COVID-19, MIS-C and Kawasaki disease: Same immune response?

The emergence of COVID-19 prompted doctors and researchers to urgently define effective treatments for this new disease, but soon new complications emerged associated with SARS-CoV-2: a subset of children infected with the virus also felt abdominal pain, headache, rash and vomiting. This new group of symptoms, defined as “multisystem inflammatory syndrome in children” or MIS-C, has required treatment in intensive care for a large number of pediatric patients.

3 inflammatory syndromes that compare and oppose each other

As the number of MIS-C cases increased, doctors began noting similarities to a pre-pandemic illness, Kawasaki disease. MIS-C and Kawasaki disease share many symptoms, including fever, rash, bloodshot eyes, although Kawasaki disease has more specific symptoms and complications, including coronary artery aneurysms and seizures. cardiac. Unlike MIS-C, which is associated with SARS-CoV-2, Kawasaki disease can be triggered by a variety of infectious and environmental stimuli.

The study: California researchers here analyze blood and tissue samples from patients with the different syndromes and, using artificial intelligence tools, compare their gene expression patterns. These analyzes reveal that:

  • MIS-C and Kawasaki disease are on the same immune response continuum as COVID-19, with MIS-C corresponding to a more severe version of the response than Kawasaki disease;
  • Despite these underlying similarities, several laboratory and clinical parameters differ between the 3 syndromes. This could make it possible to promote the diagnosis, monitoring and treatment of each of them, in pediatric patients;
  • 166 genes are found to be expressed in the various viral respiratory diseases, including COVID-19, a subset of which also corresponds to the severity of the disease;
  • this same “genetic signature” is found in both MIS-C and Kawasaki disease; which suggests that these 2 conditions arise from a similar underlying mechanism, involving in particular the rapid release of certain cytokines (IL15/IL15RA);
  • 13 genes previously used to identify Kawasaki disease constitute a genetic signature shared by MIS-C.

Subtle differences are noted between the 2 syndromes: MIS-C patients have lower platelet and eosinophil counts, 2 characteristics easily measured by routine blood tests. Finally, some serum cytokines are found at higher levels in MIS-C samples than in samples from patients with Kawasaki disease;

Therapeutic avenues: these latest results suggest the efficacy of therapies targeting some of these cytokines, in particular TNFα and IL1β, already approved by the US Food and Drug Administration (FDA) and currently being tested, as new treatments for MIS-C .

“Some children are genetically predisposed to react more intensely, leading to inflammation and unwanted symptoms throughout the body,” summarizes one of the co-authors, Dr. Jane C. Burns, a pediatrician at Rady Children’s Hospital in San Diego and director of the Kawasaki Disease Research Center at UC San Diego.

“The earlier we can identify and understand the child’s inflammatory condition, the better we can adapt our care protocol.”

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COVID-19, MIS-C and Kawasaki disease: Same immune response?

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