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.