Laboratory criteria for neuroimmunoendocrine dysregulation in multisystem inflammatory syndrome associated with SARS-CoV-2 in children

The article presents the results of an original study investigating the features of neuroendocrine regulation in children with Multisystem Inflammatory Syndrome (MIS-C) associated with SARS-CoV-2. Objective. To investigate blood laboratory parameters characterizing neuroimmunoendocrine dysregulation and identify predictors of severe disease course in MIS-C. Patients and methods. A clinical and laboratory examination of 30 children diagnosed with MIS-C was conducted. Additionally, levels of cytokines (n = 48), immunoglobulins (IgA, IgM, IgG), protein S-100B, neuron-specific enolase (NSE), and cortisol were analyzed. Results. During the acute phase of MIS-C, a significant increase was observed in the levels of 11 cytokines (IL-2Rα, IL-18, MIF, IL-1ra, IL-16, IP-10, MIG, MIP-1α, G-CSF, HGF, M-CSF), protein S-100B, and cortisol, along with a significant decrease in the levels of 9 cytokines (IFN-α2, IL-1α, IL-12(p70), TNF-β, IL-4, TRAIL, IL-3, IL-7, PDGF-BB) compared to the control group. During the convalescence period, normalization of most laboratory parameters was noted; however, a significant reduction compared to controls was observed for 16 cytokines (IFN-α2, IFN-γ, IL-1α, IL-1β, IL-6, IL-12(p70), IL-15, TNF-α, IL-4, IL-10, IL-13, MCP-3, IL-3, IL-5, IL-7, VEGF). Furthermore, levels of 5 cytokines (IL-18, IP-10, MIG, M-CSF, PDGF-BB), immunoglobulins, and platelets were significantly elevated. Laboratory predictors for the development of cardiovascular complications were identified: levels of platelets, lymphocytes, IgM, eotaxin, TNF-β, ferritin, and vascular endothelial growth factor (VEGF). Conclusion. The study identified laboratory criteria indicative of neuroimmunoendocrine dysregulation and hemostasis system disturbances in MIS-C, which correlate with the disease course severity. These findings provide a rationale for considering the use of Cytoflavin in the treatment regimen. Key words: SARS-CoV-2, S100B protein, immunoglobulins, cortisol, multisystem inflammatory syndrome in children, neuron-specific enolase, cytokines, Cytoflavin