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Simón-Fuentes M, Ríos I, Herrero C, Lasala F, Labiod N, Luczkowiak J, Roy-Vallejo E, Fernández de Córdoba-Oñate S, Delgado-Wicke P, Bustos M, Fernández-Ruiz E, Colmenares M, Puig-Kröger A, Delgado R, Vega MA, Corbí ÁL, Domínguez-Soto Á. MAFB shapes human monocyte-derived macrophage response to SARS-CoV-2 and controls severe COVID-19 biomarker expression. JCI Insight 2023; 8:e172862. [PMID: 37917179 PMCID: PMC10807725 DOI: 10.1172/jci.insight.172862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/31/2023] [Indexed: 11/04/2023] Open
Abstract
Monocyte-derived macrophages, the major source of pathogenic macrophages in COVID-19, are oppositely instructed by macrophage CSF (M-CSF) or granulocyte macrophage CSF (GM-CSF), which promote the generation of antiinflammatory/immunosuppressive MAFB+ (M-MØ) or proinflammatory macrophages (GM-MØ), respectively. The transcriptional profile of prevailing macrophage subsets in severe COVID-19 led us to hypothesize that MAFB shapes the transcriptome of pulmonary macrophages driving severe COVID-19 pathogenesis. We have now assessed the role of MAFB in the response of monocyte-derived macrophages to SARS-CoV-2 through genetic and pharmacological approaches, and we demonstrate that MAFB regulated the expression of the genes that define pulmonary pathogenic macrophages in severe COVID-19. Indeed, SARS-CoV-2 potentiated the expression of MAFB and MAFB-regulated genes in M-MØ and GM-MØ, where MAFB upregulated the expression of profibrotic and neutrophil-attracting factors. Thus, MAFB determines the transcriptome and functions of the monocyte-derived macrophage subsets that underlie pulmonary pathogenesis in severe COVID-19 and controls the expression of potentially useful biomarkers for COVID-19 severity.
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Affiliation(s)
- Miriam Simón-Fuentes
- Myeloid Cell Laboratory, Centro de Investigaciones Biológicas, CSIC, Madrid, Spain
| | - Israel Ríos
- Immunometabolism and Inflammation Unit, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Cristina Herrero
- Myeloid Cell Laboratory, Centro de Investigaciones Biológicas, CSIC, Madrid, Spain
| | - Fátima Lasala
- Instituto de Investigación Hospital Universitario 12 de Octubre (imas12), Universidad Complutense School of Medicine, Madrid, Spain
| | - Nuria Labiod
- Instituto de Investigación Hospital Universitario 12 de Octubre (imas12), Universidad Complutense School of Medicine, Madrid, Spain
| | - Joanna Luczkowiak
- Instituto de Investigación Hospital Universitario 12 de Octubre (imas12), Universidad Complutense School of Medicine, Madrid, Spain
| | - Emilia Roy-Vallejo
- Rheumatology Department, University Hospital La Princesa and Research Institute, Madrid, Spain
| | | | - Pablo Delgado-Wicke
- Molecular Biology Unit, University Hospital La Princesa and Research Institute, Universidad Autónoma de Madrid, Madrid, Spain
| | - Matilde Bustos
- Institute of Biomedicine of Seville (IBiS), Spanish National Research Council (CSIC), University of Seville, Virgen del Rocio University Hospital (HUVR), Seville, Spain
| | - Elena Fernández-Ruiz
- Molecular Biology Unit, University Hospital La Princesa and Research Institute, Universidad Autónoma de Madrid, Madrid, Spain
| | - Maria Colmenares
- Myeloid Cell Laboratory, Centro de Investigaciones Biológicas, CSIC, Madrid, Spain
| | - Amaya Puig-Kröger
- Immunometabolism and Inflammation Unit, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Rafael Delgado
- Instituto de Investigación Hospital Universitario 12 de Octubre (imas12), Universidad Complutense School of Medicine, Madrid, Spain
| | - Miguel A. Vega
- Myeloid Cell Laboratory, Centro de Investigaciones Biológicas, CSIC, Madrid, Spain
| | - Ángel L. Corbí
- Myeloid Cell Laboratory, Centro de Investigaciones Biológicas, CSIC, Madrid, Spain
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Kempuraj D, Aenlle KK, Cohen J, Mathew A, Isler D, Pangeni RP, Nathanson L, Theoharides TC, Klimas NG. COVID-19 and Long COVID: Disruption of the Neurovascular Unit, Blood-Brain Barrier, and Tight Junctions. Neuroscientist 2023:10738584231194927. [PMID: 37694571 DOI: 10.1177/10738584231194927] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), could affect brain structure and function. SARS-CoV-2 can enter the brain through different routes, including the olfactory, trigeminal, and vagus nerves, and through blood and immunocytes. SARS-CoV-2 may also enter the brain from the peripheral blood through a disrupted blood-brain barrier (BBB). The neurovascular unit in the brain, composed of neurons, astrocytes, endothelial cells, and pericytes, protects brain parenchyma by regulating the entry of substances from the blood. The endothelial cells, pericytes, and astrocytes highly express angiotensin converting enzyme 2 (ACE2), indicating that the BBB can be disturbed by SARS-CoV-2 and lead to derangements of tight junction and adherens junction proteins. This leads to increased BBB permeability, leakage of blood components, and movement of immune cells into the brain parenchyma. SARS-CoV-2 may also cross microvascular endothelial cells through an ACE2 receptor-associated pathway. The exact mechanism of BBB dysregulation in COVID-19/neuro-COVID is not clearly known, nor is the development of long COVID. Various blood biomarkers could indicate disease severity and neurologic complications in COVID-19 and help objectively diagnose those developing long COVID. This review highlights the importance of neurovascular and BBB disruption, as well as some potentially useful biomarkers in COVID-19, and long COVID/neuro-COVID.
