5
Pages
1050-1062
ISSN
  • 1078-8956 (ISSN-L)
  • 1546-170X
OpenAlex
W4213211303
Cited by
247
References
84
Citations by year
2026: 17 · 2025: 35 · 2024: 56 · 2023: 78 · 2022: 60 · 2021: 1
FWCI
54.67
Type
journal article
Language
en
Open access
Locations
  • Nature Medicine (publishedVersion)
  • medRxiv (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Aaltodoc (Aalto University) (submittedVersion, other-oa)
  • BOA (University of Milano-Bicocca) (submittedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
Funders
  • U.S. Department of Defense
  • U.S. Department of Health and Human Services (75N91019D00024)
  • Division of Intramural Research, National Institute of Allergy and Infectious Diseases (75N91019D00024)
  • Università degli Studi di Napoli Federico II
  • Suomen Lääketieteen Säätiö
  • Università degli Studi di Pavia
  • Orionin Tutkimussäätiö
  • Regione Lombardia
  • Agencia Nacional de Investigación y Desarrollo (1201240, 11181222)
  • National Institutes of Health (75N91019D00024, COVID-19)
  • Uniformed Services University of the Health Sciences
  • National Cancer Institute (75N91019D00024)
  • National Institute of Allergy and Infectious Diseases (AI001270, COVID-19, 75N91019D00024, ZIAAI001265, ZIAAI001270)
  • National Institute of Dental and Craniofacial Research
  • NHLBI Division of Intramural Research
Topics
  • Health Sciences › Medicine › Surgery › Kawasaki Disease and Coronary Complications
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
Keywords
multisystem inflammatory syndrome in children, pediatric COVID-19, SARS-CoV-2, immunopathology, type I interferon response, interferon-gamma, NF-κB signaling, T cell activation, immune repertoire, proteomics, transcriptomics, single-cell gene expression
MeSH terms
COVID-19, SARS-CoV-2, Child, Humans, T-Lymphocytes, Systemic Inflammatory Response Syndrome

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