Immunopathology of SARS-CoV-2 Infection: A Focus on T Regulatory and B Cell Responses in Children Compared with Adults

While the clinical impact of COVID-19 on adults has been massive, the majority of children develop pauci-symptomatic or even asymptomatic infection and only a minority of the latter develop a fatal outcome. The reasons of such differences are not yet established. We examined cytokines in sera and Th and B cell subpopulations in peripheral blood mononuclear cells (PBMC) from 40 children (<18 years old), evaluating the impact of COVID-19 infection during the pandemic's first waves. We correlated our results with clinical symptoms and compared them to samples obtained from 16 infected adults and 7 healthy controls. While IL6 levels were lower in SARS-CoV-2(+) children as compared to adult patients, the expression of other pro-inflammatory cytokines such as IFN gamma and TNF alpha directly correlated with early age infection and symptoms. Th and B cell subsets were modified during pediatric infection differently with respect to adult patients and controls and within the pediatric group based on age. Low levels of IgD(-) CD27(+ )memory B cells correlated with absent/mild symptoms. On the contrary, high levels of FoxP3(+)/CD25(high) T-Regs associated with a moderate-severe clinical course in the childhood. These T and B cells subsets did not associate with severity in infected adults, with children showing a predominant expansion of immature B lymphocytes and natural regulatory T cells. This study shows differences in immunopathology of SARS-CoV-2 infection in children compared with adults. Moreover, these data could provide information that can drive vaccination endpoints for children.

Automated summary

While COVID-19 has a massive clinical impact on adults, children mostly experience mild or even asymptomatic infections. This study found differences in cytokine levels and T and B cell subpopulations between infected children and adults, suggesting distinct immunopathology in pediatric infection. These findings could potentially inform vaccination strategies for children.