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Affiliation(s)
- Duraisamy Kempuraj
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Kristina K Aenlle
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
- Miami Veterans Affairs Healthcare System, Miami, FL, USA
| | - Jessica Cohen
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Annette Mathew
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Dylan Isler
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Rajendra P Pangeni
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Lubov Nathanson
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Theoharis C Theoharides
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
- Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of Immunology, School of Medicine, Tufts University, Boston, MA, USA
| | - Nancy G Klimas
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
- Miami Veterans Affairs Healthcare System, Miami, FL, USA
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3
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Stricker S, Ziegahn N, Karsten M, Boeckel T, Stich-Boeckel H, Maske J, Rugo E, Balazs A, Millar Büchner P, Dang-Heine C, Schriever V, Eils R, Lehmann I, Sander LE, Ralser M, Corman VM, Mall MA, Sawitzki B, Roehmel J. RECAST: Study protocol for an observational study for the understanding of the increased REsilience of Children compared to Adults in SARS-CoV-2 infecTion. BMJ Open 2023; 13:e065221. [PMID: 37068896 PMCID: PMC10111194 DOI: 10.1136/bmjopen-2022-065221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION The SARS-CoV-2 pandemic remains a threat to public health. Soon after its outbreak, it became apparent that children are less severely affected. Indeed, opposing clinical manifestations between children and adults are observed for other infections. The SARS-CoV-2 outbreak provides the unique opportunity to study the underlying mechanisms. This protocol describes the methods of an observational study that aims to characterise age dependent differences in immune responses to primary respiratory infections using SARS-CoV-2 as a model virus and to assess age differences in clinical outcomes including lung function. METHODS AND ANALYSIS The study aims to recruit at least 120 children and 60 adults that are infected with SARS-CoV-2 and collect specimen for a multiomics analysis, including single cell RNA sequencing of nasal epithelial cells and peripheral blood mononuclear cells, mass cytometry of whole blood samples and nasal cells, mass spectrometry-based serum and plasma proteomics, nasal epithelial cultures with functional in vitro analyses, SARS-CoV-2 antibody testing, sequencing of the viral genome and lung function testing. Data obtained from this multiomics approach are correlated with medical history and clinical data. Recruitment started in October 2020 and is ongoing. ETHICS AND DISSEMINATION The study was reviewed and approved by the Ethics Committee of Charité - Universitätsmedizin Berlin (EA2/066/20). All collected specimens are stored in the central biobank of Charité - Universitätsmedizin Berlin and are made available to all participating researchers and on request. TRIAL REGISTRATION NUMBER DRKS00025715, pre-results publication.
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Affiliation(s)
- Sebastian Stricker
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Niklas Ziegahn
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Karsten
- Karsten, Rugo, Wagner, Paediatric Practice, Berlin, Germany
| | - Thomas Boeckel
- Boeckel, Haverkaemper, Paediatric Practice and Practice for Paediatric Cardiology, Berlin, Germany
| | | | - Jakob Maske
- Maske, Pankok, Paediatric Practice, Berlin, Germany
| | - Evelyn Rugo
- Karsten, Rugo, Wagner, Paediatric Practice, Berlin, Germany
| | - Anita Balazs
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Pamela Millar Büchner
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Chantip Dang-Heine
- Clinical Study Center (CSC), Berlin Institute of Health at Charité, Berlin, Germany
| | - Valentin Schriever
- Department of Paediatric Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Center for Chronically Sick Children (Sozialpädiatrisches Zentrum, SPZ), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Eils
- Center for Digital Health, Berlin Institute of Health at Charité, Berlin, Germany
- Molecular Epidemiology Unit, Berlin Institute of Health at Charité, Berlin, Germany
| | - Irina Lehmann
- Center for Digital Health, Berlin Institute of Health at Charité, Berlin, Germany
- German Center for Lung Research, Giessen, Germany
| | - Leif E Sander
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Ralser
- Department of Biochemistry, Charité Universitätsmedizin Berlin, Berlin, Germany
- Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, UK
| | - Victor M Corman
- Institute of Virology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus A Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- German Center for Lung Research, Giessen, Germany
| | - Birgit Sawitzki
- Berlin Institute of Health, Berlin, Germany
- Institute of Medical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jobst Roehmel
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
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4
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Vanetti C, Lampasona V, Stracuzzi M, Fenizia C, Biasin M, Saulle I, Limanaqi F, Abdelsalam A, Loretelli C, Paradiso L, Longoni E, Barcellini L, Piemonti L, Marzinotto I, Dispinseri S, Amendola A, Fappani C, Tanzi E, Clerici MS, Scarlatti G, Zuccotti GV, Giacomet V, Trabattoni D. The Immunological Profile of SARS-CoV-2 Infection in Children Is Linked to Clinical Severity and Age. Int J Mol Sci 2023; 24:ijms24076779. [PMID: 37047752 PMCID: PMC10095251 DOI: 10.3390/ijms24076779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/25/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Coronavirus disease 19 (COVID-19) is clinically less severe in children, even if the wide variety and degree of severity of symptoms reported in children pose a still-unresolved challenge for clinicians. We performed an in-depth analysis of the immunological profiles of 18 hospitalized SARS-CoV-2-infected children, whose results were compared to those obtained from 13 age- and sex-matched healthy controls (HC). The patients were categorized as paucisymptomatic/moderate (55.6%) or severe/critical (44.5%) according to established diagnostic criteria and further stratified into the categories of infants (1–12 months), children (1–12 years), and adolescents (>12 years). We assessed SARS-CoV-2-specific RBD antibodies (Ab), neutralizing antibodies (nAb), and circulating cytokines/chemokines in the plasma, and the SARS-CoV-2-specific immune response was measured in PBMCs by gene expression and secretome analyses. Our results showed peculiar circulating cytokine/chemokine profiles among patients sharing a similar clinical phenotype. A cluster of patients consisting of infants with severe symptoms presented hyperinflammatory profiles, together with extremely polarized antibody profiles. In a second cluster consisting of paucisymptomatic patients, a less pronounced increase in the level of inflammatory cytokines, together with an association between the selected cytokines and humoral responses, was observed. A third cluster, again consisting of paucisymptomatic patients, showed a circulating cytokine/chemokine profile which overlapped with that of the HC. The SARS-CoV-2-stimulated production of pro-inflammatory proteins, T lymphocyte activation, and migration-specific proteins, were significantly increased in SARS-CoV-2-infected children compared to the HC. Our findings suggest that immune response activation in the course of SARS-CoV-2 infection in children is directly correlated with clinical severity and, to a lesser extent, age.
