Serology in Children with Multisystem Inflammatory Syndrome (MIS-C) associated with COVID-19
Authors: Rostad et al
Journal/ Pre-Print: MedRxiv
Tags; Clinical/ Diagnostics
Children with MIS-C had higher SARS-CoV-2 antibody titers compared to COVID-19 children, which correlated with neutralizing activity
Receptor Binding Domain (RBD) IgG titers correlated with length of stay in the hospital and ICU
Rostad et al explore the antibody responses in Multisystem Inflammatory Syndrome in Children (MIS-C) patients. The authors recruited 10 MIS-C, 10 COVID-19 children and 5 Kawasaki disease patients. Rostad et al found that MIS-C patients had higher IgG antibody titers against the SARS-CoV-2 Receptor Binding Domain compared to COVID-19 children, which correlated with neutralization. Additionally, MIS-C IgG antibody titers correlated with the length of stay in the hospital and ICU. The authors suggest that the antibody titers have diagnostic and prognostic value for MIS-C, but a larger cohort and a longitudinal study is needed to determine whether this is valuable.
Impact for SARS-CoV2/COVID19 research efforts
Develop diagnostic tools for SARS-CoV2/COVID19: This study investigates the serology of MIS-C, proposing prognostic and diagnostic value in measuring IgG antibody titers.
Clinical Cohort study (e.g. drug trials)
Patient Case study
Strengths and limitations of the paper
Novelty: The study identifies antibody titers against SARS-CoV-2 RBD as a potential diagnostic and prognostic marker for MIS-C.
Standing in the field: This study finds that white blood cell/lymphocyte count is lower in MIS-C, consistent with other studies indicating migration to inflamed tissues (Gruber et al, MedRxiv, 2020).
Appropriate statistics: Yes (countercheck please)
Viral model used: N/A
Translatability: The translatability of this study is limited. More studies with higher patient numbers are required to draw conclusions about diagnostic value.
While the small sample size for MIS-C is understandable given the rarity of the disease, there are very few controls.
COVID-19 children’s age is higher than for MIS-C, better age-matching would be useful.
8/10 COVID-19 children had an underlying condition compared to 3/10 in MIS-C,which may skew results, especially since a few patients were immunocompromised.
It would be interesting to have a longitudinal study to understand the antibody levels. For instance, the COVID-19 children may have lower IgG antibody titers since they were infected after the MIS-C patients, and these titers may change over time.
Since COVID-19 precedes MIS-C by approximately 4-6 weeks, have the authors ensured that the COVID-19 children in the study do not develop MIS-C later on?
Longitudinal samples would be valuable in understanding how antibody titres correlate with clinical course.