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儿童多系统炎症综合征(MIS-C)的炎症和自身免疫方面:一项前瞻性队列研究。

Inflammatory and Autoimmune Aspects of Multisystem Inflammatory Syndrome in Children (MIS-C): A Prospective Cohort Study.

机构信息

Wadsworth Center, New York State Department of Health, Albany, NY 12208, USA.

School of Public Health, University at Albany, Rensselaer, NY 12144, USA.

出版信息

Viruses. 2024 Jun 12;16(6):950. doi: 10.3390/v16060950.

Abstract

Multisystem Inflammatory Syndrome in Children (MIS-C) is a potentially life-threatening complication of COVID-19. The pathophysiological mechanisms leading to severe disease are poorly understood. This study leveraged clinical samples from a well-characterized cohort of children hospitalized with COVID-19 or MIS-C to compare immune-mediated biomarkers. Our objective was to identify selected immune molecules that could explain, in part, why certain SARS-CoV-2-infected children developed MIS-C. We hypothesized that type-2 helper T cell-mediated inflammation can elicit autoantibodies, which may account for some of the differences observed between the moderate-severe COVID-19 (COVID) and MIS-C cohort. We enumerated blood leukocytes and measured levels of selected serum cytokines, chemokines, antibodies to COVID-19 antigens, and autoantibodies in children presenting to an academic medical center in Connecticut, United States. The neutrophil/lymphocyte and eosinophil/lymphocyte ratios were significantly higher in those in the MIS-C versus COVID cohort. IgM and IgA, but not IgG antibodies to SARS-CoV-2 receptor binding domain were significantly higher in the MIS-C cohort than the COVID cohort. The serum levels of certain type-2 cytokines (interleukin (IL)-4, IL-5, IL-6, IL-8, IL-10, IL-13, and IL-33) were significantly higher in children with MIS-C compared to the COVID and SARS-CoV-2-negative cohorts. IgG autoantibodies to brain antigens and pentraxin were higher in children with MIS-C compared to SARS-CoV-19-negative controls, and children with MIS-C had higher levels of IgG anti-contactin-associated protein-like 2 (caspr2) compared to the COVID and SARS-CoV-19-negative controls. We speculate that autoimmune responses in certain COVID-19 patients may induce pathophysiological changes that lead to MIS-C. The triggers of autoimmunity and factors accounting for type-2 inflammation require further investigation.

摘要

儿童多系统炎症综合征 (MIS-C) 是 COVID-19 的一种潜在危及生命的并发症。导致严重疾病的病理生理机制尚未完全了解。本研究利用来自具有良好特征的 COVID-19 或 MIS-C 住院儿童队列的临床样本,比较免疫介导的生物标志物。我们的目的是确定选定的免疫分子,这些分子部分可以解释为什么某些 SARS-CoV-2 感染的儿童会发展为 MIS-C。我们假设 2 型辅助 T 细胞介导的炎症可以引发自身抗体,这可能解释了中度至重度 COVID-19(COVID)和 MIS-C 队列之间观察到的一些差异。我们对美国康涅狄格州一所学术医疗中心就诊的儿童进行了血液白细胞计数,并测量了选定的血清细胞因子、趋化因子、COVID-19 抗原抗体和自身抗体的水平。中性粒细胞/淋巴细胞和嗜酸性粒细胞/淋巴细胞比值在 MIS-C 与 COVID 队列之间显著升高。与 COVID 队列相比,MIS-C 队列中 SARS-CoV-2 受体结合域的 IgM 和 IgA,但不是 IgG 抗体显著升高。与 COVID 和 SARS-CoV-2 阴性队列相比,MIS-C 患儿血清中某些 2 型细胞因子(白细胞介素 (IL)-4、IL-5、IL-6、IL-8、IL-10、IL-13 和 IL-33)水平显著升高。与 SARS-CoV-19 阴性对照组相比,MIS-C 患儿的脑抗原和 pentraxin IgG 自身抗体更高,与 COVID 和 SARS-CoV-19 阴性对照组相比,MIS-C 患儿的 IgG 抗接触蛋白相关蛋白样 2(caspr2)更高。我们推测,某些 COVID-19 患者的自身免疫反应可能会引起导致 MIS-C 的病理生理变化。自身免疫的触发因素和导致 2 型炎症的因素需要进一步研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/71ac/11209514/33319368eb23/viruses-16-00950-g001.jpg

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