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Ludwikowska KM, Tokarczyk M, Paleczny B, Tracewski P, Szenborn L, Kusa J. Clinical Significance of B-Type Natriuretic Peptide and N-Terminal Pro-B-Type Natriuretic Peptide in Pediatric Patients: Insights into Their Utility in the Presence or Absence of Pre-Existing Heart Conditions. Int J Mol Sci 2024; 25:8781. [PMID: 39201467 PMCID: PMC11354905 DOI: 10.3390/ijms25168781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/26/2024] [Accepted: 08/01/2024] [Indexed: 09/02/2024] Open
Abstract
The clinical significance of B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in pediatric patients remains an area of evolving understanding, particularly regarding their utility in the presence or absence of pre-existing heart conditions. While clear cutoff values and established roles in heart failure are understood in adult patients, pediatric norms vary with age, complicating interpretation. Notably, the emergence of multi-system inflammatory syndrome in children (MIS-C) has highlighted the importance of these markers not only in the detection of acute heart failure but also as a marker of disease severity and even as a differential diagnosis tool. This review summarizes current knowledge on the utility of BNP and NT-proBNP in pediatric patients. Their unique physiology, including circulation and compensation mechanisms, likely influence BNP and NT-proBNP release, potentially even in non-heart failure states. Factors such as dynamic volemic changes accompanying inflammatory diseases in children may contribute. Thus, understanding the nuanced roles of BNP and NT-proBNP in pediatric populations is crucial for the accurate diagnosis, management, and differentiation of cardiac and non-cardiac conditions.
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Affiliation(s)
- Kamila Maria Ludwikowska
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland; (K.M.L.); (L.S.)
| | - Monika Tokarczyk
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland; (K.M.L.); (L.S.)
| | - Bartłomiej Paleczny
- Department of Physiology and Pathophysiology, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland;
| | - Paweł Tracewski
- Department of Pediatric Cardiology, Regional Specialist Hospital in Wroclaw, Research and Development Center, Kamieńskiego 73a, 51-124 Wrocław, Poland; (P.T.); (J.K.)
| | - Leszek Szenborn
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland; (K.M.L.); (L.S.)
| | - Jacek Kusa
- Department of Pediatric Cardiology, Regional Specialist Hospital in Wroclaw, Research and Development Center, Kamieńskiego 73a, 51-124 Wrocław, Poland; (P.T.); (J.K.)
- Pediatric Cardiology Department, Medical University of Silesia, Medyków 16, 40-752 Katowice, Poland
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Lin IC, Suen JL, Huang SK, Chou MH, Kuo HC, Lo MH, Kuo KC, Wang L. Involvement of IL-17 A/IL-17 Receptor A with Neutrophil Recruitment and the Severity of Coronary Arteritis in Kawasaki Disease. J Clin Immunol 2024; 44:77. [PMID: 38451335 PMCID: PMC10920475 DOI: 10.1007/s10875-024-01673-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/15/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE To assess the role of the interleukin (IL)-17 A/IL-17 receptor A (IL-17RA) in Kawasaki disease (KD)-related coronary arteritis (CA). METHODS In human study, the plasma levels of IL-17 A and coronary arteries were concurrently examined in acute KD patients. In vitro responses of human coronary endothelial cells to plasma stimulation were investigated with and without IL-17RA neutralization. A murine model of Lactobacillus casei cell-wall extract (LCWE)-induced CA using wild-type Balb/c and Il17ra-deficient mice were also inspected. RESULTS The plasma levels of IL-17 A were significantly higher in KD patients before intravenous immunoglobulin therapy, especially in those with coronary artery lesion. The pre-IVIG IL-17 A levels positively correlated with maximal z scores of coronary diameters and plasma-induced endothelial mRNA levels of chemokine (C-X-C motif) ligand-1, IL-8, and IL-17RA. IL-17RA blockade significantly reduced such endothelial upregulations of aforementioned three genes and inducible nitric oxide synthase, and neutrophil transmigration. IL-17RA expression was enhanced on peripheral blood mononuclear cells in pre-IVIG KD patients, and in the aortic rings and spleens of the LCWE-stimulated mice. LCWE-induced CA composed of dual-positive Ly6G- and IL-17 A-stained infiltrates. Il17ra-deficient mice showed reduced CA severity with the fewer number of neutrophils and lower early inducible nitric oxide synthase and chemokine (C-X-C motif) ligand-1 mRNA expressions than Il17ra+/+ littermates, and absent IL-17RA upregulation at aortic roots. CONCLUSION IL-17 A/IL-17RA axis may play a role in mediating aortic neutrophil chemoattraction, thus contributory to the severity of CA in both humans and mice. These findings may help to develop a new therapeutic strategy toward ameliorating KD-related CA.
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Affiliation(s)
- I-Chun Lin
- Department of Pediatrics, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung, Taiwan.
| | - Jau-Ling Suen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shau-Ku Huang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ming-Hui Chou
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Hsuan-Chang Kuo
- Department of Pediatrics, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung, Taiwan
| | - Mao-Hung Lo
- Department of Pediatrics, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung, Taiwan
| | - Kuang-Che Kuo
- Department of Pediatrics, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung, Taiwan
| | - Lin Wang
- Department of Pediatrics, Po-Jen Hospital, Kaohsiung, Taiwan.
