Review and future directions for PIMS-TS (MIS-C)

Abstract

Although still a relatively novel condition, the clinical course of PIMS-TS has been well documented, and the initial research into the immune mechanisms underlying the disease has been encouraging, with several aspects of innate and adaptive immunity of interest identified. Figure 2 shows a summary of the possible mechanisms. Identification of genetic factors associated with PIMS-TS will require a concerted, large-scale profiling of the genomes of PIMS-TS cases from different countries. That infection with SARS-CoV-2 provides a trigger for an inappropriate release of inflammatory cytokines, with T cell involvement driving systemic inflammation, with a superantigen possibly the cause of this appears plausible. The role of autoantibodies in this inflammation needs further investigation. Better characterisation of the cellular mechanisms leading to the observed acute cardiac dysfunction may uncover new therapeutic targets. The long-term implications of the condition are still being established, and to this end all data on the clinical and immunological profiles of these children after discharge are of value. Future research on these and other areas will hopefully provide us with a clear hypothesis as to the pathogenesis of the disease, and ideally will lead to improved clinical diagnosis and management of the condition.