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Affiliation(s)
- Claudia Vanetti
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
| | - Vito Lampasona
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Marta Stracuzzi
- Paediatric Infectious Disease Unit, Ospedale L. Sacco, 20157 Milan, Italy
| | - Claudio Fenizia
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Mara Biasin
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
| | - Irma Saulle
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Fiona Limanaqi
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Ahmed Abdelsalam
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
- International Center for T1D, Paediatric Clinical Research Center Romeo ed Enrica Invernizzi, Università degli Studi di Milano, 20157 Milan, Italy
| | - Cristian Loretelli
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
- International Center for T1D, Paediatric Clinical Research Center Romeo ed Enrica Invernizzi, Università degli Studi di Milano, 20157 Milan, Italy
| | - Laura Paradiso
- Department of Paediatrics, Ospedale dei Bambini V. Buzzi, 20154 Milan, Italy
| | - Emma Longoni
- Department of Paediatrics, Ospedale dei Bambini V. Buzzi, 20154 Milan, Italy
| | - Lucia Barcellini
- Department of Paediatrics, Ospedale dei Bambini V. Buzzi, 20154 Milan, Italy
| | - Lorenzo Piemonti
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Ilaria Marzinotto
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Stefania Dispinseri
- Viral Evolution and Transmission Unit, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Antonella Amendola
- Department of Health Sciences, Università degli Studi di Milano, 20133 Milan, Italy
| | - Clara Fappani
- Department of Health Sciences, Università degli Studi di Milano, 20133 Milan, Italy
| | - Elisabetta Tanzi
- Department of Health Sciences, Università degli Studi di Milano, 20133 Milan, Italy
| | - Mario Salvatore Clerici
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
| | - Gabriella Scarlatti
- Viral Evolution and Transmission Unit, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | | | - Vania Giacomet
- Paediatric Infectious Disease Unit, Ospedale L. Sacco, 20157 Milan, Italy
| | - Daria Trabattoni
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
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Rajamanickam A, Venkataraman A, Kumar NP, Sasidaran R, Pandiarajan AN, Selvaraj N, Mittal R, Gowshika K, Putlibai S, Lakshan Raj S, Ramanan PV, Babu S. Alterations of adipokines, pancreatic hormones and incretins in acute and convalescent COVID-19 children. BMC Pediatr 2023; 23:156. [PMID: 37013538 PMCID: PMC10068212 DOI: 10.1186/s12887-023-03971-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/24/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), accountable for Coronavirus disease 2019 (COVID-19), may cause hyperglycemia and additional systemic complexity in metabolic parameters. It is unsure even if the virus itself causes type 1 or type 2 diabetes mellitus (T1DM or T2DM). Furthermore, it is still unclear whether even recuperating COVID-19 individuals have an increased chance to develop new-onset diabetes. METHODS We wanted to determine the impact of COVID-19 on the levels of adipokines, pancreatic hormones, incretins and cytokines in acute COVID-19, convalescent COVID-19 and control children through an observational study. We performed a multiplex immune assay analysis and compared the plasma levels of adipocytokines, pancreatic hormones, incretins and cytokines of children presenting with acute COVID-19 infection and convalescent COVID-19. RESULTS Acute COVID-19 children had significantly elevated levels of adipsin, leptin, insulin, C-peptide, glucagon and ghrelin in comparison to convalescent COVID-19 and controls. Similarly, convalescent COVID-19 children had elevated levels of adipsin, leptin, insulin, C-peptide, glucagon, ghrelin and Glucagon-like peptide-1 (GLP-1) in comparison to control children. On the other hand, acute COVID-19 children had significantly decreased levels of adiponectin and Gastric Inhibitory Peptide (GIP) in comparison to convalescent COVID-19 and controls. Similarly, convalescent COVID-19 children had decreased levels of adiponectin and GIP in comparison to control children. Acute COVID-19 children had significantly elevated levels of cytokines, (Interferon (IFN)) IFNγ, Interleukins (IL)-2, TNFα, IL-1α, IL-1β, IFNα, IFNβ, IL-6, IL-12, IL-17A and Granulocyte-Colony Stimulating Factors (G-CSF) in comparison to convalescent COVID-19 and controls. Convalescent COVID-19 children had elevated levels of IFNγ, IL-2, TNFα, IL-1α, IL-1β, IFNα, IFNβ, IL-6, IL-12, IL-17A and G-CSF in comparison to control children. Additionally, Principal component Analysis (PCA) analysis distinguishes acute COVID-19 from convalescent COVID-19 and controls. The adipokines exhibited a significant correlation with the levels of pro-inflammatory cytokines. CONCLUSION Children with acute COVID-19 show significant glycometabolic impairment and exaggerated cytokine responses, which is different from convalescent COVID-19 infection and controls.
