Establishment of a pediatric COVID-19 biorepository: unique considerations and opportunities for studying the impact of the COVID-19 pandemic on children

Abstract

Background COVID-19, the disease caused by the highly infectious and transmissible coronavirus SARS-CoV-2, has quickly become a morbid global pandemic. Although the impact of SARS-CoV-2 infection in children is less clinically apparent, collecting high-quality biospecimens from infants, children, and adolescents in a standardized manner during the COVID-19 pandemic is essential to establish a biologic understanding of the disease in the pediatric population. This biorepository enables pediatric centers world-wide to collect samples uniformly to drive forward our understanding of COVID-19 by addressing specific pediatric and neonatal COVID-19-related questions. Methods A COVID-19 biospecimen collection study was implemented with strategic enrollment guidelines to include patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2 infected mothers, and asymptomatic children. The methodology described here, details the importance of establishing collaborations between the clinical and research teams to harmonize protocols for patient recruitment and sample collection, processing and storage. It also details modifications required for biobanking during a surge of the COVID-19 pandemic. Results Considerations and challenges facing enrollment of neonatal and pediatric cohorts are described. A roadmap is laid out for successful collection, processing, storage and database management of multiple pediatric samples such as blood, nasopharyngeal and oropharyngeal swabs, sputum, saliva, tracheal aspirates, stool, and urine. Using this methodology, we enrolled 327 participants, who provided a total of 972 biospecimens. Conclusions Pediatric biospecimens will be key in answering questions relating to viral transmission by children, differences between pediatric and adult viral susceptibility and immune responses, the impact of maternal SARS-CoV-2 infection on fetal development, and factors driving the Multisystem Inflammatory Syndrome in Children. The specimens in this biorepository will allow necessary comparative studies between children and adults, help determine the accuracy of current pediatric viral testing techniques, in addition to, understanding neonatal exposure to SARS-CoV-2 infection and disease abnormalities. The successful establishment of a pediatric biorepository is critical to provide insight into disease pathogenesis, and subsequently, develop future treatment and vaccination strategies.

Humoral signatures of protective and pathological SARS-CoV-2 infection in children

“…Informed consent of the pediatric cohort included approval to publish results from research studies using de-identified patient samples. A detailed description of the pediatric cohort characteristics was previously published 3,40 . Patients were diagnosed with COVID-19-related symptoms and had positive PCR and/or serology for SARS-CoV-2.…”

A longitudinal SARS-CoV-2 biorepository for COVID-19 survivors with and without post-acute sequelae

“…A systematic and calculated approach to investigating the course of SARS-CoV-2 infection is needed to understand varied susceptibility to severe SARS-CoV-2 disease and COVID-19 sequelae. Scientists and industry have expressed the importance of a biorepository as an essential building block for critical research [11][12][13][14][15][16][17]. Biobanking efforts for SARS-CoV-2 are underway globally, yet most are comprised of limited specimen types collected from participants at a single time point [16,[18][19][20][21].…”

“…Scientists and industry have expressed the importance of a biorepository as an essential building block for critical research [11][12][13][14][15][16][17]. Biobanking efforts for SARS-CoV-2 are underway globally, yet most are comprised of limited specimen types collected from participants at a single time point [16,[18][19][20][21]. The Northern Colorado SARS-CoV-2 Biorepository (NoCo-COBIO) is uniquely multifaceted and contains longitudinal clinical data, electronic medical records (EMR), demographics, quality of life surveys, and biological specimens of stool, saliva, nasopharyngeal swab specimens, plasma, serum, peripheral blood mononuclear cells (PBMCs), and breastmilk if available, from each SARS-CoV-2-infected participant.…”

COVID-19 Pediatric Dermatology

“… 31 Pathogenesis theories include the role of an overly robust pediatric innate and/or cellular immune response, 27 superantigen region on the SARS-CoV-2 spike protein, 32 , 33 and immune-complex development from viral antigens (type III hypersensitivity) 34 inciting strong cytokine cascade. A pediatric biorepository has been established with one main goal to better understand the complex immunologic mechanisms underpinning MIS-C. 35 …”