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Gkoutzourelas A, Bogdanos DP, Sakkas LI. Kawasaki Disease and COVID-19. Mediterr J Rheumatol 2020; 31:268-274. [PMID: 33196004 PMCID: PMC7656130 DOI: 10.31138/mjr.31.3.268] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 01/03/2023] Open
Abstract
The recent passing away of Dr. Tomisaku Kawasaki, who first described what is now known as Kawasaki Disease (KD), and recent reports of a multisystem inflammatory disease in children associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (MIS-C), makes a review on KD and MIS-C timely. Kawasaki Disease is a systemic vasculitis with predilection for coronary arteries occurring mostly in early childhood. The main features are high fever, extensive skin rash, cheilitis with red, cracking, bleeding lips and strawberry tongue, conjunctivitis, erythema and induration of hands and feet, subsiding with periungual peeling, cervical lymphadenopathy, and coronary artery dilation/aneurysms. Treatment consists of intravenous (IV) immunoglobulin (Ig) plus acetylsalicylic acid. MIS-C is considered a cytokine storm with high fever, inflammation, multi-organ dysfunction, that shares features with KD, toxic shock, and macrophage activation syndrome. Many children require admission to paediatric intensive care units for circulatory support. Bacterial sepsis, staphylococcal toxic shock syndrome, and enterovirus-causing myocarditis should be excluded. Treatment is not standardized and includes IVIg, IV methylprednisolone and IL-6 and IL-1 inhibitors.
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Affiliation(s)
- Athanasios Gkoutzourelas
- Department of Rheumatology and Clinical Immunology, Faculty of medicine, School of Health Sciences, University of Thessaly, Larissa
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of medicine, School of Health Sciences, University of Thessaly, Larissa
| | - Lazaros I Sakkas
- Department of Rheumatology and Clinical Immunology, Faculty of medicine, School of Health Sciences, University of Thessaly, Larissa.,Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Lazea C, Man O, Sur LM, Serban R, Lazar C. Unusual Presentation Of Kawasaki Disease With Gastrointestinal And Renal Manifestations. Ther Clin Risk Manag 2019; 15:1411-1416. [PMID: 31824164 PMCID: PMC6901056 DOI: 10.2147/tcrm.s226624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/17/2019] [Indexed: 12/18/2022] Open
Abstract
Diagnosis of Kawasaki disease (KD) is based on well-established clinical criteria. In incomplete or atypical KD, the diagnosis is challenging, because of the paucity of clinical signs or because of the presence of clinical manifestations that generally are not seen in KD. We describe the case of a 3-year-old female patient with persistent high fever, vomiting, watery diarrhea, metabolic acidosis and severe hypopotassemia. On the fourth day of fever, bilateral conjunctivitis, mucous and extremity changes were registered. Urine changes as glycosuria and proteinuria were also noticed. Echocardiography revealed ectasia of the left anterior descending coronary artery, and diagnosis of KD was established. The treatment consisted of intravenous immunoglobulin (IVIG) and oral aspirin. Recurrence of disease was recorded on the 23rd day of the disease, with favorable evolution after the second dose of IVIG was infused.
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Affiliation(s)
- Cecilia Lazea
- University of Medicine and Pharmacy, Emergency Clinic Hospital for Children, Department Pediatrics I, Cluj-Napoca, Romania
| | - Oana Man
- Emergency Clinic Hospital for Children, Department Pediatrics I, Cluj-Napoca, Romania
| | - Lucia Maria Sur
- University of Medicine and Pharmacy, Emergency Clinic Hospital for Children, Department Pediatrics I, Cluj-Napoca, Romania
| | - Radu Serban
- University of Medicine and Pharmacy, Emergency Clinic Hospital for Children, Department Pediatrics I, Cluj-Napoca, Romania
| | - Calin Lazar
- University of Medicine and Pharmacy, Emergency Clinic Hospital for Children, Department Pediatrics I, Cluj-Napoca, Romania
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Rodriguez-Gonzalez M, Perez-Reviriego AA, Castellano-Martinez A, Cascales-Poyatos HM. N-terminal probrain natriuretic peptide as biomarker for diagnosis of Kawasaki disease. Biomark Med 2019; 13:307-323. [PMID: 30900472 DOI: 10.2217/bmm-2018-0324] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Shores DR, Everett AD. Children as Biomarker Orphans: Progress in the Field of Pediatric Biomarkers. J Pediatr 2018; 193:14-20.e31. [PMID: 29031860 PMCID: PMC5794519 DOI: 10.1016/j.jpeds.2017.08.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Darla R Shores
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Allen D Everett
- Division of Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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Abstract
Kawasaki disease (KD) is a medium vessel vasculitis with predilection for coronary arteries. Due to lack of a reliable confirmatory laboratory test, the diagnosis of KD is based on a constellation of clinical findings that appear in a typical temporal sequence. These diagnostic criteria have been modified from time to time and the most recent guidelines have been proposed by the American Heart Association (AHA) in 2017. However, several children may have incomplete or atypical forms of KD and the diagnosis can often be difficult, especially in infants and young children. In this review, we have detailed the steps involved in arriving at a diagnosis of KD and also highlight the important role of echocardiography in diagnosis and management of children with KD.
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Affiliation(s)
- Surjit Singh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Kumar Pilania
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Affiliation(s)
- Amit Rawat
- Pediatric Allergy Immunology Unit, Advanced Pediatrics Center, PGIMER, Chandigarh, India.
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Koracevic GP. Are we consistent in using 14 different units for brain natriuretic peptide instead of ng/L? Am J Emerg Med 2016; 34:750-1. [PMID: 26897708 DOI: 10.1016/j.ajem.2016.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 01/25/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Goran P Koracevic
- Department of Cardiology, Clinical Centre and Medical Faculty, University of Nis, Nis, Serbia.
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