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Affiliation(s)
- Anuradha Rajamanickam
- National Institutes of Health-National Institute for Research in Tuberculosis - International Center for Excellence in Research, Chennai, India.
| | | | | | - R Sasidaran
- Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India
| | - Arul Nancy Pandiarajan
- National Institutes of Health-National Institute for Research in Tuberculosis - International Center for Excellence in Research, Chennai, India
| | - Nandhini Selvaraj
- National Institutes of Health-National Institute for Research in Tuberculosis - International Center for Excellence in Research, Chennai, India
| | - Ruchi Mittal
- Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | - K Gowshika
- Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | | | - S Lakshan Raj
- Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India
| | | | - Subash Babu
- National Institutes of Health-National Institute for Research in Tuberculosis - International Center for Excellence in Research, Chennai, India
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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6
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Beijnen EMS, Odumade OA, Haren SDV. Molecular Determinants of the Early Life Immune Response to COVID-19 Infection and Immunization. Vaccines (Basel) 2023; 11:vaccines11030509. [PMID: 36992093 DOI: 10.3390/vaccines11030509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/11/2023] [Accepted: 02/18/2023] [Indexed: 02/25/2023] Open
Abstract
Clinical manifestations from primary COVID infection in children are generally less severe as compared to adults, and severe pediatric cases occur predominantly in children with underlying medical conditions. However, despite the lower incidence of disease severity, the burden of COVID-19 in children is not negligible. Throughout the course of the pandemic, the case incidence in children has substantially increased, with estimated cumulative rates of SARS-CoV-2 infection and COVID-19 symptomatic illness in children comparable to those in adults. Vaccination is a key approach to enhance immunogenicity and protection against SARS-CoV-2. Although the immune system of children is functionally distinct from that of other age groups, vaccine development specific for the pediatric population has mostly been limited to dose-titration of formulations that were developed primarily for adults. In this review, we summarize the literature pertaining to age-specific differences in COVID-19 pathogenesis and clinical manifestation. In addition, we review molecular distinctions in how the early life immune system responds to infection and vaccination. Finally, we discuss recent advances in development of pediatric COVID-19 vaccines and provide future directions for basic and translational research in this area.
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Affiliation(s)
- Elisabeth M S Beijnen
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Oludare A Odumade
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
- Department of Pediatrics, Division of Medicine Critical Care, Boston Children's Hospital, Boston, MA 02115, USA
| | - Simon D van Haren
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
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7
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Cytokine Levels and Severity of Illness Scoring Systems to Predict Mortality in COVID-19 Infection. Healthcare (Basel) 2023; 11:healthcare11030387. [PMID: 36766961 PMCID: PMC9914724 DOI: 10.3390/healthcare11030387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023] Open
Abstract
Various scoring systems and cytokines have been cited as predicting disease severity in COVID-19 infection. This study analyzed the link between mortality rate, levels of cytokines, and scoring systems such as the Glasgow Coma Scale (GCS), Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Charlson Comorbidity Index in patients infected with COVID-19. Adult patients infected with COVID-19 were followed up in the intensive care unit (ICU) and analyzed prospectively. We measured serum cytokine levels (Interleukin-10 (IL-10), Interleukin-8 (IL-8), Interleukin-6 (IL-6), Interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α) and High mobility group box 1 (HMGB-1)) and recorded GCS, APACHE II, SOFA, and Charlson comorbidity index scores on admission to the ICU. Receiver operating curve (ROC) analysis was performed to predict mortality from IL-1β, IL-6 IL-10, IL-8, TNF-α, and HMGB-1 values. Study participants were grouped as follows: Group A, survivors, and Group B, deceased, during the 28-day follow-up. The mean age was 65.69 (±13.56) in Group A (n = 36) and 70.85 (±10.06) in Group B (n = 27). The female/male ratio was 23/40. Age, sex, body mass index (BMI), comorbid illnesses, GCS, APACHE II, SOFA, and Charlson scores, duration of hospitalization or ICU admission, therapeutic choices, and lymphocyte, PMNL, NLR, platelet, D-dimer, fibrinogen, GGT, CRP, procalcitonin, and lactate levels were similar between the groups. The frequency of acute kidney injury (AKI) was higher in Group B (p = 0.005). Serum IL-10, IL-8, IL-6, IL-1β, TNF-α, HMGB-1, ferritin, and LDH values were higher, and PaO2/FiO2 was lower in Group B than in Group A. ROC analysis showed that there was an association between serum IL-1β (>1015.7), serum IL-6 (>116.7), serum IL-8 (>258.4), serum IL-10 (>247.5), serum TNF-α (>280.7), and serum HMGB-1 (>23.5) and mortality. AKI gave rise to a greater risk of mortality (odds ratio: 7.081, p = 0.014). Mortality was associated with serum IL-10, IL-8, IL-6, IL-1β, TNF-α, and HMGB-1 but not with GCS, APACHE II, SOFA, or Charlson comorbidity index scores. AKI increased the risk of mortality by seven times. Our findings suggest that cytokine levels (serum IL-10, IL-8, IL-6, IL-1β, TNF-α, and HMGB-1) were predictors of mortality in COVID-19 infection. In addition, our results might give an opinion about the course of COVID-19 infection.
