Go to The Journal of Clinical Investigation
  • About
  • Editors
  • Consulting Editors
  • For authors
  • Publication ethics
  • Transfers
  • Advertising/recruitment
  • Contact
  • Current Issue
  • Past Issues
  • By specialty
    • COVID-19
    • Cardiology
    • Immunology
    • Metabolism
    • Nephrology
    • Oncology
    • Pulmonology
    • All ...
  • Videos
  • Collections
    • Technical Advances
    • Clinical Medicine
    • Reviews
    • Editorials
    • Perspectives
    • Top read articles
  • JCI This Month
    • Current issue
    • Past issues

  • Current issue
  • Past issues
  • Specialties
  • In-Press Preview
  • Concise Communication
  • Editorials
  • Viewpoint
  • Top read articles
  • About
  • Editors
  • Consulting Editors
  • For authors
  • Publication ethics
  • Transfers
  • Advertising/recruitment
  • Contact
Top
  • View PDF
  • Download citation information
  • Send a letter
  • Share this article
  • Terms of use
  • Standard abbreviations
  • Need help? Email the journal
  • Top
  • Abstract
  • Version history
  • Article usage
  • Citations to this article
Advertisement

Clinical MedicineIn-Press PreviewInfectious disease Open Access | 10.1172/jci.insight.148694

Natural mucosal barriers and COVID-19 in children

Carl A. Pierce,1 Sharlene Sy,2 Benjamin Galen,3 Doctor Y. Goldstein,4 Erika P. Orner,4 Marla J. Keller,3 Kevan C. Herold,5 and Betsy C. Herold2

1Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, United States of America

2Department of Pediatrics, Albert Einstein College of Medicine, Bronx, United States of America

3Department of Medicine, Montefiore Medical Center, Bronx, United States of America

4Department of Pathology, Montefiore Medical Center, Bronx, United States of America

5Department of Immunobiology and Internal Medicine, Yale University School of Medicine, New Haven, United States of America

Find articles by Pierce, C. in: JCI | PubMed | Google Scholar |

1Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, United States of America

2Department of Pediatrics, Albert Einstein College of Medicine, Bronx, United States of America

3Department of Medicine, Montefiore Medical Center, Bronx, United States of America

4Department of Pathology, Montefiore Medical Center, Bronx, United States of America

5Department of Immunobiology and Internal Medicine, Yale University School of Medicine, New Haven, United States of America

Find articles by Sy, S. in: JCI | PubMed | Google Scholar

1Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, United States of America

2Department of Pediatrics, Albert Einstein College of Medicine, Bronx, United States of America

3Department of Medicine, Montefiore Medical Center, Bronx, United States of America

4Department of Pathology, Montefiore Medical Center, Bronx, United States of America

5Department of Immunobiology and Internal Medicine, Yale University School of Medicine, New Haven, United States of America

Find articles by Galen, B. in: JCI | PubMed | Google Scholar |

1Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, United States of America

2Department of Pediatrics, Albert Einstein College of Medicine, Bronx, United States of America

3Department of Medicine, Montefiore Medical Center, Bronx, United States of America

4Department of Pathology, Montefiore Medical Center, Bronx, United States of America

5Department of Immunobiology and Internal Medicine, Yale University School of Medicine, New Haven, United States of America

Find articles by Goldstein, D. in: JCI | PubMed | Google Scholar |

1Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, United States of America

2Department of Pediatrics, Albert Einstein College of Medicine, Bronx, United States of America

3Department of Medicine, Montefiore Medical Center, Bronx, United States of America

4Department of Pathology, Montefiore Medical Center, Bronx, United States of America

5Department of Immunobiology and Internal Medicine, Yale University School of Medicine, New Haven, United States of America

Find articles by Orner, E. in: JCI | PubMed | Google Scholar |

1Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, United States of America

2Department of Pediatrics, Albert Einstein College of Medicine, Bronx, United States of America

3Department of Medicine, Montefiore Medical Center, Bronx, United States of America

4Department of Pathology, Montefiore Medical Center, Bronx, United States of America

5Department of Immunobiology and Internal Medicine, Yale University School of Medicine, New Haven, United States of America

Find articles by Keller, M. in: JCI | PubMed | Google Scholar

1Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, United States of America

2Department of Pediatrics, Albert Einstein College of Medicine, Bronx, United States of America

3Department of Medicine, Montefiore Medical Center, Bronx, United States of America

4Department of Pathology, Montefiore Medical Center, Bronx, United States of America

5Department of Immunobiology and Internal Medicine, Yale University School of Medicine, New Haven, United States of America

Find articles by Herold, K. in: JCI | PubMed | Google Scholar |

1Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, United States of America

2Department of Pediatrics, Albert Einstein College of Medicine, Bronx, United States of America

3Department of Medicine, Montefiore Medical Center, Bronx, United States of America

4Department of Pathology, Montefiore Medical Center, Bronx, United States of America

5Department of Immunobiology and Internal Medicine, Yale University School of Medicine, New Haven, United States of America

Find articles by Herold, B. in: JCI | PubMed | Google Scholar

Published April 6, 2021 - More info

JCI Insight. https://doi.org/10.1172/jci.insight.148694.
Copyright © 2021, Pierce et al. This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Published April 6, 2021 - Version history
View PDF
Abstract

Background: COVID-19 is more benign in children compared to adults for unknown reasons. This contrasts with other respiratory viruses where disease manifestations are often more severe in children. We hypothesize that a more robust early innate immune response to SARS-CoV-2 protects against severe disease.

Methods: Clinical outcomes, SARS-CoV-2 viral copies and cellular gene expression were compared in nasopharyngeal swabs obtained at the time of presentation to the Emergency Department from 12 children and 27 adults using bulk RNA sequencing and quantitative reverse transcription PCR. Total protein, cytokines and anti-SARS-CoV-2 IgG and IgA were quantified in nasal fluid.

Results: SARS-CoV-2 copies, ACE2 and TMPRSS2 gene expression were similar in children and adults, but children displayed higher expression of genes associated with interferon signaling, NLRP3 inflammasome, and other innate pathways. Higher levels of IFN-α2, IFN-γ, IP-10, IL-8, and IL-1β protein were detected in nasal fluid in children versus adults. Children also expressed higher levels of genes associated with immune cells whereas expression of those associated with epithelial cells did not differ in children versus adults. Anti-SARS-CoV-2 IgA and IgG were detected at similar levels in nasal fluid from both groups. None of the children required supplemental oxygen whereas 7 adults did (p=0.03); four adults died.

Conclusions: These findings provide direct evidence of a more vigorous early mucosal immune response in children compared to adults and suggest that this contributes to favorable clinical outcomes.

Graphical Abstract
graphical abstract
Version history
  • Version 1 (April 6, 2021): In-Press Preview

Article tools

  • View PDF
  • Download citation information
  • Send a letter
  • Share this article
  • Terms of use
  • Standard abbreviations
  • Need help? Email the journal

Metrics

  • Article usage
  • Citations to this article

Go to

  • Top
  • Abstract
  • Version history
Advertisement
Advertisement

Copyright © 2021 American Society for Clinical Investigation
ISSN 2379-3708

Sign up for email alerts