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Understanding the age divide in COVID-19: why are children overwhelmingly spared?
Lingappan, K; Karmouty-Quintana, H; Davies, J; Akkanti, B; Harting, M T.
  • Lingappan K; Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
  • Karmouty-Quintana H; Department of Biochemistry and Molecular Biology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas.
  • Davies J; Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
  • Akkanti B; Divisions of Pulmonary, Critical Care, Sleep Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas.
  • Harting MT; Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas.
Am J Physiol Lung Cell Mol Physiol ; 319(1): L39-L44, 2020 07 01.
Article in English | MEDLINE | ID: covidwho-506052
ABSTRACT
The rapid emergence and subsequent global dissemination of SARS-CoV-2 disease (COVID-19) has resulted in over 4 million cases worldwide. The disease has a marked predilection for adults, and children are relatively spared. Understanding the age-based differences in pathophysiological pathways and processes relevant to the onset and progression of disease both in the clinical course and in experimental disease models may hold the key to the identification of therapeutic targets. The differences in the clinical course are highlighted by the lack of progression of the SARS-CoV-2 infection beyond mild symptoms in a majority of children, whereas in adults the disease progresses to acute lung injury and an acute respiratory distress syndrome (ARDS)-like phenotype with high mortality. The pathophysiological mechanisms leading to decreased lung injury in children may involve the decreased expression of the mediators necessary for viral entry into the respiratory epithelium and differences in the immune system responses in children. Specifically, decreased expression of proteins, including angiotensin-converting enzyme 2 (ACE2) and Transmembrane Serine Protease 2 (TMPRSS2) in the airway epithelium in children may prevent viral entry. The immune system differences may include a relative preponderance of CD4+ T cells, decreased neutrophil infiltration, decreased production of proinflammatory cytokines, and increased production of immunomodulatory cytokines in children compared with adults. Notably, the developing lung in children may have a greater capacity to recover and repair after viral infection. Understanding the relative contributions of the above processes to the protective phenotype in the developing lung can guide the trial of the appropriate therapies in adults.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Peptidyl-Dipeptidase A / Betacoronavirus Type of study: Diagnostic study / Prognostic study / Randomized controlled trials Limits: Adult / Child / Humans Language: English Journal: Am J Physiol Lung Cell Mol Physiol Journal subject: Molecular Biology / Physiology Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Peptidyl-Dipeptidase A / Betacoronavirus Type of study: Diagnostic study / Prognostic study / Randomized controlled trials Limits: Adult / Child / Humans Language: English Journal: Am J Physiol Lung Cell Mol Physiol Journal subject: Molecular Biology / Physiology Year: 2020 Document Type: Article