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Review
. 2023 Mar 16;24(6):5711.
doi: 10.3390/ijms24065711.

Immunology of Multisystem Inflammatory Syndrome after COVID-19 in Children: A Review of the Current Evidence

Filippos Filippatos  1 , Elizabeth-Barbara Tatsi  1 , Athanasios Michos  1
Affiliations
Review

Immunology of Multisystem Inflammatory Syndrome after COVID-19 in Children: A Review of the Current Evidence

Filippos Filippatos et al. Int J Mol Sci. .

Abstract

Immune responses following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are still under investigation. Even though coronavirus disease 2019 (COVID-19) is usually mild in the pediatric population, some children exhibit severe clinical manifestations, require hospitalization, or develop the most severe condition: a multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection. The activated innate, humoral and T-cell-mediated immunological pathways that lead certain pediatric populations to present with MIS-C or remain asymptomatic after SARS-CoV-2 infection are yet to be established. This review focuses on the immunological aspects of MIS-C with respect to innate, humoral, and cellular immunity. In addition, presents the role of the SARS-CoV-2 Spike protein as a superantigen in the pathophysiological mechanisms, discusses the great heterogeneity among the immunological studies in the pediatric population, and highlights possible reasons why some children with a certain genetic background present with MIS-C.

Keywords: COVID-19; SARS-CoV-2; cellular immunity; humoral immunity; multisystem inflammatory syndrome in children.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The spike (S) protein of SARS-CoV-2 may act as a superantigen, triggering a cytokine storm that contributes to the development of MIS-C. Superantigens interact directly with the invariant region of the class II MHC molecule, bypassing the need for an antigen-presenting cell-mediated phase. The figure was originally designed by the Biorender in silico tool (https://biorender.com, accessed on 14 January 2023).
See this image and copyright information in PMC

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