1
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Vaňková L, Bufka J, Křížková V. Pathophysiological and clinical point of view on Kawasaki disease and MIS-C. Pediatr Neonatol 2023; 64:495-504. [PMID: 37453902 PMCID: PMC10286520 DOI: 10.1016/j.pedneo.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/24/2023] [Accepted: 05/19/2023] [Indexed: 07/18/2023] Open
Abstract
This article compares two important pathophysiological states, Kawasaki disease, and multisystem inflammatory syndrome, in children associated with COVID-19 (MIS-C). Both occur predominantly in children, have a temporal association with an infectious agent, and are associated with immune-system alteration and systemic inflammation under certain circumstances. The two share common pathophysiology, including enhancement of interleukin-1 neutrophils, activation of the inflammasome, pyroptosis, or NETosis. Moreover, the clinical presentation of the diseases overlaps. However, they are indeed two separate diseases, proven by the differences in the epidemiological and etiological aspects and the pathophysiological processes involved in the development and frequency of some clinical signs. This article highlights potentially exciting areas that have not yet been studied in detail, which could help better understand the development of these diseases.
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Affiliation(s)
- Lenka Vaňková
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Czech Republic.
| | - Jiří Bufka
- Department of Pediatrics, Teaching Hospital in Pilsen, Czech Republic
| | - Věra Křížková
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Czech Republic
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2
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Duan Y, Li H, Luo D, Jiang J, Liu B, Li G. Serum IL-41 might be a biomarker for IVIG resistance and coronary artery lesions in Kawasaki disease. Int Immunopharmacol 2023; 122:110600. [PMID: 37423157 DOI: 10.1016/j.intimp.2023.110600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/11/2023] [Accepted: 07/01/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND This study aimed to evaluate serum IL-41 levels in IVIG resistance and CALs, and to elucidate the relationship between IL-41 and Kawasaki disease (KD)-related clinical parameters. METHODS 93 children with KD were collected. Baseline clinical data were obtained by physical examination. Serum IL-41 levels were detected with an enzyme-linked immunosorbent assay. The correlations between IL-41 and the clinical parameter of KD were performed by Spearman correlation coefficient. Receiver operating characteristic curve analysis was performed to assess the predictive ability of IL-41 for IVIG resistance and CALs. RESULTS Serum IL-41 levels were significantly increased in the IVIG resistance group compared with the response group, and serum IL-41 levels in the CALs group were higher than those in the non-CALs group. Serum IL-41 levels were positively correlated with erythrocyte sedimentation rate, C-reactive protein and C-reactive protein/albumin ratio, but negatively correlated with albumin. Serum IL-41 levels was an independent risk factor for CALs, and total fever days and neutrophil-to-lymphocyte ratio (NLR) were independent predictors for IVIG resistance. The area under the curve (AUC) value for serum IL-41 to predict IVIG resistance was 0.73, yielding a sensitivity of 54.55% and a specificity of 81.71%. The AUC of serum IL-41 was 0.712, with a sensitivity of 63.16% and a specificity of 72.97% for predicting CALs. IL-41 was not inferior to NLR in predicting IVIG resistance (z = 0.282, p = 0.7783). CONCLUSIONS Serum IL-41 was increased in IVIG resistance and CALs. Serum IL-41 might be a new potential biomarker for IVIG resistance and CALs.
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Affiliation(s)
- Yan Duan
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China
| | - Hui Li
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China
| | - Dinghua Luo
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China
| | - Jun Jiang
- Department of General Surgery (Thyroid Surgery), the Affiliated Hospital of Southwest Medical University, China; Metabolic Vascular Diseases Key Laboratory of Sichuan Province, China
| | - Bin Liu
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China.
| | - Gang Li
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, Sichuan, China; Sichuan Clinical Research Center for Birth Defects, China.
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3
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Characterization of the nasopharyngeal microbiome in patients with Kawasaki disease. An Pediatr (Barc) 2022; 97:300-309. [DOI: 10.1016/j.anpede.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/16/2021] [Indexed: 11/07/2022] Open
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4
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Gallego DF, Ruiz MEZ, Marshall DA. Oblivion: autopsy findings of a 31-year-old man with sudden cardiac arrest, a case report of a sequalae of Kawasaki disease. Autops Case Rep 2022; 12:e2021404. [PMID: 36312877 PMCID: PMC9613377 DOI: 10.4322/acr.2021.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
A 31-year-old man presented to the hospital after suffering a sudden cardiac arrest. Despite optimal therapy, the patient passed away. His medical history included febrile rash at age 2. At autopsy, there was aneurysmal dilation and severe coronary artery stenosis by atherosclerotic plaques and myocardial fibrosis. These findings were presumed to be due to complications of Kawasaki disease, given the remote history of severe febrile rash as a toddler and the presence of chronic coronary artery injury, recanalization, and thrombosis with ischemic heart disease leading to sudden cardiac collapse and death.
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Affiliation(s)
| | - Maria Eugenia Zuluaga Ruiz
- Universidad del Valle, Grupo de Investigación en Rehabilitación de la Universidad del Valle, Cali, Valle del Cauca, Colombia
| | - Desiree Ann Marshall
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, Washington, United States
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5
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Sánchez-Manubens J, Henares D, Muñoz-Almagro C, Brotons de los Reyes P, Timoneda N, Antón J. Caracterización del microbioma nasofaríngeo en pacientes con enfermedad de Kawasaki. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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6
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Guo MMH, Huang YH, Wang FS, Chang LS, Chen KD, Kuo HC. CD36 is Associated With the Development of Coronary Artery Lesions in Patients With Kawasaki Disease. Front Immunol 2022; 13:790095. [PMID: 35154107 PMCID: PMC8828496 DOI: 10.3389/fimmu.2022.790095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Kawasaki disease (KD) is an autoimmune-like vasculitis of childhood involving the coronary arteries. Macrophages require scavenger receptors such as CD36 to effectively clear cellular debris and induce self-tolerance. In this study, we hypothesized that CD36 plays an important role in the immunopathogenesis of KD, by aiding in the clearance of plasma mitochondrial DNA, and by amplifying the immune response by activating the inflammasome pathway via AIM2. Fifty-two healthy controls, 52 febrile controls, and 102 KD patients were recruited for RT-PCR of target mRNA expression and plasma mitochondrial DNA. Blood samples were obtained 24 hours prior and 21 days after the administration of intravenous immunoglobulin (IVIG) therapy. Patients with acute KD had higher plasma levels of cell-free mitochondrial DNA (ND1, ND4, and COX1), and higher mRNA expressions of CD36 and AIM2 when compared to both healthy and febrile controls. A greater decrease in both CD36 and AIM2 mRNA expression after IVIG therapy was associated with the development of coronary artery lesions. Coronary artery lesions were associated with a larger decrease of CD36 expression following IVIG therapy, which may indicate that prolonged expression of the scavenger receptor may have a protective effect against the development of coronary artery lesions in KD.
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Affiliation(s)
- Mindy Ming-Huey Guo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ying-Hsien Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Feng-Sheng Wang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Center for Laboratory Animals, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ling-Sai Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuang-Den Chen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedicine, Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ho-Chang Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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7
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Stone JR. Diseases of small and medium-sized blood vessels. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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8
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Lee JK. Hygiene Hypothesis as the Etiology of Kawasaki Disease: Dysregulation of Early B Cell Development. Int J Mol Sci 2021; 22:ijms222212334. [PMID: 34830213 PMCID: PMC8622879 DOI: 10.3390/ijms222212334] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022] Open
Abstract
Kawasaki disease (KD) is an acute systemic vasculitis that occurs predominantly in children under 5 years of age. Despite much study, the etiology of KD remains unknown. However, epidemiological and immunological data support the hygiene hypothesis as a possible etiology. It is thought that more sterile or clean modern living environments due to increased use of sanitizing agents, antibiotics, and formula feeding result in a lack of immunological challenges, leading to defective or dysregulated B cell development, accompanied by low IgG and high IgE levels. A lack of B cell immunity may increase sensitivity to unknown environmental triggers that are nonpathogenic in healthy individuals. Genetic studies of KD show that all of the KD susceptibility genes identified by genome-wide association studies are involved in B cell development and function, particularly in early B cell development (from the pro-B to pre-B cell stage). The fact that intravenous immunoglobulin is an effective therapy for KD supports this hypothesis. In this review, I discuss clinical, epidemiological, immunological, and genetic studies showing that the etiopathogenesis of KD in infants and toddlers can be explained by the hygiene hypothesis, and particularly by defects or dysregulation during early B cell development.
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Affiliation(s)
- Jong-Keuk Lee
- Asan Medical Center, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul 05505, Korea
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9
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Gavriilaki E, Eftychidis I, Papassotiriou I. Update on endothelial dysfunction in COVID-19: severe disease, long COVID-19 and pediatric characteristics. J LAB MED 2021. [DOI: 10.1515/labmed-2021-0134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Abstract
Objectives
To review current literature on the role of endothelial dysfunction in coronavirus disease-2019 (COVID-19) infection in terms of pathophysiology, laboratory features and markers, clinical phenotype in adults and children, as well as long COVID-19.
Content
We conducted a thorough assessment of the literature and critically analyzed current data, mostly utilizing the PubMed and Medline search engines to find original studies published in the previous decade.
Summary and Outlook
Accumulating evidence suggests that endothelial dysfunction may be a common denominator of severe COVID-19 in adults and children, as well as long COVID-19, implicating mutual pathophysiological pathways. This narrative review summarizes the up-to-date knowledge of endothelial dysfunction caused by COVID-19, including novel aspects of long COVID-19 and pediatric disease. This knowledge is important in order not only to understand the multisystemic attack of COVID-19, but also to improve patient management and prognosis.
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Affiliation(s)
- Eleni Gavriilaki
- Hematology Department – BMT Unit , G. Papanikolaou Hospital , Thessaloniki , Greece
| | - Ioannis Eftychidis
- Hematology Department – BMT Unit , G. Papanikolaou Hospital , Thessaloniki , Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry , “Aghia Sophia” Children’s Hospital , Athens , Greece
- IFCC Emerging Technologies Division , Emerging Technologies in Pediatric Laboratory Medicine (C-ETPLM) , Milan , Italy
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10
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Wang Z, Xie L, Ding G, Song S, Chen L, Li G, Xia M, Han D, Zheng Y, Liu J, Xiao T, Zhang H, Huang Y, Li Y, Huang M. Single-cell RNA sequencing of peripheral blood mononuclear cells from acute Kawasaki disease patients. Nat Commun 2021; 12:5444. [PMID: 34521850 PMCID: PMC8440575 DOI: 10.1038/s41467-021-25771-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 08/25/2021] [Indexed: 12/25/2022] Open
Abstract
Kawasaki disease (KD) is the most common cause of acquired heart disease in children in developed countries. Although functional and phenotypic changes of immune cells have been reported, a global understanding of immune responses underlying acute KD is unclear. Here, using single-cell RNA sequencing, we profile peripheral blood mononuclear cells from seven patients with acute KD before and after intravenous immunoglobulin therapy and from three age-matched healthy controls. The most differentially expressed genes are identified in monocytes, with high expression of pro-inflammatory mediators, immunoglobulin receptors and low expression of MHC class II genes in acute KD. Single-cell RNA sequencing and flow cytometry analyses, of cells from an additional 16 KD patients, show that although the percentage of total B cells is substantially decreased after therapy, the percentage of plasma cells among the B cells is significantly increased. The percentage of CD8+ T cells is decreased in acute KD, notably effector memory CD8+ T cells compared with healthy controls. Oligoclonal expansions of both B cell receptors and T cell receptors are observed after therapy. We identify biological processes potentially underlying the changes of each cell type. The single-cell landscape of both innate and adaptive immune responses provides insights into pathogenesis and therapy of KD.
