1. Kawasaki-like disease in children with COVID-19: A hypothesis.
- Author
-
Amirfakhryan H
- Subjects
- Angiotensin-Converting Enzyme 2, Asia epidemiology, COVID-19, Child, Coronary Vessels immunology, Coronary Vessels pathology, Coronavirus Infections epidemiology, Coronavirus Infections genetics, Cytokine Release Syndrome etiology, Disease Progression, Endothelium, Vascular virology, Genetic Predisposition to Disease, Humans, Inflammation, Macrophage Activation, Mucocutaneous Lymph Node Syndrome epidemiology, Mucocutaneous Lymph Node Syndrome genetics, Mucocutaneous Lymph Node Syndrome immunology, Netherlands epidemiology, Peptidyl-Dipeptidase A biosynthesis, Peptidyl-Dipeptidase A genetics, Peptidyl-Dipeptidase A physiology, Pneumonia, Viral epidemiology, Pneumonia, Viral genetics, Receptors, Virus biosynthesis, Receptors, Virus genetics, Receptors, Virus physiology, SARS-CoV-2, Seasons, Spike Glycoprotein, Coronavirus physiology, Tumor Necrosis Factor-alpha physiology, United States epidemiology, Betacoronavirus physiology, Coronavirus Infections complications, Models, Immunological, Mucocutaneous Lymph Node Syndrome etiology, Pandemics, Pneumonia, Viral complications
- Abstract
With rapid spread of severe acute respiratory syndrome- corona virus-2 (SARS-COV-2) globally, some new aspects of the disease have been reported. Recently, it has been reported the incidence of Kawasaki-like disease among children with COVID-19. Since, children had been known to be less severely affected by the virus in part due to the higher concentration of Angiotensin converting enzyme (ACE)-2 receptor, this presentation has emerged concerns regarding the infection of children with SARS-COV2. ACE2 has anti-inflammatory, anti-fibrotic and anti-proliferative characteristics through converting angiotensin (Ag)-II to Ang (1-7). ACE2 receptor is downregulated by the SARS-COV through the spike protein of SARS-CoV (SARS-S) via a process that is tightly coupled with Tumor necrosis factor (TNF)-α production. TNF-α plays a key role in aneurysmal formation of coronary arteries in Kawasaki disease (KD). Affected children by COVID-19 with genetically-susceptible to KD might have genetically under-expression of ACE2 receptor that might further decrease the expression of ACE2 due to the downregulation of the receptor by the virus in these patients. It appears that TNF- α might be the cause and the consequence of the ACE2 receptor downregulation which results in arterial walls aneurysm. Conclusion: Genetically under-expression of ACE2 receptor in children with genetically-susceptible to KD who are infected with SARS-CoV-2 possibly further downregulates the ACE2 expression by TNF-α and leads to surge of inflammation including TNF-α and progression to Kawasaki-like disease., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)
- Published
- 2020
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