1
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Suzuki T, Michihata N, Hashimoto Y, Yoshikawa T, Saito K, Matsui H, Fushimi K, Yasunaga H. Association between aspirin dose and outcomes in patients with acute Kawasaki disease: a nationwide retrospective cohort study in Japan. Eur J Pediatr 2024; 183:415-424. [PMID: 37917176 DOI: 10.1007/s00431-023-05302-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/25/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023]
Abstract
This study aimed to identify the appropriate dose of aspirin to be prescribed to patients with acute Kawasaki disease (KD). Using a Japanese national inpatient database, we identified patients with KD treated with intravenous immunoglobulin between 2010 and 2021.The outcomes included the occurrence of coronary artery abnormalities and intravenous immunoglobulin resistance, length of hospital stay, and medical costs. Restricted cubic spline functions were performed to examine the association between aspirin dose and the outcomes. Data of 82,109 patients were extracted from the database. Non-linear associations were observed between aspirin dose and the outcomes. In comparison with an aspirin dose of 30 mg/kg/day, the odds ratio (95% confidence interval) for coronary artery abnormalities was 1.40 (1.13-1.75) at 5 mg/kg/day. An aspirin dose of ≥ 30 mg/kg/day did not significantly change the odds ratio for coronary artery abnormalities. Intravenous immunoglobulin resistance was significantly lower at a dose of 60 mg/kg/day or higher. CONCLUSION The results showed no significant association between aspirin escalation over standard-dose and coronary artery abnormalities in patients with acute KD. High-dose aspirin showed the potential to reduce hospital stay and medical costs without increasing complications. WHAT IS KNOWN • Aspirin is used as a standard treatment together with intravenous immunoglobulin for acute Kawasaki disease (KD). However, few studies have shown the most effective dosage of aspirin to prevent coronary artery abnormalities (CAAs). WHAT IS NEW • There was no significant association between aspirin dose escalation and CAAs in patients with acute KD.
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Affiliation(s)
- Takanori Suzuki
- Department of Pediatrics, Fujita Health University, Aichi, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - Kazuyoshi Saito
- Department of Pediatrics, Fujita Health University, Aichi, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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2
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Huang H, Xu L, Ding Y, Qin J, Huang C, Li X, Tang Y, Qian G, Lv H. Bioinformatics identification of hub genes and signaling pathways regulated by intravenous immunoglobulin treatment in acute Kawasaki disease. Exp Ther Med 2021; 22:784. [PMID: 34055083 PMCID: PMC8145699 DOI: 10.3892/etm.2021.10216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/11/2021] [Indexed: 01/01/2023] Open
Abstract
Kawasaki disease (KD) is an acute, self-limiting form of vasculitis commonly encountered in infants and young children. Intravenous immunoglobulin (IVIG) is the primary drug used for the treatment of KD, which may significantly reduce the occurrence of coronary artery lesions. However, the specific molecular profile changes of KD caused by IVIG treatment have remained elusive and require further research. The present study was designed to identify key genes, pathways and immune cells affected by IVIG treatment using multiple bioinformatics analysis methods. The results suggested that myeloid cells and neutrophils were affected by IVIG treatment. Kyoto Encyclopedia of Genes and Genomes pathway analysis identified that hematopoietic cell lineages and osteoclast differentiation may have an important role in the mechanism of action of IVIG treatment. Immune cell analysis indicated that the levels of monocytes, M1 macrophages, neutrophils and platelets were markedly changed in patients with KD after vs. prior to IVIG treatment. The key upregulated genes, including ZW10 interacting kinetochore protein, GINS complex subunit 1 and microRNA-30b-3p in whole blood cells of patients with KD following treatment with IVIG indicated that these IVIG-targeted molecules may have important roles in KD. In addition, these genes were further examined by literature review and indicated to be involved in cell proliferation, apoptosis and virus-related immune response in patients with KD. Therefore, the present results may provide novel insight into the mechanisms of action of IVIG treatment for KD.
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Affiliation(s)
- Hongbiao Huang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, P.R. China
| | - Lei Xu
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, P.R. China
| | - Yueyue Ding
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, P.R. China
| | - Jie Qin
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, P.R. China
| | - Chengcheng Huang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, P.R. China
| | - Xuan Li
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, P.R. China
| | - Yunjia Tang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, P.R. China
| | - Guanghui Qian
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, P.R. China
| | - Haitao Lv
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, P.R. China
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3
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Suzuki Y, Tanino Y, Nikaido T, Minemura H, Umeda T, Rikimaru M, Onuma T, Naito S, Takiguchi Y, Tomita H, Kawamata T, Togawa R, Sato Y, Uematsu M, Morimoto J, Kitakawa K, Tsukada Y, Nakamura K, Kanemitsu K, Iseki K, Shibata Y. Severe Coronavirus Disease 2019 That Recovered from Respiratory Failure by Treatment That Included High-dose Intravenous Immunoglobulin. Intern Med 2021; 60:457-461. [PMID: 33328409 PMCID: PMC7925270 DOI: 10.2169/internalmedicine.6326-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/01/2020] [Indexed: 12/13/2022] Open
Abstract
We herein report a case of severe coronavirus disease 2019 (COVID-19) in which high-dose intravenous immunoglobulin (IVIg) treatment achieved significant clinical improvement of deterioration of pulmonary inflammation after temporary clinical improvement. In the present case, clinical and radiological deterioration occurred despite a decrease in viral load, suggesting that deterioration was caused by reactivation of proinflammatory factors, such as tumor necrosis factor-α and interleukin-6, rather than direct viral effects. IVIg treatment may provide not only immunosuppressive effects but also inhibition of proinflammatory cytokines, indicating that treatment including IVIg may be effective by inhibiting cytokine storm in severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection.