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MESH Headings
- Acute Disease
- Adaptive Immunity/drug effects
- B-Lymphocytes/drug effects
- B-Lymphocytes/immunology
- B-Lymphocytes/pathology
- CD8-Positive T-Lymphocytes/drug effects
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/pathology
- Case-Control Studies
- Cell Proliferation
- Child
- Child, Preschool
- Clone Cells
- Female
- Gene Expression
- Humans
- Immunity, Innate/drug effects
- Immunoglobulins, Intravenous/therapeutic use
- Immunophenotyping
- Male
- Monocytes/drug effects
- Monocytes/immunology
- Monocytes/pathology
- Mucocutaneous Lymph Node Syndrome/drug therapy
- Mucocutaneous Lymph Node Syndrome/genetics
- Mucocutaneous Lymph Node Syndrome/immunology
- Mucocutaneous Lymph Node Syndrome/pathology
- Plasma Cells/drug effects
- Plasma Cells/immunology
- Plasma Cells/pathology
- Receptors, Antigen, B-Cell/genetics
- Receptors, Antigen, B-Cell/immunology
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/immunology
- Sequence Analysis, RNA
- Single-Cell Analysis
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Affiliation(s)
- Zhen Wang
- Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China.
| | - Lijian Xie
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Guohui Ding
- Institute for Digital Health, International Human Phenome Institutes (Shanghai), Shanghai, China
- Gui'an Bio-Med Big Data Center, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Guiyang, China
| | - Sirui Song
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Liqin Chen
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Guang Li
- Shanghai QianBei Med. Technology Co. Ltd, Shanghai, China
| | - Min Xia
- Department of Clinical Laboratory, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Dingding Han
- Department of Clinical Laboratory, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yue Zheng
- Department of Clinical Laboratory, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jia Liu
- Shanghai QianBei Med. Technology Co. Ltd, Shanghai, China
| | - Tingting Xiao
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hong Zhang
- Department of Clinical Laboratory, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yujuan Huang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yixue Li
- Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, China.
- Bio-Med Big Data Center, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, China.
- Collaborative Innovation Center for Genetics and Development, Fudan University, Shanghai, China.
- Guangzhou Laboratory, Guangzhou, China.
| | - Min Huang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China.
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Wang Z, Zhang J, Dong L. Is there any association between asthma and Kawasaki disease? A systematic review and meta-analysis. Pediatr Pulmonol 2021; 56:2503-2511. [PMID: 33983684 DOI: 10.1002/ppul.25443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Shared immune factors are involved in the pathogenesis of asthma and Kawasaki disease (KD). Consequently, several observational studies have explored an association between KD and asthma. This systematic review and meta-analysis aimed to explore the association between KD and asthma. METHODS PubMed and Embase databases were searched for cross-sectional, case-control and cohort studies that investigated the association between KD and asthma. The first author, publication year, study type, sample size, and participant demographics were retrieved. The association between KD and asthma was expressed by the odds ratio (OR) and 95% confidence interval (CI). RESULTS Eleven studies were eligible in the systematic review. The crude ORs (cORs) were extracted from 11 studies, and seven of them also provided adjusted ORs (aORs). The cORs between KD and asthma was 1.53 (95% CI, 1.29-1.81). After adjustment for some confounding factors (age, sex, region), asthma also had an association with KD (aOR, 1.08; 95% CI, 1.00-1.17). The subgroup analyses showed the study design and study location to influence between-study heterogeneity. Analyses of aOR values revealed that asthma onset before KD onset does not appear to increase KD prevalence, whereas people suffering from KD could increase the prevalence of developing asthma. CONCLUSION Our meta-analysis suggested a possible association between preceding KD and asthma onset, but care must be taken when interpreting this result. Prospective cohort studies are needed to assess a causal relationship between these two diseases.
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Affiliation(s)
- Zihan Wang
- Department of Respiratory, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Respiratory, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Shandong Institute of Respiratory Diseases, Shandong University, Jinan, China
| | - Jintao Zhang
- Department of Respiratory, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Respiratory, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Shandong Institute of Respiratory Diseases, Shandong University, Jinan, China
| | - Liang Dong
- Department of Respiratory, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Shandong Institute of Respiratory Diseases, Shandong University, Jinan, China
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12
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Murata K, Onoyama S, Yamamura K, Mizuno Y, Furuno K, Matsubara K, Hatae K, Masuda K, Nomura Y, Ohno T, Kinumaki A, Miura M, Sakai Y, Ohga S, Fukushima W, Kishimoto J, Nakamura Y, Hara T. Kawasaki Disease and Vaccination: Prospective Case-Control and Case-Crossover Studies among Infants in Japan. Vaccines (Basel) 2021; 9:vaccines9080839. [PMID: 34451964 PMCID: PMC8402330 DOI: 10.3390/vaccines9080839] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 12/19/2022] Open
Abstract
The causal effects of vaccines on Kawasaki disease (KD) remain elusive. We aimed to examine the association between vaccines administered during infancy and the development of KD in Japan. We conducted a multicenter prospective case-control study using questionnaires and compared the vaccination status of infants (age: 6 weeks to 9 months) who developed KD (KD group; n = 102) and those who did not develop KD (non-KD group; n = 139). Next, we performed a case-crossover study of 98 cases in the KD group and compared the status of vaccinations between the case and control periods. We also compared the incidence of KD in children for each 5-year period before and after the addition of new vaccines (2012–2013) using data from the Nationwide Survey of KD. In the case-control study, the vaccination status of the KD and control groups did not differ to a statistically significant extent. Multivariable analysis of the vaccination status and patient backgrounds showed no significant association between vaccination and KD development. In the case-crossover study, the status of vaccinations during the case and control periods did not differ to a statistically significant extent. In the analysis of data from the Nationwide Survey of KD, the incidence of KD in children of ages subject to frequent vaccination showed no significant increases in the latter five years, 2014–2018. Based on these prospective analyses, we confirmed that vaccination in early infancy did not affect the risk of KD.
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Affiliation(s)
- Kenji Murata
- Kawasaki Disease Center, Fukuoka Children’s Hospital, Fukuoka 813–0017, Japan; (K.M.); (S.O.); (Y.M.); (K.F.)
| | - Sagano Onoyama
- Kawasaki Disease Center, Fukuoka Children’s Hospital, Fukuoka 813–0017, Japan; (K.M.); (S.O.); (Y.M.); (K.F.)
- Department of Pediatrics, Japanese Red Cross Fukuoka Hospital, Fukuoka 815–8555, Japan;
| | - Kenichiro Yamamura
- Department of Perinatal and Pediatric Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812–8582, Japan;
| | - Yumi Mizuno
- Kawasaki Disease Center, Fukuoka Children’s Hospital, Fukuoka 813–0017, Japan; (K.M.); (S.O.); (Y.M.); (K.F.)
| | - Kenji Furuno
- Kawasaki Disease Center, Fukuoka Children’s Hospital, Fukuoka 813–0017, Japan; (K.M.); (S.O.); (Y.M.); (K.F.)
| | - Keita Matsubara
- Department of Pediatrics, Hiroshima City Funairi Citizens Hospital, Hiroshima 730–0844, Japan;
| | - Ken Hatae
- Department of Pediatrics, Japanese Red Cross Fukuoka Hospital, Fukuoka 815–8555, Japan;
| | - Kiminori Masuda
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima 890–8760, Japan; (K.M.); (Y.N.)
| | - Yuichi Nomura
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima 890–8760, Japan; (K.M.); (Y.N.)
| | - Takuro Ohno
- Department of Pediatrics, Oita Prefectural Hospital, Oita 870–8511, Japan;
| | - Akiko Kinumaki
- Department of General Pediatrics, Tokyo Metropolitan Children’s Medical Center, Fuchu, Tokyo 183–8561, Japan;
| | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children’s Medical Center, Fuchu, Tokyo 183–8561, Japan;
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812–8582, Japan; (Y.S.); (S.O.)
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812–8582, Japan; (Y.S.); (S.O.)
| | - Wakaba Fukushima
- Department of Public Health, Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, Osaka City University, Osaka 558–8585, Japan;
| | - Junji Kishimoto
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka 812–8582, Japan;
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke 329–0498, Japan;
| | - Toshiro Hara
- Kawasaki Disease Center, Fukuoka Children’s Hospital, Fukuoka 813–0017, Japan; (K.M.); (S.O.); (Y.M.); (K.F.)
- Correspondence: ; Tel.: +81-92-682-7000
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13
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Ionescu MD, Taras R, Dombici B, Balgradean M, Berghea EC, Nicolescu A. The Challenging Diagnosis of Pediatric Multisystem Inflammatory Syndrome Associated with Sars-Cov-2 Infection-Two Case Reports and Literature Review. J Pers Med 2021; 11:jpm11040318. [PMID: 33921718 PMCID: PMC8073032 DOI: 10.3390/jpm11040318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023] Open
Abstract
Severe acute respiratory coronavirus 2 (SARS-CoV-2) is a novel coronavirus discovered in 2019 that caused the coronavirus disease 2019 (COVID19). During the last year, over 70 million people were infected and more than 1.5 million people died. Despite the tremendous number of people infected, children were less affected and presented milder forms of the disease. A short time after the pandemic was declared, a new hyperinflammatory syndrome resembling Kawasaki disease (KD) was described in children with confirmed or suspected SARS-CoV-2 infection named multisystem inflammatory syndrome in children (MIS-C). The incidence of MIS-C is low and it has a polymorphous clinical presentation, making the diagnosis difficult. Although the incidence is reduced, there is a high risk of cardiovascular complications. In order to raise awareness, we present the cases of two pediatric patients diagnosed with MIS-C in our clinic.
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Affiliation(s)
- Marcela Daniela Ionescu
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.D.I.); (R.T.); (B.D.); (M.B.)
- Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania;
| | - Roxana Taras
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.D.I.); (R.T.); (B.D.); (M.B.)
- Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania;
| | - Bianca Dombici
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.D.I.); (R.T.); (B.D.); (M.B.)
| | - Mihaela Balgradean
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.D.I.); (R.T.); (B.D.); (M.B.)
- Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania;
| | - Elena Camelia Berghea
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.D.I.); (R.T.); (B.D.); (M.B.)
- Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania;
- Correspondence:
| | - Alin Nicolescu
- Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania;
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14
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Medaglia AA, Siracusa L, Gioè C, Giordano S, Cascio A, Colomba C. Kawasaki disease recurrence in the COVID-19 era: a systematic review of the literature. Ital J Pediatr 2021; 47:95. [PMID: 33874991 PMCID: PMC8054252 DOI: 10.1186/s13052-021-01041-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/26/2021] [Indexed: 12/14/2022] Open
Abstract
Kawasaki disease (KD) is a vasculitis of unknown origin of small and medium caliber blood vessels, especially involving coronary arteries and is the leading cause of acquired heart disease in childhood in developed countries. Although rarely, it can recur: most recurrences occur within 2 years of the initial episode. No data are available on incidence of recurrent KD in Europe and multiple recurrences are rarely seen. We reviewed the medical literature on Kawasaki disease recurrence and reported a new case of Kawasaki disease recurrence in a child with SARS-CoV-2 infection. We believe that in our case SARS Cov2 acted as a trigger capable to determine, in a genetically susceptible individual, a second recurrence of the disease. In the Covid-19 era we affirm the importance for Kawasaki disease to be tested for SARS Cov2 infection.
