MIS-C is defined by lymphocyte activation, including elevated plasmablast frequencies and marked activation of CX3CR1+ CD8+ T cells. Pediatric COVID-19 following SARS-CoV-2 infection is associated with fewer hospitalizations and often milder disease than in adults. A subset of children, however, present with Multisystem Inflammatory Syndrome in Children (MIS-C) that can lead to vascular complications and shock, but rarely death. The immune features of MIS-C compared to pediatric COVID-19 or adult disease remain poorly understood. We analyzed peripheral blood immune responses in hospitalized SARS-CoV-2 infected pediatric patients (pediatric COVID-19) and patients with MIS-C. MIS-C patients had patterns of T cell-biased lymphopenia and T cell activation similar to severely ill adults, and all patients with MIS-C had SARS-CoV-2 spike-specific antibodies at admission. A distinct feature of MIS-C patients was robust activation of vascular patrolling CX3CR1+ CD8+ T cells that correlated with the use of vasoactive medication. Finally, whereas pediatric COVID-19 patients with acute respiratory distress syndrome (ARDS) had sustained immune activation, MIS-C patients displayed clinical improvement over time, concomitant with decreasing immune activation. Thus, non-MIS-C versus MIS-C SARS-CoV-2 associated illnesses are characterized by divergent immune signatures that are temporally distinct from one another and implicate CD8+ T cells in the clinical presentation and trajectory of MIS-C.
【초록키워드】 COVID-19, SARS-CoV-2, ARDS, immune response, Hospitalized, acute respiratory distress syndrome, Hospitalization, antibody, T cells, SARS-COV-2 infection, pediatric, children, CD8+ T cells, immune, MIS-C, Peripheral blood, lymphopenia, lymphocyte, Adults, T cell, Shock, immune activation, immune responses, Patient, death, Complication, Clinical improvement, trajectory, medication, disease, Admission, CD8+ T cell, T cell activation, specific antibodies, acute respiratory distress, Frequency, COVID-19 patient, respiratory distress, Activation, Pediatric patient, Vascular, adult disease, syndrome, CX3CR1, feature, Vasoactive, robust, immune signature, severely ill adults, defined, analyzed, elevated, characterized, correlated, subset, illness, sustained, SARS-CoV-2 spike-specific, 【제목키워드】 COVID-19, pediatric, immune profiling, deep,