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National Institutes of Health (NIH) Collaborates with Stanford Medicine

As the nationÔÇÖs leading biomedical research funding entity, the NIH was well aware of Stanford MedicineÔÇÖs prowess in ÔÇ£systems immunologyÔÇØ: the use of genomics, epigenomics, proteomics, metabolomics, and pretty much every other ÔÇ£omicsÔÇØ you can think of to learn how genes, cells, and those highly complicated organisms called ÔÇ£peopleÔÇØ respond to infections. So, the Cincinnati ChildrenÔÇÖs Hospital investigators teamed up with Pulendran, who is co-director of the Stanford Institute for Immunity, Transplantation and Infection and ÔÇö along with ITI director Mark Davis, PhD ÔÇö a leading practitioner of systems biology.

Then came the pandemic, and the lockdown. In this isolation, flu cases fell off a cliff while COVID-19 began to surge.

The scientists pivoted to a study of COVID-19 in kids. Florian Wimmers, PhD, then a postdoc in PulendranÔÇÖs lab, and his colleagues got hold of nasal and blood samples collected from 54 infants whoÔÇÖd become infected with SARS-CoV-2 before reaching age 2, and from 27 other children whoÔÇÖd tested negative throughout the observation period. For comparison, the researchers obtained similar samples from several dozen adults.

All infected children in the study were, at most, mildly symptomatic.

ÔÇ£We were desperate to find kids with severe symptoms,ÔÇØ Pulendran said. ÔÇ£We asked our Cincinnati ChildrenÔÇÖs collaborators to please send us samples of kids with severe disease. Try as they might, they couldnÔÇÖt find samples from kids with severe infection in all four years they were collecting them.ÔÇØ

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In a study led by Pulendran and just published in Cell, he and colleagues at Stanford Medicine and several other institutions discovered telling differences between infants and adults.

In the blood of SARS-CoV-2-infected adults, SARS-specific antibody levels rose quickly to a robust peak, then dropped off precipitously, declining by 10-fold within six months.

InfantsÔÇÖ blood-borne antibodies to SARS-CoV-2 were a little slower to spike upward in response to SARS-CoV-2 infection. But in stark contrast to adults, their antibody levels never dropped ÔÇö they either plateaued at a high level or kept on rising throughout the 300-day observation period, eventually rivaling those of the adults at peak.

ÔÇ£In no case did we see a decline,ÔÇØ Pulendran said. ÔÇ£This was completely unexpected.ÔÇØ

The kidsÔÇÖ antibodies, he noted, tended to be somewhat narrow-spectrum: highly effective against the original invading variant but providing less protection against other SARS-CoV-2 variants.

Another difference: In the blood of adults with even mild COVID-19 cases, there was a big increase in levels of a number of inflammation-promoting signaling proteins, previously shown to be associated with more severe symptoms. In infected kidsÔÇÖ blood, this increase wasnÔÇÖt seen.

In kids’ noses, though, it was another story.

ÔÇ£In the mucous membranes of the nasal cavity, we saw plenty of these very inflammation-promoting proteins,ÔÇØ Pulendran said. Among them was one called alpha-interferon, which has a noted knack for shutting down viral replication in infected cells.

Also absent in kidsÔÇÖ blood, but relatively abundant in the mucous membranes of their noses, was an immune molecule that calls in the thugs: That is, it recruits all-purpose pugnacious immune-cell buddies known as neutrophils to the area.

This big overall dichotomy between whatÔÇÖs going on in infected infants’ blood versus in their noses indicates to Pulendran that ÔÇ£the virus may be getting nipped in the bud in the nasal tracts,ÔÇØ which have a rapid, surprisingly effective immune response to a SARS-CoV-2 infection and deny the virus a launchpad for its spread to the lungs.

Pulendran wants to see if any of this nasal magic extends beyond COVID-19 ÔÇö he is now collaborating with the Cincinnati ChildrenÔÇÖs Hospital group on influenza and other viruses. He suspects that his COVID-19 findings may not translate directly to other respiratory infections. Kids, after all, get severe cases of respiratory syncytial virus (RSV) and influenza.

ÔÇ£Each pathogen has its own peculiarities,ÔÇØ he said.

But, he added, ÔÇ£If weÔÇÖve indeed identified a source of infants’ resilience to COVID-19, we should exploit it.ÔÇØ

Pulendran envisions, for example, a nasal spray that could be given every couple of months to stimulate in adults’ upper respiratory tracts the same immune-response capabilities that infants routinely have in theirs, and prevent the virus from getting a foothold.

ÔÇ£Can we design a COVID-19 vaccine, or an additive to existing ones, that induces an increase in mucosal immunity in the adult nose, as occurs naturally in infants? We don’t know,ÔÇØ he said.

ÔÇ£You could say weÔÇÖre in the infancy of this research.ÔÇØ

A researcher at the University of Tubingen contributed to the study.

The research was supported by the National Institutes of Health (grants R01 AI048638, U19 AI057266, and U19 AI167903), the Bill and Melinda Gates Foundation, Open Philanthropy, and the Violetta L. Horton and Soffer Endowments.

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