A biomarker of COVID-19 in children


A rare but serious inflammatory disease that affects children who contract COVID-19 produces a distinct model of biomarkers that can help doctors predict the severity of the disease and also help researchers develop new treatments, according to a study conducted by Cedars -Sinai.

The study focused on multisystem inflammatory syndrome in children (MIS-C), an inflammatory response involving multiple organs that can occur weeks after infection with SARS-CoV-2, the virus that causes COVID -19. Although most patients improve with medical care, more than half of MIS-C cases in the United States require intensive care admission, and the condition can be life-threatening.

A total of 4,404 cases of MIS-C and 37 deaths in the United States had been reported to the Centers for Disease Control and Prevention as of August 15. The median age of MIS-C patients was 9 years old, and more than 60% of cases were in black or Latin children, according to the report.

“Improving our understanding of MIS-C in today’s environment is crucial, given reports of an increasing rate of children hospitalized with COVID-19 in the United States and the return of many students to the United States. ‘school for the fall term, “Moshe Arditi said. , MD, director of the pediatric infectious disease division at Cedars-Sinai. “The disproportionate impact of MIS-C linked to race and ethnicity is particularly disturbing.”

Arditi, professor of pediatrics and GUESS? / Fashion Industries Guild chair in children’s community health, is co-lead author of the new study, published in the peer-reviewed Journal of Clinical Investigation. The other co-lead authors are Jennifer Van Eyk, PhD, director of the Institute for Research in Advanced Clinical Biosystems at the Smidt Heart Institute, Cedars-Sinai, and Mascha Binder, MD, of Martin Luther University, Halle-Wittenberg, Germany. .

Researchers examined a small group of patients to identify a range of pathogens culminating in MIS-C, as well as proteins in the blood that may act as biomarkers to predict the severity of the syndrome and help make treatment decisions.

A picture is emerging of MIS-C as an autoimmune disease in which the immune system becomes overactive and mistakenly attacks the body’s own organs, Arditi explained. This process can be triggered by extensive tissue damage caused by infection with SARS-CoV-2.

Children with MIS-C often show symptoms similar to those seen in the so-called cytokine storm, an inflammatory response that can be fatal in COVID-19 patients. These symptoms can include a persistent fever and gastrointestinal, respiratory, neurological, and cardiovascular problems, such as shock and inflammation of the heart muscle.

Research co-led by Arditi and her team and colleagues at the University of Pittsburgh School of Medicine, published last year, uncovered similar biological processes involved in MIS-C, the cytokine storm and the toxic shock syndrome, a rare and life-threatening complication of bacterial infections. These findings were further elucidated earlier this year in two peer-reviewed studies co-authored by Arditi.

For the new study from the Journal of Clinical Investigation, the research team took an interdisciplinary approach, bringing together specialists from Cedars-Sinai and five other institutions.

“We have deployed a range of advanced techniques including proteomics, RNA sequencing, and antibody and immune system signaling analyzes,” said Van Eyk, professor of cardiology, biomedical sciences and pathology and laboratory medicine and expert in proteomics, the study of proteins at the molecular and genetic levels. “By joining forces, we are better able to accelerate scientific discovery to keep pace with the rapidly evolving pandemic and to inform clinical decisions.”

Investigators noted that their study was limited by its small size. They examined 69 children, including those with and without MIS-C and seven with another pediatric inflammatory disorder, Kawasaki disease. Future investigations are needed to validate the results in a larger patient group, Arditi said.

Reference: Porritt RA, Binek A, Paschold L, et al. The autoimmune signature of multisystem hyperinflammatory inflammatory syndrome in children. J Clin Invest. 2021. doi: 10.1172 / JCI151520

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