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Affiliation(s)
- Yasuhito Suzuki
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Japan
| | - Yoshinori Tanino
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Japan
| | - Takefumi Nikaido
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Japan
| | - Takashi Umeda
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Japan
| | - Mami Rikimaru
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Japan
| | - Takumi Onuma
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Japan
| | - Shotaro Naito
- Department of General Internal Medicine, Fukushima Medical University, Japan
| | - Yoshinori Takiguchi
- Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University, Japan
| | - Hikaru Tomita
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Japan
| | - Takaya Kawamata
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Japan
| | - Ryuichi Togawa
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Japan
| | - Yuki Sato
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Japan
| | - Manabu Uematsu
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Japan
| | - Julia Morimoto
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Japan
| | | | - Yasuhiko Tsukada
- Department of Emergency and Critical Care Medicine, Fukushima Medical University, Japan
| | - Kiwamu Nakamura
- Department of Infection Control, Fukushima Medical University, Japan
| | - Keiji Kanemitsu
- Department of Infection Control, Fukushima Medical University, Japan
| | - Ken Iseki
- Department of Emergency and Critical Care Medicine, Fukushima Medical University, Japan
| | - Yoko Shibata
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Japan
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Jia X, Du X, Bie S, Li X, Bao Y, Jiang M. What dose of aspirin should be used in the initial treatment of Kawasaki disease? A meta-analysis. Rheumatology (Oxford) 2021; 59:1826-1833. [PMID: 32159800 DOI: 10.1093/rheumatology/keaa050] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/19/2019] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The use of IVIG plus high- or low-dose aspirin for the initial treatment of Kawasaki disease remains controversial. The aim of this study was to evaluate the efficacy of IVIG plus high-dose aspirin compared with IVIG plus low-dose aspirin in the treatment of Kawasaki disease. METHODS Studies related to aspirin therapy for Kawasaki disease were selected by searching the databases of Medline (PubMed), Embase and the Cochrane Library before March 2019. Statistical analyses were performed by using a Review Manager Software package and STATA v.15.1. RESULTS Eight retrospective cohort studies, characterizing 12 176 patients, were analysed. Overall, no significant difference was found in the incidence of coronary artery abnormalities between the high- and low-dose aspirin groups [relative risk (RR) 1.15; 95% CI: 0.93, 1.43; P = 0.19; random-effects model]. The patients treated with high-dose aspirin had slightly faster resolution of fever [mean difference (MD) -0.30; 95% CI: -0.58, -0.02; P = 0.04; random-effects model]. but the rates of IVIG resistance (RR, 1.26; 95% CI: 0.55, 2.92; P = 0.59; random-effects model) and days in hospital (MD, 0.22; 95% CI: -0.93, 1.37; P = 0.71; random-effects model) were similar between the two groups. CONCLUSION Low-dose aspirin plus IVIG might be as effective as high-dose aspirin plus IVIG for the initial treatment of Kawasaki disease. Considering that high-dose aspirin may cause more adverse reactions than low-dose aspirin, low-dose aspirin plus IVIG should be recommended as the first-line therapy in the initial treatment of Kawasaki disease.
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Affiliation(s)
- Xinyi Jia
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou.,Department of Pediatrics, Jinhua Hospital, Zhejiang University and Jinhua Municipal Central Hospital, Jinhua, Zhejiang, People's Republic of China
| | - Xiao Du
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou
| | - Shuxian Bie
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou
| | - Xiaobing Li
- Department of Pediatrics, Jinhua Hospital, Zhejiang University and Jinhua Municipal Central Hospital, Jinhua, Zhejiang, People's Republic of China
| | - Yunguang Bao
- Department of Pediatrics, Jinhua Hospital, Zhejiang University and Jinhua Municipal Central Hospital, Jinhua, Zhejiang, People's Republic of China
| | - Mizu Jiang
- Department of Gastroenterology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou
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5
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SARS-CoV-2 infection complicated by inflammatory syndrome. Could high-dose human immunoglobulin for intravenous use (IVIG) be beneficial? Autoimmun Rev 2020; 19:102559. [PMID: 32361195 PMCID: PMC7252087 DOI: 10.1016/j.autrev.2020.102559] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 01/12/2023]
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6
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The time option of IVIG treatment is associated with therapeutic responsiveness and coronary artery abnormalities but not with clinical classification in the acute episode of Kawasaki disease. Pediatr Rheumatol Online J 2019; 17:53. [PMID: 31366406 PMCID: PMC6668082 DOI: 10.1186/s12969-019-0352-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/10/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In the last decade, incomplete Kawasaki disease (KD), intravenous immunoglobulin (IVIG) non-response and coronary artery abnormalities (CAA) have experienced the increasing trends in China. In addition, the enhancement of pediatricians' awareness may also raise the diagnostic rate of incomplete KD and stimulate more aggressive initial therapy in the acute episode of KD. Given this background, we hypothesize that the time option of IVIG treatment should be in parallel with peak time of systemic inflammation; either earlier or later IVIG treatment may affect the clinical classification, therapeutic responsiveness and CAA occurrence in KD patients. Therefore, the major objective of the present study is to identify whether the time option of IVIG treatment could be associated with the clinical classification, therapeutic responsiveness and CAA occurrence in the acute episode of KD. MATERIALS AND METHODS A total of 153 children with KD were recruited between July 2015 and May 2018. All patients received the standard therapy of KD, including a single infusion of IVIG (2 g/kg) and aspirin (30-50 mg/kg/d). Blood samples were collected from all subjects within 24 h pre-IVIG treatment, respectively. Echocardiography was performed during the period from 2 days to 14 days after IVIG treatment. RESULTS (1) The clinical classification presented no significant heterogenicity among different treatment time (x2 = 1.59, p > 0.05) (2) Eleven KD patients resisted to IVIG treatment and 7 of them (63.60%) received the initial IVIG dose on day 5 and 6. (3) The distribution of CAA onset was subjected to a significant difference according to timing option of IVIG treatment (x2 = 11.94, p < 0.05). CONCLUSIONS The time option of IVIG treatment is associated with therapeutic responsiveness and CAA but not with clinical classification in the acute episode of KD.
