# Biological role of SARS-CoV2 Superantigenic structure in hyperinflammatory syndromes

> **NIH NIH R01** · CEDARS-SINAI MEDICAL CENTER · 2020 · $184,894

## Abstract

PROJECT ABSTRACT
The Coronavirus Disease 2019 (COVID-19) pandemic has been associated with the emergence of a new febrile
pediatric entity called multisystem inflammatory syndrome in children (MIS-C), that involved systemic
hyperinflammation, multiorgan involvement and gastrointestinal symptoms. In some cases, this syndrome also
demonstrated clinical attributes, such as persistent fever, rashes, conjunctivitis and generalized pain in the
extremities, that mirror some features observed during Kawasaki Disease (KD). MIS-C patients are critically ill
and present with prominent cardiogenic shock and impressive myocardial dysfunction. While initially designated
as “Kawasaki-like” because of the few features that were reminiscent of KD, it has been suggested that the
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can trigger KD in children, however many
clinical laboratory as well as cardiac findings indicate that MIS-C and KD are different entities, and that MIS-C
presents more similarities with toxic shock syndrome (TSS), which is triggered by bacterial or viral superantigens.
In recognition of the NIH Strategic Plan and the urgent need for research on Coronavirus Disease 2019 (COVID-
19) and its causative agent, SARS-CoV-2, here we propose to expand the planned studies of our R01 by adding
experiments examining the role of SARS-CoV-2 superantigenic activity and its connection to the emergence of
MIS-C. Our preliminary computational analysis of SARS-CoV-2 suggest that the virus has a superantigen (SAg)
motif between the S1 and S2 spike proteins. However, this specific finding needs to be assessed biologically in
MIS-C patients and by in vitro experiments using human PBMCs.
Therefore, we hypothesize that KD and MIS-C are distinct entities triggered by different immune mechanisms,
and that the aberrant immune response observed in MIS-C patients is the result of SARS-CoV-2 superantigenic
stimulation. We propose to investigate the hypothesis that the SARS-CoV-2 SAg motif triggers
hyperinflammation in MIS-C patients and severe COVID-19 cases by performing the following supplemental
specific AIMS 1) Determine the involvement of a Superantigen (SAg) in the pathogenesis of Multisystem
Inflammatory Syndrome in Children (MIS-C) by characterization of the MIS-C patient T Cell Receptor
(TCR) repertoire and 2) Determine if the Spike protein of SARS-CoV-2 possesses superantigen-like
activity in vitro and in vivo. Successful completion of the aims of this administrative supplement could reveal
new avenues to predict, prevent, and treat MIS-C and severe COVID-19 disease in adults.

## Key facts

- **NIH application ID:** 10205906
- **Project number:** 3R01AI072726-10S1
- **Recipient organization:** CEDARS-SINAI MEDICAL CENTER
- **Principal Investigator:** Moshe Arditi
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $184,894
- **Award type:** 3
- **Project period:** 2020-09-02 → 2022-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10205906

## Citation

> US National Institutes of Health, RePORTER application 10205906, Biological role of SARS-CoV2 Superantigenic structure in hyperinflammatory syndromes (3R01AI072726-10S1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10205906. Licensed CC0.

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