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Affiliation(s)
- Alice Annalisa Medaglia
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Infectious Diseases Unit, University of Palermo, Palermo, Italy.
- ARNAS Civico-Di Cristina, Pediatric Infectious Diseases Unit, Palermo, Italy.
| | - Lucia Siracusa
- ARNAS Civico-Di Cristina, Pediatric Infectious Diseases Unit, Palermo, Italy
| | - Claudia Gioè
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Infectious Diseases Unit, University of Palermo, Palermo, Italy
- ARNAS Civico-Di Cristina, Pediatric Infectious Diseases Unit, Palermo, Italy
| | - Salvatore Giordano
- ARNAS Civico-Di Cristina, Pediatric Infectious Diseases Unit, Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Infectious Diseases Unit, University of Palermo, Palermo, Italy
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Infectious Diseases Unit, University of Palermo, Palermo, Italy
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15
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Kitoh T, Ohara T, Muto T, Okumura A, Baba R, Koizumi Y, Yamagishi Y, Mikamo H, Daigo K, Hamakubo T. Increased Pentraxin 3 Levels Correlate With IVIG Responsiveness and Coronary Artery Aneurysm Formation in Kawasaki Disease. Front Immunol 2021; 12:624802. [PMID: 33912155 PMCID: PMC8072470 DOI: 10.3389/fimmu.2021.624802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/17/2021] [Indexed: 12/19/2022] Open
Abstract
Kawasaki disease (KD) is a febrile disease of childhood characterized by systemic vasculitis that can lead to coronary artery lesions (CAL). This was a prospective cohort study to determine the levels of the pentraxin 3 (PTX3), soluble CD24-Subtype (Presepsin) and N-terminal pro-brain natriuretic peptide (NT-pro BNP) in consecutive KD patients. From January 2013 to March 2015, all patients with KD admitted to Aichi Medical University Hospital who provided consent had their plasma saved before IVIG administration. In total, 97 cases were registered. 22 cases of incomplete KD were excluded from the outcome analysis. The total 75 cases were used for statistical analyses. A PTX3 threshold of >7.92 ng/ml provided a specificity of 88.5 %, a sensitivity of 94.4 %, and a likelihood ratio as high as 15.92 for the diagnosis of KD compared with febrile non-KD controls. Although an echocardiographic diagnosis of CAL in the early course of the disease was confirmed in 24 cases, it was not in the remaining 51 cases. Neither NT-proBNP nor Presepsin had statistical significance for the prediction of the echocardiographic CAL diagnosis. Only PTX3 was significantly predictive of the echocardiographic CAL diagnosis (p=0.01). The PTX3 level was significantly higher in the intravenous immunoglobulin (IVIG) non-responders (45.9±7.45) than in the IVIG responders (17.0 ± 1.46 ng/ml) (p< 0.001). The PTX3 level also correlated with the number of IVIG treatment courses needed to resolve fever (R² =0.64). Persistent CAL (pCAL) formation was observed in three cases; one of aneurysm only and two aneurysms with dilatations. The patients with pCAL had significantly higher PTX3 levels (85 ± 8.4 ng/ml) than patients without pCAL (22 ± 2.2 ng/ml) (p< 0.0001). In terms of pCAL prediction, the area under the curve (AUC) of receiver operating characteristic ROC curve of PTX3 was 0.99, and it was significantly greater than that of Presepsin (0.67) or NT-proBNP (0.75). PTX3 is a soluble pattern recognition molecule that acts as a main component of the innate immune system. These data suggest that PTX3 can be utilized as a definitive biomarker for the prediction of IVIG resistance and subsequent CAL formation in patients with KD.
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Affiliation(s)
- Toshiyuki Kitoh
- Laboratory of Pediatrics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan.,Department of Pediatrics, School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Tsuyoshi Ohara
- Laboratory of Pediatrics, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Taichiro Muto
- Department of Pediatrics, School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Akihisa Okumura
- Department of Pediatrics, School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Reizo Baba
- Department of Pediatrics, School of Medicine, Aichi Medical University, Nagakute, Japan.,Department of Lifelong Sports and Health Sciences, College of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Kenji Daigo
- Department of Protein-protein Interaction Research, Institute for Advanced Medical Sciences, Nippon Medical School, Tokyo, Japan
| | - Takao Hamakubo
- Department of Protein-protein Interaction Research, Institute for Advanced Medical Sciences, Nippon Medical School, Tokyo, Japan
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16
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Pousa PA, Mendonça TSC, Oliveira EA, Simões-E-Silva AC. Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations. J Pediatr (Rio J) 2021; 97:116-139. [PMID: 32980319 PMCID: PMC7508521 DOI: 10.1016/j.jped.2020.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of this review was to summarize the most common extrapulmonary manifestations in pediatric patients with COVID-19, as well as to discuss clinical, epidemiological, and pathophysiological aspects of these clinical presentations in children. SOURCE OF DATA An extensive search of literature was performed in order to identify pediatric cases with extrapulmonary manifestations between January 1, 2020 and June 21, 2020. Generic keywords, such as "Novel coronavirus" or "Novel coronavirus 2019" or "2019 nCoV" or "COVID-19" or "SARS-CoV-2" were searched on PubMed database, associated either with age filters or generic pediatric terms. SUMMARY OF FINDINGS A total of 28 articles, including 199 patients, were considered suitable to review and data extraction. The main findings were summarized in tables. The main non-pulmonary manifestations in pediatric patients, in decreasing order of frequency, were gastrointestinal, renal, cardiovascular, neurological, hematological and lymphatic, cutaneous, hepatic, ocular, olfactory, and gustatory. Multisystem impairment and Kawasaki-like disease were also described. CONCLUSIONS Differences in immune response of children and variations of tissue expression of angiotensin converting enzyme 2, the virus receptor, are likely to influence clinical, epidemiological, and pathophysiological patterns of the disease.
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Affiliation(s)
- Pedro A Pousa
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Pesquisa Médica, Belo Horizonte, MG, Brazil
| | - Tamires S C Mendonça
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Pesquisa Médica, Belo Horizonte, MG, Brazil
| | - Eduardo A Oliveira
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Unidade de Nefrologia Pediátrica, Belo Horizonte, MG, Brazil
| | - Ana Cristina Simões-E-Silva
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Pesquisa Médica, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Unidade de Nefrologia Pediátrica, Belo Horizonte, MG, Brazil.
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17
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Ding YY, Ren Y, Qin J, Qian GH, Tang YJ, Chen Y, Li X, Xu L, Qiao CH, Sun L, Lv HT. Clinical characteristics of Kawasaki disease and concurrent pathogens during isolation in COVID-19 pandemic. World J Pediatr 2021; 17:263-271. [PMID: 34160770 PMCID: PMC8219783 DOI: 10.1007/s12519-021-00431-2] [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: 02/08/2021] [Accepted: 04/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study is to explore the characteristics of Kawasaki disease (KD) and concurrent pathogens due to a stay-at-home isolation policy during coronavirus disease 2019 (COVID-19) epidemic. METHODS All patients with KD admitted between February and April in 2015-2020, were classified into before (group 1, in 2015-2019) and after (group 2, in 2020) isolation groups. A total of 4742 patients [with KD (n = 98) and non-KD (n = 4644)] referred to Mycoplasma pneumoniae (MP) and virus detection were analyzed in 2020. Clinical characteristics, laboratory data, and 13 pathogens were analyzed retrospectively. RESULTS Group 2 had a significantly increased incidence of KD (0.11%) with 107 patients compared to that of group 1 (0.03%) with 493 patients. The comparisons of oral mucosal change, strawberry tongue, desquamation of the fingertips, cervical lymphadenopathy and neutrophil percentage decreased in group 2 compared to group 1. The infection rate of MP increased significantly in group 2 (34.7%) compared to group 1 (19.3%), while the positive rate of viruses decreased significantly in group 2 (5.3%) compared to group 1 (14.3%). In 2020, the positive rate of MP infection increased significantly in patients with KD compared to the increase in patients with non-KD. The infection rate of MP for younger children aged less than 3 years old was higher in group 2 than in group 1. CONCLUSION Compared with the characteristics of KD from 2015 to 2019 years, the incidence of KD was increased in 2020 and was accompanied by a high incidence of MP infection, especially in younger children (less than 3 years old) during the isolation due to COVID-19 pandemic.
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Affiliation(s)
- Yue-Yue Ding
- Cardiology Department, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Yan Ren
- Department of Radiology, Huashan Hospital of Fudan University, 12 Mid Wulumuqi Road, Shanghai, 200040, China
| | - Jie Qin
- Cardiology Department, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Guang-Hui Qian
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Yun-Jia Tang
- Cardiology Department, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Ye Chen
- Cardiology Department, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Xuan Li
- Cardiology Department, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Lei Xu
- Cardiology Department, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Chun-Hong Qiao
- Department of Biostatistics and Computational Biology, School of Life Science, Fudan University, Shanghai, 200433, China
| | - Ling Sun
- Cardiology Department, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Hai-Tao Lv
- Cardiology Department, Children's Hospital of Soochow University, Suzhou, 215025, China.
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18
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Farahmand M, Ahmadi-Vasmehjani A, Esteghamati A, Sayyahfar S, Minaeian S, Khanaliha K, Naghdalipour M, Tavakoli A. A meta-analysis on association between viral infections and Kawasaki disease in children. Future Virol 2021. [DOI: 10.2217/fvl-2020-0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To investigate the association between different viral infections and the development of Kawasaki disease (KD) in children. Materials & methods: Electronic databases were searched for relevant studies published from inception to May 2020. The pooled odds ratios (ORs) of the association of different viral pathogens with KD were estimated using a random-effects model weighted by the inverse variance method. Results: The strongest associations were found between KD and human parvovirus B19 viremia (OR = 41.05; 95% CI: 5.13–328.28; I-square = 0%), EBV IgM seropositivity (OR = 7.18; 95% CI: 3.65–14.12, I-square = 0%) and human herpesvirus-6 IgG seropositivity (OR = 5.83; 95% CI: 1.06–32.01). Conclusion: Human parvovirus B19, EBV and human herpesvirus-6 are highly suspected to be key contributors to the development of KD.
