Pathobiological alterations affecting the distinct clinical courses of pediatric versus adult COVID-19 syndrome

Authors: EMRAH ŞENEL, SEYHAN TÜRK, ÜMİT YAVUZ MALKAN, MUSTAFA ÇAĞRI PEKER, CAN TÜRK, HATİCE RAHMET GÜNER, GÜLBERK UÇAR, SEVAL İZDEŞ, BİRCAN KAYAASLAN, GÜLSÜM İCLAL BAYHAN, SERHAT EMEKSİZ, İMRAN HASANOĞLU, ŞERİFE GÖKBULUT BEKTAŞ, ŞEYMA BÜTÜN TÜRK, SERHAN ÖZCAN, AHMET ERTÜRK, AHMET GÖKHAN AKDAĞ, AYŞEGÜL YILMAZ, İBRAHİM CELALETTİN HAZNEDAROĞLU

Abstract: Background/aim: The clinical presentation of pediatric coronavirus disease 2019 (COVID-19) is associated with a milder disease course than the adult COVID-19 syndrome. The disease course of COVID-19 has three clinicobiological phases: initiation, propagation, and complication. This study aimed to assess the pathobiological alterations affecting the distinct clinical courses of COVID-19 in pediatric age groups versus the adult population. We hypothesized that critical biogenomic marker expressions drive the mild clinical presentations of pediatric COVID-19. Materials and methods: Blood samples were obtained from 72 patients with COVID-19 hospitalized at Ankara City Hospital between March and July 2021. Peripheral blood mononuclear cells were isolated using Ficoll-Paque and density-gradient sedimentation. The groups were compared using a t-test and limma analyses. Mean standardized gene expression levels were used to hierarchically cluster genes employing Euclidean Gene Cluster 3.0. The expression levels of identified genes were determined using reverse transcriptionpolymerase chain reaction. Results: This study found that ANPEP gene expression was significantly downregulated in the pediatric group (p < 0.05, FC: 1.57) and IGF2R gene expression was significantly upregulated in the adult group (p < 0.05, FC: 2.98). The study results indicated that the expression of critical biogenomic markers, such as the first-phase (ACE2 and ANPEP) and second-phase (EGFR and IGF2R) receptor genes, was crucial in the genesis of mild clinical presentations of pediatric COVID-19. ANPEP gene expression was lower in pediatric COVID-19. Conclusion: The interrelationship between the ANPEP and ACE2 genes may prevent the progression of COVID-19 from initiation to the propagating phase in pediatric patients. High IGF2R gene expression could potentially contribute to a protective effect and may be a contributing factor for the mild clinical course observed in pediatric patients.

Keywords: Pediatric COVID-19, adult COVID-19, ACE2, ANPEP, EGFR, IGF2R

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