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Innate Immunity in Children and the Role of ACE2 Expression in SARS-CoV-2 Infection

Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy
Unità Operativa Nefrologia e Dialisi, Presidio Ospedaliero Scorrano, ASL (Azienda Sanitaria Locale) Lecce, Via Giuseppina Delli Ponti, 73020 Scorrano, Italy
U.S.C.A. “Unità Speciali di Continuità Assistenziale” Troia 2, ASL “Azienda Sanitaria Locale” Foggia Contrada Fontanelle, 71029 Troia, Italy
Department of Basic Medical Sciences, Neurosciences and Sensory Organs, Division of Complex Operating Unit of Dentistry, “Aldo Moro” University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy
Author to whom correspondence should be addressed.
Academic Editor: Thomas Boehler
Pediatr. Rep. 2021, 13(3), 363-382;
Received: 17 June 2021 / Revised: 28 June 2021 / Accepted: 28 June 2021 / Published: 2 July 2021
(This article belongs to the Special Issue COVID-19: What Happens in Pediatric Research in the Era of Pandemic)
COVID-19 (Coronavirus Disease 2019) is an emerging viral disease caused by the coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which leads to severe respiratory infections in humans. The first reports came in December 2019 from the city of Wuhan in the province of Hubei in China. It was immediately clear that children developed a milder disease than adults. The reasons for the milder course of the disease were attributed to several factors: innate immunity, difference in ACE2 (angiotensin-converting enzyme II) receptor expression, and previous infections with other common coronaviruses (CovH). This literature review aims to summarize aspects of innate immunity by focusing on the role of ACE2 expression and viral infections in children in modulating the antibody response to SARS-CoV-2 infection. This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles deemed potentially eligible were considered, including those dealing with COVID-19 in children and providing more up-to-date and significant data in terms of epidemiology, prognosis, course, and symptoms, focusing on the etiopathogenesis of SARS-CoV-2 disease in children. The bibliographic search was conducted using the search engines PubMed and Scopus. The following search terms were entered in PubMed and Scopus: COVID-19 AND ACE2 AND Children; COVID-19 AND Immunity innate AND children. The search identified 857 records, and 18 studies were applicable based on inclusion and exclusion criteria that addressed the issues of COVID-19 concerning the role of ACE2 expression in children. The scientific literature agrees that children develop milder COVID-19 disease than adults. Milder symptomatology could be attributed to innate immunity or previous CovH virus infections, while it is not yet fully understood how the differential expression of ACE2 in children could contribute to milder disease. View Full-Text
Keywords: COVID-19; SARS-CoV-2; coronavirus; ACE-2; adolescents; children COVID-19; SARS-CoV-2; coronavirus; ACE-2; adolescents; children
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MDPI and ACS Style

Dioguardi, M.; Cazzolla, A.P.; Arena, C.; Sovereto, D.; Caloro, G.A.; Dioguardi, A.; Crincoli, V.; Laino, L.; Troiano, G.; Lo Muzio, L. Innate Immunity in Children and the Role of ACE2 Expression in SARS-CoV-2 Infection. Pediatr. Rep. 2021, 13, 363-382.

AMA Style

Dioguardi M, Cazzolla AP, Arena C, Sovereto D, Caloro GA, Dioguardi A, Crincoli V, Laino L, Troiano G, Lo Muzio L. Innate Immunity in Children and the Role of ACE2 Expression in SARS-CoV-2 Infection. Pediatric Reports. 2021; 13(3):363-382.

Chicago/Turabian Style

Dioguardi, Mario, Angela P. Cazzolla, Claudia Arena, Diego Sovereto, Giorgia A. Caloro, Antonio Dioguardi, Vito Crincoli, Luigi Laino, Giuseppe Troiano, and Lorenzo Lo Muzio. 2021. "Innate Immunity in Children and the Role of ACE2 Expression in SARS-CoV-2 Infection" Pediatric Reports 13, no. 3: 363-382.

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