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7
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Pilania RK, Jindal AK, Guleria S, Singh S. An Update on Treatment of Kawasaki Disease. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00115-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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8
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Escobar HA, Meneses-Gaviria G, Ijají-Piamba JE, Triana-Murcia HM, Molina-Bolaños JA, Vidal-Martínez JF, Correa-Gallego CF, Cedeño-Burbano AA. Tratamiento farmacológico de la enfermedad de Kawasaki. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n1.64144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La enfermedad de Kawasaki corresponde a una vasculitis sistémica de origen desconocido y su principal complicación es la formación de aneurismas coronarios.Objetivo. Realizar una revisión actualizada de la literatura acerca del tratamiento farmacológico de la enfermedad de Kawasaki.Materiales y métodos. Se realizó una búsqueda estructurada de la literatura en las bases de datos ProQuest, EBSCO, ScienceDirect, PubMed, LILACS, Embase, Trip Database, SciELO y Cochrane Library con los términos “Kawasaki disease AND therapeutics”, “Kawasaki disease AND treatment” y “Mucocutaneous Lymph Node Syndrome AND therapeutics”, en inglés y con sus equivalentes en español.Resultados. Se encontraron 51 artículos con información relevante para el desarrollo de la presente revisión.Conclusiones. El diagnóstico y el tratamiento oportuno de la enfermedad de Kawasaki son fundamentales para la prevención de las complicaciones coronarias. El tratamiento incluye la terapia combinada de ácido acetilsalicílico más inmunoglobulina G, la cual reduce la incidencia de aneurismas coronarios. Por su parte, las terapias con corticosteroides y otros fármacos inmunosupresores son alternativas utilizadas en el tratamiento de la enfermedad de Kawasaki resistente a inmunoglobulina.
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9
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Huang X, Huang P, Zhang L, Xie X, Xia S, Gong F, Yuan J, Jin L. Is aspirin necessary in the acute phase of Kawasaki disease? J Paediatr Child Health 2018; 54:661-664. [PMID: 29271519 DOI: 10.1111/jpc.13816] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 09/30/2017] [Accepted: 10/04/2017] [Indexed: 11/28/2022]
Abstract
AIM To explore whether aspirin is necessary for treatment in the acute phase of Kawasaki disease (KD). METHODS Nine hundred ten patients who fulfilled the criteria of KD and maintained follow-up for 2 years were included in this retrospective study. All patients initially received a single dose of intravenous immunoglobulin (IVIG, 2 g/kg) in the acute phase. Patients were classified into three groups according to the doses of aspirin. Group 1 included 152 cases treated with IVIG only in the acute phase. Group 2 included 672 cases treated with IVIG plus 3-5 mg/kg/day aspirin as the low-dose group, and group 3 included 86 cases treated with IVIG plus 30-50 mg/kg/day aspirin as the moderate-dose group. Changes in inflammatory indices and platelet count after treatment were compared by one-way analysis of variance or analysis of covariance to analyse the clinical effect of aspirin in acute KD. The relationship between aspirin use and coronary artery lesion complications was analysed by logistic regression. RESULTS There was no significant difference among the three groups in terms of the anti-inflammation effect revealed by C-reactive protein level, white blood cell count, percentage of neutrophils in white blood cells, decreasing platelet count or prevention of the formation of coronary artery lesion. CONCLUSIONS The role of aspirin in the treatment of the acute phase of KD should be questioned as a definite benefit has not been shown in our study. Further prospective studies incorporating large multicentre samples of patients are needed to confirm this finding.
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Affiliation(s)
- Xijing Huang
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Ping Huang
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Li Zhang
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xiaofei Xie
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Shuliang Xia
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Fang Gong
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jia Yuan
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Liling Jin
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
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10
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Lo MS, Newburger JW. Role of intravenous immunoglobulin in the treatment of Kawasaki disease. Int J Rheum Dis 2017; 21:64-69. [PMID: 29205910 DOI: 10.1111/1756-185x.13220] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Intravenous immunoglobulin (IVIg) is a purified plasma product that is used for many immune-deficient conditions and autoimmune conditions. Use of IVIg for treatment for Kawasaki disease (KD) is critical for control of inflammation. The American Heart Association (AHA) recommends a single infusion of 2 g/kg preferably given during the first 10 days of illness. In this review, we have discussed the possible mechanisms of action of IVIg in KD and its clinical usage in this condition.
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Affiliation(s)
- Mindy S Lo
- Division of Immunology, Boston Children's Hospital, Boston, MA.,Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Jane W Newburger
- Department of Pediatrics, Harvard Medical School, Boston, MA.,Division of Cardiology, Boston Children's Hospital, Boston, MA
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11
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Revisiting the role of steroids and aspirin in the management of acute Kawasaki disease. Curr Opin Rheumatol 2017; 29:547-552. [DOI: 10.1097/bor.0000000000000425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Kim GB, Yu JJ, Yoon KL, Jeong SI, Song YH, Han JW, Hong YM, Joo CU. Medium- or Higher-Dose Acetylsalicylic Acid for Acute Kawasaki Disease and Patient Outcomes. J Pediatr 2017; 184:125-129.e1. [PMID: 28043685 DOI: 10.1016/j.jpeds.2016.12.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/10/2016] [Accepted: 12/05/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the effect of medium- or higher-dose acetylsalicylic acid (ASA) for treating acute-phase Kawasaki disease to prevent coronary artery aneurysm (CAA). STUDY DESIGN Among the children with acute Kawasaki disease investigated in the eighth nationwide survey in the Republic of Korea, 8456 children with adequate data were included in this study. The subjects were divided into 2 groups according to the use of medium- or higher-dose ASA (≥30 mg/kg/day), or-low dose ASA (3-5 mg/kg/day) during the acute febrile phase. Both z- score-based criteria and Japanese criteria for CAA were used. RESULTS The prevalence of CAA based on z-score (24.8% vs 18.3%; P = .001) and on the Japanese criteria (19.0% vs 10.4%; P < .001) was higher in the 7947 patients who received medium- or higher-dose ASA compared with the 509 patients who received low-dose ASA. The use of medium- or higher-dose ASA was a significant predictor of CAA based on both sets of criteria by univariate analysis (based on z-score: OR, 1.472, 95% CI, 1.169-1.854, P = .001; based on Japanese criteria: OR, 2.013, 95% CI, 1.507-2.690, P < .001) and multivariate logistic regression analysis (OR, 1.527, 95% CI, 1.166-2.0, P = .003 and OR, 2.198, 95% CI, 1.563-3.092, P < .001, respectively). CONCLUSIONS The use of medium- or higher-dose ASA in acute Kawasaki disease did not prevent CAA. A future randomized controlled trial is needed to determine the optimum dose of ASA.