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Affiliation(s)
- Mohammad Farahmand
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran 1416753955, Iran
| | - Abbas Ahmadi-Vasmehjani
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran 1416753955, Iran
| | - Abdoulreza Esteghamati
- Research Center of Pediatric Infectious Diseases, Institute of Immunology & Infectious Diseases, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Shirin Sayyahfar
- Research Center of Pediatric Infectious Diseases, Institute of Immunology & Infectious Diseases, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Sara Minaeian
- Antimicrobial Resistance Research Center, Institute of Immunology & Infectious Diseases, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Khadijeh Khanaliha
- Research Center of Pediatric Infectious Diseases, Institute of Immunology & Infectious Diseases, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Mehri Naghdalipour
- Research Center of Pediatric Infectious Diseases, Institute of Immunology & Infectious Diseases, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Ahmad Tavakoli
- Research Center of Pediatric Infectious Diseases, Institute of Immunology & Infectious Diseases, Iran University of Medical Sciences, Tehran 1449614535, Iran
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran
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19
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Brar E, Saxena A, Dukler C, Xu F, Saxena D, Cheema Brar P, Guo Y, Li X. Vaping, SARS-CoV-2, and Multisystem Inflammatory Syndrome: A Perfect Storm. Front Pediatr 2021; 9:647925. [PMID: 34055688 PMCID: PMC8149601 DOI: 10.3389/fped.2021.647925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/12/2021] [Indexed: 12/19/2022] Open
Abstract
The use of electronic cigarettes (e-cigarettes) and vaping among adolescents has risen exponentially in the last decade. E-cigarette flavors has driven adolescents to use these convenient, USB-like devices, designed to create a desired social image, while being seemingly unaware of the serious health consequences of their behavior. Vaping impacts protective pulmonary barriers by attenuating the mucociliary clearance and by increasing peribronchial inflammation and fibrosis. The recent SARS-CoV-2 (COVID-19) pandemic has been characterized by a plethora of unusual disease presentations. Among them, a unique presentation seen exclusively in children and adolescents was multisystem inflammatory syndrome (MIS-C). Seventy percent of adolescents who had MIS-C also had acute respiratory distress syndrome (ARDS), and we speculate that there may exist common denominator that links MIS-C and adolescents: the use of e-cigarettes. The virus targets the angiotensin converting receptor (ACE receptor), and studies have shown nicotine-based e-cigarettes or vaping cause oxidative stress and resulting in the upregulation of ACE2, which might worsen ARDS in MIS-C. Our mini-review highlights that adolescents using e-cigarette have alterations in their pulmonary defenses against SARS-CoV-2: an upregulation of the ACE2 receptors, the primary target of SARS-CoV-2. Their compromised immune system makes them more uniquely vulnerable to Covid-19 related MIS-C, increasing their risk for ARDS and related morbidities. Currently, studies have shown an association between MIS-C and vaping, we speculate that adolescents who vape/smoke might be especially vulnerable to serious respiratory symptoms if they develop a hyper-inflammatory state MIS-C.
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Affiliation(s)
- Esha Brar
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY, United States
| | - Anish Saxena
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY, United States
| | - Claudia Dukler
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY, United States
| | - Fangxi Xu
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY, United States
| | - Deepak Saxena
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY, United States.,Department of Surgery, New York University School of Medicine, New York, NY, United States
| | - Preneet Cheema Brar
- Department of Pediatrics, New York University School of Medicine, New York, NY, United States
| | - Yuqi Guo
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY, United States
| | - Xin Li
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY, United States
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20
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Quiat D, Kula T, Shimizu C, Kanegaye JT, Tremoulet AH, Pitkowsky Z, Son M, Newburger JW, Elledge SJ, Burns JC. High-Throughput Screening of Kawasaki Disease Sera for Antiviral Antibodies. J Infect Dis 2020; 222:1853-1857. [PMID: 32386318 PMCID: PMC8171798 DOI: 10.1093/infdis/jiaa253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/05/2020] [Indexed: 12/26/2022] Open
Abstract
Clinical features of Kawasaki disease (KD) display overlap with common pediatric viral illnesses, leading some to hypothesize that a viral infection is the inciting event for KD. To investigate viral infection history in KD patients, we performed comprehensive serological profiling using a high-throughput phage immunoprecipitation sequencing assay covering the complete reference protein sequences of known viruses with human tropism. KD and matched febrile control sera did not demonstrate differences in antiviral antibody profiles. We conclude that in the acute and subacute phases of disease, KD patients do not exhibit serologic evidence of exposure to known viruses that differs from controls.
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Affiliation(s)
- Daniel Quiat
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Tomasz Kula
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Chisato Shimizu
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - John T Kanegaye
- Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Adriana H Tremoulet
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
- Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Zachary Pitkowsky
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - MaryBeth Son
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Jane W Newburger
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen J Elledge
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Genetics, Program in Virology, Harvard University Medical School, Howard Hughes Medical Institute, Boston, Massachusetts, USA
| | - Jane C Burns
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
- Rady Children’s Hospital San Diego, San Diego, California, USA
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21
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Vella L, Giles JR, Baxter AE, Oldridge DA, Diorio C, Kuri-Cervantes L, Alanio C, Pampena MB, Wu JE, Chen Z, Huang YJ, Anderson EM, Gouma S, McNerney KO, Chase J, Burudpakdee C, Lee JH, Apostolidis SA, Huang AC, Mathew D, Kuthuru O, Goodwin EC, Weirick ME, Bolton MJ, Arevalo CP, Ramos A, Jasen C, Giannini HM, DAndrea K, Meyer NJ, Behrens EM, Bassiri H, Hensley SE, Henrickson SE, Teachey DT, Betts MR, Wherry EJ. Deep Immune Profiling of MIS-C demonstrates marked but transient immune activation compared to adult and pediatric COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32995826 DOI: 10.1101/2020.09.25.20201863] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pediatric COVID-19 following SARS-CoV-2 infection is associated with fewer hospitalizations and often milder disease than in adults. A subset of children, however, present with Multisystem Inflammatory Syndrome in Children (MIS-C) that can lead to vascular complications and shock, but rarely death. The immune features of MIS-C compared to pediatric COVID-19 or adult disease remain poorly understood. We analyzed peripheral blood immune responses in hospitalized SARS-CoV-2 infected pediatric patients (pediatric COVID-19) and patients with MIS-C. MIS-C patients had patterns of T cell-biased lymphopenia and T cell activation similar to severely ill adults, and all patients with MIS-C had SARS-CoV-2 spike-specific antibodies at admission. A distinct feature of MIS-C patients was robust activation of vascular patrolling CX3CR1+ CD8 T cells that correlated with use of vasoactive medication. Finally, whereas pediatric COVID-19 patients with acute respiratory distress syndrome (ARDS) had sustained immune activation, MIS-C patients displayed clinical improvement over time, concomitant with decreasing immune activation. Thus, non-MIS-C versus MIS-C SARS-CoV-2 associated illnesses are characterized by divergent immune signatures that are temporally distinct and implicate CD8 T cells in clinical presentation and trajectory of MIS-C.
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22
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Consiglio CR, Cotugno N, Sardh F, Pou C, Amodio D, Rodriguez L, Tan Z, Zicari S, Ruggiero A, Pascucci GR, Santilli V, Campbell T, Bryceson Y, Eriksson D, Wang J, Marchesi A, Lakshmikanth T, Campana A, Villani A, Rossi P, Landegren N, Palma P, Brodin P. The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19. Cell 2020; 183:968-981.e7. [PMID: 32966765 PMCID: PMC7474869 DOI: 10.1016/j.cell.2020.09.016] [Citation(s) in RCA: 595] [Impact Index Per Article: 148.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/29/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is typically very mild and often asymptomatic in children. A complication is the rare multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, presenting 4-6 weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation. The pathogenesis is unclear but has overlapping features with Kawasaki disease suggestive of vasculitis and a likely autoimmune etiology. We apply systems-level analyses of blood immune cells, cytokines, and autoantibodies in healthy children, children with Kawasaki disease enrolled prior to COVID-19, children infected with SARS-CoV-2, and children presenting with MIS-C. We find that the inflammatory response in MIS-C differs from the cytokine storm of severe acute COVID-19, shares several features with Kawasaki disease, but also differs from this condition with respect to T cell subsets, interleukin (IL)-17A, and biomarkers associated with arterial damage. Finally, autoantibody profiling suggests multiple autoantibodies that could be involved in the pathogenesis of MIS-C.
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Affiliation(s)
- Camila Rosat Consiglio
- Science for Life Laboratory, Department of Women's and Children Health, Karolinska Institutet, Stockholm 17165, Sweden
| | - Nicola Cotugno
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome 00165, Italy; Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome 00133, Italy
| | - Fabian Sardh
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm 17176, Sweden
| | - Christian Pou
- Science for Life Laboratory, Department of Women's and Children Health, Karolinska Institutet, Stockholm 17165, Sweden
| | - Donato Amodio
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome 00165, Italy; Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome 00133, Italy
| | - Lucie Rodriguez
- Science for Life Laboratory, Department of Women's and Children Health, Karolinska Institutet, Stockholm 17165, Sweden
| | - Ziyang Tan
- Science for Life Laboratory, Department of Women's and Children Health, Karolinska Institutet, Stockholm 17165, Sweden
| | - Sonia Zicari
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Alessandra Ruggiero
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Giuseppe Rubens Pascucci
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome 00165, Italy
| | - Veronica Santilli
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome 00165, Italy; Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | - Tessa Campbell
- Center for Regenerative Medicine, Department of Medicine, Karolinska Institutet, Stockholm 14186, Sweden
| | - Yenan Bryceson
- Center for Regenerative Medicine, Department of Medicine, Karolinska Institutet, Stockholm 14186, Sweden
| | - Daniel Eriksson
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm 17176, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University and Department of Clinical Genetics, Uppsala University Hospital, Uppsala 75185, Sweden
| | - Jun Wang
- Science for Life Laboratory, Department of Women's and Children Health, Karolinska Institutet, Stockholm 17165, Sweden
| | - Alessandra Marchesi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | - Tadepally Lakshmikanth
- Science for Life Laboratory, Department of Women's and Children Health, Karolinska Institutet, Stockholm 17165, Sweden
| | - Andrea Campana
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | - Alberto Villani
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | - Paolo Rossi
- Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome 00133, Italy; Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome 00165, Italy
| | | | - Nils Landegren
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm 17176, Sweden; Science for life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala 75237, Sweden.
| | - Paolo Palma
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children's Hospital, Rome 00165, Italy; Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome 00133, Italy.
| | - Petter Brodin
- Science for Life Laboratory, Department of Women's and Children Health, Karolinska Institutet, Stockholm 17165, Sweden; Pediatric Rheumatology, Karolinska University Hospital, Stockholm 17164, Sweden.
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Imanaka-Yoshida K, Tawara I, Yoshida T. Tenascin-C in cardiac disease: a sophisticated controller of inflammation, repair, and fibrosis. Am J Physiol Cell Physiol 2020; 319:C781-C796. [PMID: 32845719 DOI: 10.1152/ajpcell.00353.2020] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Tenascin-C (TNC) is a large extracellular matrix glycoprotein classified as a matricellular protein that is generally upregulated at high levels during physiological and pathological tissue remodeling and is involved in important biological signaling pathways. In the heart, TNC is transiently expressed at several important steps during embryonic development and is sparsely detected in normal adult heart but is re-expressed in a spatiotemporally restricted manner under pathological conditions associated with inflammation, such as myocardial infarction, hypertensive cardiac fibrosis, myocarditis, dilated cardiomyopathy, and Kawasaki disease. Despite its characteristic and spatiotemporally restricted expression, TNC knockout mice develop a grossly normal phenotype. However, various disease models using TNC null mice combined with in vitro experiments have revealed many important functions for TNC and multiple molecular cascades that control cellular responses in inflammation, tissue repair, and even myocardial regeneration. TNC has context-dependent diverse functions and, thus, may exert both harmful and beneficial effects in damaged hearts. However, TNC appears to deteriorate adverse ventricular remodeling by proinflammatory and profibrotic effects in most cases. Its specific expression also makes TNC a feasible diagnostic biomarker and target for molecular imaging to assess inflammation in the heart. Several preclinical studies have shown the utility of TNC as a biomarker for assessing the prognosis of patients and selecting appropriate therapy, particularly for inflammatory heart diseases.