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8
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Yayla BCC, Aykac K, Boluk O, Fidanci I, Tasar MA, Pamuk U, Karakoc AE, Karakaya J, Ozsurekci Y. The comparison of COVID-19 vs seasonal influenza in children. Pediatr Int 2023; 65:e15684. [PMID: 38037544 DOI: 10.1111/ped.15684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Influenza in children has been well described, whereas there has been a paucity of pediatric data regarding COVID-19. It is crucial for clinicians to differentiate cases of COVID-19 from cases of influenza because of the upcoming influenza season in the new pandemic era. METHODS This retrospective study included pediatric patients who were diagnosed with laboratory-confirmed COVID-19 between March and September 2020, or seasonal influenza between October 2019 and March 2020. RESULTS A total of 315 children were included in this study; 151 were diagnosed with influenza and 164 had confirmed COVID-19. The median age of patients with COVID-19 was 10 years (interquartile range [IQR]: 3-15 years), whereas the median age of patients with influenza was 4 years (IQR: 1-6 years) (p = 0.001). In the COVID-19 group, 6.3% of patients had underlying diseases, the most frequent being neurological conditions (3%). In the influenza group, 20.9% of patients had an underlying disease, the most frequent being asthma (14.5%). Fever (odds ratio [OR]: 20.476; 95% confidence interval [CI]: 2.438-171.995; p = 0.005), dyspnea/tachypnea (OR 13.950; 95% CI: 2.607-74.634; p = 0.002), and increased C-reactive protein (CRP) (OR: 7.650; 95% CI: 2.094-27.955; p = 0.002) were main predictors of influenza diagnosis in comparison to COVID-19. Lymphopenia was detected in 43.2% of patients with influenza and 19.9% of patients with COVID-19 (p = 0.001). CONCLUSIONS The accurate differentiation between "influenza or COVID-19" seems possible by evaluating a combination of factors including cough, fever, vomiting, leucopenia, lymphopenia, pneumonia, in pediatric patients with high CRP as well as age.
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Affiliation(s)
- Burcu Ceylan Cura Yayla
- Department of Pediatric Infectious Diseases, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Kubra Aykac
- Department of Pediatric Infectious Diseases, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Oguz Boluk
- Department of Pediatric Disease, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Ilknur Fidanci
- Department of Pediatric Emergency, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Medine Aysin Tasar
- Department of Pediatric Emergency, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Utku Pamuk
- Department of Pediatric Cardiology, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Ayse Esra Karakoc
- Department of Pediatric Cardiology, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Jale Karakaya
- Department of Bioistatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yasemin Ozsurekci
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
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9
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SARS-CoV-2 Variant-Specific Infectivity and Immune Profiles Are Detectable in a Humanized Lung Mouse Model. Viruses 2022; 14:v14102272. [PMID: 36298826 PMCID: PMC9612296 DOI: 10.3390/v14102272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022] Open
Abstract
Small animal models that accurately model pathogenesis of SARS-CoV-2 variants are required for ongoing research efforts. We modified our human immune system mouse model to support replication of SARS-CoV-2 by implantation of human lung tissue into the mice to create TKO-BLT-Lung (L) mice and compared infection with two different variants in a humanized lung model. Infection of TKO-BLT-L mice with SARS-CoV-2 recapitulated the higher infectivity of the B.1.1.7 variant with more animals becoming infected and higher sustained viral loads compared to mice challenged with an early B lineage (614D) virus. Viral lesions were observed in lung organoids but no differences were detected between the viral variants as expected. Partially overlapping but distinct immune profiles were also observed between the variants with a greater Th1 profile in VIDO-01 and greater Th2 profile in B.1.1.7 infection. Overall, the TKO-BLT-L mouse supported SARS-CoV-2 infection, recapitulated key known similarities and differences in infectivity and pathogenesis as well as revealing previously unreported differences in immune responses between the two viral variants. Thus, the TKO-BLT-L model may serve as a useful animal model to study the immunopathobiology of newly emerging variants in the context of genuine human lung tissue and immune cells.