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Affiliation(s)
- Gi Beom Kim
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jeong Jin Yu
- Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Kyung Lim Yoon
- Department of Pediatrics, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Soo In Jeong
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young Hwan Song
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Ji Whan Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Chan Uhng Joo
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Republic of Korea
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13
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McCrindle BW, Selamet Tierney ES. Acute Treatment for Kawasaki Disease: Challenges for Current and Future Therapies. J Pediatr 2017; 184:7-10. [PMID: 28233548 DOI: 10.1016/j.jpeds.2017.01.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/31/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Brian W McCrindle
- Department of Pediatrics Labatt Family Heart Centre The Hospital for Sick Children University of Toronto Toronto, Ontario, Canada.
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology Department of Pediatrics Lucile Packard Children's Hospital at Stanford Stanford University Medical Center Palo Alto, California
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14
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Alphonse MP, Duong TT, Shumitzu C, Hoang TL, McCrindle BW, Franco A, Schurmans S, Philpott DJ, Hibberd ML, Burns J, Kuijpers TW, Yeung RSM. Inositol-Triphosphate 3-Kinase C Mediates Inflammasome Activation and Treatment Response in Kawasaki Disease. THE JOURNAL OF IMMUNOLOGY 2016; 197:3481-3489. [PMID: 27694492 DOI: 10.4049/jimmunol.1600388] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 09/04/2016] [Indexed: 01/05/2023]
Abstract
Kawasaki disease (KD) is a multisystem vasculitis that predominantly targets the coronary arteries in children. Phenotypic similarities between KD and recurrent fever syndromes point to the potential role of inflammasome activation in KD. Mutations in NLRP3 are associated with recurrent fever/autoinflammatory syndromes. We show that the KD-associated genetic polymorphism in inositol-triphosphate 3-kinase C (ITPKC) (rs28493229) has important functional consequences, governing ITPKC protein levels and thereby intracellular calcium, which in turn regulates NLRP3 expression and production of IL-1β and IL-18. Analysis of transcript abundance, protein levels, and cellular response profiles from matched, serial biospecimens from a cohort of genotyped KD subjects points to the critical role of ITPKC in mediating NLRP3 inflammasome activation. Treatment failure in those with the high-risk ITPKC genotype was associated with the highest basal and stimulated intracellular calcium levels and with increased cellular production of IL-1β and IL-18 and higher circulating levels of both cytokines. Mechanistic studies using Itpkc-deficient mice in a disease model support the genomic, cellular, and clinical findings in affected children. Our findings provide the mechanism behind the observed efficacy of rescue therapy with IL-1 blockade in recalcitrant KD, and we identify that regulation of calcium mobilization is fundamental to the underlying immunobiology in KD.
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Affiliation(s)
- Martin Prince Alphonse
- Department of Immunology, University of Toronto, Toronto, Ontario M5S 1A8, Canada.,Cell Biology Research Program, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Trang T Duong
- Cell Biology Research Program, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Chisato Shumitzu
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093
| | | | - Brian W McCrindle
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Alessandra Franco
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093
| | - Stéphane Schurmans
- Laboratory of Functional Genetics, GIGA-Research Center, University of Liege, 4000 Liege, Belgium; and
| | - Dana J Philpott
- Department of Immunology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | | | - Jane Burns
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093
| | - Taco W Kuijpers
- Department of Pediatrics, Sanquin Blood Bank, 1066 Amsterdam, the Netherlands
| | - Rae S M Yeung
- Department of Immunology, University of Toronto, Toronto, Ontario M5S 1A8, Canada; .,Cell Biology Research Program, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
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High-Dose Aspirin is Associated with Anemia and Does Not Confer Benefit to Disease Outcomes in Kawasaki Disease. PLoS One 2015; 10:e0144603. [PMID: 26658843 PMCID: PMC4686074 DOI: 10.1371/journal.pone.0144603] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/21/2015] [Indexed: 01/31/2023] Open
Abstract
Background Kawasaki disease (KD) is also known as multiple mucocutaneous lymph node syndrome of systemic vasculitis and is a leading cause of coronary artery lesions (CAL) in childhood. Intravenous immunoglobulin (IVIG) has been proven to effectively reduce the incidence of CAL, but the role and effect dose of aspirin in KD is still unclear. Moreover, overt bleeding and anemia are associated with the use of aspirin, and anemia is common in patients with KD. Thus, the aim of this study was conducted to compare the treatment efficacy, degree of anemia and inflammation, and changes in serum hepcidin in children who received a combination of high-dose aspirin and IVIG in the acute stage of KD, and those who received IVIG alone. Materials and Methods KD patients from two medical centers were retrospectively analyzed from 1999–2009. All patients were initially treated with a single dose of IVIG (2 g/kg) as the standard care of treatment. In group 1, high-dose aspirin was prescribed (> 30 mg/kg/day) until the fever subsided, and then low-dose aspirin (3–5 mg/kg/day) was prescribed until all the inflammation signs had resolved. In group 2, low-dose aspirin was prescribed without high-dose aspirin. Laboratory data were collected for analysis in both groups. Results A total of 851 KD patients (group 1, N = 305, group 2, N = 546) were enrolled in this study. There were no significant differences between group 1 and group 2 in terms of gender (p = 0.51), IVIG resistance rate (31/305 vs. 38/546, p = 0.07), CAL formation (52/305 vs. 84/546, p = 0.67), and duration of hospitalization (6.3 ± 0.2 vs. 6.7 ± 0.2 days, p = 0.13). There were also initially no significant differences in total white blood cell count, hemoglobin level, platelet count, and CRP before IVIG treatment between groups (all p>0.1). After IVIG treatment, group 1 had significantly lower levels of hemoglobin (p = 0.006) and higher CRP (p<0.001) as well as a smaller decrease in CRP level (p = 0.012). Furthermore, there was also a higher serum level of hepcidin and a delayed decrease in hepcidin level after receiving IVIG in group 1 (p = 0.04 and 0.02, respectively). Conclusions These results provide evidence demonstrating that high-dose aspirin in the acute phase of KD does not confer any benefit with regards to inflammation and it does not appear to improve treatment outcomes. Therefore, high-dose aspirin is unnecessary in acute phase KD.