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Affiliation(s)
- Kyoko Imanaka-Yoshida
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Tsu, Japan.,Mie University Research Center for Matrix Biology, Tsu, Japan
| | - Isao Tawara
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan.,Mie University Research Center for Matrix Biology, Tsu, Japan
| | - Toshimichi Yoshida
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Tsu, Japan.,Mie University Research Center for Matrix Biology, Tsu, Japan
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The Platelet microRNA Profile of Kawasaki Disease: Identification of Novel Diagnostic Biomarkers. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9061568. [PMID: 32733962 PMCID: PMC7383328 DOI: 10.1155/2020/9061568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/17/2020] [Accepted: 05/21/2020] [Indexed: 12/22/2022]
Abstract
Challenging diagnosis and unknown etiology of Kawasaki disease (KD) increase the coronary artery lesions incidence. microRNAs (miRNAs) are the most promising biomarkers because of their stability in peripheral blood and noninvasive measurement procedure, whose potential utility have been proved in cancers. To explore the utility of differentially expressed (DE) miRNAs as early diagnostic markers, 44 patients (25 incomplete KD and 19 complete KD) and 31 febrile controls were recruited for small RNA sequencing. From all the 1922 expressed miRNA, 210 DE miRNAs were found between KD and febrile control groups. Though platelet miRNA profiles of complete KD incomplete KD were much similar through cluster analysis, the DE miRNAs were not identical. Eight DE miRNAs were validated by real-time quantitative PCR (qRT-PCR) in complete or incomplete KD groups using a normalizer, miR-126-3p, which was identified by geNorm and NormFinder tools. The expression level of miRNAs continuous changed over time was observed and the function analysis showed the potential role of miRNAs as therapeutic biomarkers. Additionally, the prediction model for KD showed a sensitivity of 78.8% and a specificity of 71.4%, respectively. This study used small RNA sequencing to identify miRNA biomarkers KD diagnosis based on a large sample size. Our findings shine a light on the understanding of molecular pathogenesis of KD and may improve the accuracy of KD diagnosis and prognosis in clinical.
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25
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Hicar MD. Antibodies and Immunity During Kawasaki Disease. Front Cardiovasc Med 2020; 7:94. [PMID: 32671098 PMCID: PMC7326051 DOI: 10.3389/fcvm.2020.00094] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 04/30/2020] [Indexed: 12/14/2022] Open
Abstract
The cause of Kawasaki disease (KD), the leading cause of acquired heart disease in children, is currently unknown. Epidemiology studies support that an infectious disease is involved in at least starting the inflammatory cascade set off during KD. Clues from epidemiology support that humoral immunity can have a protective effect. However, the role of the immune system, particularly of B cells and antibodies, in pathogenesis of KD is still unclear. Intravenous immunoglobulin (IVIG) and other therapies targeted at modulating inflammation can prevent development of coronary aneurysms. A number of autoantibody responses have been reported in children with KD and antibodies have been generated from aneurysmal plasma cell infiltrates. Recent reports show that children with KD have similar plasmablast responses as other children with infectious diseases, further supporting an infectious starting point. As ongoing studies are attempting to identify the etiology of KD through study of antibody responses, we sought to review the role of humoral immunity in KD pathogenesis, treatment, and recovery.
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Affiliation(s)
- Mark Daniel Hicar
- University at Buffalo, Buffalo, NY, United States.,John R. Oishei Children's Hospital, Buffalo, NY, United States.,Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
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26
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Abstract
Kawasaki disease is an acute febrile illness and systemic vasculitis of unknown aetiology that predominantly afflicts young children, causes coronary artery aneurysms and can result in long-term cardiovascular sequelae. Kawasaki disease is the leading cause of acquired heart disease among children in the USA. Coronary artery aneurysms develop in some untreated children with Kawasaki disease, leading to ischaemic heart disease and myocardial infarction. Although intravenous immunoglobulin (IVIG) treatment reduces the risk of development of coronary artery aneurysms, some children have IVIG-resistant Kawasaki disease and are at increased risk of developing coronary artery damage. In addition, the lack of specific diagnostic tests and biomarkers for Kawasaki disease make early diagnosis and treatment challenging. The use of experimental mouse models of Kawasaki disease vasculitis has considerably improved our understanding of the pathology of the disease and helped characterize the cellular and molecular immune mechanisms contributing to cardiovascular complications, in turn leading to the development of innovative therapeutic approaches. Here, we outline the pathophysiology of Kawasaki disease and summarize and discuss the progress gained from experimental mouse models and their potential therapeutic translation to human disease. This Review outlines the pathophysiology of Kawasaki disease and discusses the progress gained from experimental mouse models and their potential therapeutic translation to human disease. Kawasaki disease is a childhood systemic vasculitis leading to the development of coronary artery aneurysms; it is the leading cause of acquired heart disease in children in developed countries. The cause of Kawasaki disease is unknown, although it is suspected to be triggered by an unidentified infectious pathogen in genetically predisposed children. Kawasaki disease might not be a normal immune response to an unusual environmental stimulus, but rather a genetically determined unusual and uncontrolled immune response to a common stimulus. Although the aetiological agent in humans is unknown, mouse models of Kawasaki disease vasculitis demonstrate similar pathological features and have substantially accelerated discoveries in the field. Genetic and transcriptomic analysis of blood samples from patients with Kawasaki disease and experimental evidence generated using mouse models have demonstrated the critical role of IL-1β in the pathogenesis of this disease and the therapeutic potential of targeting this pathway (currently under investigation in clinical trials).
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Untapped potential: The utility of drylands for testing eco-evolutionary relationships between hosts and parasites. INTERNATIONAL JOURNAL FOR PARASITOLOGY-PARASITES AND WILDLIFE 2020; 12:291-299. [PMID: 32426218 PMCID: PMC7229972 DOI: 10.1016/j.ijppaw.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 01/30/2023]
Abstract
Drylands comprise over 41% of all terrestrial surface area and are home to approximately 35.5% of the world's population; however, both free-living and parasitic fauna of these regions remain relatively understudied. Yet, the very conditions that make these regions challenging to study – extreme environmental conditions and low population density for various organisms – also make them potentially untapped natural laboratories for examining eco-evolutionary relationships between hosts and parasites. Adaptations and ecological patterns illustrated by desert parasite communities can serve as exemplars within the extremes regarding the evolution of virulence, breadth of host spectra, and lifecycle strategies. This review provides relevant examples for each of these three topics using parasites from dryland regions in order to encourage future empirical tests of hypotheses regarding parasite ecology and evolution within dryland ecosystems and stimulate wider investigation into the parasitofauna of arid regions in general. As global climate changes and anthropogenic disturbance increases, desertification is a growing problem which has been labeled as a threat to global health. Thus, deserts not only provide useful natural laboratories in which to study parasite transmission but understanding parasite transmission within these habitats becomes increasingly important as larger, likely highly resource insecure, populations are projected to live on the margins of desert regions in the future. Drylands comprise over 41% of Earth's surface but their parasites are understudied. Desert parasite communities are exemplars within the extremes of parasite ecology. Can test hypotheses of virulence evolution, host spectra, and lifecycle strategies. Drylands can provide increasingly important insight into parasite transmission. Larger human populations are projected to live in arid regions as climate changes.
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28
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Tang B, Lo HH, Lei C, U KI, Hsiao WLW, Guo X, Bai J, Wong VKW, Law BYK. Adjuvant herbal therapy for targeting susceptibility genes to Kawasaki disease: An overview of epidemiology, pathogenesis, diagnosis and pharmacological treatment of Kawasaki disease. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2020; 70:153208. [PMID: 32283413 PMCID: PMC7118492 DOI: 10.1016/j.phymed.2020.153208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/17/2020] [Accepted: 03/16/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND Kawasaki disease (KD) is a self-limiting acute systemic vasculitis occur mainly in infants and young children under 5 years old. Although the use of acetylsalicylic acid (AAS) in combination with intravenous immunoglobulin (IVIG) remains the standard therapy to KD, the etiology, genetic susceptibility genes and pathogenic factors of KD are still un-elucidated. PURPOSE Current obstacles in the treatment of KD include the lack of standard clinical and genetic markers for early diagnosis, possible severe side effect of AAS (Reye's syndrome), and the refractory KD cases with resistance to IVIG therapy, therefore, this review has focused on introducing the current advances in the identification of genetic susceptibility genes, environmental factors, diagnostic markers and adjuvant pharmacological intervention for KD. RESULTS With an overall update in the development of KD from different aspects, our current bioinformatics data has suggested CASP3, CD40 and TLR4 as the possible pathogenic factors or diagnostic markers of KD. Besides, a list of herbal medicines which may work as the adjunct therapy for KD via targeting different proposed molecular targets of KD have also been summarized. CONCLUSION With the aid of modern pharmacological research and technology, it is anticipated that novel therapeutic remedies, especially active herbal chemicals targeting precise clinical markers of KD could be developed for accurate diagnosis and treatment of the disease.
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Key Words
- AAS, acetylsalicylic acid
- AHA, the American Heart Association
- Adjuvant therapy
- C IVIG, intravenous immunoglobulin
- CALs, coronary artery lesions
- CASP, caspase
- CD, cluster of differentiation
- CRP, C-reactive protein
- DAVID, Database for Annotation, Visualization and Integrated Discovery
- Diagnostic marker
- Epidemiology
- FCGR2A, Fc fragment of immunoglobulin G, low-affinity IIa
- GWAS, genome-wide association method
- HAdV, the human adenovirus
- Herbal chemicals
- IL, Interleukin
- ITPKC, inositol 1,4,5-triphosphate 3-kinase
- KD, Kawasaki disease
- Kawasaki disease
- MyD88, myeloid differentiation factor 88
- NF-κB, nuclear factor κB
- RS, Reye's syndrome
- SNPs, single nucleotide polymorphisms
- Susceptibility genes
- TCMs, traditional Chinese medicines
- TLR4, toll-like receptor 4
- TNF, tumor necrosis factor
- Th, T helper
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Affiliation(s)
- Bin Tang
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Hang Hong Lo
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Cheng Lei
- Department of Pediatrics, Kiang Wu Hospital, Macau SAR, China
| | - Ka In U
- Department of Pediatrics, Kiang Wu Hospital, Macau SAR, China
| | - Wen-Luan Wendy Hsiao
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Xiaoling Guo
- South Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, China
| | - Jun Bai
- South Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, China
| | - Vincent Kam-Wai Wong
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
| | - Betty Yuen-Kwan Law
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
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Abstract
PURPOSE OF THE REVIEW Kawasaki disease (KD) is a childhood systemic vasculitis of unknown etiology that causes coronary artery aneurysms (CAA), and if left undiagnosed can result in long-term cardiovascular complications and adult cardiac disease. Up to 20% of KD children fail to respond to IVIG, the mainstay of therapy, highlighting the need for novel therapeutic strategies. Here we review the latest findings in the field regarding specific etiology, genetic associations, and advancements in treatment strategies to prevent coronary aneurysms. RECENT FINDINGS Recent discoveries using the Lactobacillus casei cell wall extract (LCWE)-induced KD vasculitis mouse model have accelerated the study of KD pathophysiology and have advanced treatment strategies including clinical trials for IL-1R antagonist, Anakinra. KD remains an elusive pediatric vasculitis syndrome and is the leading cause of acquired heart disease among children in the USA and developed countries. Advancements in combination treatment for refractory KD with further understanding of novel genetic risk factors serve as a solid foundation for future research endeavors in the field.
