PLoS ONE (Jan 2022)

Inflammatory responses in SARS-CoV-2 associated Multisystem Inflammatory Syndrome and Kawasaki Disease in children: An observational study

  • G. Biesbroek,
  • B. Kapitein,
  • I. M. Kuipers,
  • M. P. Gruppen,
  • D. van Stijn,
  • T. E. Peros,
  • M. van Veenendaal,
  • M. H. A. Jansen,
  • C. W. van der Zee,
  • M. van der Kuip,
  • E. G. J. von Asmuth,
  • M. G. Mooij,
  • M. E. J. den Boer,
  • G. W. Landman,
  • M. A. van Houten,
  • D. Schonenberg-Meinema,
  • A. M. Tutu van Furth,
  • M. Boele van Hensbroek,
  • H. Scherpbier,
  • K. E. van Meijgaarden,
  • T. H. M. Ottenhoff,
  • S. A. Joosten,
  • N. Ketharanathan,
  • M. Blink,
  • C. L. H. Brackel,
  • H. L. Zaaijer,
  • P. Hombrink,
  • J. M. van den Berg,
  • E. P. Buddingh,
  • T. W. Kuijpers

Journal volume & issue
Vol. 17, no. 11

Abstract

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Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe inflammatory disease in children related to SARS-CoV-2 with multisystem involvement including marked cardiac dysfunction and clinical symptoms that can resemble Kawasaki Disease (KD). We hypothesized that MIS-C and KD might have commonalities as well as unique inflammatory responses and studied these responses in both diseases. In total, fourteen children with MIS-C (n=8) and KD (n=6) were included in the period of March-June 2020. Clinical and routine blood parameters, cardiac follow-up, SARS-CoV-2-specific antibodies and CD4+ T-cell responses, and cytokine-profiles were determined in both groups. In contrast to KD patients, all MIS-C patients had positive Spike protein-specific CD3+CD4+ T-cell responses. MIS-C and KD patients displayed marked hyper-inflammation with high expression of serum cytokines, including the drug-targetable interleukin (IL)-6 and IFN-γ associated chemokines CXCL9, 10 and 11, which decreased at follow-up. No statistical differences were observed between groups. Clinical outcomes were all favourable without cardiac sequelae at 6 months follow-up. In conclusion, MIS-C and KD-patients both displayed cytokine-associated hyper-inflammation with several high levels of drug-targetable cytokines.