Immunopathological signatures in multisystem inflammatory syndrome in children and pediatric COVID-19
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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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Jin, H., Zhan, L., Mei, S.-F., et al. (2020) · Medical Science Monitor · doi:10.12659/msm.923449 · Cited by 13 · see citing works
Increased serum levels of IL‐33 and soluble ST2 in neonates with human cytomegalovirus infection
Chen, Y., & Qian, J. (2018) · Journal of Medical Virology · doi:10.1002/jmv.25187 · Cited by 7 · see citing works
Autoantibodies Detected in MIS-C Patients due to Administration of Intravenous ImmunoglobulinPreprint
Burbelo, P. D., Castagnoli, R., Shimizu, C., et al. (2021) · medRxiv · doi:10.1101/2021.11.03.21265769 · Cited by 4 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 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
Cited by
Sorted by citations
COVID-19 and cellular senescence
Schmitt, C. A., Tchkonia, T., Niedernhofer, L. J., Robbins, P. D., Kirkland, J. L., & Lee, S. (2023) · Nature Reviews Immunology · doi:10.1038/s41577-022-00785-2 · Cited by 153 · see citing works
- 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.
- ORCID
- Sacco, Keith
- Castagnoli, Riccardo
- Vakkilainen, Svetlana
- Liu, Can
- Delmonte, Ottavia M.
- Oguz, Cihan
- Kaplan, Ian M.
- Alehashemi, Sara
- Burbelo, Peter D.
- Bhuyan, Farzana
- Dobbs, Kerry
- Rosen, Lindsey B.
- Cheng, Aristine
- Shaw, Elana
- Vakkilainen, Mikko S.
- Pala, Francesca
- Lack, Justin
- Zhang, Yu
- Fink, Danielle L.
- Oikonomou, Vasileios
- Snow, Andrew L.
- Dalgard, Clifton L.
- Chen, Jinguo
- Sellers, Brian A.
- Barron, Karyl
- Rey-Jurado, Emma
- Vial, Cecilia
- Poli, Maria Cecilia
- Licari, Amelia
- Montagna, Daniela
- Marseglia, Gian Luigi
- Licciardi, Francesco
- Ramenghi, Ugo
- Discepolo, Valentina
- Guarino, Alfredo
- Eisenstein, Eli M.
- Imberti, Luisa
- Sottini, Alessandra
- Biondi, Andrea
- Gerstbacher, Dana
- Stack, Michael A.
- Bosticardo, Marita
- Kawai, Tomoki
- Danielson, Jeffrey J.
- Hulett, Tyler
- Askenazi, Manor
- Hu, Shaohui
- Cheng, Xi
- Martins, Andrew J.
- Palterer, Boaz
- Oler, Andrew J.
- Rastegar, Andre
- Astudillo, Camila
- González, Ricardo
- Votto, Martina
- Cohen, Jeffrey I.
- Su, Helen C.
- Kuhns, Douglas B.
- Lionakis, Michail S.
- Snyder, Thomas M.
- Holland, Steven M.
- Tsang, John S.
- Notarangelo, Luigi D.
- Venue
- Nature Medicine
- Published
- 2022-02-17
- Volume
- 28
- Issue
- 5
- Pages
- 1050-1062
- ISSN
- 1078-8956 (ISSN-L)
- 1546-170X
- PMC
- PMC9119950
- 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
- bronze
- doi.org
- 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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