SARS-CoV-2–related MIS-C: A key to the viral and genetic causes of Kawasaki disease?
Vanessa Sancho‐Shimizu, Petter Brodin, Aurélie Cobat, Catherine M. Biggs, Julie Toubiana, C. Lucas, Sarah E. Henrickson, Alexandre Bélot, MIS-C@CHGE, Élie Haddad, Kathie Béland, Aurora Pujol, Agatha Schlüter, Laura Planas‐Serra, Sergio Aguilera, Juan Valencia-Ramos, Agustí Rodríguez‐Palmero, Marta Gut, Jacques G. Rivière, Roger Colobrán, Pere Soler‐Palacín, Carlos Rodríguez‐Gallego, Rebeca Pérez de Diego, Carlos Flores, Laia Alsina, Daniel Blázquez‐Gamero, Iolanda Jordán, Sevgi Keleş, Melike Emiroğlu, Özge Metin Akcan, Gülsüm Alkan, Selma Erol Aytekin, Yahya Gül, Şadiye Kübra Tüter Öz, Şefika Elmas Bozdemir, Gülsüm İclal Bayhan, Saliha Kanık Yüksek, Aslınur Özkaya Parlakay, Belgi̇n Gülhan, Aysun Yahşi, Ahmet Osman Kılıç, Adem Karbuz, Emine Hafize Erdeniz, Esra Akyüz Özkan, Zerrin Orbak, Şehnaz Aydemir, Jale Bengi Çelik, Bahar Kandemir, Gökhan Aytekіn, Hasan Kapaklı, Volkan Yarar, Alper Yosunkaya, Hülya Vatansev, Caner Aytekin, Selda Hançerlı Törün, Serdar Nepesov, Taner Çoşkuner, Betül Sözeri, Yasemin Kendir Demirkol, Özgür Kasapçopur, Mehmet Yıldız, Esra Şevketoğlu, Nevin Hatipoğlu, Tayfun Özçelık, Osman Yeşilbaş, Zeynep Gökçe Gayretli Aydın, Anna Šedivá, Adam Klocperk, Markéta Bloomfield, Isabelle Meyts, Selket Delafontaine, Filomeen Haerynck, Levi Hoste, Mohammad Shahrooei, Laura Marque, João Farela Neves, Giuseppe Novelli, Antonio Novelli, Alessandro Aiuti, Giorgio Casari, Amed Aziz Bousfiha, Saleh Zaid Al-Muhsen, Ali Sobh, Alenka Gagro, Fanny Bajolle, Damien Bonnet, Pierre Lebon, Wei‐Te Lei, Danyel Lee, Yoann Seeleuthner, Peng Zhang, Majistor Maglorius, Quentin Philippot, Simon J. Pelham, Paul Bastard, Qian Zhang, Emmanuelle Jouanguy, Anne Puel, Jethro Herberg, Taco W. Kuijpers
Abstract
Multisystem inflammatory syndrome in children (MIS-C) emerged in April 2020 in communities with high COVID-19 rates. This new condition is heterogenous but resembles Kawasaki disease (KD), a well-known but poorly understood and clinically heterogenous pediatric inflammatory condition for which weak associations have been found with a myriad of viral illnesses. Epidemiological data clearly indicate that SARS-CoV-2 is the trigger for MIS-C, which typically occurs about 1 mo after infection. These findings support the hypothesis of viral triggers for the various forms of classic KD. We further suggest that rare inborn errors of immunity (IEIs) altering the immune response to SARS-CoV-2 may underlie the pathogenesis of MIS-C in some children. The discovery of monogenic IEIs underlying MIS-C would shed light on its pathogenesis, paving the way for a new genetic approach to classic KD, revisited as a heterogeneous collection of IEIs to viruses.