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10
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Sengupta S, Bhattacharya G, Chatterjee S, Datey A, Shaw SK, Suranjika S, Nath P, Barik PK, Prasad P, Chattopadhyay S, Swain RK, Parida A, Devadas S. Underlying Co-Morbidity Reveals Unique Immune Signatures in Type II Diabetes Patients Infected With SARS-CoV2. Front Immunol 2022; 13:848335. [PMID: 35572555 PMCID: PMC9094480 DOI: 10.3389/fimmu.2022.848335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/25/2022] [Indexed: 12/13/2022] Open
Abstract
Background SARS-CoV2 infection in patients with comorbidities, particularly T2DM, has been a major challenge globally and has been shown to be associated with high morbidity and mortality. Here, we did whole blood immunophenotyping along with plasma cytokine, chemokine, antibody isotyping, and viral load from oropharyngeal swab to understand the immune pathology in the T2DM patients infected with SARS-CoV2. Methods Blood samples from 25 Covid-19 positive patients having T2DM, 10 Covid-19 positive patients not having T2DM, and 10 Covid-19 negative, non-diabetic healthy controls were assessed for various immune cells by analyzing for their signature surface proteins in mass cytometry. Circulating cytokines, chemokines, and antibody isotypes were determined from plasma while viral copy number was determined from oropharyngeal swabs. All our representative data corroborated with laboratory findings. Results Our observations encompass T2DM patients having elevated levels of both type I and type II cytokines and higher levels of circulating IgA, IgM, IgG1, and IgG2 as compared to NDM and healthy volunteers. They also displayed higher percentages of granulocytes, mDCs, plasmablasts, Th2-like cells, CD4+ EM cells, and CD8+ TE cells as compared to healthy volunteers. T2DM patients also displayed lower percentages of pDCs, lymphocytes, CD8+ TE cells, CD4+, and CD8+ EM. Conclusion Our study demonstrated that patients with T2DM displayed higher inflammatory markers and a dysregulated anti-viral and anti-inflammatory response when compared to NDM and healthy controls and the dysregulated immune response may be attributed to meta inflammation.
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Affiliation(s)
- Soumya Sengupta
- Department of Infectious Disease Biology, Institute of Life Sciences, Bhubaneswar, India.,Regional Centre for Biotechnology (RCB), 3rd Milestone, Faridabad-Gurgaon, India
| | - Gargee Bhattacharya
- Department of Infectious Disease Biology, Institute of Life Sciences, Bhubaneswar, India.,Regional Centre for Biotechnology (RCB), 3rd Milestone, Faridabad-Gurgaon, India
| | - Sanchari Chatterjee
- Department of Infectious Disease Biology, Institute of Life Sciences, Bhubaneswar, India.,Regional Centre for Biotechnology (RCB), 3rd Milestone, Faridabad-Gurgaon, India
| | - Ankita Datey
- Department of Infectious Disease Biology, Institute of Life Sciences, Bhubaneswar, India.,School of Biotechnology, Kalinga Institute of Industrial Technology (KIIT) University, Bhubaneswar, India
| | - Shubham K Shaw
- Department of Infectious Disease Biology, Institute of Life Sciences, Bhubaneswar, India.,Regional Centre for Biotechnology (RCB), 3rd Milestone, Faridabad-Gurgaon, India
| | - Sandhya Suranjika
- Department of Infectious Disease Biology, Institute of Life Sciences, Bhubaneswar, India
| | - Paritosh Nath
- Department of Infectious Disease Biology, Institute of Life Sciences, Bhubaneswar, India
| | - Prakash K Barik
- Department of Infectious Disease Biology, Institute of Life Sciences, Bhubaneswar, India
| | - Punit Prasad
- Department of Infectious Disease Biology, Institute of Life Sciences, Bhubaneswar, India.,Regional Centre for Biotechnology (RCB), 3rd Milestone, Faridabad-Gurgaon, India
| | - Soma Chattopadhyay
- Department of Infectious Disease Biology, Institute of Life Sciences, Bhubaneswar, India.,Regional Centre for Biotechnology (RCB), 3rd Milestone, Faridabad-Gurgaon, India
| | - Rajeeb K Swain
- Department of Infectious Disease Biology, Institute of Life Sciences, Bhubaneswar, India.,Regional Centre for Biotechnology (RCB), 3rd Milestone, Faridabad-Gurgaon, India
| | - Ajay Parida
- Department of Infectious Disease Biology, Institute of Life Sciences, Bhubaneswar, India.,Regional Centre for Biotechnology (RCB), 3rd Milestone, Faridabad-Gurgaon, India
| | - Satish Devadas
- Department of Infectious Disease Biology, Institute of Life Sciences, Bhubaneswar, India.,Regional Centre for Biotechnology (RCB), 3rd Milestone, Faridabad-Gurgaon, India
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11
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Önal P, Kılınç AA, Aygün FD, Aygün F, Durak C, Akkoç G, Ağbaş A, Elevli M, Çokuğraş H. Diagnostic and Prognostic Biomarkers of Coronavirus Disease 2019 in Children. J Trop Pediatr 2022; 68:6531893. [PMID: 35179604 PMCID: PMC8903470 DOI: 10.1093/tropej/fmac003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Predictors of early diagnosis and severe infection in children with coronavirus disease 2019 (COVID-19), which has killed more than 4 million people worldwide, have not been identified. However, some biomarkers, including cytokines and chemokines, are associated with the diagnosis, pathogenesis and severity of COVID-19 in adults. We examined whether such biomarkers can be used to predict the diagnosis and prognosis of COVID-19 in pediatric patients. Eighty-nine children were included in the study, comprising three patient groups of 69 patients (6 severe, 36 moderate and 27 mild) diagnosed with COVID-19 by real-time polymerase chain reaction observed for 2-216 months and clinical findings and 20 healthy children in the same age group. Hemogram, coagulation, inflammatory parameters and serum levels of 16 cytokines and chemokines were measured in blood samples and were analyzed and compared with clinical data. Interleukin 1-beta (IL-1β), interleukin-12 (IL-12) and interferon gamma-induced protein 10 (IP-10) levels were significantly higher in the COVID-19 patients (p = 0.035, p = 0.006 and p < 0.001). Additionally, D-dimer and IP-10 levels were higher in the severe group (p = 0.043 for D-dimer, area under the curve = 0.743, p = 0.027 for IP-10). Lymphocytes, C-reactive protein and procalcitonin levels were not diagnostic or prognostic factors in pediatric patients (p = 0.304, p = 0.144 and p = 0.67). Increased IL-1β, IL-12 and IP-10 levels in children with COVID-19 are indicators for early diagnosis, and D-dimer and IP-10 levels are predictive of disease severity. In children with COVID-19, these biomarkers can provide information on prognosis and enable early treatment.
