Figure 2: The ACE2-independent pathway of virus entry depends
on the expression of Fc receptors on the cellular membrane of the immune
cells. Binding of virus-antibody complex to Fc receptors induces
cellular endocytosis resulting in immune cell activation and subsequent
acute inflammation.
In conclusion, a few months after the COVID-19 pandemic, a significant
frequency of MIS-C cases linked to SRAS-COV-2 infection were reported in
different countries. There is an apparent correlation between the
percentage of asymptomatic SRAS-COV-2 infection in children and the
incidence of MIS-C. The absence of SARS-COV-2 RNA in seropositive
individuals suggests the possible role of SARS-COV-2 non-specific
antibodies in the development of MIS-C disease via ADE. As such, the
phenomenon of ADE should be considered in vaccine development against
SARS-COV-2.
Funding: This work is partially supported by National Institute
of
Allergy and Infectious Diseases Grant R01 AI129745, National Institute
of Mental Health Grant P30MH062261 and Frances E. Lageschulte and Evelyn
B. Weese New Frontiers in Medical Research Fund to SNB.