Scientists discover pathways to severe COVID-19 in children

Researchers have discovered the pathways that are activated in severe cases of COVID-19 in children, an advance that can lead to earlier diagnosis and more targeted treatments for the disease.

The study, published in the journal Nature Communications, identified disease mechanisms in children with COVID-19 who present with the multisystem inflammatory syndrome, where different body parts can become inflamed including the heart, lungs, and brain and acute respiratory distress syndrome, a type of lung disease.

The main triggers for severe COVID-19 in children were blood clotting and how proteins in the immune system reacted to the virus, the researchers said.

”Children are in general less susceptible to COVID-19 and present with milder symptoms, but it remained unclear what caused some to develop very severe disease,” said Conor McCafferty, Ph.D. student at the University of Melbourne in Australia.

“Our research was the first to uncover the specific blood clotting and immune protein pathways impacted in children with COVID-19 who developed serious symptoms,” McCafferty said in a statement. For the study, blood samples from 20 healthy children were collected and samples from 33 SARS-CoV-2 infected children with multisystem inflammatory syndrome or acute respiratory distress syndrome were collected.

Professor Damien Bonnet, from the Greater Paris University Hospitals, France, said collecting samples to further describe the mechanisms of these syndromes and establishing worldwide collaborations were considered key issues to improve treatment and outcomes.

The research found that 85 and 52 proteins were specific to multisystem inflammatory syndrome and acute respiratory distress syndrome, respectively. Both syndromes are major potential outcomes of severe COVID-19.

Data shows 1.7 percent of reported pediatric hospitalized cases of COVID-19 included admission to the Intensive Care Unit, according to the researchers.

Children with COVID-19 who present with the multisystem inflammatory syndrome also show similar clinical features to Kawasaki disease and toxic shock syndrome such as fever, abdominal pain, vomiting, skin rash, and conjunctivitis, making it difficult to quickly diagnose patients, they said.

”The results provided an understanding of the processes that underly severe COVID-19 in children, which would help in the development of diagnostic tests for early identification of children at risk, as well as therapeutic targets to improve the outcomes for those with severe cases,” said Professor Vera Ignjatovic from Murdoch Children’s Research Institute (MCRI) in Australia.

”Knowing the mechanisms associated with severe COVID-19 in children and how the blood clotting and immune systems in children react to the virus will help diagnose and detect acute COVID-19 cases and allow us to develop targeted treatment,” Ignjatovic added.