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Sun Y, Yuan Y, Yan H, Wan H, Li X, Chen S, Li H, Tang C, Du J, Liu G, Jin H. Plasma H2S predicts coronary artery lesions in children with Kawasaki disease. Pediatr Int 2015; 57:840-4. [PMID: 25808254 DOI: 10.1111/ped.12631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 01/17/2015] [Accepted: 02/13/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim of this study was to determine whether plasma hydrogen sulfide (H2S) is a biomarker for predicting coronary artery lesions (CAL) in children with Kawasaki disease (KD). METHODS A prospective study was conducted on 50 KD patients and 27 healthy children. Plasma H2 S was analyzed at the acute stage. Plasma H2S was detected using the sensitive electrode method, and receiver operating characteristic curve (ROC) analysis was carried out. RESULTS Plasma H2S in KD patients at the acute stage was significantly lower than that of controls. CAL patients had reduced plasma H2S at acute stage compared with the non-CAL patients. A plasma H2S cut-off of 31.2 µmol/L provided a sensitivity of 81% and a specificity of 62.5% for predicting coronary injuries in KD. Optimal specificity and sensitivity were obtained when using plasma H2S to predict CAL in KD children. CONCLUSION Plasma H2S level in the acute period is a potentially useful biomarker for predicting CAL in KD children.
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Affiliation(s)
- Yan Sun
- Department of Pediatrics, Peking University First Hospital
| | - Yue Yuan
- Department of Pediatric Cardiology, Beijing Children's Hospital
| | - Hui Yan
- Department of Pediatrics, Peking University First Hospital
| | - Hong Wan
- Department of Pediatrics, Peking University First Hospital
| | - Xueying Li
- Department of Medical Statistics, Peking University First Hospital
| | - Siyao Chen
- Department of Pediatrics, Peking University First Hospital
| | - Hongxia Li
- Department of Pediatrics, Peking University First Hospital
| | - Chaoshu Tang
- Department of Physiology and Pathophysiology, Peking University Health Science Center
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital.,Key Laboratory of Molecular Cardiology, Ministry of Education
| | - Guiying Liu
- Department of Pediatrics, Beijing Anzhen Hospital, Beijing, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital
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Obeidat HR, Al-Dossary S, Asseri A. Kawasaki disease with Glucose-6-Phosphate Dehydrogenase deficiency, case report. Saudi Pharm J 2015; 23:455-7. [PMID: 27134550 PMCID: PMC4834672 DOI: 10.1016/j.jsps.2014.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/11/2014] [Indexed: 11/24/2022] Open
Abstract
Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that occurs predominantly in infants and children younger than 5 years of age. Coronary artery abnormalities are the most serious complication. Based on the literatures infusion of Intravenous Immunoglobulin of 2 g/kg and a high dose of oral aspirin up to 100 mg/kg/day are the standard treatment for Kawasaki disease in the acute stage, and should be followed by antiplatelet dose of aspirin for thrombocytosis. Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is an inherited X-linked hereditary disorder, and aspirin can induce hemolysis in patients with G6PD deficiency. We report a case of a 5 year and 8 month old male with KD and G6PD deficiency.
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Affiliation(s)
| | - Sahar Al-Dossary
- Pediatric and Neonatology Department, Saad Specialist Hospital, Alkhobar 31952, Saudi Arabia
| | - Abdulsalam Asseri
- Pharmacy Department, Saad Specialist Hospital, Alkhobar 31952, Saudi Arabia
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Luban NL, Wong EC, Henrich Lobo R, Pary P, Duke S. Intravenous immunoglobulin-related hemolysis in patients treated for Kawasaki disease. Transfusion 2015; 55 Suppl 2:S90-4. [DOI: 10.1111/trf.13089] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Naomi L.C. Luban
- Division of Laboratory Medicine; Children's National Medical Center; Washington DC
- Department of Pediatrics; Washington DC
- Department of Pathology; the George Washington University School of Medicine and Health Sciences; Washington DC
| | - Edward C.C. Wong
- Division of Laboratory Medicine; Children's National Medical Center; Washington DC
- Department of Pediatrics; Washington DC
- Department of Pathology; the George Washington University School of Medicine and Health Sciences; Washington DC
| | - Rodolfo Henrich Lobo
- Department of Pathology; the George Washington University School of Medicine and Health Sciences; Washington DC
| | - Philippe Pary
- Division of Laboratory Medicine; Children's National Medical Center; Washington DC
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20
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Eleftheriou D, Levin M, Shingadia D, Tulloh R, Klein N, Brogan P. Authors' response to 'aspirin dose for treatment of Kawasaki disease'. Arch Dis Child 2015; 100:300-1. [PMID: 25425602 DOI: 10.1136/archdischild-2014-307798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Michael Levin
- Paediatric Infectious Diseases Group, Division of Medicine, Imperial College London
| | | | - Robert Tulloh
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Nigel Klein
- Institute of Child Health and Great Ormond Street, London
| | - Paul Brogan
- Institute of Child Health and Great Ormond Street, London
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Nakada T. Effects of anti-inflammatory drugs on intravenous immunoglobulin therapy in the acute phase of Kawasaki disease. Pediatr Cardiol 2015; 36:335-9. [PMID: 25158631 DOI: 10.1007/s00246-014-1010-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/20/2014] [Indexed: 12/18/2022]
Abstract
This retrospective study aimed to investigate the effects of anti-inflammatory drugs (ADs) on intravenous immunoglobulin (IVIG) therapy in the acute phase of Kawasaki disease. In total, 182 pediatric patients who received IVIG therapy for Kawasaki disease between 1999 and 2013 at the Department of Pediatrics, Aomori Prefectural Central Hospital were enrolled. Patients were divided into 2 groups: an S group, including 111 patients who received single IVIG therapy with delayed administration of ADs, and a T group, including 71 patients who received concomitant AIDs with IVIG. During the study, the only ADs administered were aspirin (A: 30 mg/kg/day) or flurbiprofen (F: 3-5 mg/kg/day). Steroids were not administered to any patient. The regimen of the S group was partially used after 2004 and was used to all patients after 2009. The following clinical findings were significantly different between the S and T groups: disease onset before 2003 (0 vs. 59%, P < 0.001) and after 2009 (70 vs. 0%, P < 0.001), use of 2-g/kg/day IVIG therapy (100 vs. 93%, P = 0.034), ADs type (A/F: 62/49 vs. 17/54, P < 0.001), and the prevalence of coronary artery lesions (CAL) up to (1/111 vs. 11/71, P < 0.001) and after 30 days of illness (0/111 vs. 4/71, P = 0.022). Logistic regression analysis revealed that IVIG therapy only (S group; P = 0.009) and 2-g/kg/day IVIG therapy (P = 0.015) were significant factors for CAL suppression. The findings revealed a possible negative impact of ADs on initial IVIG therapy in the acute phase of Kawasaki disease. Initial single IVIG therapy with delayed administration of ADs may be useful to suppress CAL caused by Kawasaki disease.