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Affiliation(s)
- Pınar Önal
- Department of Pediatric Infectious Diseases, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Ayşe Ayzıt Kılınç
- Department of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Fatma Deniz Aygün
- Department of Pediatric Infectious Diseases, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul 34303, Turkey
| | - Fatih Aygün
- Department of Pediatric Intensive Care, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Cansu Durak
- Department of Pediatric Intensive Care, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, Istanbul 34098, Turkey
| | - Gülşen Akkoç
- Department of Pediatric Infectious Diseases, University of Health Sciences, Istanbul Haseki Education and Research Hospital, Istanbul 34265, Turkey
| | - Ayşe Ağbaş
- Department of Pediatric Nephrology, University of Health Sciences, Istanbul Haseki Education and Research Hospital, Istanbul 34265, Turkey
| | - Murat Elevli
- Department of Pediatrics, University of Health Sciences, Haseki Training and Research Hospital, Istanbul 34265, Turkey
| | - Haluk Çokuğraş
- Department of Pediatric Infectious Diseases, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, Istanbul 34098, Turkey
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12
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Qi X, Shen L, Chen J, Shi M, Shen B. Predicting the Disease Severity of Virus Infection. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1368:111-139. [DOI: 10.1007/978-981-16-8969-7_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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13
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Shi Q, Wang Z, Liu J, Wang X, Zhou Q, Li Q, Yu Y, Luo Z, Liu E, Chen Y. Risk factors for poor prognosis in children and adolescents with COVID-19: A systematic review and meta-analysis. EClinicalMedicine 2021; 41:101155. [PMID: 34693233 PMCID: PMC8523335 DOI: 10.1016/j.eclinm.2021.101155] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study provides the first systematic review and meta-analysis to identify the predictors of unfavorable prognosis of COVID-19 in children and adolescents. METHODS We searched literature databases until July 2021 for studies that investigated risk factors for unfavorable prognosis of children and adolescents with COVID-19. We used random-effects models to estimate the effect size with 95% confidence interval (CI). FINDINGS We identified 56 studies comprising 79,104 individuals. Mortality was higher in patients with multisystem inflammatory syndrome (MIS-C) (odds ratio [OR]=58.00, 95% CI 6.39-526.79) and who were admitted to intensive care (OR=12.64, 95% CI 3.42-46.68). Acute respiratry distress syndrme (ARDS) (OR=29.54, 95% CI 12.69-68.78) and acute kidney injury (AKI) (OR=55.02, 95% CI 6.26-483.35) increased the odds to be admitted to intensive care; shortness of breath (OR=16.96, 95% CI 7.66-37.51) increased the need of respiratory support; and neurological diseases (OR=5.16, 95% CI 2.30-11.60), C-reactive protein (CRP) level ≥80 mg/L (OR=11.70, 95% CI 4.37-31.37) and D-dimer level ≥0.5ug/mL (OR=20.40, 95% CI 1.76-236.44) increased the odds of progression to severe or critical disease. INTERPRETATION Congenital heart disease, chronic pulmonary disease, neurological diseases, obesity, MIS-C, shortness of breath, ARDS, AKI, gastrointestinal symptoms, elevated CRP and D-dimer are associated with unfavourable prognosis in children and adolescents with COVID-19.
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Affiliation(s)
- Qianling Shi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
- Lanzhou University Institute of Health Data Science, Lanzhou 730000, China
| | - Zijun Wang
- Lanzhou University Institute of Health Data Science, Lanzhou 730000, China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Jiao Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Xingmei Wang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Qi Zhou
- Lanzhou University Institute of Health Data Science, Lanzhou 730000, China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Qinyuan Li
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Yang Yu
- Department of Tumor Surgery, Lanzhou University Second Hospital, Lanzhou 730000, China
- The Second School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Enmei Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Yaolong Chen
- Lanzhou University Institute of Health Data Science, Lanzhou 730000, China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou 730000, China
- Lanzhou University GRADE Center, Lanzhou 730000, China
- Guideline International Network Asia, Lanzhou 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China
- Affiliate of the Cochrane China Network, Lanzhou University, Lanzhou 730000, China
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14
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Curatola A, Chiaretti A, Ferretti S, Bersani G, Lucchetti D, Capossela L, Sgambato A, Gatto A. Cytokine Response to SARS-CoV-2 Infection in Children. Viruses 2021; 13:v13091868. [PMID: 34578450 PMCID: PMC8473005 DOI: 10.3390/v13091868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023] Open
Abstract
The causal connection between serum biomarkers and COVID-19 severity or pathogenicity in children is unclear. The aim of this study was to describe clinical and immunological features of children affected by COVID-19. The secondary aim was to evaluate whether these cytokines could predict severity of COVID-19. All children (aged 0−18) admitted to the Pediatric Emergency Department and tested with nasopharyngeal swab for SARS-CoV-2 were recruited and assigned to three groups: COVID-19, other infections, control group. Clinical and laboratory data of these patients, including circulating cytokine levels, were analyzed in three groups. Fever was the most frequent symptom in COVID-19 (67.3%). Neutropenia was found in the COVID-19 group (p < 0.05); no difference was observed for lymphocyte counts in the three groups. Higher levels of IL-6 and TNF-alpha were found in the COVID-19 group compared to other infections and control groups (p = 0.014 and p = 0.001, respectively). Whereas, in the COVID-19 group, no difference was observed as for the same cytokines among sub-groups of different disease severity (p = 0.7 and p = 0.8). Serum levels of IL-6 and TNF-alpha were higher in COVID-19 children than in children with other infectious diseases, but those levels did not correlate with disease severity. Clinical studies in a large pediatric population are necessary to better define the role of the immune-mediated response in SARS-CoV-2 infections in children.
