Lifespan Research on COVID-19

Why doesn’t SARS-CoV-2 affect kids the same way it affects adults?

It’s been a relief for parents and pediatric specialists alike that children, as a group, don’t seem to get as sick as adults do from COVID-19. It’s also an urgent research question: Why don’t they?

“There might be factors in children that protect them,” says pediatric pulmonologist and critical care specialist Peter Mourani, MD. “Alternately, there could be factors in adults that make them more vulnerable. And there are kids who do get very sick, and we want to understand why that happens, while other kids are protected.”

A cross-institutional biobank for COVID-19

Back in April, Thomas Flaig, MD, was thinking about those questions, too. As Vice Chancellor for Research at the University of Colorado Denver and Anschutz Medical Campus, home to Children’s Colorado and the University of Colorado School of Medicine, he knew he’d be fielding a lot of requests for COVID-19 data and specimens.

“We had all these research groups planning to do individual biobanks,” he says. “We said, let’s do a campus-level protocol, put them all together and support research that covers the entire lifespan.”

The resulting campus-wide biobank collects COVID-19+ tissues from consenting pediatric and adult patients, harvesting specimens from testing and blood from labs into a shared repository that syncs tissue samples up with electronic health record data. That would be crucial — to align the samples with the clinical data to better understand correlations between anomalies and outcomes.

But it’s difficult, too, because different institutions keep electronic health records differently. Combining the data in a meaningful, reliable way requires special expertise. Luckily, the Anschutz Medical Campus had that infrastructure in place in the form of Health Data Compass, an existing campus resource set up to leverage electronic health record data for cross-institutional collaborations exactly like this one.

And in this case, it would support dozens of different research projects.

Extracting RNA to understand SARS-CoV-2

“So for example, my group is interested in extracting RNA from respiratory specimens to understand how characteristics of the SARS-CoV-2 virus, the respiratory tract microbiome, and host gene expression interact to impact disease severity across the age span,” says Dr. Mourani, who leads the biobanking effort for Children’s Colorado. “We’ll send an application to the biobank and request those samples together with patient data that tells us how that patient did, how sick they got, whether they needed critical care or a ventilator, how long they spent in the hospital, all these patient outcomes. And we try to identify relationships between these data and the severity of disease. We’re looking for patterns, trying to understand why.”

Other research projects up for consideration look at genetic factors, gene expression, protein function, immune response. Several look at antibodies: how they protect, to what extent, and whether they can be artificially generated. Several of these studies are already underway.

Still, the low incidence of acute disease in children means relatively fewer samples. Children’s Colorado participates in multi-center pediatric studies supported by the Centers for Disease Control and the National Institutes of Health that combine specimens and data from children at numerous institutions.

And yet another campus-wide biobank is in the works to study healthcare workers: how and under what circumstances they acquire COVID-19, and what antibody responses they generate. That effort will help formulate better policies around personal protective equipment and returning to work.

Translating COVID-19 knowledge across viruses

Ultimately, Dr. Mourani hopes the biobank will help lead to a better understanding of the SARS-CoV-2 virus and how it impacts kids’ bodies. That understanding could not only lead to better treatments for adults and kids who develop severe COVID-19, but perhaps for other forms of infectious pediatric respiratory disease as well.

“It’s an interesting virus. Most viruses differentially impact children. They’re much more severe in young kids than in older kids and adults,” he said. “With this virus, the youngest kids are protected. If we understood why a 6-month-old can protect themselves from COVID-19, maybe we could translate that mechanism to another respiratory infection and help protect them from influenza or RSV. I don’t know if that’ll happen, but it could be hugely impactful.”