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Affiliation(s)
- Toshimasa Nakada
- Department of Pediatrics, Aomori Prefectural Central Hospital, Higashi-Tukurimiti 2-1-1, Aomori City, Aomori Prefecture, 030-8553, Japan,
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22
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Bal AK, Prasad D, Umali Pamintuan MA, Mammen-Prasad E, Petrova A. Timing of intravenous immunoglobulin treatment and risk of coronary artery abnormalities in children with Kawasaki disease. Pediatr Neonatol 2014; 55:387-92. [PMID: 24636168 DOI: 10.1016/j.pedneo.2013.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 10/11/2013] [Accepted: 11/26/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is a type of febrile self-limiting systemic vasculitis, which affects the coronary arteries (CA) and may cause cardiac ischemia during childhood and adult life. Intravenous immunoglobulin (IVIG) has become the standard therapy for KD. However, it is still uncertain if CA outcome is associated with the timing of IVIG administration with reference to fever onset. METHODS The present study was designed to identify the risk for development and delay in resolution of CA abnormalities in association with IVIG administration within or after 10 days of KD onset. A retrospective analysis of clinical signs, laboratory data, and prospectively collected echocardiography (ECHO) results of 106 children hospitalized with KD was utilized. RESULTS IVIG was administered to 86 (81.1%) patients within 10 days, and 20 (18.9%) patients received the first dose of IVIG after 10 days of illness. Among 23 (21.6%) patients who were diagnosed with CA lesions, 18 had a CA abnormality at initial ECHO, whereas they appeared after IVIG therapy in five patients. The risk for CA lesions on initial ECHO was higher among the patients who were admitted after 10 days of disease onset [odds ratio (OR) = 5.3, 95% confidence interval (CI) = 1.7-15.9] but comparable with the post-IVIG treatment group (OR = 3.1, 95% CI = 0.48-19.8). The age <1 year and erythrocyte sedimentation rate (ESR) > 40 mm/hour were associated with non-resolution of CA lesions within 9 weeks of KD onset. Overall, 95.6% of children had resolution of CA abnormalities within 6 months of onset of KD symptoms. CONCLUSION The results of this study suggest that although IVIG treatment within 10 days is important to minimize development of cardiac pathology, neither occurrence of CA lesions in IVIG-treated children nor the time frame for resolution of established CA abnormalities was associated with the timing of IVIG administration. Age <1 year and high ESR (>40 mm/hour) predict a delay in resolution of CA lesions among children with KD.
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Affiliation(s)
- Aswine K Bal
- Rutgers Robert Wood Johnson Medical School, Department of Pediatrics, 1 Robert Wood Johnson Place, New Brunswick, NJ 08903, USA; K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, 1945 Corlies Avenue, Neptune, NJ 07754, USA.
| | - Deepa Prasad
- K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, 1945 Corlies Avenue, Neptune, NJ 07754, USA
| | - Maria Angela Umali Pamintuan
- K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, 1945 Corlies Avenue, Neptune, NJ 07754, USA
| | - Elizabeth Mammen-Prasad
- K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, 1945 Corlies Avenue, Neptune, NJ 07754, USA
| | - Anna Petrova
- Rutgers Robert Wood Johnson Medical School, Department of Pediatrics, 1 Robert Wood Johnson Place, New Brunswick, NJ 08903, USA; K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, 1945 Corlies Avenue, Neptune, NJ 07754, USA
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Fülber I, Bacher M, Dodel R, Röskam S. Evaluating the Murine Anti-Human Antibody Response and Assessment of General Activity and Cognition after Treatment with Human Intravenous Immunoglobulins in Healthy Adult C57/B6J Mice. EUR J INFLAMM 2014. [DOI: 10.1177/1721727x1401200310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Human intravenous immunoglobulin (IVIG) is a fractionated blood product that is used for the treatment of several autoimmune and immunodeficiency disorders. Recently, IVIG has been suggested for the treatment of Alzheimer's disease (AD). However, the molecular mode of action is still largely unknown. Therefore, preclinical assessment of the therapeutic efficacy of IVIG in animals may provide valuable information of the function of IVIG in vivo. However, it is recommended to determine the murine-anti-human antibody (MAHA) response in those animals before starting immunotherapy and subsequent assessment of the therapeutic efficacy in animal models for AD. After weekly administration of 400 μg IVIG in C57/B6J mice for the duration of twelve weeks, we found a significant increase of MAHA response against human IgG. Even after increased MAHA levels starting from week nine after treatment, there was no significant change in basic exploratory behavior, anxiety, and cognition. Therefore, it is suitable to study pharmacological and immunological activity, therapeutic efficacy, as well as mode of action of IVIG in animal models only for a short duration to avoid interference with IVIG treatment and neutralize possible therapeutic effects.
