Department of Cellular and Molecular Medicine, University of California San Diego, San Diego, USA.
Department of Medicine, University of California San Diego, San Diego, USA.
Nat Commun. 2022 May 16;13(1):2687. doi: 10.1038/s41467-022-30357-w.
Multisystem inflammatory syndrome in children (MIS-C) is an illness that emerged amidst the COVID-19 pandemic but shares many clinical features with the pre-pandemic syndrome of Kawasaki disease (KD). Here we compare the two syndromes using a computational toolbox of two gene signatures that were developed in the context of SARS-CoV-2 infection, i.e., the viral pandemic (ViP) and severe-ViP signatures and a 13-transcript signature previously demonstrated to be diagnostic for KD, and validated our findings in whole blood RNA sequences, serum cytokines, and formalin fixed heart tissues. Results show that KD and MIS-C are on the same continuum of the host immune response as COVID-19. Both the pediatric syndromes converge upon an IL15/IL15RA-centric cytokine storm, suggestive of shared proximal pathways of immunopathogenesis; however, they diverge in other laboratory parameters and cardiac phenotypes. The ViP signatures reveal unique targetable cytokine pathways in MIS-C, place MIS-C farther along in the spectrum in severity compared to KD and pinpoint key clinical (reduced cardiac function) and laboratory (thrombocytopenia and eosinopenia) parameters that can be useful to monitor severity.
儿童多系统炎症综合征 (MIS-C) 是一种在 COVID-19 大流行期间出现的疾病,但与大流行前川崎病 (KD) 的综合征有许多临床特征相似。在这里,我们使用在 SARS-CoV-2 感染背景下开发的两个基因特征的计算工具箱,即病毒大流行 (ViP) 和严重-ViP 特征,以及先前证明对 KD 具有诊断意义的 13 个转录本特征,来比较这两种综合征,并在全血 RNA 序列、血清细胞因子和福尔马林固定的心脏组织中验证我们的发现。结果表明,KD 和 MIS-C 与 COVID-19 一样,处于宿主免疫反应的同一连续谱上。这两种儿科综合征都汇聚在以 IL15/IL15RA 为中心的细胞因子风暴上,提示免疫发病机制存在共同的近端途径;然而,它们在其他实验室参数和心脏表型上存在差异。ViP 特征揭示了 MIS-C 中独特的可靶向细胞因子途径,将 MIS-C 与 KD 相比,在严重程度上处于更严重的范围内,并确定了关键的临床(心脏功能降低)和实验室(血小板减少和嗜酸性粒细胞减少)参数,这些参数可用于监测严重程度。