SARS-CO-V2 ANTIBODY STATUS IN CHILDREN WITH MITOCHONDRIAL DISEASE

ABSTRACT

Introduction: The impact of the COVID19 pandemic on pediatric neurodevelopmental disorders like mitochondrial disease (MtD) has not been well characterized. Viral infection is a major cause of morbidity in children with MtD. Historically, pediatric patients with MtD experience neurologic decline and metabolic decompensation if exposed to viral infection and families practice strict risk mitigation behavior to avoid infection. As many caregivers of children with MtD are essential workers, the household serves as a transmission risk factor. To better understand SARS-CoV-2 infection in children with MtD, we conducted a serologic study of MtD households. Methods: Families with a child with MtD were shipped a Neoteryx Blood Collection kit. Patient samples came from fifteen states across the United States as well as two European countries. All household individuals provided a dried blood sample which was shipped back for analysis of SARS-CoV-2 antibodies against both the nucleocapsid and the spike protein. Online questionnaires were also distributed to each family to assess exposure risks, MtD severity, and viral symptomatology. These data will allow us to define the status of proximate contacts of children with MtD, as well as symptomatology and asymptomatic infection. Results: Twenty families enrolled with N = 83 samples collected. All 20 families had at least one member with a positive nucleocapsid antibody test. Of the 21 patients with mitochondrial disease, 18 were positive for antibodies against the nucleocapsid antibody. However, of the 14 MtD patients who reported community testing prior to sampling, only one patient with MtD had known a positive test in the community. Of those with positive nucleocapsid antibodies, 29% had a known exposure to someone with COVID-19 infection. Symptomatology analysis concluded that between March of 2020 and the sampling date, 6 patients experienced fever or chills, 2 experienced a new or worsening cough, 1 experienced shortness of breath, 2 experienced pneumonia and 1 presented with muscle or body aches. Conclusion: There is serologic evidence that the majority of families affected by mitochondrial disease have been exposed to COVID19 despite strict risk mitigation behaviors. Of the patients exposed to COVID19, almost all had another family member also exposed, indicating the household as a possible transmission factor. None of these patients experienced hospitalization, neurologic decline, or metabolic decompensation. This implies that patients with mitochondrial disease may be capable of having asymptomatic COVID19 infections and may be able to tolerate this disease without acute decompensation. This may have implications about mitochondrial function in the immune response to COVID19. Future directions for this study include a network scale up model which will aid in making broader generalizations about this disease community through exposure levels.