Serum ACE2 and Anti-MMR Antibody Profiles in Pediatric Patients with and without SARS-CoV-2 Infection

Coronavirus Disease 2019 (COVID-19) typically manifests with milder symptoms and lower mortality rates in children when compared to adults. To investigate potential mechanisms underlying this age-related protection, we examined whether serum levels of angiotensin-converting enzyme 2 (ACE2) and IgG a...

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Bibliographic Details
Published in:Iranian journal of immunology Vol. 22; no. 3; p. 251
Main Authors: Labbani-Motlagh, Zohre, Nozarian, Zohreh, Haghi Ashtiani, Mohammad Taghi, Movahedinia, Sajjadeh, Vasei, Mohammad, Hosseini Rouzbahani, Negin
Format: Journal Article
Language:English
Published: Shiraz Shiraz Institute for Cancer Research 30.09.2025
Subjects:
ACE2
Adolescent
Age
Angiotensin
Angiotensin-converting enzyme 2
Angiotensin-Converting Enzyme 2 - blood
Antibodies
Antibodies, Viral - blood
Antibodies, Viral - immunology
Case-Control Studies
Child
Child, Preschool
Children
Coronaviruses
COVID-19
COVID-19 - blood
COVID-19 - immunology
Cross-reactivity
Enzyme-linked immunosorbent assay
Female
Humans
Immunodeficiency
Immunoglobulin G
Immunoglobulin G - blood
Immunoglobulin G - immunology
Infant
Infections
Male
Measles
Measles-Mumps-Rubella Vaccine - immunology
Mumps
Pediatrics
Peptidyl-dipeptidase A
Rubella
SARS-CoV-2 - immunology
Serum levels
Severe acute respiratory syndrome coronavirus 2
COVID-19
ACE2
Rubella
SARS-CoV-2
Measles
Mumps
MMR vaccine
ISSN:1735-1383, 1735-367X, 1735-367X
Online Access:Get full text
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Summary:Coronavirus Disease 2019 (COVID-19) typically manifests with milder symptoms and lower mortality rates in children when compared to adults. To investigate potential mechanisms underlying this age-related protection, we examined whether serum levels of angiotensin-converting enzyme 2 (ACE2) and IgG antibody titers against Measles, Mumps, and Rubella (MMR) vaccines are associated with susceptibility to SARS-CoV-2 infection in the pediatric population. In this case-control study, conducted before the introduction of mass COVID-19 vaccination, we enrolled children aged 1-15 years. The cases were hospitalized children with confirmed COVID-19, while the control group consisted of outpatients with non-infectious, non-immunodeficient conditions and no documented history of COVID-19. The COVID-19 status was confirmed using RT-PCR. Serum levels of ACE2 and anti-MMR IgG antibodies were assessed using ELISA. Eighty-three patients including 39 cases with COVID-19 infection and 44 controls were enrolled in this study. The median serum ACE2 levels were 3.6 in COVID-19 cases and 3.8 ng/mL in control cases (P=0.440). Similarly, antibody levels against Mumps (P=0.788), Measles (P=0.281), and Rubella (P=0.083) did not differ significantly between the groups, although Rubella seropositivity was more frequent in COVID-19 cases than in controls (P=0.039). Our findings did not support a significant association between serum ACE2 levels or MMR antibody titers and protection against COVID-19 in children. The higher prevalence of Rubella seropositivity among infected cases may suggest possible cross-reactivity, but causal relationships could not be established in this study.
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ISSN:1735-1383
1735-367X
1735-367X
DOI:10.22034/iji.2025.104055.2879