Multisystem Inflammatory Syndrome and Severe COVID-19 in children have distinct metabolism pathways affected by pathogenic genetic variants.

The coronavirus disease 2019 (COVID-19) pandemic has triggered a global health crisis, with over 700 million confirmed cases and at least 7 million deaths reported by early 2024. Children are less vulnerable to severe SARS-CoV-2 infection than adults and typically experience milder respiratory symptoms. However, a rare but significant complication, known as multisystem inflammatory syndrome in children (MIS-C), can develop weeks after infection, characterized by a spectrum of inflammatory symptoms. This study employed whole-exome sequencing and over-representation analysis to identify distinct pathogenic genetic variants related to MIS-C or severe COVID-19 in a group of children with acute respiratory distress syndrome (ARDS), all of whom were unvaccinated for COVID-19. We observed an enrichment of pathogenic variants in genes related to carbohydrate metabolism, particularly glycogen breakdown, in severe COVID-19 pediatric patients, and in genes related to cholesterol and lipoprotein metabolism in MIS-C patients. These findings offer insights into the genetic underpinnings of MIS-C and severe COVID-19, suggesting potential genes and biological pathways for further research.