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Affiliation(s)
- Antonietta Curatola
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.C.); (A.C.); (L.C.)
| | - Antonio Chiaretti
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.C.); (A.C.); (L.C.)
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.B.); (A.G.)
| | - Serena Ferretti
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.C.); (A.C.); (L.C.)
- Correspondence: ; Tel.: +39-063-015-4475; Fax: +39-063-383-211
| | - Giulia Bersani
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.B.); (A.G.)
| | - Donatella Lucchetti
- Department of Translational Medicine and Surgery, Faculty of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Lavinia Capossela
- Department of Pediatrics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.C.); (A.C.); (L.C.)
| | - Alessandro Sgambato
- Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), 05028 Rionero in Vulture (PZ), Italy;
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (G.B.); (A.G.)
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15
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Melo AKG, Milby KM, Caparroz ALMA, Pinto ACPN, Santos RRP, Rocha AP, Ferreira GA, Souza VA, Valadares LDA, Vieira RMRA, Pileggi GS, Trevisani VFM. Biomarkers of cytokine storm as red flags for severe and fatal COVID-19 cases: A living systematic review and meta-analysis. PLoS One 2021; 16:e0253894. [PMID: 34185801 PMCID: PMC8241122 DOI: 10.1371/journal.pone.0253894] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 06/16/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To describe the laboratory parameters and biomarkers of the cytokine storm syndrome associated with severe and fatal COVID-19 cases. METHODS A search with standardized descriptors and synonyms was performed on November 28th, 2020 of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, LILACS, and IBECS to identify studies of interest. Grey literature searches and snowballing techniques were additionally utilized to identify yet-unpublished works and related citations. Two review authors independently screened the retrieved titles and abstracts, selected eligible studies for inclusion, extracted data from the included studies, and then assessed the risk of bias using the Newcastle-Ottawa Scale. Eligible studies were those including laboratory parameters-including serum interleukin-6 levels-from mild, moderate, or severe COVID-19 cases. Laboratory parameters, such as interleukin-6, ferritin, hematology, C-Reactive Protein, procalcitonin, lactate dehydrogenase, aspartate aminotransferase, creatinine, and D-dimer, were extracted from the studies. Meta-analyses were conducted using the laboratory data to estimate mean differences with associated 95% confidence intervals. DATA SYNTHESIS The database search yielded 9,620 records; 40 studies (containing a total of 9,542 patients) were included in the final analysis. Twenty-one studies (n = 4,313) assessed laboratory data related to severe COVID-19 cases, eighteen studies (n = 4,681) assessed predictors for fatal COVID-19 cases and one study (n = 548) assessed laboratory biomarkers related to severe and fatal COVID-19 cases. Lymphopenia, thrombocytopenia, and elevated levels of interleukin-6, ferritin, D-dimer, aspartate aminotransferase, C-Reactive-Protein, procalcitonin, creatinine, neutrophils and leucocytes were associated with severe and fatal COVID-19 cases. CONCLUSIONS This review points to interleukin-6, ferritin, leukocytes, neutrophils, lymphocytes, platelets, C-Reactive Protein, procalcitonin, lactate dehydrogenase, aspartate aminotransferase, creatinine, and D-dimer as important biomarkers of cytokine storm syndrome. Elevated levels of interleukin-6 and hyperferritinemia should be considered as red flags of systemic inflammation and poor prognosis in COVID-19.
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Affiliation(s)
- Ana Karla G. Melo
- Division of Rheumatology, Department of Clinical Medicine, Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba, João Pessoa, PB, Brazil
- Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Keilla M. Milby
- Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ana Luiza M. A. Caparroz
- Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Pediatric Rheumatology, Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Ana Carolina P. N. Pinto
- Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Biological and Health Sciences, Universidade Federal do Amapá, Macapá, AP, Brazil
- Fulbright Alumna at University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Rodolfo R. P. Santos
- Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Data Science, Synova Health, Campinas, SP, Brazil
| | - Aline P. Rocha
- Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Gilda A. Ferreira
- Department of Lokomotor System, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Viviane A. Souza
- Department of Clinical Medicine, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Rejane M. R. A. Vieira
- Department of Clinical Medicine, Universidade Estadual do Ceará, Fortaleza, CE, Brazil
- Department of Clinical Medicine, Universidade de Fortaleza, Fortaleza, CE, Brazil
| | - Gecilmara S. Pileggi
- Department of Rheumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Virgínia F. M. Trevisani
- Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Rheumatology, Universidade de Santo Amaro, São Paulo, SP, Brazil
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