Figure 6.

Schematic of the role of neutrophils in pediatric COVID-19 and MIS-C

Acute SARS-CoV-2 infection begins in the respiratory epithelium, and interferon signaling induces ISG+ neutrophils in circulation. Weeks later, viral persistence in the gut lumen results in zonulin release from gut epithelial cells, leading to loss of tight junctions and SARS-CoV-2 antigen leakage. Finally, immune complexes trigger NETosis and induce G-MDSCs, resulting in endothelial dysfunction and cardiovascular complications.