2022: a year in MIS-C research NatRevRheumatol UCSDMedSchool radychildrens children child childhealth Paediatrics Paediatricrheumatology rheumatology
Background MIS-C is characterized by acute hyperinflammation in multiple organ systems in the following weeks of a viral infection, which can be fatal. The clinical manifestations of the syndrome have been well-characterized; however, data on the immunological responses, pathophysiology, and outcomes of the syndrome are limited.
Nature of vascular injury in MIS-C Studies conducted during the initial COVID-19 period indicated vascular pathophysiology, with coronary artery dilation observed on ECG , with serological findings of thrombocytopenia or reduced platelet count and elevated D-dimer levels. The vascular findings were indicative of low-grade coagulation within the blood vessels. However, further assessments indicated that the coronary vessel damage was short-term.
Studies have reported that the human cardiac endothelium expresses ACE2 , the receptors required by SARS-CoV-2 for entry into host cells. However, the endothelial cells do not permit SARS-CoV-2 replication. The finding could justify the sparing effect of the coronary endothelium among MIS-C patients.
Another study evaluated T lymphocyte responses to SARS-CoV-2 peptide pools among children during the subacute MIS-C period. Numerous Vβ21.3-possessing CD4+ lymphocytes and CD8+ lymphocytes were observed; however, the lymphocytes were not a part of the T lymphocyte population activated by SARS-CoV-2. The findings indicated that the T lymphocyte expansion occurs as a response to an antigen unrelated to SARS-CoV-2.
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