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30
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Guo MMH, Chang LS, Huang YH, Wang FS, Kuo HC. Epigenetic Regulation of Macrophage Marker Expression Profiles in Kawasaki Disease. Front Pediatr 2020; 8:129. [PMID: 32309269 PMCID: PMC7145949 DOI: 10.3389/fped.2020.00129] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/09/2020] [Indexed: 12/16/2022] Open
Abstract
Kawasaki disease (KD) is a common systemic vasculitides in children younger than 5 years of age. Activated macrophages are key drivers of vascular inflammation in KD. The aim of this study was to examine differences in M1 and M2 macrophage marker expression in patients with KD. Blood samples were obtained from 18 healthy controls and 18 patients with KD at 24 h prior and 21 days after to intravenous immunoglobulin therapy. GeneChip Human Transcriptome Array 2.0 and Illumina HumanMethylation450 BeadChip were used to examined the mRNA expression and corresponding CpG site methylation ratios of 10 M1 surface markers and 15 M2 surface markers. Of the markers examined 2 M1 markers (TLR2, IL2RA) and 8 M2 markers (ARG1, CCR2, TLR1, TLR8, TLR5, MS4A6A, CD36, and MS4A4A) showed increased mRNA expression in the acute phase of KD which decreased after IVIG therapy (P < 0.05). Corresponding CpG sites in the promoter regions these markers were hypomethylated in the acute phase of KD and significantly increased after IVIG therapy. In conclusion, both M1 and M2 markers showed increased mRNA expression in the acute phase of KD. CpG site methylation may be one of the mechanisms governing macrophage polarization in KD.
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Affiliation(s)
- Mindy Ming-Huey Guo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan.,Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung City, Taiwan
| | - Ling-Sai Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan.,Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Ying-Hsien Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan.,Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Feng-Sheng Wang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung City, Taiwan.,Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan.,Core Laboratory for Phenomics & Diagnostics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Ho-Chang Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan.,Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung City, Taiwan
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31
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Ko TM, Kiyotani K, Chang JS, Park JH, Yin Yew P, Chen YT, Wu JY, Nakamura Y. Immunoglobulin profiling identifies unique signatures in patients with Kawasaki disease during intravenous immunoglobulin treatment. Hum Mol Genet 2019; 27:2671-2677. [PMID: 29771320 PMCID: PMC6048982 DOI: 10.1093/hmg/ddy176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/01/2018] [Accepted: 05/01/2018] [Indexed: 12/18/2022] Open
Abstract
Identifying the causes of high fever syndromes such as Kawasaki disease (KD) remains challenging. To investigate pathogen exposure signatures in suspected pathogen-mediated diseases such as KD, we performed immunoglobulin (Ig) profiling using a next-generation sequencing method. After intravenous Ig (IVIG) treatment, we observed disappearance of clonally expanded IgM clonotypes, which were dominantly observed in acute-phase patients. The complementary-determining region 3 (CDR3) sequences of dominant IgM clonotypes in acute-phase patients were commonly observed in other Ig isotypes. In acute-phase KD patients, we identified 32 unique IgM CDR3 clonotypes shared in three or more cases. Furthermore, before the IVIG treatment, the sums of dominant IgM clonotypes in IVIG-resistant KD patients were significantly higher than those of IVIG-sensitive KD patients. Collectively, we demonstrate a novel approach for identifying certain Ig clonotypes for potentially interacting with pathogens involved in KD; this approach could be applied for a wide variety of fever-causing diseases of unknown origin.
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Affiliation(s)
- Tai-Ming Ko
- Department of Medicine, University of Chicago, Chicago, Illinois, USA.,Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.,Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Kazuma Kiyotani
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jeng-Sheng Chang
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Jae-Hyun Park
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Poh Yin Yew
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Yuan-Tsong Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.,Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Jer-Yuarn Wu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Yusuke Nakamura
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
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32
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Deep Neck Space Involvement of Kawasaki Disease in the US: A Population-Based Study. J Pediatr 2019; 215:118-122. [PMID: 31477383 DOI: 10.1016/j.jpeds.2019.07.054] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/05/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To describe the rate and risk factors of deep neck space involvement of Kawasaki disease. STUDY DESIGN We performed a retrospective analysis using the Kids' Inpatient Database from 2006, 2009, 2012, and 2016. Kawasaki disease and deep neck space involvement cases were identified using International Classification of Diseases codes among children aged <12 years. Demographic and outcome data of Kawasaki disease cases with and without deep neck space involvement were compared. RESULTS Of 20 787 patients with Kawasaki disease, 0.6% (130 cases) had deep neck space involvement. On multivariable analysis, children aged ≥4 years (OR 8.41; 95% CI 3.79-18.7 in those aged 6-11 years), Asian or Pacific Islanders (OR 3.72; 95% CI 1.90-7.27), non-Hispanic black children (OR 2.39; 95% CI 1.34-4.28), and Northeast hospital region (OR 2.32; 95% CI 1.21-4.46) were associated with deep neck space involvement. Surgical drainage was performed in 21.7% of patients with deep neck space involvement. Deep neck space involvement was associated with longer hospital stay and greater costs. CONCLUSIONS Approximately 0.6% of patients with Kawasaki disease present with deep neck space involvement in the US. Deep neck space involvement of Kawasaki disease occurs primarily in older (≥4 years old), non-white, non-Hispanic children. Deep neck space involvement is associated with operative procedures for presumed abscess, longer hospital stay, and greater costs. In caring for children with suspected deep neck space abscess, particularly when they are not responding to antibiotics, clinicians should evaluate them for the possibility of Kawasaki disease.
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Lindquist ME, Hicar MD. B Cells and Antibodies in Kawasaki Disease. Int J Mol Sci 2019; 20:ijms20081834. [PMID: 31013925 PMCID: PMC6514959 DOI: 10.3390/ijms20081834] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 12/22/2022] Open
Abstract
The etiology of Kawasaki disease (KD), the leading cause of acquired heart disease in children, is currently unknown. Epidemiology supports a relationship of KD to an infectious disease. Several pathological mechanisms are being considered, including a superantigen response, direct invasion by an infectious etiology or an autoimmune phenomenon. Treating affected patients with intravenous immunoglobulin is effective at reducing the rates of coronary aneurysms. However, the role of B cells and antibodies in KD pathogenesis remains unclear. Murine models are not clear on the role for B cells and antibodies in pathogenesis. Studies on rare aneurysm specimens reveal plasma cell infiltrates. Antibodies generated from these aneurysmal plasma cell infiltrates showed cross-reaction to intracellular inclusions in the bronchial epithelium of a number of pathologic specimens from children with KD. These antibodies have not defined an etiology. Notably, a number of autoantibody responses have been reported in children with KD. Recent studies show acute B cell responses are similar in children with KD compared to children with infections, lending further support of an infectious disease cause of KD. Here, we will review and discuss the inconsistencies in the literature in relation to B cell responses, specific antibodies, and a potential role for humoral immunity in KD pathogenesis or diagnosis.
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Affiliation(s)
- Michael E Lindquist
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA.
| | - Mark D Hicar
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14222, USA.
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34
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Dai N, Zhao C, Kong Q, Li D, Cai Z, Wang M. Vascular repair and anti-inflammatory effects of soluble epoxide hydrolase inhibitor. Exp Ther Med 2019; 17:3580-3588. [PMID: 30988740 PMCID: PMC6447806 DOI: 10.3892/etm.2019.7396] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 12/13/2018] [Indexed: 12/19/2022] Open
Abstract
Kawasaki disease (KD) is the leading cause of acquired heart disease in pediatric patients in developed countries. Coronary artery aneurysms and myocardial infarction may occur if the disease remains untreated. An estimated 10-20% of KD patients do not respond to intravenous gamma globulin (IVIG), and thus, alternative treatments are currently being investigated. Epoxyeicosatrienoic acids (EETs) are natural anti-inflammatory factors and angiogenic mediators degraded by soluble epoxide hydrolase (sEH). sEH inhibitory factors have been demonstrated to stabilize EET levels, inhibit inflammation and promote vascular repair in vivo. The present study aimed to determine whether an increase in EET levels induced by treatment with the sEH inhibitor 12-(3-adamantan-1-yl-ureido)-dodecanoic acid (AUDA) promotes vascular repair in human coronary arterial endothelial cells (HCAECs) and reduces inflammation in a mouse model of KD induced by Lactobacillus casei cell wall extract. The effect of AUDA on vascular repair in HCAECs was assessed by using cell proliferation, migration, adhesion and tube formation assays, and the anti-inflammatory effect of AUDA in the mouse model of KD was determined by detecting the expression of matrix metalloproteinase (MMP)-9, tumor necrosis factor (TNF)-α and interleukin (IL)-1β at the protein level via ELISA. The results demonstrated that AUDA increased the proliferation, migration, adhesion and tube formation ability of HCAECs in a dose-dependent manner. Furthermore, in the mouse model of KD, AUDA reduced the protein expression of MMP-9, IL-1β and TNF-α, indicating that AUDA may alleviate inflammatory reactions in the coronary arteries of KD model mice. The present results also indicate that these effects may be exerted through the peroxisome proliferator activated receptor γ signaling pathway. Taken together, the present study supports the potential utility of AUDA in the treatment of KD.
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Affiliation(s)
- Na Dai
- Department of Pediatrics, Qilu Hospital, Shandong University, Ji'nan, Shandong 250012, P.R. China.,Department of Pediatrics, Jinan Maternity and Child Care Hospital, Ji'nan, Shandong 250012, P.R. China
| | - Cuifen Zhao
- Department of Pediatrics, Qilu Hospital, Shandong University, Ji'nan, Shandong 250012, P.R. China
| | - Qingyu Kong
- Department of Pediatrics, Qilu Hospital, Shandong University, Ji'nan, Shandong 250012, P.R. China
| | - Dong Li
- Department of Pediatrics, Qilu Hospital, Shandong University, Ji'nan, Shandong 250012, P.R. China
| | - Zhifeng Cai
- Department of Pediatrics, Qilu Hospital, Shandong University, Ji'nan, Shandong 250012, P.R. China
| | - Minmin Wang
- Department of Pediatrics, Qilu Hospital, Shandong University, Ji'nan, Shandong 250012, P.R. China
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Abstract
Kawasaki disease (KD) is a multisystem vasculitis that primarily affects the coronary arteries of young children. The causes of KD remain a mystery. It is suspected that some sort of infectious agent is involved because KD has epidemicity and seasonality. That said, the incidence of the disease is high among Japanese people, so it can be speculated that the hosts may have some sort of genetic characteristic that leaves them susceptible to KD. Various theories regarding the etiology have been asserted, such as the infectious vasculitis theory, autoantigen theory, superantigen theory, and RNA virus theory; however, none of them have been able to overcome this epidemicity. Taking into consideration the knowledge gained from previous reports, the best scenario explaining the pathogenesis is "individuals with certain genetic backgrounds are affected by microorganisms which trigger KD." In this article, the pathogenesis of KD is discussed with a focus on the microorganisms mentioned above, along with the previous and current hypotheses as well as my own opinion.
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Affiliation(s)
- Satoru Nagata
- Departments of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
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36
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Nakamura A, Ikeda K, Hamaoka K. Aetiological Significance of Infectious Stimuli in Kawasaki Disease. Front Pediatr 2019; 7:244. [PMID: 31316950 PMCID: PMC6611380 DOI: 10.3389/fped.2019.00244] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/29/2019] [Indexed: 01/23/2023] Open
Abstract
Kawasaki disease (KD) is a pediatric vasculitis syndrome that is often involves coronary artery lesions (e. g., coronary artery aneurysms). Although its causal factors and entire pathogenesis remain elusive, the available evidence indicates that the pathogenesis of KD is closely associated with dysregulation of immune responses to various viruses or microbes. In this short review, we address several essential aspects of the etiology of KD with respect to the immune response to infectious stimuli: 1) the role of viral infections, 2) the role of bacterial infections and the superantigen hypothesis, 3) involvement of innate immune response including pathogens/microbe-associated molecular patterns and complement pathways, and 4) the influence of genetic background on the response to infectious stimuli. Based on the clinical and experimental evidence, we discuss the possibility that a wide range of microbes and viruses could cause KD through common and distinct immune processes.