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Affiliation(s)
- I. Fülber
- Department of Neurology, Philipps-University Marburg, Germany
| | - M. Bacher
- Department of Immunology, Philipps-University Marburg, Germany
| | - R. Dodel
- Department of Neurology, Philipps-University Marburg, Germany
| | - S. Röskam
- Department of Neurology, Philipps-University Marburg, Germany
- Department of Animal Physiology, Philipps-University Marburg, Germany
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Abstract
Kawasaki disease is a systemic vasculitis and the leading cause of acquired heart disease in North American and Japanese children. The epidemiology, cause, and clinical characteristics of this disease are reviewed. The diagnostic challenge of Kawasaki disease and its implications for coronary artery outcomes are discussed, as are the recommended treatment, ongoing treatment controversies, concerns associated with treatment resistance, and the importance of ongoing follow up.
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Affiliation(s)
- Rosie Scuccimarri
- Division of Pediatric Rheumatology, Department of Pediatrics, Montreal Children's Hospital, McGill University, 2300 Tupper, Room C-505, Montreal, Quebec H3H 1P3, Canada.
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28
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Kawasaki Disease. TEXTBOOK OF CLINICAL PEDIATRICS 2012. [PMCID: PMC7176211 DOI: 10.1007/978-3-642-02202-9_165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Blankier S, McCrindle BW, Ito S, Yeung RSM. The role of atorvastatin in regulating the immune response leading to vascular damage in a model of Kawasaki disease. Clin Exp Immunol 2011; 164:193-201. [PMID: 21361911 PMCID: PMC3087911 DOI: 10.1111/j.1365-2249.2011.04331.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2011] [Indexed: 02/06/2023] Open
Abstract
Superantigens have been implicated in a number of diseases including Kawasaki disease (KD), a multi-system vasculitis resulting in coronary artery aneurysms. We have characterized a murine disease model in which coronary arteritis is induced by a novel superantigen found in Lactobacillus casei cell wall extract (LCWE). Using this animal model of KD, we have identified three pathogenic steps leading to coronary artery aneurysm formation. These steps include T cell activation and proliferation, production of the proinflammatory cytokine tumour necrosis factor (TNF)-α and up-regulation of matrix metalloproteinase 9 (MMP-9), an elastolytic protease. In addition to their cholesterol-lowering effects, 3-hydroxy-3-methylglutaryl (HMG) coenzyme A (CoA) reductase inhibitors (statins) have pleotropic immunomodulatory properties. Thus, we examined the effect of atorvastatin in modulating each of these three critical pathogenic processes leading to aneurysm formation in the disease model. Atorvastatin inhibited lymphocyte proliferation in response to superantigen stimulation in a dose-dependent manner. This inhibition was also observed for production of soluble mediators of inflammation including interleukin (IL)-2 and TNF-α. The inhibitory effect on proliferation was rescued completely by mevalonic acid, confirming that the mechanism responsible for this inhibitory activity on immune activation was inhibition of HMG-CoA reductase. Similarly, TNF-α-induced MMP-9 production was reduced in a dose-dependent manner in response to atorvastatin. Inhibition of extracellular-regulated kinase (ERK) phosphorylation appears to be the mechanism responsible for inhibition of MMP-9 production. In conclusion, atorvastatin is able to inhibit critical steps known to be important in the development of coronary aneurysms, suggesting that statins may have therapeutic benefit in patients with KD.
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Affiliation(s)
- S Blankier
- Cell Biology Program, The Hospital for Sick Children Research Institute, Toronto, Canada
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The functions of endothelial progenitor cells were significantly improved after treatment with intravenous immunoglobulin and aspirin in children with Kawasaki disease. Pediatr Cardiol 2011; 32:455-60. [PMID: 21327631 DOI: 10.1007/s00246-011-9900-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
Abstract
We sought to determine the effects of treatment with intravenous immunoglobulin (IVIG) and aspirin on the functions of endothelial progenitor cells (EPCs) in patients with Kawasaki disease (KD) as well as its relationship with concentrations of tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP). Ten KD patients in the acute phase of their disease were recruited. We investigated EPC functions in children with KD before and after treatment with IVIG and aspirin. In vitro assays were used to measure the functions, including proliferation, adhesion, and migration activities, of EPCs. Plasma levels of TNF-α and hs-CRP were also assessed. All of the data were assessed before and at 7 days after treatment initiation. EPC functions after 7 days of treatment with IVIG and aspirin were significantly improved than they were before treatment with IVIG and aspirin. Treatment with IVIG and aspirin significantly decreased TNF-α and hs-CRP concentrations. There was a significant linear regression relationship between decreased plasma TNF-α levels, hs-CRP levels, and increased functions of circulating EPCs. The results of our study indicate that the functions of circulating EPCs improved after treatment with IVIG and aspirin, which may be related to decreased concentrations of TNF-α and hs-CRP.
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Abstract
Extensive research work over the past couple of decades has indicated a series of intricate relations between immune and reproductive systems. A range of reproductive immunology topics including the roles of adoptive and innate immunity in infertility and pregnancy, the immune system's role in induction of labor and preterm delivery, and immuno-modulatory effects of the female sex hormones will be discussed in this and the next issue of the Journal. The implications of this research on the development of novel therapeutic approaches are also addressed.
