They find a clue to explain the aftermath of COVID-19 in children

A sequel that can develop after coronavirus infection in girls, boys and adolescents is multisystem inflammatory syndrome.. Although it is not frequently diagnosed, scientists and doctors have been wondering since it was detected early last year. because COVID-19 can cause inflammation of children’s hearts, lungs, kidneys, and even eyes. However, a study conducted at the prestigious Mount Sinai Hospital, in New York, in the United States, provided a clue to understand the problem.

In the Americas, a total of 24 countries and territories have reported 7,030 cases of multisystem inflammatory syndrome in childhood, according to the latest report from the Pan American Health Organization. There have been 138 deaths from the syndrome in the region since the start of the pandemic.

Researchers at the New York Hospital began to research biological mechanisms that led to the development of the syndrome. They published the research in the magazine Nature Communication. “Although an autoimmune pathogenesis has been proposed, the genes, pathways and cell types responsible for this new disease remain unknown”They said at work.

Researchers performed RNA sequencing of blood samples from patients with multisystem inflammatory syndrome from the COVID-19 biobank of Mount Sinai. This study allowed them to discover that Some cells of the immune system that fight infection are downregulated in children with the syndrome. This alteration is associated with a sustained inflammatory response, a hallmark of the coronavirus infection that causes COVID-19.

Multisystem inflammatory syndrome It is characterized by fever, pain, and inflammation of several organs, such as the heart, lungs, kidneys, skin, eyes, or gastrointestinal tract. Thanks to the in-depth study of gene expression, researchers have taken a key step in providing the field with new avenues of exploration involving complex networks and subnetworks of genes they have constructed from pediatric cases. with inflammatory syndrome.

One of the most important of these gene networks involved the suppression of two types of immune cells: a population of lymphocytes, called “natural killers” (known as NK from its English name) and the population. of CD8 + T lymphocytes.

Previous research has shown that when CD8 + T cells are persistently exposed to pathogens, they enter a state of “exhaustion”, resulting in a loss of their efficiency and ability to proliferate. Researchers in the new study specifically noted that CD8 + T cells are in this depleted state. This condition could weaken the inflammatory immune response. An increase in NK cells is also associated with depletion of CD8 + T cells.

“Our study found that T cell depletion in patients with multisystem inflammatory syndrome is one possible cause of this disease, suggesting that an increase in both circulating depleted NK cells and cells CD8 + T could improve symptoms of inflammatory disease “, said co-lead author Dr Noam Beckmann, associate professor of genetics and genomic sciences and member of the Center for Clinical Intelligence at the Mount Sinai Icahn School of Medicine.

“In addition, we found nine key regulators of this network that are known to have associations with the functionality of K cells and depleted CD8 + T cells.” Beckmann added that one of these regulators, TBX21 is a promising therapeutic target because it serves as the primary coordinator of the transition of CD8 + T cells from efficient to depleted. In other words, a drug could be developed to intervene at this stage.

Mount Sinai’s work on inflammatory syndrome is the hospital’s first COVID-19 biobank gene expression study. It was created thanks to the work of a team of volunteers made up of more than 100 nurses, doctors and researchers. Today, the repository forms the backbone of the rapidly expanding research on COVID-19 from Mount Sinai.

The team collected blood samples from several hundred COVID-19 patients (including “longitudinal” or multiple samples from the same person) admitted to partner hospitals by the Mount Sinai health system. which, in turn, have generated a diverse set of molecular data that has provided invaluable information to better understand the disease and adopt new therapeutic approaches.

The health agency PAHO launched in July an appeal to public health authorities and the medical community to strengthen early management of cases of children and adolescents with the disorder generated after COVID-19. “As cases of multisystem inflammatory syndrome increase, it is important that each country / territory characterizes the cases, in order to help fill information gaps, by promoting updating of clinical management. and response measures “, recommended by PAHO in its epidemiological update.

The 5 symptoms of inflammatory syndrome in children and adolescents that must be taken care of because they require urgent hospitalization are: severe abdominal pain; difficulty in breathing; the skin, lips, or nail beds become pale, grayish, or bluish according to normal skin tone; experience sudden confusion; or they develop an inability to wake up or stay awake, according to the Mayo Clinic in the United States.

“With the advancement of the pandemic, the characteristics of childhood multisystem inflammatory syndrome have become more widely known and detailed. We now know that it can develop 4-6 weeks after children go through the acute phase of coronavirus infection.», Recently explained to Infobae doctor Gabriela Ensinck, of the Infectious Diseases Committee of the Argentine Pediatric Society, which together with other authors established the first consensus on the disease and its treatment in the country.

“Children and adolescents with symptoms of multisystem inflammatory syndrome should go to the hospital,” Dr. Ensinck warned. Quick, they need to be given a high dose of intravenous gamma globulin. Several times associated with corticosteroids. Aspirin and anti-inflammatory drugs may be indicated. In fgeneral, if it is diagnosed early, they have a good course. Thereafter, cardiological monitoring and other compromised organs will be carried out ”.

“You have to take into account that inflammatory syndrome does not only develop in boys who have had severe COVID-19 images. It can develop in children as well as in adolescents who have had mild, moderate or severe symptoms, ”added Dr. Ensinck.

Even today, we know that the syndrome can appear in two different types. “There are pictures that look like Kawasaki syndrome. This is why we say Kawasaki associated with COVID-19 ″, he pointed out. Kawasaki usually causes inflammation of the walls of the coronary arteries, which supply blood to the heart muscle. The other type of multisystemic inflammatory syndrome caused by the coronavirus “is more nonspecific: vomiting, abdominal pain and diarrhea predominate,” Ensinck stressed.

“Today, the medical community must be more attentive to the multisystemic inflammatory syndrome. Early diagnosis and early cardiovascular support allow boys to have a better course. Right now, the challenge is that some Latin American countries have higher mortality from the syndrome because the health system is not able to respond on time, ”he said. Infobae Dr Facundo Jorro Barón, Deputy Secretary of the Emergency and Intensive Care Committee of the Argentine Pediatric Society and Intensive Care Physician at Pedro Elizalde Pediatric Hospital in the City of Buenos Aires.

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