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Affiliation(s)
- Akihiro Nakamura
- Central Research Laboratory, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuyuki Ikeda
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Hamaoka
- Pediatric Cardiology and Kawasaki Disease Center, Uji-Tokushukai Medical Center, Kyoto, Japan.,Faculty of Life and Medical Sciences, Doshisha University, Kyoto, Japan
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37
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National consensus on the cardiological treatment and follow-up of Kawasaki disease. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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38
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Dilating Vascular Diseases: Pathophysiology and Clinical Aspects. Int J Vasc Med 2018; 2018:9024278. [PMID: 30225143 PMCID: PMC6129317 DOI: 10.1155/2018/9024278] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/29/2018] [Indexed: 01/22/2023] Open
Abstract
Atherosclerotic disease of the vessels is a significant problem affecting mortality and morbidity all over the world. However, dilatation of the vessels either in the arterial system or in the venous territory is another vessel disease. Varicocele, pelvic, and peripheral varicose veins and hemorrhoids are aneurysms of the venous vascular regions and have been defined as dilating venous disease, recently. Coronary artery ectasia, intracranial aneurysm, and abdominal aortic aneurysm are examples of arterial dilating vascular diseases. Mostly, they have been defined as variants of atherosclerosis. Although there are some similarities in terms of pathogenesis, they are distinct from atherosclerotic disease of the vessels. In addition, pathophysiological and histological similarities and clinical coexistence of these diseases have been demonstrated both in the arterial and in the venous system. This situation underlies the thought that dilatation of the vessels in any vascular territory should be considered as a systemic vessel wall disease rather than being a local disease of any vessel. These patients should be evaluated for other dilating vascular diseases in a systematic manner.
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39
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Melatonin: A hypothesis for Kawasaki disease treatment. Med Hypotheses 2018; 119:6-10. [PMID: 30122493 DOI: 10.1016/j.mehy.2018.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/11/2018] [Indexed: 01/18/2023]
Abstract
Kawasaki disease (KD) is the most common cause of acquired heart disease with unknown etiology among children in developed countries. Acute inflammation of the vasculature, genetic susceptibility and immunopathogenesis based on a transmittable and infectious origin, are the pathologic events involved in the early inflammatory etiology and progression of this disease. However, the exact causes of KD remain unknown. Current proposed recommendations include three therapy lines; firstly, an initial standard therapy with intravenous immunoglobulin (IVIG) followed by aspirin. Secondly, in cases of high risk of coronary lesions, the adjunctive therapy with corticosteroid is commonly considered. Thirdly, in KD patients refractory to the previous therapies, tumor necrosis factor (TNF-α) antagonists are being used to modulate pro-inflammatory cytokines. In view of this status quo, our starting hypothesis is that the ubiquitous and non-toxic neurohormone melatonin could be of critical importance in developing novel adjuvant therapies against KD, as it occurs with a plethora of other diseases. Considering its pleiotropic properties, particularly its antiinflammatory and immunoregulatory capacities, melatonin should be of great therapeutic interest for helping to control the main pathologic features of KD patients. In addition, this multifunctional indole has a safe pharmacological profile, enhancing the therapeutic activity of several drugs and reducing their possible side effects. Consequently, melatonińs actions to manage KD need to be tested in further clinical studies.
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40
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Barrios Tascón A, Centeno Malfaz F, Rojo Sombrero H, Fernández-Cooke E, Sánchez-Manubens J, Pérez-Lescure Picarzo J. [National consensus on the cardiological treatment and follow-up of Kawasaki disease]. An Pediatr (Barc) 2018; 89:188.e1-188.e22. [PMID: 29778491 DOI: 10.1016/j.anpedi.2018.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/01/2018] [Indexed: 12/20/2022] Open
Abstract
Kawasaki disease is a self-limiting acute vasculitis that affects small and medium-sized vessels, and is the most common cause of acquired heart disease in children in our environment. Up to 25% of untreated patients develop coronary aneurysms. It is suspected that an infectious agent may be the trigger of the disease, but the causative agent is still unknown. Based on the previous evidence, recommendations are proposed for the diagnosis, treatment of acute disease, and the long-term management of these patients, in order to unify criteria. The diagnosis must be quick, based on easy-to-use algorithms and with the support of complementary tests. This document includes the indication of available imaging techniques, as well as the planning of cardiological examinations based on the initial involvement. Intravenous immunoglobulin is the basis of the initial treatment. The role of corticosteroids is still controversial, but there are studies that support its use as adjuvant treatment. A multidisciplinary working group has developed a scheme with different treatment guidelines depending on the risk factors at diagnosis, the patient's clinical situation, and response to previous treatment, including indications for thromboprophylaxis in patients with coronary involvement. The stratification of risk for long-term treatment is essential, as well as the recommendations on the procedures based on the initial cardiological involvement and its progression. Patients with coronary aneurysms require continuous and uninterrupted cardiological monitoring for life.
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Affiliation(s)
- Ana Barrios Tascón
- Cardiología infantil, Servicio de Pediatría, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas.
| | - Fernando Centeno Malfaz
- Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas; Cardiología infantil, Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, España
| | - Henar Rojo Sombrero
- Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas; Cardiología infantil, Servicio de Pediatría, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Elisa Fernández-Cooke
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Materno Infantil Doce de Octubre, Madrid, España; Sociedad Española de Infectología Pediátrica
| | - Judith Sánchez-Manubens
- Unidad de Reumatología Pediátrica, Servicio de Pediatría, Hospital Parc Taulí, Sabadell, Barcelona, España; Sociedad Española de Reumatología Pediátrica
| | - Javier Pérez-Lescure Picarzo
- Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas; Cardiología infantil, Servicio de Pediatría, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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41
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Abstract
Kawasaki disease is an acute systemic vasculitis that was first reported in 1961. Over the last 5 decades multiple papers have been published to further understand this disease. The diagnosis of Kawasaki disease is made based on the clinical findings. Atypical Kawasaki disease includes patients who do not meet all the criteria for diagnosis. The main complication of Kawasaki disease is coronary aneurysm, and the treatment is intravenous immunoglobulin and aspirin. A second dose of immunoglobulin is given if the patient does not improve, and several other treatment options have been proposed over the last few years as second and third line options.
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42
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Abstract
Although the etiology of Kawasaki disease (KD) is largely unknown, a large body of clinical, epidemiologic, immunologic, pathologic and ultrastructural evidence suggests that an infectious agent triggers a cascade that causes the illness. However, this elusive infectious agent remains unidentified at present. Increasingly sensitive molecular methods for identifying microbial nucleic acids and proteins in tissue samples continue to rapidly emerge, and these methods should be utilized in studies on KD etiology as they become available. Identifying the etiology of this enigmatic disease remains the single most important research goal in the field, and accomplishing this goal is the best means to improve diagnosis, treatment and prevention of this potentially fatal childhood disease.
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Affiliation(s)
- Anne H Rowley
- Departments of Pediatrics and Microbiology/Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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43
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Joshi M, Tulloh R. Kawasaki disease and coronary artery aneurysms: from childhood to adulthood. Future Cardiol 2017; 13:491-501. [DOI: 10.2217/fca-2017-0039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Kawasaki disease is an acute, systemic vasculitis of childhood and confers a 25% risk of developing coronary artery aneurysms. Its etiology is unknown, but the incidence is increasing rapidly with linked gene polymorphisms having been identified. A constellation of symptoms, epidemics and seasonality all implicate an unidentified infective or environmental cause. Intravenous immunoglobulin therapy, aspirin and steroids all form the mainstay of acute treatment and reduces the incidence of coronary artery aneurysms if given before 7 days. However, in some, these lesions persist and require ongoing management during follow-up during childhood and into adult life. Evidence for further investigations in order to minimize complications is presented in order to minimize the myofibroblast proliferation and stenosis in the long term.
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Affiliation(s)
- Manjiri Joshi
- Department of Cardiology, University of Bristol & Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - Robert Tulloh
- Department of Cardiology, University of Bristol & Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
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44
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Noval Rivas M, Lee Y, Wakita D, Chiba N, Dagvadorj J, Shimada K, Chen S, Fishbein MC, Lehman TJA, Crother TR, Arditi M. CD8+ T Cells Contribute to the Development of Coronary Arteritis in the Lactobacillus casei Cell Wall Extract-Induced Murine Model of Kawasaki Disease. Arthritis Rheumatol 2017; 69:410-421. [PMID: 27696768 DOI: 10.1002/art.39939] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/15/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Kawasaki disease (KD) is the leading cause of acquired heart disease among children in developed countries. Coronary lesions in KD in humans are characterized by an increased presence of infiltrating CD3+ T cells; however, the specific contributions of the different T cell subpopulations in coronary arteritis development remain unknown. Therefore, we sought to investigate the function of CD4+ and CD8+ T cells, Treg cells, and natural killer (NK) T cells in the pathogenesis of KD. METHODS We addressed the function of T cell subsets in KD development by using a well-established murine model of Lactobacillus casei cell wall extract (LCWE)-induced KD vasculitis. We determined which T cell subsets were required for development of KD vasculitis by using several knockout murine strains and depleting monoclonal antibodies. RESULTS LCWE-injected mice developed coronary lesions characterized by the presence of inflammatory cell infiltrates. Frequently, this chronic inflammation resulted in complete occlusion of the coronary arteries due to luminal myofibroblast proliferation (LMP) as well as the development of coronary arteritis and aortitis. We found that CD8+ T cells, but not CD4+ T cells, NK T cells, or Treg cells, were required for development of KD vasculitis. CONCLUSION The LCWE-induced murine model of KD vasculitis mimics many histologic features of the disease in humans, such as the presence of CD8+ T cells and LMP in coronary artery lesions as well as epicardial coronary arteritis. Moreover, CD8+ T cells functionally contribute to the development of KD vasculitis in this murine model. Therapeutic strategies targeting infiltrating CD8+ T cells might be useful in the management of KD in humans.
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Affiliation(s)
| | - Youngho Lee
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Daiko Wakita
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Norika Chiba
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Shuang Chen
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Thomas J A Lehman
- Hospital for Special Surgery and Weill Medical College of Cornell University, New York, New York
| | | | - Moshe Arditi
- Cedars-Sinai Medical Center and University of California, Los Angeles
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45
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Lu WH, Huang SJ, Yuh YS, Hsieh KS, Tang CW, Liou HH, Ger LP. Platelet Endothelial Cell Adhesion Molecule-1 Gene Polymorphisms are Associated with Coronary Artery Lesions in the Chronic Stage of Kawasaki Disease. ACTA CARDIOLOGICA SINICA 2017; 33:273-284. [PMID: 28559658 DOI: 10.6515/acs20161010a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Kawasaki disease is the most common cause of pediatric acquired heart disease. The role of platelet endothelial cell adhesion molecule-1 in the inflammatory process has been documented. To date, no report has investigated the relationship between coronary artery lesions of Kawasaki disease and platelet endothelial cell adhesion molecule-1 polymorphisms. METHODS A total of 114 Kawasaki disease children with coronary artery lesions and 185 Kawasaki disease children without coronary artery lesions were recruited in this study. The TaqMan assay was conducted to identify the genotype in this case-control study. RESULTS In three single nucleotide polymorphisms (Leu125Val, Ser563Asn, and Arg670Gly) of platelet endothelial cell adhesion molecule-1, we found that the Leu-Ser-Arg haplotype was associated with a significantly increased risk for coronary artery lesions in the chronic stage (odds ratio 3.05, 95% confidence interval 1.06-8.80, p = 0.039), but not for coronary artery lesions in the acute stage. Analysis based on the diplotypes of platelet endothelial cell adhesion molecule-1 also showed that Kawasaki disease with one or two alleles of Leu-Ser-Arg had a significantly increased risk of chronic coronary artery lesions (odds ratio 3.38, 95% confidence interval 1.11-10.28, p = 0.032) and had increased platelet counts after Kawasaki disease was diagnosed, as compared to those with other diplotypes. CONCLUSIONS The haplotype of platelet endothelial cell adhesion molecule-1 Leu-Ser-Arg might be associated with the increased platelet counts and the following risk of chronic coronary artery lesions in a dominant manner in Kawasaki disease.