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Choueiter NF, Olson AK, Shen DD, Portman MA. Prospective open-label trial of etanercept as adjunctive therapy for kawasaki disease. J Pediatr 2010; 157:960-966.e1. [PMID: 20667551 PMCID: PMC2970727 DOI: 10.1016/j.jpeds.2010.06.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 05/04/2010] [Accepted: 06/08/2010] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine the safety and pharmacokinetics of etanercept (Amgen, Thousand Oaks, California) a tumor necrosis factor-α receptor blocker, in children with acute Kawasaki disease (KD). Standard therapy of acute KD includes intravenous immunoglobulin (IVIG) and high-dose aspirin, but a substantial number of patients are refractory and require additional treatment. Tumor necrosis factor-α levels are elevated in children with KD, suggesting a role for etanercept in treatment. STUDY DESIGN We performed a prospective open-label trial of etanercept in patients with KD (age range, 6 months-5 years; n = 17) meeting clinical criteria and with fever ≤ 10 days. All received IVIG and high-dose aspirin. They received etanercept immediately after IVIG infusion and then weekly two times. For the initial safety evaluation, the first 5 patients received 0.4 mg/kg/dose. Subsequent subjects received 0.8 mg/kg/dose. RESULTS Fifteen patients completed the study. The pharmacokinetics were similar to that in older children in published series. No serious adverse events related to etanercept occurred. No patient demonstrated prolonged or recrudescent fever requiring re-treatment with IVIG. No patient showed an increase in coronary artery diameter or new coronary artery dilation/cardiac dysfunction. CONCLUSION Etanercept appears to be safe and well tolerated in children with KD. The data support performance of a placebo-controlled trial.
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Affiliation(s)
- Nadine F. Choueiter
- Division of Cardiology, Department of Pediatrics, University of Washington and Center for Developmental Therapeutics, Seattle Children’s Hospital and Research Institute, School of Pharmacy, UW, Seattle WA
| | - Aaron K. Olson
- Division of Cardiology, Department of Pediatrics, University of Washington and Center for Developmental Therapeutics, Seattle Children’s Hospital and Research Institute, School of Pharmacy, UW, Seattle WA
| | - Danny D. Shen
- Department of Pharmacy and Pharmaceutics, School of Pharmacy, UW, Seattle WA
| | - Michael A. Portman
- Division of Cardiology, Department of Pediatrics, University of Washington and Center for Developmental Therapeutics, Seattle Children’s Hospital and Research Institute, School of Pharmacy, UW, Seattle WA
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Galeotti C, Bayry J, Kone-Paut I, Kaveri SV. Kawasaki disease: aetiopathogenesis and therapeutic utility of intravenous immunoglobulin. Autoimmun Rev 2010; 9:441-8. [PMID: 20004744 PMCID: PMC7185630 DOI: 10.1016/j.autrev.2009.12.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 12/03/2009] [Indexed: 12/17/2022]
Abstract
Kawasaki disease (KD) is an acute febrile childhood vasculitis, associated with the development of coronary artery abnormalities in 25–30% of untreated patients. The aetiopathogenesis is not well known but it is accepted that an undefined infectious trigger in genetically predisposed individuals results in the disease. KD is characterized by an endothelial cell injury, which could be due to abnormal cytokine production and to generation of cytotoxic antibodies against the endothelial cells. Intravenous immunoglobulin IVIG is an effective treatment in preventing the occurrence of coronary artery abnormalities in KD. Several mechanisms may explain the anti-inflammatory effects of IVIG in this disease. They include modification of the cytokine balance, and alteration on both the differentiation and the function of monocytes/macrophages, neutrophils and lymphocytes.
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Affiliation(s)
- Caroline Galeotti
- INSERM U 872, Centre de Recherche des Cordeliers, Paris, F-75006, France
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Yun KW, Yun SW, Lee JJ, Chae SA, Lim IS, Choi ES, Yoo BH, Lee MK. Clinical significance of matrix metalloproteinase 9 and tissue inhibitor of metalloproteinase 1 and 2 in Kawasaki disease. KOREAN JOURNAL OF PEDIATRICS 2010. [DOI: 10.3345/kjp.2010.53.4.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ki Wook Yun
- Department of Pediatrics, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Sin Weon Yun
- Department of Pediatrics, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Jung Ju Lee
- Department of Pediatrics, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Soo Ahn Chae
- Department of Pediatrics, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - In Seok Lim
- Department of Pediatrics, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Eung Sang Choi
- Department of Pediatrics, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Byoung Hoon Yoo
- Department of Pediatrics, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Mi-Kyung Lee
- Department of Laboratory Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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35
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Imbach P, Lazarus AH, Kühne T. Intravenous immunoglobulins induce potentially synergistic immunomodulations in autoimmune disorders. Vox Sang 2009; 98:385-94. [PMID: 19821958 DOI: 10.1111/j.1423-0410.2009.01264.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The increase in platelets in patients with immune thrombocytopenia (ITP) by intravenous administration of human immunoglobulin concentrates (IVIG) reflects a therapeutic immunomodulatory intervention targeted at the disturbed immune response in many inflammatory and autoimmune disorders. These immunoglobulin concentrates contain large numbers of antibodies as well as trace levels of various other immunologically active molecules. Clinical and laboratory studies have documented various mechanisms of action of IVIG. The complex network of immunological reactions resulting from the infusion of IVIG includes changes in several cytokines, interactions with dendritic cells, T- and B- lymphocyte effects, macrophage effects, mediated by distinct Fc-gamma receptors. In addition, effects on complement components and apoptosis have also been observed. Synergism between the different elements of the immune response characterizes the beneficial effects of IVIG in inflammatory and autoimmune disorders. They have immunopathogeneses and clinical manifestations which are difficult to define and therefore IVIG treatment indications remain heterogeneous. Dose finding studies are missing for most of the indications of the drug. In future research, defining the appropriate subgroups of patients should be undertaken. This may be accomplished by prospective registries collecting data on large numbers of patients with long-term follow-up. Controlled clinical and laboratory studies may follow based on new, validated patient selection criteria and focused on mechanisms of action, leading to more evidence-based indications.
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Affiliation(s)
- P Imbach
- Pediatric Hematology-Oncology, University Children's Hospital, Medical Faculty of University of Basel, Basel, Switzerland.
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