Quantitative SARS-CoV-2 Serology in Children With Multisystem Inflammatory Syndrome (MIS-C)

Abstract

This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version.

Deep Immune Profiling of MIS-C demonstrates marked but transient immune activation compared to adult and pediatric COVID-19

“…In the United States, almost all MIS-C patients are seropositive for SARS-CoV-2 specific antibodies, consistent with a delayed clinical presentation compared to acute SARS-CoV-2 infection 40,[108][109][110] . Both pediatric COVID-19 and MIS-C had similar frequencies of naive B cells, CD27-IgD-B cells, non-switched memory, and switched memory B cells (Fig S5A-C).…”

Multisystem Inflammatory Syndrome in Children and SARS-CoV-2 Serology

“…The anti-RBD antibody levels correlated with the erythrocyte sedimentation rate, suggesting that higher anti- Some investigators have hypothesized that children may have milder COVID-19 disease due to cross-reactive immunity to other coronaviruses, 24,25 but it is also conceivable that such prior coronavirus exposures might have increased risks of an inflammatory response or worse disease, as seen with dengue hemorrhagic fever. 26,27 The findings of Rostad et al 20 increased morbidity and mortality when vaccinees were later infected with circulating virus. [29][30][31][32] If strong anti-RBD responses are associated with an increased risk of inflammatory disorders, it may then be advantageous to develop vaccines that, while eliciting excellent anti-SARS-CoV-2 neutralizing activity, preferentially avoid eliciting strong anti-RDB immune responses.…”

“…1 The children also had high SARS-CoV-2 neutralization titers, consistent with the observations that anti-RBD antibodies can effectively neutralize the virus. 21 The MIS-C patients described in Rostad et al 20 also tended to have higher antibody levels against the entire spike protein and the viral nucleocapsid (N) protein, which is not exposed on the surface of the virion. The anti-RBD antibody levels correlated with the erythrocyte sedimentation rate, suggesting that higher anti- Some investigators have hypothesized that children may have milder COVID-19 disease due to cross-reactive immunity to other coronaviruses, 24,25 but it is also conceivable that such prior coronavirus exposures might have increased risks of an inflammatory response or worse disease, as seen with dengue hemorrhagic fever.…”

“…In this issue of Pediatrics, Rostad et al 20 showed that children hospitalized with MIS-C have significantly higher concentrations of antibodies against the receptor-binding domain (RBD), a part of the SARS-CoV-2 spike protein (S). RBD is the part of S mediating virus binding to its receptor, angiotensin-converting enzyme 2 (ACE2), on host cells.…”

Complexities of the COVID‐19 vaccine and multisystem inflammatory syndrome in children

“…This syndrome can be characterized by severe cardiovascular outcomes in pediatric patients, including significant coronary artery dilation in 17% and even nearly 30% of severely affected patients requiring extracorporeal membrane oxygenation support in a large Swiss and French cohort 9 . Children who have been diagnosed with severe MIS‐C have been found to have higher levels of antibody response to SARS‐CoV‐2 including higher levels of receptor‐binding domain, neutralization titers, and antibody levels against the spike protein and viral nucleocapsid 10,11 …”