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Affiliation(s)
- Wen-Hsien Lu
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung.,National Yang-Ming University, Taipei.,Fooyin University
| | - Sin-Jhih Huang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Yeong-Seng Yuh
- Department of Pediatrics, Cheng Hsin General Hospital, Taipei
| | - Kai-Sheng Hsieh
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
| | - Chia-Wan Tang
- Department of Pediatrics, Antai Medical Care Corporation Antai Tian-Sheng Memorial Hospital, Pingtung
| | - Huei-Han Liou
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Luo-Ping Ger
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Dissecting Kawasaki disease: a state-of-the-art review. Eur J Pediatr 2017; 176:995-1009. [PMID: 28656474 PMCID: PMC5511310 DOI: 10.1007/s00431-017-2937-5] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 12/12/2022]
Abstract
UNLABELLED Kawasaki disease (KD) is a pediatric vasculitis with coronary artery aneurysms (CAA) as its main complication. The diagnosis is based on the presence of persistent fever and clinical features including exanthema, lymphadenopathy, conjunctival injection, and changes to the mucosae and extremities. Although the etiology remains unknown, the current consensus is that it is likely caused by an (infectious) trigger initiating an abnormal immune response in genetically predisposed children. Treatment consists of high dose intravenous immunoglobulin (IVIG) and is directed at preventing the development of CAA. Unfortunately, 10-20% of all patients fail to respond to IVIG and these children need additional anti-inflammatory treatment. Coronary artery lesions are diagnosed by echocardiography in the acute and subacute phases. Both absolute arterial diameters and z-scores, adjusted for height and weight, are used as criteria for CAA. Close monitoring of CAA is important as ischemic symptoms or myocardial infarction due to thrombosis or stenosis can occur. These complications are most likely to arise in the largest, so-called giant CAA. Apart from the presence of CAA, it is unclear whether KD causes an increased cardiovascular risk due to the vasculitis itself. CONCLUSION Many aspects of KD remain unknown, although there is growing knowledge on the etiology, treatment, and development and classification of CAA. Since children with previous KD are entering adulthood, long-term follow-up is increasingly important. What is known: • Kawasaki disease (KD) is a pediatric vasculitis with coronary artery damage as its main complication. • Although KD approaches its 50th birthday since its first description, many aspects of the disease remain poorly understood. What is new: • In recent years, multiple genetic candidate pathways involved in KD have been identified, with recently promising information about the ITPKC pathway. • As increasing numbers of KD patients are reaching adulthood, increasing information is available about the long-term consequences of coronary artery damage and broader cardiovascular risk.
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Hara T, Nakashima Y, Sakai Y, Nishio H, Motomura Y, Yamasaki S. Kawasaki disease: a matter of innate immunity. Clin Exp Immunol 2016; 186:134-143. [PMID: 27342882 PMCID: PMC5054572 DOI: 10.1111/cei.12832] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 12/26/2022] Open
Abstract
Kawasaki disease (KD) is an acute systemic vasculitis of childhood that does not have a known cause or aetiology. The epidemiological features (existence of epidemics, community outbreaks and seasonality), unique age distribution and clinical symptoms and signs of KD suggest that the disease is caused by one or more infectious environmental triggers. However, KD is not transmitted person-to-person and does not occur in clusters within households, schools or nurseries. KD is a self-limited illness that is not associated with the production of autoantibodies or the deposition of immune complexes, and it rarely recurs. Regarding the underlying pathophysiology of KD, innate immune activity (the inflammasome) is believed to play a role in the development of KD vasculitis, based on the results of studies with animal models and the clinical and laboratory findings of KD patients. Animal studies have demonstrated that innate immune pathogen-associated molecular patterns (PAMPs) can cause vasculitis independently of acquired immunity and have provided valuable insights regarding the underlying mechanisms of this phenomenon. To validate this concept, we recently searched for KD-specific PAMPs and identified such molecules with high specificity and sensitivity. These molecules have structures similar to those of microbe-associated molecular patterns (MAMPs), as shown by liquid chromatography-tandem mass spectrometry. We propose herein that KD is an innate immune disorder resulting from the exposure of a genetically predisposed individual to microbe-derived innate immune stimulants and that it is not a typical infectious disease.
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Affiliation(s)
- T Hara
- Fukuoka Children's Hospital.
- Department of Pediatrics, Graduate School of Medical Sciences.
- Division of Molecular Immunology, Research Center for Infectious Diseases, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan.
| | - Y Nakashima
- Department of Pediatrics, Graduate School of Medical Sciences
| | - Y Sakai
- Department of Pediatrics, Graduate School of Medical Sciences
| | - H Nishio
- Department of Pediatrics, Graduate School of Medical Sciences
| | - Y Motomura
- Department of Pediatrics, Graduate School of Medical Sciences
- Division of Molecular Immunology, Research Center for Infectious Diseases, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
| | - S Yamasaki
- Division of Molecular Immunology, Research Center for Infectious Diseases, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan
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Khosla A, Andring B, Atchie B, Zerr J, White B, MacFarlane J, Kalva SP. Systemic Vasculopathies. Radiol Clin North Am 2016; 54:613-28. [DOI: 10.1016/j.rcl.2015.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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49
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Wakita D, Kurashima Y, Crother TR, Noval Rivas M, Lee Y, Chen S, Fury W, Bai Y, Wagner S, Li D, Lehman T, Fishbein MC, Hoffman HM, Shah PK, Shimada K, Arditi M. Role of Interleukin-1 Signaling in a Mouse Model of Kawasaki Disease-Associated Abdominal Aortic Aneurysm. Arterioscler Thromb Vasc Biol 2016; 36:886-97. [PMID: 26941015 DOI: 10.1161/atvbaha.115.307072] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/22/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Kawasaki disease (KD) is the most common cause of acquired cardiac disease in US children. In addition to coronary artery abnormalities and aneurysms, it can be associated with systemic arterial aneurysms. We evaluated the development of systemic arterial dilatation and aneurysms, including abdominal aortic aneurysm (AAA) in the Lactobacillus casei cell-wall extract (LCWE)-induced KD vasculitis mouse model. METHODS AND RESULTS We discovered that in addition to aortitis, coronary arteritis and myocarditis, the LCWE-induced KD mouse model is also associated with abdominal aorta dilatation and AAA, as well as renal and iliac artery aneurysms. AAA induced in KD mice was exclusively infrarenal, both fusiform and saccular, with intimal proliferation, myofibroblastic proliferation, break in the elastin layer, vascular smooth muscle cell loss, and inflammatory cell accumulation in the media and adventitia. Il1r(-/-), Il1a(-/-), and Il1b(-/-) mice were protected from KD associated AAA. Infiltrating CD11c(+) macrophages produced active caspase-1, and caspase-1 or NLRP3 deficiency inhibited AAA formation. Treatment with interleukin (IL)-1R antagonist (Anakinra), anti-IL-1α, or anti-IL-1β mAb blocked LCWE-induced AAA formation. CONCLUSIONS Similar to clinical KD, the LCWE-induced KD vasculitis mouse model can also be accompanied by AAA formation. Both IL-1α and IL-1β play a key role, and use of an IL-1R blocking agent that inhibits both pathways may be a promising therapeutic target not only for KD coronary arteritis, but also for the other systemic arterial aneurysms including AAA that maybe seen in severe cases of KD. The LCWE-induced vasculitis model may also represent an alternative model for AAA disease.
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Affiliation(s)
- Daiko Wakita
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Yosuke Kurashima
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Timothy R Crother
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Magali Noval Rivas
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Youngho Lee
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Shuang Chen
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Wen Fury
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Yu Bai
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Shawn Wagner
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Debiao Li
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Thomas Lehman
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Michael C Fishbein
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Hal M Hoffman
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Prediman K Shah
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Kenichi Shimada
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.)
| | - Moshe Arditi
- From the Division of Infectious Diseases and Immunology, Department of Biomedical Sciences and Pediatrics (D.W., T.R.C., M.N.R., Y.L., S.C., K.S., M.A.), Infectious and Immunologic Diseases Research Center, Department of Biomedical Sciences (T.R.C., S.C., K.S., M.A.), Biomedical Imaging Research Institute, Department of Biomedical Sciences (S.W., D.L.), and Division of Cardiology, Oppenheimer Atherosclerosis Research Center Cedars-Sinai Heart Institute (P.K.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan (Y.K.); Regeneron Pharmaceuticals, Tarrytown, NY (W.F., Y.B.); Pediatric Rheumatology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY (T.L.); Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); Departments of Pediatrics (H.M.H.) and Medicine (H.M.H.), University of California, San Diego, La Jolla; and Department of Pediatrics, Rady Children's Hospital, San Diego, CA (H.M.H.).
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Gorrab AA, Fournier A, Bouaziz AA, Spigelblatt L, Scuccimarri R, Mrabet A, Dahdah N. Incidence Rate and Epidemiological and Clinical Aspects of Kawasaki Disease in Children of Maghrebi Origin in the Province of Quebec, Canada, Compared to the Country of Origin. Glob Pediatr Health 2016; 3:2333794X16630670. [PMID: 27336001 PMCID: PMC4905125 DOI: 10.1177/2333794x16630670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 01/12/2023] Open
Abstract
The incidence of Kawasaki disease in Maghreb countries is apparently low, unlike those living in the province of Quebec, Canada. This retrospective study compared Maghrebi children living in Quebec to the countries of origin, Morocco, Algeria, and Tunisia. The annualized incidence rate in Quebec (18.49/year/100 000 children under 5 years of age) was 4 to 12 times higher than in Tunisia, Morocco, and Algeria (0.95, 4.52, and 3.15, respectively). The prevalence of incomplete diagnostic criteria was higher in Quebec at 39%, Morocco 43%, and Tunisia 39% compared to Algeria at 8%, with minimal delayed diagnosis (7%) only in Quebec compared to 30%, 35%, and 62%, respectively (P < .001). The rate of coronary aneurysms was comparable however (11% in Quebec vs 4%, 10%, and 25%, in Tunisia, Morocco, and Algeria, respectively; P = .31). The higher incidence of Kawasaki disease in the Maghreb community in Quebec versus the countries of origin seems due to underdiagnosis, which represents a public health concern in those countries.
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Affiliation(s)
- Arbia Abir Gorrab
- CHU Ste-Justine, University of Montreal, Montreal. Canada; Tunis El Manar, Tunis, Tunisia
| | - Anne Fournier
- CHU Ste-Justine, University of Montreal, Montreal. Canada
| | | | - Linda Spigelblatt
- Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Canada
| | | | | | - Nagib Dahdah
- CHU Ste-Justine, University of Montreal, Montreal. Canada
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