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Kawasaki-like disease in children with COVID-19: A hypothesis.
Med Hypotheses. 2020 Oct; 143:110117.MH

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.

Authors+Show Affiliations

Preventative Cardiovascular Medicine, Faculty of Health Science, University of South Wales, UK. Electronic address: malihe.amirfakhrian@gmail.com.

Pub Type(s)

Letter

Language

eng

PubMed ID

32721809

Citation

Amirfakhryan, Hamideh. "Kawasaki-like Disease in Children With COVID-19: a Hypothesis." Medical Hypotheses, vol. 143, 2020, p. 110117.
Amirfakhryan H. Kawasaki-like disease in children with COVID-19: A hypothesis. Med Hypotheses. 2020;143:110117.
Amirfakhryan, H. (2020). Kawasaki-like disease in children with COVID-19: A hypothesis. Medical Hypotheses, 143, 110117. https://doi.org/10.1016/j.mehy.2020.110117
Amirfakhryan H. Kawasaki-like Disease in Children With COVID-19: a Hypothesis. Med Hypotheses. 2020;143:110117. PubMed PMID: 32721809.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Kawasaki-like disease in children with COVID-19: A hypothesis. A1 - Amirfakhryan,Hamideh, Y1 - 2020/07/18/ PY - 2020/06/10/received PY - 2020/07/07/revised PY - 2020/07/15/accepted PY - 2020/7/30/pubmed PY - 2020/10/21/medline PY - 2020/7/30/entrez KW - ACE2 receptor KW - Downregulation KW - Kawasaki disease KW - Kawasaki-like disease KW - SARS-CoV2 KW - TNF- α SP - 110117 EP - 110117 JF - Medical hypotheses JO - Med Hypotheses VL - 143 N2 - 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. SN - 1532-2777 UR - https://www.unboundmedicine.com/medline/citation/32721809/Kawasaki_like_disease_in_children_with_COVID_19:_A_hypothesis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0306-9877(20)31727-8 DB - PRIME DP - Unbound Medicine ER -