From asymptomatic to fatal cases, including people with mild symptoms and those who require hospitalization and/or assisted breathing. The clinical manifestations of covid are wide-ranging, although their severity is normally associated with factors such as age or the existence of previous pathologies. Children, who have a powerful protective shield against the severity of the infection, may hold the key to the solution for adults, according to research by Sant Joan de Déu.
“At the beginning of the pandemic we asked ourselves three questions,” says Juanjo García, head of pediatrics at the center: “If the children were infected, because we had a practically empty hospital; if they were capable of transmitting the disease and, lastly, what do children have that prevents them from becoming infected or developing serious illnesses”.
Children optimally produce this essential protein in defense against viral infections
The first two questions have an answer. Indeed, children become infected and contagious. The third, also, according to various investigations: children produce more type 1 interferon, an essential protein in the defense against viral infections. It is secreted by cells of the immune system and is considered one of the most effective elements of antiviral defense.
The infected cell secretes interferons (a type of cytokine, small proteins crucial for controlling the growth and activity of other cells of the immune system), generating an activation of antiviral defenses in nearby cells. A very powerful immune reaction that determined the mildness of the infection in children. But already in the first phase of the pandemic, doctors Laia Alsina and Iolanda Jordan, from the Sant Joan de Déu Research Institute, began to observe cases of hyperinflammatory syndrome, with symptoms similar to Kawasaki disease. “This more serious infection in children was post-infectious phenomena, similar to the case in adults,” they point out.
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These children produced an exaggerated inflammatory response after 4-6 weeks. Apparently, one of the factors that causes the severe clinical course of covid is a minimal or delayed interferon response, which leads to an inefficient antiviral response in the initial phase and an overproduction of cytokines and a hyperinflammatory state.
The researchers have compared the response in more than 80 patients, both adults and children, with varying degrees of severity, in order to determine cytokine patterns that help predict the clinical evolution of each patient and be able to personalize treatments in the future. In addition, they have selected two genes and have verified that low levels of the CIITA gene and high levels of SOC1 are indicative of the most serious cases of covid.
The work, published in the journal iScience concludes that the analysis of some cytokines derived from the expression pattern of the selected genes “could be useful as a future biomarker when selecting the population with the highest risk of severe covid”, explains Laia Alsina, head of the allergy and clinical immunology of Sant Joan de Déu.
“That what kills the patient is not the infection but the inflammation has already been seen. Now it is a matter of being able to act on the inflammatory chain through drugs, of developing the system so that when the patient arrives at the emergency room, cytokines can be administered quickly”, says Iolanda Jordan. The sample of patients studied is small. A larger cohort is required and further research is needed to determine the cut-off points that define the progression of the disease towards severity. It is an open road.
On the other hand, the team has determined that the sporadic cases of poor response in children in the production of type 1 interferon respond to two reasons: genetic factors and production of type 2 interferon, antibodies that neutralize the action of the first barrier , type 1 interferon.
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